The U.S. Census Bureau reports that, in 2012, there were 43.1 million adults over the age of 65, and this number is estimated to double by 2050, up to 83.7 million. Many of these senior citizens are members of the baby boomer generation – those born between 1946 and 1964 – who grew up in a culture of free love and drug experimentation. This generation may be taking illicit drug and alcohol abuse, as well as struggles with addiction, with them into their advancing age.
Alcohol may be the most commonly abused substance in the older generation. The journal Psych Central reported that around 3 million seniors over the age of 65 battle alcohol abuse, and this number may jump to more than 6 million by the year 2020.
What are addiction treatment options for the elderly?
Older adults may not recognize the need for addiction treatment, which makes an addiction intervention vital. After a successful intervention, the person will be prepared to enter treatment, and there are a variety of facilities with programs made just for older adults. Those programs may offer medical detox, residential treatment, and/or outpatient treatment, as necessary.
Medical and mental health conditions may increase as individuals age, creating the need for high levels of prescription drug usage. The Psychiatric Times estimates that around a quarter of all prescription drugs in the United States are sold to elderly people, and close to 11 percent of this population may abuse these medications. Psychoactive medications, including painkillers like opioid narcotics, and anti-anxiety or sedative medications, such as benzodiazepines, may be commonly prescribed to and abused by this population.
The journal Today’s Geriatric Medicine published that older adults use prescription drugs three times more than other demographics do, which may increase the rate of abuse and dependency in this population. The New York Times publishes that as of 2010, between 6 and 8 million American senior citizens battled a substance abuse or mental health disorder. Treatment for addiction in the elderly population may need to be specialized, as adults over the age of 65 are likely to have unique circumstances and specific needs that are different than those experienced by younger generations.
Identifying Substance Abuse and Addiction in the Older PopulationIt may not be as simple to recognize or diagnose a substance abuse or dependency concern in adults over the age of 65. This is partly due to possible social isolation. Seniors are often retired and no longer in the workforce; they may live alone or far from family members; and personal social circles may dwindle as peers pass away or become less ambulatory. Even doctors may hesitate to diagnose a substance abuse problem as a kind of ageism, or prejudice, may exist with the notion that elderly individuals are entitled to their drugs or alcohol. People may not want to take substances away from elderly individuals and risk potentially negatively impacting their quality of life.
Alcohol and drugs present unique problems for the older adult population, however, negatively affecting both mental and physical health. As individuals age, physiological changes occur in the brain and body, making people more susceptible to, and less tolerant of, the effects of drugs or alcohol. Metabolism slows down, and medical complications may interfere with the way alcohol or drugs are broken down in the body. Substance abuse can increase the risk for falling and breaking bones, becoming addicted, having suicidal tendencies, exacerbate memory loss and possible delirium, and heighten the odds for a negative drug or co-occurring disorder interaction, the journal Future Medicine reports.
Side effects of substance abuse and addiction may also be similar to signs of aging, further making a substance abuse or dependency diagnosis more convoluted.
Addiction may start innocently enough, as elderly individuals are likely not abusing drugs to get high, but rather may be using them to reduce physical pain or emotional difficulties. Senior citizens may struggle with the aging process and may use drugs or alcohol to cope with mental or physical distress related to illness, chronic pain, the death of a spouse or loved one, families moving away, a decrease in ability to engage in some activities, big life changes such as the loss of a job or change in living arrangements, increasing psychiatric issues, or social isolation.
Lower amounts of alcohol or drugs may have bigger effects, and tolerance levels may be lower. Older adults are also highly likely to have a comorbid medical or mental health concern, as the Psychiatric Times publishes that psychiatric illness and substance abuse likely co-occur in the elderly population at rates between 21 and 66 percent. Depression and anxiety disorders may be common in seniors who also abuse alcohol or drugs. Substance abuse may be a form of self-medication to temporarily reduce symptoms of mental illness, although in reality substance abuse will only serve to complicate treatment and make side effects of both disorders worse in the long run.
Many of the medications older adults may take are mind-altering and potentially addictive substances that, when taken for a long period of time, create dependency that can morph into addiction very easily. Older adults may be more likely to take more medications for longer, to take more than one medication or supplement at a time, and to be prescribed long-term medications than younger individuals, the National Institute on Drug Abuse (NIDA) reports. These substances make chemical changes in the brain and, over time, may lead to compulsive drug-seeking behavior, cravings, and a lack of control over drug use patterns, indicating that abuse may have developed into an addiction.
Addiction may start innocently with initially just taking more medication than prescribed at one time, or by mixing drugs and alcohol that may have unforeseen negative interactions with each other. Additionally, many seniors are on a fixed income and may have financial difficulties that may encourage the sharing of medications to save money.
Regardless of the reason for abusing prescription or illicit drugs or alcohol, abuse can lead to addiction, which is a disease that can be managed with the proper treatment.
Recognizing when substance abuse is concerning is often the first step in getting necessary treatment for a drug or alcohol problem. In many cases, the individual may not recognize the need for treatment, and an intervention may be necessary. An intervention is a carefully planned meeting of loved ones and family members affected by a person’s substance abuse. Often, the help of a trained professional is beneficial in the planning process as well as in the actual intervention.
The goal of an intervention is to help someone see the need for, and willingly enter, a treatment program. With older individuals, the Substance Abuse and Mental Health Services (SAMHSA) states that only one or two loved ones, particularly a spouse, child, close medical professional, or housemate, be involved in an intervention to avoid potential confusion and to reduce the chances of overwhelming the person emotionally. Motivational counseling and education on substance abuse and addiction may help someone gain the internal motivation to seek treatment and may be as effective for some people as a structured intervention.
