Substance Abuse and Mental Health Issues Among Older Adults

Aging can lead to increased stress and depression, making seniors vulnerable to alcohol and substance use problems. The gradual inability to perform common daily tasks, loss of friends and increasing isolation can weigh heavily on once active, social adults. When coupled with declining health, memory and vision loss, and increased instances of diabetes or high blood pressure, one’s “golden years” can quickly become very bleak.

As the Baby Boom generation, the largest age demographic in the nation, grows older, many issues associated with aging are coming to the forefront. Under recognized substance abuse and mental health problems in this age group leads to increased health care utilization, a compromised quality of life, heightened stress on caregivers, increased mortality, and a higher risk of suicide.

According to the National Council on Aging (NCOA), demographic projections indicate that Baby Boomers alone will increase the proportion of persons over age 65 from the current 13 percent to 20 percent by the year 2030. When this point is reached the number of persons with psychiatric disorders, including substance abuse disorders, in this older group will equal or exceed the number with mental illness in younger age groups (ages 18 to 29, 30 to 44, or 45 to 65). For an already overburdened healthcare system, this is an epidemic in the making.

Indeed, a growing percentage of older adults misuse alcohol, prescription drugs, or other substances. In fact, SAMHSA projects that the number of older adults in need of substance abuse treatment will more than double from 1.8 million in 2010/2011 to 4.4 million by 2020.

In addition, SAMHSA has estimated that as many as one in four older adults has a significant mental disorder including depression, anxiety disorders, and dementia. Over the next 25 years, the number of older adults with major psychiatric illnesses will more than double from the currently estimated 7 to 15 million individuals.

Elderly alcohol abusers can be divided into two general types: the “hardy survivors,” those who have been abusing alcohol for many years and have reached 65, and the “late onset” group, those who begin abusing alcohol later in life. According to research findings from the National Institute on Alcoholism and Alcohol Abuse (NIAAA), the late onset group’s alcohol abuse is often triggered by changes in life such as retirement; death; separation from a family member, a friend or a pet; health concerns; reduced income; impairment of sleep or familial conflict.

Because alcohol has a higher absorption rate in the elderly, similar to women, the same amount of alcohol produces higher blood alcohol levels, causing a greater degree of intoxication than the same amount of alcohol would cause in younger drinkers.

NIAAA also indicates that alcohol abuse in the Baby Boom generation is complicated by the use of prescription and over-the-counter (OTC) medications. The elderly spend over $500 million yearly on medications. Combining medications and alcohol frequently result in significant adverse reactions. Due to reduced blood flow to the liver and kidneys in the elderly, there can be a 50 percent decrease in the rate of metabolism of some medications, especially benzodiazepines.

Additionally, some common medications that the elderly take including chlordiazepoxide (Librium) and diazepam (Valium), have such long half-lives (often several days) that prolonged sedation from these drugs, combined with the sedative effects of alcohol, can increase the risk of falls and fractures. The users of another prescription drug, benzodiazepine, may become confused and take extra doses or other medications that can cause overdose or even death.

Serious consequences can also result solely from OTC medication use, as well as combining these medications with alcohol. Laxatives, for example, can cause chronic diarrhea, which can lead to sodium and potassium imbalance and potentially heart rhythm irregularities. Antihistamines, another popular OTC medication, can cause confusion. Cold medications can elevate one’s blood pressure and lead to strokes. Caffeine is frequently added to OTC medications and can cause anxiety and insomnia. Mixing alcohol and OTC medications often increases the occurrence of side effects and can intensify potential negative consequences.

SAMHSA notes that nicotine dependence is also a significant problem in the elderly, caused by boredom as life changes and a need to find something that can make them feel better. Use early in life sets the stage for morbidity and mortality from this addiction. More than 400,000 people in the U.S. die each year from smoking-related diseases. Elderly smokers not only impair their respiratory systems with continued smoking, but are also more apt to die from respiratory diseases.

For many older persons, gambling can become much more than a form of entertainment or a recreational pursuit. Gambling too can become an addiction, often rooted in the overwhelming feelings of loneliness and depression that can accompany the aging process.

As treatment demands increase, the State’s substance abuse and mental health treatment systems will need to continue to promote a shift in focus to address the special needs of an older population of substance abusers. This was underscored by Bartels, Blow, Brochmann and Van Citters in their 2005 report titled “Substance Abuse and Mental Health Among Older Americans: The State of the Knowledge and Future Directions,” (written for SAMSHA and available online)

Such a shift in focus should include the adoption of policies that support:

  • age-specific group treatment that is supportive and non-confrontational and aims to build or rebuild the patient’s self-esteem;
  • a focus on coping with depression, loneliness, and loss including the death of a spouse or retirement;
  • an emphasis on rebuilding the client’s social support network;
  • a pace and content of treatment appropriate for the older person; and
  • a skilled clinical workforce interested and experienced in working with older adults.

New York’s behavioral health services for the aging can be improved by strengthening linkages with medical services, social services for the aging, and institutional settings for referral into and out of treatment, and case management. We also need to develop improved tools for measuring substance abuse and mental health problems among older adults.

Promising evidence-based practices should continue to be identified and promoted throughout the treatment system.

Substance abuse and mental health issues are a worsening crisis in this growing population segment. The implications for both the nation and the State of New York are a public health priority. New York will continue to innovate and develop strategies to address substance abuse and mental illness in the elderly. Our aging citizens are an important segment of our society and we must continue to do our best to offer them age-specific supports and services to maintain health and overall quality of life.

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