Substance abuse on the rise among boomers
Age compounds toxic addictions
‘Three Scotches a night: What’s the harm?’
-- Dr. Gary S. Moak, SPEAKING OF A COMMON ATTITUDE VOICED BY SOME SENIORS
But as the baby-boom generation, now ages 48 to 66, expands the ranks of an already-sizeable older population, substance abuse is on the rise among elders.
Tobacco addiction continues to be the leading addiction among older adults, according to Dr. Douglas M. Ziedonis, professor and chairman of the Department of Psychiatry at University of Massachusetts Medical School, but abuse of prescription drugs, alcohol and even marijuana and other illegal drugs is an often hidden, but serious, issue.
“We think the numbers we have (on substance abuse) just reflect the tip of the iceberg,” said Dr. Gary S. Moak, clinical associate professor at the medical school and a geriatric psychiatrist who practices in Westboro.
“We are seeing the leading edge of what will be a tsunami.”
A report released by the federal Substance Abuse and Mental Health Services Administration projected that the need for substance abuse treatment among Americans over age 50 would double by 2020.
The report found that based on a survey done between 2006 and 2008, an estimated 4.3 million adults, or 4.7 percent of adults age 50 or older had used an illicit drug in the past year. Marijuana use was more common than nonmedical use of prescription drugs for adults age 50 to 59, while nonmedical use of prescription drugs was more common among those 65 and older.
The survey didn’t look at alcohol or tobacco use.
Another study, by the same agency, found that illicit drug use among adults 50 to 59 increased to 5.8 percent of the population in 2010 from 2.7 percent in 2002. Among those 55 to 59, the rate increased to 4.1 percent from 1.9 percent.
Substance abuse can cause health problems at any age, and among older adults, the effects of chemicals on the body are compounded.
“You take a couple that used to have a couple of martinis a night and now their bodies don’t metabolize as well. The ability to process the alcohol decreases with age and the volume of distribution: There’s more fat and less muscle,” said Dr. David A. Wilner, a geriatrician and medical director at Summit ElderCare in Worcester, an adult-day health program for nursing home-eligible elders. “Plus, the alcohol interacts with prescription drugs.”
“The other issue that’s different (among the elderly) is people who don’t see ongoing drug abuse as a problem,” Dr. Moak said.
Dr. Wilner said drinking and other substance abuse are often hidden by the isolation that can accompany old age. “I am frequently surprised to find someone having an alcohol problem that I wasn’t aware of,” he said.
Older adults who are retired don’t have to show up for work; they might not drive; they might not have family members around who could express concern about the drinking or drug abuse.
“ ‘Three Scotches a night: What’s the harm?’ ” Dr. Moak said was a common attitude among the elderly and their caregivers alike.
The harm, he said, is that alcohol makes people more depressed, already a problem among many older adults; it increases cognitive impairment; it interacts with prescription drugs; and it makes frail elders more prone to fall and end up in a nursing home.
“Those three Scotches are more like eight (to a frail elder),” Dr. Moak said. “It’s much more toxic now and it compounds the risk.”
When it comes to the surface, Dr. Wilner said, it’s like an “Aha!” moment, in which the cause for the person’s erratic behavior, which mimics cognitive impairment and other age-related problems, suddenly becomes clear.
Sometimes physicians aren’t aware of an alcohol problem until the person is hospitalized for another reason, and goes through withdrawal, with severe symptoms of delirium tremens and risk of seizure, which are worse than among younger adults.
Dr. Wilner said the extensive intake process at Summit ElderCare, which includes a medical evaluation and assessment with a social worker, home health nurse, and physical and recreational therapists, sometimes brings substance abuse issues to light, and helps the team coordinate a care plan with the caregiver at home.
For alcohol treatment, in particular, Dr. Wilner said the socialization and structure of coming to the day health program can help focus on the the problem. “If there’s a willingness to alter that, we can do quite a bit here,” he said.
Prescription drug abuse is also often hidden by age-related health problems and isolated living conditions.
Patrice M. Muchowski, who has a doctorate in psychology and is vice president of clinical services at Adcare Hospital in Worcester, said a person might start out with a prescription for a medical problem, such as pain killers or tranquilizers, and then become addicted to it. If the prescription drug use is combined with alcohol use, the problem is compounded.
But as with drinking, older people don’t always see taking their medication as a potential problem.
“There’s often a mind-set that if a prescription is written by a physician, then it must not be harmful,” Ms. Muchowski said.
She attributed part of the problem to the growing number of prescriptions being written for everything, and the number of doctors an elderly person might see, who don’t always communicate well with one another.
“Of the elderly folks that come through, we see them with a lot of prescriptions,” she said. “They’re often astounded that they can get physically dependent over time.”
Conventional drug or alcohol rehabilitation such as 12-step programs or Antabuse to treat alcoholism may not work for the elderly who have some cognitive impairment, Dr. Moak said. And even those without underlying impairment might not connect with a group of 20- and 30-year-olds who face a different set of life issues.
But gradually weaning an elderly person off a substance seems to work pretty well, he said.
Ms. Muchowski said Adcare offers specialty age-related groups as an option, although many older adults enjoy the energy of mixed-age groups.
You’re never too old to kick an addiction, including tobacco, and improve your health and quality of life, according to Dr. Ziedonis. “The important message for elderly is it still makes a difference.”
Original Article from the Worcester Telegram