Substance Abuse is Getting Old: How Addiction is Becoming a Risk to Seniors
Pick your poison. From nicotine and alcohol, to opioids like OxyContin, Vicodin and Percocet, more and more seniors are turning to substances to cope with aging or external factors such as COVID-19 lockdowns. Some have been hooked for decades, and they bring their lifelong struggle into their sunset years. Other seniors develop their dependency at the age of 65 or older. Either way, if you or your loved one is battling substance abuse or addiction, this guide is for you. It also contains preventative measures to keep seniors from succumbing to addiction.
First, we must deal with the elephant in the room. That is, why do seniors develop substance abuse problems in the first place? The answer might surprise you. And it's critical that we understand the root of the problem before we begin to discuss prevention.
Don't worry, we're going to break this down for you and lay it all on the table. This guide covers what you need to know about seniors and substance abuse. It also explores the ways in which seniors and their loved ones can reduce the risk of substance abuse ever becoming an issue. So, let's dive right in.
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Why Senior Citizens Use Substances
Younger people turn to alcohol, illegal drugs, and prescription drugs for reasons that include social pressure, media influences, boredom, escape, self-medication, lack of confidence, rebellion and the quick feel-good effects. Some of these reasons resonate with senior citizens as well. Take a look at many of the motives underlying seniors' use:
- Self-medication for physical and/or emotional pain
- Self-medication for comorbidities such as anxiety or mental illness
- Loss of independence
- Sleep issues (needing a sleep aid)
- Chronic pain
- Feeling no purpose in life
- Untreated earlier trauma
- Major moves (to assisted living, to a relative's house, etc.)
- Deaths of spouse or loved ones
- Caregiving for a sick spouse
- Retirement, even expected retirement
- Job loss
- Health woes
- Limited mobility
- Misconception/lack of education that they can develop addiction issues
- Dementia (wanting to seek mental clarity)
- Addiction after a doctor prescribes prescription drugs for surgery, injuries or pain
Risk factors include an avoidance coping style and a history of alcohol abuse or addiction. Affluence can be another risk factor. Yet another is being on the young end—for example, being 65 or 66 as opposed to 85. There's also a relationship between substance abuse and mental disorders. In fact, 21 percent to 66 percent of seniors who abuse substances may have co-occurring psychiatric issues such as depression or anxiety.
The Twisty Road of Addiction
The winding, dangerous road of addiction and substance abuse has many places for folks to get on. You can be 15, 30, 50, 65, 80, or 90. However, as many people age, their world becomes progressively smaller. As younger adults, many seniors could go for a walk down the road anytime to socialize with neighbors. They could jump into the car for a five-minute drive to see their best friend or settle in for a four-hour plane trip to visit family members. They went to work five days a week and socialized with dozens of colleagues. Many didn't deal with chronic pain.
Now? They may deal with severe, ongoing pain, they don't work, and driving is unsafe. Friends could be in similar straits and physically unable to visit. Their loved ones might even be dead. They might feel like they have no purpose in life. They may view themselves as a burden to others. The chronic pain doesn't stop. In fact, it keeps getting worse as new conditions develop, and techniques such as massage therapy are useless. The loneliness and despair can be crushing.
Prevalence and Severity
Exactly how prevalent is substance abuse among seniors anyway, and how serious does it get? The good news first: Addiction and substance abuse are less of a problem in older age groups compared with younger groups. However, it's still a problem and is poised to grow, perhaps even explode (it may have already!). This is partially because of Baby Boomers. They have higher rates of drug use, and many of them don't stop using just because they're older. A good number of seniors also deal with chronic pain and other conditions that they may try to self-medicate for. In fact, eight out of 10 seniors struggle with multiple conditions. Also keep in mind that the rates of senior substance misuse have been underreported.
What about severity? That's the bad news. If a senior does abuse substances, the consequences could be dire. For example, being dizzy from alcohol could cause a senior to fall and fracture his hip. That fracture could lead to a number of physical, emotional, and mental problems.
In general, cognitive issues, balance problems, depression, delirium, and serious side effects from other medications could result when a senior is addicted to a substance.
Seniors tend to be on many medications. These substances don't always mix well and can lead to dangerous side effects that worsen conditions such as diabetes and high blood pressure. What's more, it takes a lower dose of a substance to affect a senior, and seniors' tolerance levels are lower.
The takeaway: Suppose your loved ones have no history of addiction and no pre-existing issues such as anxiety. There's little cause to start thinking they are at extremely high risk simply because they are somewhat more isolated or troubled than before. Do keep an eye on them. Keep the lines of communication open, and accompany them to doctors' appointments when possible so you know what medications they've been prescribed and why.
