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Addiction Treatment Options for People Over Age 65
No one is ever too old to get treatment for a substance use disorder. Because the segment of the population over 65 years old is the fastest-growing proportion of Americans, many rehab facilities are making special arrangements to address issues with addiction in this age group.
A Growing Demographic
According to the United States Census Bureau, the fastest-growing segment of the United States population is the group of individuals over age 65. It is expected that by 2030, people above 65 years old will outnumber those under age 18.
As people live longer, many of the demographic factors of people who are over the age of 65 have changed substantially, and the group is no longer homogenous. Typically, the elderly population is divided into three different age brackets:
- People between the ages of 65 and 74: If you are in this age group, you are often referred to as “young-old.”
- People between the ages of 75 and 84: If you are in this age group, you are referred to as “old” or “middle old.”
- People over the age of 85: If you are in this age group, you are often referred to as “old-old.”
None of these labels are very flattering; however, it is important to designate different levels of people over 65 due to differences in their physical functioning and cultural and life experiences. If you do not like the label, just refer to the age bracket.
Quick Facts About Older People
According to the U.S. Census Bureau and the Substance Abuse and Mental Health Services Administration (SAMHSA):
- If you are a member of the young-old, you are more likely to be working, married, and have internet access than the other groups.
- The most prevalent physical disability across all levels of the elderly is difficulty with walking up a set of stairs.
- If you are over age 65, you are more likely to be female than male across all divisions.
- If you are over age 65, you are more likely to be married if you are male and widowed if you are female.
- The poverty rate among elderly individuals is lowest for those 65 to 74 years old and highest for the old-old (over age 85).
Drug Use in the Elderly
According to the National Institute on Drug Abuse (NIDA), the major drugs of abuse in individuals over age 65 are alcohol and prescription medications. It is estimated that about 70 percent of individuals older than 65 years old have misused a prescription medication at least once.
Triggers for Substance Abuse in the Elderly
If you have had any type of substance abuse issue, you are likely to think that certain factors caused your substance abuse. Unfortunately, there is no identified specific cause associated with the development of a substance use disorder. Instead, substance abuse is a result of numerous interacting factors that may differ substantially among different people.
People age 65-plus have their own specific challenges that can contribute to substance abuse in addition to other identified risk factors that occur across all groups, such as genetic associations and stress. Some of the things that might affect you if you older than 65 include:
- Issues with a personal sense of self-worth or identity (These might include retirement, death of a spouse or other family member, or relocating to a community living center.)
- Changes in physical health
- Family conflicts
- Issues with sleeping
- Being overwhelmed with the rate that information is now disseminated to people
- A decline in cognition or mental health (These might include issues with memory, the development of dementia, susceptibility to depression, anxiety, and other emotional factors)
- Boredom
- Increased feelings of isolation or loneliness if you have lost your spouse, family members, or a significant number of close friends
Specific Dangers of Elderly Substance Abuse
If you are older than age 65, you have experienced some significant changes in the way your body works. These changes will continue as you get older.
One of the major changes is that your metabolism works much more slowly than it did when you were younger, and your ability to metabolize complex substances like prescription medications has changed. Less of any particular medication can produce more significant effects in you.
Benzodiazepines are regularly prescribed to individuals older than 65, and these may have a significant effect on you if you use them in doses that are typically prescribed for younger individuals. Alcohol use may also affect you differently.
This can increase your chances of developing issues with abuse and physical dependence.
Signs of Addiction in Elderly Individuals
Even if you are 65-plus, the diagnosis of a substance use disorder will be based on the diagnostic criteria as developed by the American Psychiatric Association. Nonetheless, if you are over 65, some specific indicators may serve as red flags that you have developed a potential substance use disorder. These include the following:
- You use alcohol secretively, or you most often drink alcohol while alone.
- You have a ritual of having alcohol before, during, and after your meals.
- You regularly consume alcohol with your prescription medications.
- You frequently use benzodiazepines or pain medications.
- You find that activities that once gave you pleasure no longer do so and that using alcohol or medications substitutes for these activities.
- People have commented that you are not paying as much attention to your physical appearance, household chores, and other aspects of self-care as you used to.
- You find yourself more irritable, hostile, and depressed than you used to be. You may use alcohol or drugs to alleviate these issues.
- People have commented that you seem to be using alcohol and/or prescription medications much more often than you used to.
Who Is Most at Risk?
According to NIDA and SAMHSA, the highest rates of alcohol use disorders occur in people over age 75 who lost a partner. Rates of substance use disorders among elderly patients in nursing homes may be extremely high. A large percentage of new hospital admissions in elderly individuals may be related to the abuse of alcohol or other drugs.
Treatment
NIDA specifically states that if you are over the age of 65, you will respond just as well to standard treatment interventions for substance use disorders as younger individuals. However, there may be some adjustments that may make you more comfortable with treatment.
- Choose a rehab program that has experience or specializes in the treatment of elderly individuals. Because this proportion of the population is growing so quickly, you may find several programs available to suit your specific needs.
- Attempt to find therapy groups or support groups that have a large number of elderly individuals in them so that you can identify with other members.
- Work with therapists and other treatment professionals that are closer in age to you.
- Make sure to have your treatment providers explain the effects if your medications are combined with alcohol and how your age has changed how you may respond to these.
- Understand that the use of counseling or therapy does not mean that you are mentally ill. It means that you need to more effectively learn to address certain issues that lead to the abuse of drugs or alcohol.
- Be aware that medications and therapy do not “cure” a substance use disorder and that you have to continue to work at it.
- You may be more comfortable if you integrate your treatment for substance usage with your primary care treatment program. Get your primary care physician involved in the program.
- Undergo a formal assessment for any other psychological issues, such as depression or anxiety. If you are older than age 65, it is very common for people in your age group to have issues with substance abuse and a co-occurring psychological issue like depression. These must be treated together.
- Make sure you are heard. Effective treatment will address your specific needs in addition to following the standard treatment approach for substance abuse.
SOURCES
(October 2018) A Snapshot of the Fast Growing U.S. Population. United States Census Bureau. Retrieved April 2019 from https://www.census.gov/library/stories/2018/10/snapshot-fast-growing-us-older-population.html
(October 2018) National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. Retrieved April 2019 from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf
(December 2011) Substance Abuse Among Older Adults. National Institute on Drug Abuse. Retrieved April 2019 from https://www.drugabuse.gov/news-events/nida-notes/2011/12/substance-abuse-among-older-adults
(2013) The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. American Psychiatric Association.