Substance Abuse in the Mature Adult

Substance Abuse in the Mature Adult

There seems to be significant media focus on the substance abuse epidemic affecting our young people, and that media attention is appropriate. Both individuals and families are struggling with the often-tragic results of substance abuse.

That being said, there is also a substance abuse epidemic affecting mature adults. Approximately 10% of the general population has a substance abuse problem, while 17% of those over the age of 60 have substance abuse problems. That means substance abuse is a full 70% higher in the mature adult than in the general population. Hospitalization rates for substance abuse in the mature adult are nearly equivalent to those for heart attack.

So let’s look at some of the similarities and differences between younger and older substance abusers, some of the myths, barriers to treatment, and strategies for approaching this issue.

Similarities

Regardless of age of the abuser, the same five characteristics are required for a substance to be considered addictive – it must be euphoric, readily available, fast-acting, have unclear cultural guidelines, and have tolerance changes associated with its use.

And, we see the same five universal consequences of alcoholism and addiction – psychological dependence, tolerance, withdrawal (acute and post-acute), loss of control (of stop points, start points, and behavior while under the influence), and progressive damage (physical, psychological, social, and spiritual).

Differences

In the mature adult, particularly those with life-long substance abuse, we tend to see different health problems than in younger substance abusers. These include more cancers (specifically related to substance abuse), including esophageal, liver, pancreatic and kidney cancers, as well as cardiovascular disease, dehydration, malnutrition, and falls leading to severe orthopedic injuries and closed-head injuries.

We also find that substance abuse tends to accelerate the progression and the effects of various medical conditions often associated with aging, including diabetes, Alzheimer’s, neurological and neuromuscular disorders, and cardio-vascular incidents (stroke and heart attack).

Substance Abuse Myths Related to Age

  • Appearance: (“she doesn’t look like an alcoholic, doesn’t wear a trench coat, doesn’t live on skid-row, and has never had a DUI” – substance abuse is an equal opportunity disease, and affects people from all walks of life and of all appearances)
  • Harm: (“she’s not hurting anyone but herself” – right up until she plows her car into a crosswalk full of pedestrians)
  • Pleasure: (“give him a break; it’s his only pleasure” – when in fact real alcoholics and addicts are no longer deriving pleasure from their substance abuse; they’re just trying to stay “right”)
  • Entitlement: (“she’s earned the right” – nobody is entitled to harm others, their families, their communities)
  • Sleep: (“it helps him sleep better” – in fact people get less, not more, restorative sleep when under the influence)
  • Impotence: (“there’s nothing we can do” – in truth, there is always something that can be done, from intervention, to treatment, to therapy, to meetings, etc.)
  • Old dogs: (“you can’t teach an old dog new tricks” – my wife was speaking at a meeting and saw an 86-year old take a one-year cake, and say “this has been the best year of my life” – it’s never too late)
  • Heart: (“leave her alone; don’t you see those TV ads that say a bottle of red wine per day is good for your heart?” – it’s a glass of red wine, not a bottle!!)

Barriers to Treatment

There are three primary barriers, and multiple secondary barriers, to the mature adult receiving treatment for substance abuse. Only the primary barriers will be discussed here.

Substance abuse is often invisible in this population, thanks to isolation. Because so many mature adults have retired, they longer have strict work schedules to which they must adhere. They can, and do, spend large amounts of time at home, where their patterns of abuse go unseen. There are no co-workers to smell booze on their breath, no quarterly performance evaluations by a supervisor to see decreased productivity and increased mistake making. Both drugs and alcohol can be delivered to the home, allowing isolation and invisibility of the extent of the mature adult’s drinking and/or drugging.

Substance abuse is often invisible in this population, thanks to isolation. Because so many mature adults have retired, they longer have strict work schedules to which they must adhere. They can, and do, spend large amounts of time at home, where their patterns of abuse go unseen.-Jay WestbrookPseudo addiction is addict like behavior in a non-addict, with a goal of pain relief, rather than to get high. When a mature adult has pain that is inadequately managed by their physician, they may go to multiple physicians, trying to get a medication that really addresses their pain. They fill those prescriptions in the pharmacies located near each physician’s office. So, they end up with prescriptions from multiple physicians, filled at multiple pharmacies, and that looks very much like the behavior of a drug-seeking addict. The mature adult may well end up physiologically dependent on those medications, but has gotten there seeking comfort, as opposed to euphoria.

Finally, there is a tendency to fail to screen mature adults for substance abuse, because most physicians and nurses are not trained in how to perform such an assessment, and because mature adults are treated differently than younger persons. If a 35-year old were slurring their speech at a doctor’s office, the doctor would suspect substance abuse. If a 70-year old presented in the same way, the doctor would likely suspect TIA (mini-stroke) or a full stroke, and would not even assess for intoxication. If a 35-year old were falling at a doctor’s office, the doctor would suspect substance abuse.

If a 70-year old presented in the same way, the doctor would likely suspect a movement disorder such as Parkinson’s disease and would order a neuromuscular evaluation. If a 35-year old showed up for the same appointment two days in a row, forgetting they’d been there the day before, the doctor would suspect substance abuse. If a 70-year old presented in the same way, the doctor would likely suspect early stages of Alzheimer’s or some other memory disorder, and would not even assess for intoxication.

Strategies

Intervention works well with the mature adult, and the gentle eulogy-like model seems to work better than the angry ultimatum-driven model of intervention. That being said, mature adults are less likely to go directly from the intervention to treatment than an adolescent or young adult, but are more likely than the young adult to keep their commitment to go to treatment a couple days after an intervention.

Additional strategies include:

  • Treatment can work well for the mature adult, although there are some special considerations. Location should be within reasonable time and distance to an acute care hospital, in case of a health emergency, and the physical layout of the treatment center should be easy to traverse.
  • Treatment for mature adults should include clinicians skilled in addressing grief, loneliness, depression, and PTSD, as these are more prevalent in the mature adult than in the younger adult. In fact, these four may well be the cause of late-onset substance abuse, and can certainly serve as the trigger for continued abuse and/or relapse.
  • Local treatment rather than geographically distant treatment may better serve the mature adult substance abuser. For the young substance abuser, who may be more likely to bolt from treatment, a geographically distant treatment center is more difficult to walk away from than a local one. But mature adults are less likely to bolt, once they’ve made a commitment to treatment, and therefore the preventive aspect of a geographically distant location is not necessary. The advantage of local treatment for the mature adult, is that they have the opportunity to commence building a network of sober connections that they can maintain as they transition back to the community.
  • Finally, age-segregated treatment seems to work better than age-integrated treatment. Mature adults, who may have served their country, raised a family, and built a profession, business or career, may not be willing to open up in front of a young person who has few accomplishments under their belt, and who may bring greater entitlement and language that is off-putting to the mature adult. That being said, there are very few treatment centers specifically geared to the mature adult. Also, while we are “not people who would normally mix,” if someone is truly desperate for recovery, they will look for the similarities, rather than the differences, and find a way to recover.

I hope this brief article provided a useful glimpse into substance abuse in the mature adult.
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