Age-Specific and Mixed-Age Addiction Treatment ProgramsAs the need for elderly addiction and mental health treatment increases, more and more facilities are providing care options that cater to this specific demographic. There are usually two main types of treatment programs: those that are general programs and contain all ages, and those that are age- or peer-specific and tailored to certain populations. Just as teenagers may have special needs and mitigating circumstances, so might the elderly population. Sometimes gender-specific programs may be beneficial also.
Generally speaking, it may suit someone better to be in a treatment program with peers and other individuals in similar life circumstances. Since older adults may abuse substances for different reasons than younger ones, it may be beneficial to separate treatment programs for different peer groups.
Treatment options may vary depending on the level of care required and include:
- Preventative, education, and support services
- Medical detox
- Residential treatment
- Outpatient treatment
Detox is the safe removal of drugs and alcohol from an individual who is dependent on the substance and who may suffer both drug cravings and potentially dangerous withdrawal symptoms when the substances are removed. Medical detox may use medications to accomplish this process is an inpatient or outpatient setting, depending on individual circumstances.
Health professionals treating older adults in medical detox need to be aware of all the medications a person may be taking to manage other health concerns in order to avoid any negative interactions. Medical conditions and mental health concerns also need to be evaluated before dispensing medications during detox, and some of the medications used in other demographics may not be recommended for this age group. For example, SAMHSA reports that while benzodiazepines are commonly used to stabilize individuals during medical detox from psychoactive prescription drugs, these drugs in long-acting or high-dose formulations may build up in an older person’s body, creating lasting cognitive or toxic effects. Individuals who are over 65 and battling addiction may therefore be best suited to a treatment program that understands the particular complications that may face the elderly population.
Residential or Outpatient Treatment
Both residential and outpatient treatment models usually have similar components, such as therapy, group and individual counseling, 12-Step and mutual support group meetings, educational opportunities, life skills training workshops, and holistic treatment methods. With outpatient treatment models, individuals attend sessions or meetings during the day and return to their residences at night, while residential treatment means individuals will stay on site at a specialized substance abuse treatment facility, and receive care and supervision around the clock.
Since life circumstances may be different for a senior citizen than a younger person, the particular components of treatment may need to be age-specific. Many programs may separate similar populations into groups during therapy, counseling, life skills training, education, and support group meetings.
When a comorbid mental illness is also present, integrated treatment models that use teams of medical and mental health professionals to treat both disorders simultaneously may be important. With an older individual who may also have a medical or mental health condition and who may be taking multiple medications, it may be even more essential for all medical professionals to be on the same page and working together.
Behavioral therapy is often used during substance abuse and addiction treatment, as it helps individuals to find and recognize the connections between potential triggers, negative thoughts, and subsequent actions. Emotional, social, or physical triggers may be unique to an older adult and may center around certain life events or circumstances that a younger person may not relate to.
Motivational Interviewing (MI) is another therapy method that helps people to recognize that change is necessary while promoting acceptance in a nonthreatening and non-confrontational manner. Stigmas surrounding age and addiction may need to be absolved in order to ensure that treatment needs are fully met.
Residential treatment likely provides the most comprehensive level of care as medications can be monitored for adverse effects, and individuals can receive medical and mental healthcare 24 hours a day. Residential treatment programs may include holistic treatments, such as yoga, walking groups, or massage therapy, that can be tailored to suit an older population. Professionals in a comprehensive treatment program may also help design a balanced nutrition plan and help individuals manage medications.
Recovery Support and Relapse PreventionSupport groups are often an essential part of a substance abuse treatment program and may be especially helpful after a more intensive treatment plan, or a stay in a residential program, has ended.
Relapse is a return to drug- or alcohol-abusing behavior and may be particularly dangerous for the older adult population, as the risk for a fatal overdose may be high during a relapse. When someone abuses drugs or alcohol for a long time, body and brain chemistry adapts to certain levels of the substance, and a tolerance builds up. Detox removes these toxins from the body and helps to reset these chemical changes in the brain and body. When people then return to abusing drugs or alcohol at levels they may have been previously tolerant to, the body is not able to handle these amounts any longer, and overdose may occur.
Self-help and 12-Step programs may have age-specific groups and meetings for older adults that can provide a safe haven and supportive peer network for individuals in recovery to help prevent episodes of relapse. SAMHSA also recommends that a case manager who can check in with an elderly person regularly after leaving rehab, or a community-centered program, may be helpful to watch for signs of relapse. Friends and family members, and members of an elderly individual’s community, can all be important parts of a healthy support system that will enhance addiction treatment and promote long-term recovery.
Adults over the age of 65 are enrolled in the federal Medicare insurance program. The benefits available may provide coverage for mental health and/or substance abuse treatment. Substance abuse treatment centers typically have staff members who are extremely knowledgeable in how to help fund or use insurance to pay for addiction treatment. Substance abuse treatment can save families and individuals money in the long run, and many times Medicare or supplemental insurance can be used to help pay for the costs.
For an elderly individual, treatment may start with a primary care doctor who then may refer a person to a treatment program as needed.
A detailed medical and mental health assessment as well as a drug screening may be done to help determine what level of care is best.
Addiction is a treatable disease, regardless of a person’s age. There are numerous substance abuse and mental health treatment options open to older individuals. Recovery is possible.