Substance abuse is highly under-diagnosed among older adults, says UB School of Nursing associate dean for research
By Deborah Jeanne Sergeant
Angst-ridden teens and anxiety-ridden young adults seem easy examples of typical substance abusers; however, a growing number of older adults turn to alcohol and prescription and illicit drugs.
They’re seldom identified as having a substance abuse problem.
According to the National Institutes of Health (NIH), the rate of people over 50 who abuse substances is expected to top 5.7 million by 2020.
The baby boomer generation grew up in the era of widespread drug experimentation. To those who used drugs recreationally in the ‘60s and ‘70s, the current growing expansion of acceptance of medical and recreational marijuana tacitly condones using substances to self-treat physical and mental health issues.
The NIH also states that alcohol predominates as this age group’s substance of choice, although abuse of illicit and prescription drug has risen in recent years, too.
Yu-Ping Chang, associate dean for research and scholarship at UB School of Nursing, studies addiction in seniors. She said substance abuse is highly under-diagnosed among older adults.
She added that respect for elders and the generational mindset of minding one’s business may keep substance abuse problems taboo to discuss for either the elder or their children and the peers around them.
“We feel they’re wiser and should know better because they’ve been through so much,” she said. “It’s a stereotype.”
Ironically, many older people often visit a physician for chronic health issues, yet a substance abuse issue often goes unnoticed by their physicians. Even family and friends may not notice, suspect something else or choose not to say anything if they do suspect.
“Mental health issues are co-existing issues oftentimes,” Chang said. “[Seniors] want to feel better and may use a substance as a coping mechanism. The providers aren’t well prepared to detect the problem, especially in the emergency room setting.”
Chang wants more providers to screen for substance abuse and to look deeper at psychological issues.
For some older adults, chronic pain from an illness or injury initiated a prescription for pain medication. Once the refills end, alcohol, other prescriptions or illicit drugs may stand in for pain control or to ease loneliness, depression or anxiety.
According to experts, it’s not uncommon for seniors abusing prescriptions to “borrow” extras from a neighbor or family member who has hoarded medication from their own prescriptions. Feeling sympathetic, they unknowingly enable further substance abuse.
The opioid crisis has influenced more physicians to minimize opioid use and help patients develop a plan to use habit-forming pain medication in smaller amounts and for shorter duration. This also helps reduce the number of hoarded pills.
Since many families spread out and neighbors aren’t always as close as they used to be decades ago, many older adults continue to abuse substances unnoticed.
More vulnerable as we age
Drugs and alcohol may affect older adults differently than when they were younger. For instance, muscle mass declines decade by decade as the body ages. Frail older adults have less muscle mass and cannot process alcohol and drugs as efficiently as they used to.
“Their health has changed over the years so the amount that would become problematic is much less than a younger adult,” said Kelly Whitman, licensed clinical social worker and vice president of Substance Use Disorder Services & Housing at Best Self Behavioral Health in Buffalo. “They also have medication they’re taking oftentimes. That can change how alcohol affects the body and mind.”
Substance abuse can contribute to a greater risk for falling and breaking bones, which can trigger loss of independence and many negative health outcomes.
Whitman said that older people who abuse substances are usually either early onset users, who have been using a substance throughout their lives as a coping mechanism, and late onset users, who perhaps were social drinkers and later in life turn to a substance to cope with a tragic event.
Unfortunately, few substance abuse programs exist to help older adults who abuse substances. Whitman said that many older adults feel uncomfortable in a typical group setting with mostly younger people.
“They need to be able to relate to people in the group,” Whitman said. “Most are middle aged and younger in group therapy. We need treatment modalities that relate to older adults.”
One-on-one help may be too costly for some seniors. For some of these, accessing care is complicated by affording co-pays and transportation three times a week well.
“We have to be good with checking on our older adults and asking uncomfortable questions and seeing possible signs,” Whitman said. “Don’t avoid it. Ask how things are going. Maybe you see that prescription bottle and ask how much they’re taking.”