The number of seniors with substance abuse problems is expected to double in the United States within the next five years. Changing demographics and the graying of the baby boomers, along with a spike in opioid abuse nationwide, are some of the reasons for the imminent jump in addicted seniors.
According to the Hazelden Betty Ford Foundation, about 17 percent of people 60 years and older in the United States are substance abusers. Similarly, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that up to 19 percent of Americans 50 and older misuse the combination of alcohol and medication.
As the population ages and the baby-boomer generation enters its golden years the number of senior citizen addicts is expected to explode.
“There’s pretty good evidence that in the 65 to 75 age range there is increase in use of all kinds of substances, mostly marijuana, alcohol, and prescriptions, such opioids and benzodiazepines,” Dr. David W. Oslin, a psychiatrist who specializes in geriatric addiction, told Healthline.
Oslin says a longer-living population is part of the reason for the increase in substance abuse by the older adults.
“As we’ve gotten better at being healthier and living longer, being 65 isn’t what it was 30 years ago. People take their bad habits with them,” Oslin, who is also a professor at the Perelman School of Medicine at the University of Pennsylvania, said.
Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse agrees. He told Healthline exposure to substances earlier in life also plays a part.
“We’re seeing this with baby boomers as they hit retirement,” he said. “As they have more time on their hands and face the stress of aging, their use of substances may emerge in new ways.”
Changes in body chemistry may also be a factor. The older people get, the longer it takes to clear medications and alcohol from their bodies.
“Since we get more fat as we age, drugs stick around in our bodies longer, and we get a higher blood alcohol level with the amount of alcohol we drink,” Dr. Alison Moore, a geriatrician at the UCLA Medical Center, told Healthline. “Even if someone has five drinks, it may feel like seven.”
SAMHSA’s data shows that about 25 percent of older adults use prescription psychoactive medications that have a potential to be misused and abused. These drugs may be prescribed for anxiety, pain, and insomnia.
“Opioids and other drugs like sedatives and muscle relaxers, which affect the brain, are increasing in use because of older adults living longer and therefore having more pain and other ailments that come along with aging bodies,” Moore said.
She notes that many older adults believe that once they’ve been prescribed a medication, they can improvise on how, when, and why to use it.
“The issue becomes complicated. There’s certainly many legitimate reasons for elders to use drugs for reasons that help them. Either they’re stressed out or in pain and keep using them for longer than they should, more than they should, or for reasons other than originally intended,” Moore said. “A subset of those people will get addicted and meet the criteria for a substance use disorder.”
The amount of people meeting such criteria is alarming enough to have caught the eye of Congress. Sen. Sherrod Brown (D-Ohio) introduced the Stopping Medication Abuse and Protecting Seniors Act of 2015. Its goal is to prevent prescription drug abuse among Medicare recipients.
The law would require that the estimated 170,000 elders with a history of opioid abuse who receive Medicare be limited to a single pharmacy and single doctor. The rule would prevent patients from “doctor-shopping” for providers that may be unaware that other prescriptions have been issued to the patient.
Treatment Options are Scarce
As the problem of substance abuse quickly worsens, there is a shortage of treatment options for older patients facing addiction.
“Making sure our health system and substance treatment system are ready for an older population is a real concern and I’m glad people are beginning to draw attention to it,” Compton said. “Not enough research in this area is being done and I’m doing what I can to get some additional scientists to pay attention to it.”
One solution that Compton and Moore agree on is the push for healthcare providers who treat older patients to screen for signs of addiction.
“An evaluation of a 65-year-old with alcohol, marijuana, and tobacco use includes a much more medical evaluation of their physical health status than a 30-year-old. They’re likely to have all sorts of complicated health conditions,” Compton said.
Moore says red flags include problems with thinking that arise suddenly as well as seniors who suddenly becoming ungroomed, unsteady, or bruised.
Once a problem is identified, getting an older adult patient to agree to treatment can be a challenge.
“Older adults are even more stigmatized about substance abuse than younger adults so they don’t want to get help,” Moore said. “The best way to approach them is to say they have a health issue and that you want them to be independent rather than calling them an addict or an abuser.”
While treatment centers often say they are equipped to treat addiction in elders, Oslin says be selective.
“A lot of centers will say they treat older adults, but I don’t know how much experience they really have. It’s problematic to find qualified people, particularly in smaller towns or cities,” he said.
Oslin noted he uses the same essential methods of treatment on his older adult patients with addiction as those for younger adult patients, including a combination of psychotherapy, counseling, peer support, and pharmacotherapy.
However, older people require special considerations and flexibility when it comes to delivering treatment. For instance, Oslin says data suggest that some treatment options are not as popular among seniors.
“Doesn’t mean they’re less effective, but people have less preference for them. For example, as most of us get older, we really like our privacy, so group sessions are not preferred by elders,” he said.
Older adults may also have more difficulty getting around.
“I wouldn’t send a person with bad arthritis to a clinic where they need to climb five flights of stairs. Also, I have a lot of patients who don’t drive at night so treatments that involve appointments at 5p.m. are out of the question,” Oslin said. “Or if they don’t drive at all, getting to programs that require being there four to five times a week, like many outpatient programs are designed, is out of the question.”
Seniors with substance abuse issues looking to connect with a specialist should visit the website of SAMSHA, which includes a treatment locator. The National Council on Alcohol and Drug Abuse or an individual’s primary care physician may also know of resources in the community.
“The truth is elders and substance abuse just hasn’t been thought about enough, but it’s a real growing problem that deserves to be [attended to],” Oslin said.