People in their 50s, 60s and beyond are often not considered likely candidates for drug and alcohol problems. But the combination of chronic pain, the loneliness that can come with retirement and a comfort level with illicit drugs acquired during their teen years can lead older adults into dangerous habits — and even addiction.
A new book published by Hazelden Publishing and AARP gives much-needed guidance to those whose loved ones may be misusing drugs or alcohol. Not As Prescribed: Recognizing and Facing Alcohol and Drug Misuse in Older Adults, by Dr. Harry Haroutunian, describes the common denominators of misuse or addiction and the dangers of combining certain prescription medications. The book also offers suggestions for loved ones on what to do to help.
Haroutunian, an authority on addiction, serves as physician director of professional and residential programs at the Betty Ford Center in Rancho Mirage, Calif.
Particularly interesting elements of the book include a discussion of which prescription drugs can cause dementia-like symptoms (a couple of examples cited are antihistamines and antidepressants). Combinations of such drugs are especially likely to produce behavior that looks like dementia.
About 50 percent of those who make up the boomer generation grew up experimenting with illegal drugs, even if only briefly.
— Dr. Harry Haroutunian
An excerpt from the introduction of the book is reprinted below, with permission from the publishers:
Not As Prescribed
Over the years, society has adopted quite a few derogatory descriptors for alcoholics and addicts: “drunkard,” “junkie,” “wino,” “sot.”
These words might stir up thoughts of slovenly, obnoxious, foul-smelling panhandlers stumbling through the streets or dazed, scab-ridden youths lounging in a coma-like state in some God-forsaken apartment or abandoned warehouse on the wrong side of town.
The stereotypical thoughts and images these words conjure up are true in some cases. But they are only a very small part of the picture. Addiction and drug misuse encompass a much larger group of people and extend far beyond dingy bars and dark alleys.
The disease of addiction (yes, addiction is a diagnosable disorder) is what we in the addiction recovery field call “an equal opportunity destroyer.” Alcohol and drug misuse, from mild abuse to full-blown addiction, can affect anyone, regardless of race, gender, nationality, profession, income level, religious affiliation — or age. This includes older adults — moms and dads, grandparents, great-grandparents, retirees, neighbors, friends, coworkers — even those who had never experienced a problem with alcohol or other drugs during earlier life stages.
It might be hard to imagine a 70-year-old grandfather passed out in the recliner from combining his prescription painkillers with scotch, but it’s happening. And, for a host of reasons, it’s happening at an alarming rate.
Addiction in older adults may be unleashed by the innocent consumption of prescription medication or the gradual increase of alcohol or marijuana intake. It may be masked by the normal symptoms of aging or the need to medicate chronic pain.
The Scope of the Problem
Drug misuse and addiction to alcohol and other drugs among older adults (which I am defining as men and women age 50 and older) is one of the fastest-growing, yet most unrecognized, health problems in this country. Statistics show that 17 percent of older adults misuse alcohol and prescription drugs.
When we include misuse of other drugs, that number is even higher. By 2020, the number of addicted older adults is expected to double to about 6 million. Widowers over age 75 suffer the highest rate of alcoholism in the United States.
Addiction, whether ongoing or late onset, leads to increased hospital admissions, emergency department visits and psychiatric hospital admissions. In fact, older adults are hospitalized as often for alcohol-related problems as they are for heart attacks, one of the nation’s leading killers.
Notice that addiction is considered a “health problem” — not a moral failing or a sin but a problem that compromises the health and welfare of those it affects: the addict and at least five to 10 family members, friends, coworkers, employers or anyone touched by the addict’s actions. And a person doesn’t have to be addicted to have his or her alcohol or other drug misuse cause physical and mental health problems as well as concern among friends and loved ones.
Four major factors contribute to the large number of older adults now having problems with alcohol and other drugs.
First, the number of people reaching retirement age is growing by leaps and bounds. In 2011, the first of the 76 million boomers turned 65. Every day for the next 20 years, 8,000 to 10,000 boomers in the United States will reach age 65, and many will retire — with time on their hands.
Second, about 50 percent of those who make up the boomer generation grew up experimenting with illegal drugs, even if only briefly. When careers and raising a family took precedence, most of this generation gave up their attachment to mood-altering substances. But in retirement, or as empty nesters, a growing number of boomers are reverting to using drugs as a means of dealing with the stressors that can accompany aging — including boredom, health issues and financial worries, as well as loss of a spouse, loss of identity, and, in some cases, loss of a certain degree of freedom.
A 2011 Substance Abuse and Mental Health Services Administration study found that the rate of current illicit drug use among people in their 50s increased from 2.7 percent in 2002 to 6.3 percent in 2011 [i.e., more than doubled], indicating that the baby boomer generation is more likely than previous generations to turn to drugs as older adults.
More Prescribed for Pain
Third, since the late 1990s, when the medical community began monitoring pain as a fifth vital sign (in addition to temperature, heartbeat, breathing rate and blood pressure), prescription-painkiller use has experienced a dramatic rise in the United States.
Worldwide, Americans take the lead, consuming about 80 percent of all prescription painkillers. Painkillers such as OxyContin and Vicodin fall into a highly addictive class of drugs called opioids, which also includes heroin. Since 2002, use of prescription painkillers has doubled.
The result: From 1998 to 2008, the number of people being treated for opioid abuse increased 400 percent. And those who can no longer manage to get their drugs via prescription are turning to the street, where dealers have these pills readily available as well as very pure heroin — which is stronger and often cheaper than pills — creating an epidemic of frequently fatal overdoses across the country.
Fourth, older adults have been conditioned to turn to drugs for relief, whether taking a couple of ibuprofen to soothe an inflamed joint or an opioid painkiller for major back pain.
According to a U.S. Census report, as many as 92 percent of U.S. adults live with at least one chronic condition; 41 percent have three or more conditions. Each year, doctors write 17 million tranquilizer prescriptions for older adults, including for benzodiazepines (think Valium, Xanax and Ativan), the most widely misused class of drugs among that age group. In 2014, Americans filled over 4 billion prescriptions at retail pharmacies alone; and adults over 65 fill more than twice as many prescriptions as those younger than 65. This is for a nation of 290 million people.
A Comfort Level
Older adults may have been comfortable using drugs in their youth, they trust their doctors to prescribe only medication that’s good for them and they trust the television commercials promoting prescription drugs.
And who can blame them? Pharmaceuticals have their place in the world. They reduce suffering for millions of people every day. The problem starts when the drugs stop helping and start hurting instead.
In some cases, the drug combination (whether mood-altering or not) is the culprit. In these situations, addiction is not the issue — toxic drug combinations, some of which produce dementia-like symptoms, are the problem.
But when people cross the line from normal use to misuse and then dependence, addiction starts running the show. And when addiction takes over, the negative consequences start piling up and affecting loved ones like you.
Not Just for Kicks
Few older adults start out with a hedonistic urge to get high. Most are following doctor’s orders, taking medications as prescribed. Others have been victimized by polypharmacy (taking multiple medications to help with various health issues), the result of seeing multiple doctors who don’t talk to each other, coupled with a lack of patient advocacy to protect them.
Others begin drinking or smoking marijuana to numb feelings of loneliness or depression that can be common in older adults for a variety of reasons. The effects of the recent decriminalization and legalization of medical marijuana in some states are, as of this writing, still largely unknown.
Regardless of intentions or age, the results of addiction are the same: Addiction destroys lives and families. Recovery from addiction can reverse these damages by promoting a fulfilling life that heals relationships.