Are You at Risk for Alcohol or Drug Addiction?

Nobody wants to get any disease, but addiction is one of those conditions that many of us especially want to distance ourselves from. That’s not me, we may tell ourselves. I can handle my liquor/drug. And most of the time, most of us can.

But like pretty much any health issue, alcoholism and drug addiction can strike anyone at any time. And there’s good evidence that more Americans are being struck by substance abuse in midlife.

A November 2015 New York University study of over 37,000 New Yorkers found that the majority of people seeking treatment for opioid addiction (this included prescription painkillers like oxycodone as well as illicit drugs such as heroin) were in their 50s. Between 1996 and 2012, the percentage of people ages 50 to 59 who sought treatment jumped from about 8 percent of patients in the mid-90s to nearly 36 percent of patients. Similarly, in 1996 just 1.5 percent of patients were in their 60s; by 2012 that number had grown to 12 percent.

During the same period, the overall number of people seeking treatment for opioid addiction fell, even while the number of older Americans needing treatment grew significantly. A 2012 report by the Institute of Medicine concluded that as many as 20 percent of the country’s elderly population “have one or more mental problems stemming from substance misuse or abuse,” which includes alcoholism.

So what’s behind the higher rates of addiction to booze and other drugs as we age? Experts say there are a number of factors at play.

“First, [older] people have more free time because they aren’t working, which is sometimes a cause for excessive drinking,” says Dr. Akikur Mohammad, a board-certified psychiatrist in addiction medicine and author of The Anatomy of Addiction: What Science and Research Tells Us About the True Causes, Best Preventive Techniques, and Most Successful Treatments. “The extra free time can be due to retirement, but occasionally it is the result of being forced out of work.”

Other factors, says Mohammad, may include grief over the loss of a spouse, friends or family members; feeling isolated; health issues and depression.

“Depression affects many older adults and can be prompted by declining health or a decrease in financial stability or loss of income,” explains Mohammad. “Using drugs or alcohol is a common way for many people to cope with depression. While these are some of the most common reasons people of all ages turn to using substances, they are especially common for older adults.”

You may have drunk (and/or taken drugs) in moderation for years, even decades, and think you’re in the clear. But your body likely isn’t the same as it was in your 30s or 40s. For starters, you’re probably taking at least one legit medication for one condition or another. (Americans over 65 account for more than one-third of all spending on prescription meds, says the National Institute on Drug Abuse.) Prescribed drugs can interact with one another, with over-the-counter medications and supplements, and yes, with illicit drugs and alcohol as well.

“Many seniors use legal medications prescribed by a doctor to aid in mental or physical difficulties due to aging,” says Mohammad. “Adding non-prescribed drugs or alcohol to the mix can have adverse effects.”

An especially common recipe for disaster is combining a nightly cocktail (or more than one) with whatever meds your doctor prescribed. “The combination of sedating medications such as benzodiazepines or other sleep aids with alcohol or prescribed opioids is associated with an increased risk of overdose,” says Dr. E. Jennifer Edelman, an assistant professor of medicine specializing in addiction medicine at Yale School of Medicine in New Haven, Conn. Those ages 55 to 64 are at the highest risk for overdose from prescription painkillers, in fact, according to data from the Centers for Disease Control.

Edelman cautions, too, that abusing alcohol and/or other drugs makes it less likely that you’ll stick to the medication regimen your doctor prescribed for you, possibly leading to medication errors — missing doses or taking too much or too little of the drug, for instance.

Simply put, if you’ve got health issues, too much of any intoxicating substance — legal or not — is going to make those condition worse, in all likelihood.

“Decreased liver and kidney function [can lead] to impaired ability to metabolize substances,” adds Edelman. Meaning that if your organs aren’t working as well as they once did, your body may not be able to excrete drugs as easily, raising your risk for toxic levels. “Cocaine use is associated with spasm of the coronary arteries, premature cardiovascular disease and arrhythmia,” she notes. “So older adults with underlying heart disease who use cocaine may be particularly likely to experience a heart problem. Alcohol may exacerbate depressive symptoms. Opioids may increase the risk of falls and fractures.”

When you’re over 65, your body handles alcohol differently, notes the Substance Abuse and Mental Health Services Administration (SAMHSA); this is because of age-related changes, including a decrease in water in the body; increased sensitivity and decreased tolerance to alcohol and reduced metabolism of alcohol in the GI tract.

So what should you look out for, whether in yourself or someone you love, that might point to a problem with addiction? Mohammad and Edelman offer this list of possible signs:

• Depression
• Isolation, wanting to be left alone
• Acting sneaky, or trying to hide things (like drinking, buying drugs, or financial records that would indicate spending on drugs)
• Denial
• Morning hangovers
• Sexual dysfunction
• Sleep disturbances
• Doctor-shopping (seeing multiple physicians to get prescriptions filled) or asking friends or family to get, buy, or give drugs or alcohol

Other common signs of addiction — including falling, confusion and fatigue — can be mistaken for “normal” signs of aging, says Mohammad. “It’s important to watch for any changes that occur rapidly or become more obvious. And of course the most obvious sign is when someone is drinking [or using drugs] more frequently without trying to hide it,” he adds.

For a complete list of criteria for alcohol use disorder, visit the National Institute on Alcohol Abuse and Alcoholism.

If you suspect your spouse, family member or friend is addicted, “express your concern for the loved one and let them know that help is available,” says Edelman, who recommends SAMHSA (call 800-662-HELP or use SAMHSA’s Behavioral Health Treatment Services Locator to find help in your area) or the National Institute on Drug Abuse as reputable sources for learning more. “There are effective treatments, including counseling-based therapies and medications for substance use disorders,” she stresses.

“Wanting to get help is the hardest part for most people with addiction,” Mohammad notes. “They are usually in denial that they have a problem and their substance use makes them feel good or ‘normal.’” He recommends seeing an addiction specialist since many primary care doctors are not trained in diagnosing or treating addiction. “They may dismiss the symptoms, which could delay much-needed treatment and make things worse,” says Mohammad.

Whoever you or your loved one sees, make sure a full medical assessment is done at the outset, including an evaluation of any other mental health disorders. “That’s necessary to make an informed diagnosis, just as with any chronic disease, such as diabetes,” says Mohammad. “Without knowing for certain, it’s impossible to provide the best course of action.”