Which Substances Seniors Turn To
Many seniors seek solace from substances such as alcohol. In fact, alcohol is the most common substance that older adults use. Nicotine is another popular, legally accessible substance that seniors turn to. A third prevalent substance is marijuana, and it's becoming legal in more places throughout the United States. Other drugs that seniors use include prescription drugs (legally obtained and illegally obtained), cocaine, meth, heroin, inhalants, and hallucinogens. Males are generally more likely to turn to alcohol, while females may prefer prescription drugs.
Each Situation Is Unique
What might work to prevent addiction in your father might not work for your mother. Similarly, what succeeded for Uncle Bob might drive someone else into the arms of a substance.
Each situation is unique. That's why it is important to be aware of addiction risk factors such as a history of substance misuse, a history of anxiety or mental issues, loneliness, a spouse's recent death, or chronic pain. Seniors in rural areas can be particularly at risk of opioid addiction due to fewer alternative treatments, a lack of resources, and a lack of education about the potential for addiction.
Chances are, you're busy. You barely have time to manage your own life, much less constantly manage your senior citizen loved ones' lives. That's OK. They don't want to be micromanaged either. One of the best things you can do to prevent addiction and substance abuse in cases of loneliness is to create socialization opportunities on an ongoing basis. Sometimes, you may have to nudge seniors into these opportunities. For example:
- Bring your senior loved ones to family events such as birthday parties
- Have dinner with them once a week
- Chat on the phone, following a set schedule
- Ask them to help you with something
- Give them a project such as writing a history of their life/their relatives for a family collection
- Hire in-home caregivers
- Vary the people who help out
- Move a senior from deep isolation at home into assisted living
- Give seniors control over their own lives when appropriate
COVID-19 certainly has made life difficult. Assisted living facilities severely restricted visitors, and adult activity centers closed or went online. Many seniors had to figure out a middle road between their mental health and the risks of catching the virus.
It was rarely easy. Family members visited one another on video chat, via windows, or through outdoor socially distanced hangouts. Quite a few people across the age spectrum developed or worsened addiction issues during lockdowns.
If a senior has a history of addiction, it's even more important to help out with finances in a smart way. Say that you give Uncle Joe $400 cash a month to help with the rent. Maybe Uncle Joe uses that money exactly as it is meant for. However, if months go by and the rent's unpaid plus Uncle Joe smells of alcohol, has unexplained bruises, mood swings and anxiety, he could be misusing substances again. In such cases, don't enable the use by giving seniors cash directly. Cut the check to the landlord instead. The same principle applies to any bills you pay for.
Suppose a senior citizen has been healthy all her life until an injury. Alternatively, she may still be healthy but opts for a surgery such as cochlear implantation. For the first time in her life, she could find herself taking pain drugs that have the potential for addiction. In fact, 15 percent of seniors leaving the hospital do so with prescriptions for opioids in hand.
A large swath of seniors deals with chronic pain issues. They've tried remedies such as over-the-counter drugs, physical therapy, and massage to little or no effect. Interestingly, many over-the-counter medications that older adults take carry heightened side effects affecting bleeding, kidney function, and many other areas. The risks of taking them may not be worth it, especially if they hardly help with the pain. What does help? Sometimes, it's opioids such as OxyContin, Vicodin, and Percocet.
Fortunately, the issue of opioid addiction has broken into the national consciousness. Doctors are less likely now to prescribe a month's worth of pills post-surgery when a week's supply may suffice. Likewise, many doctors won't refill prescriptions unless they truly believe seniors are in pain and need the opioid to function in their everyday lives—they're not simply craving more medications because of a straightforward addiction issue.
Prevention on your end: Doctor-prescribed opiates are a delicate balancing act. Opioids go a long way for palliative relief in cases such as severe spinal stenosis and osteoarthritis. So, it's not necessarily a reason for alarm if you find out that your parent has been prescribed an opioid to deal with pain, especially if it's as a last resort. Doctors typically start with much lower doses for seniors and should space prescriptions out appropriately.
Accompany your loved ones to doctors' visits so you can ask questions about dosage amounts and the expected results of the medication. Be on the lookout for opioid side effects such as constipation, confusion, falls, and fractures (de-clutter the senior's living space!). Hold open conversations with your loved ones and their doctors. The doctors should absolutely recognize the balancing act for what it is. If they seem dismissive of anyone's concerns, whether the concerns center on needing a lower or higher dose, it could be an indicator to look for another doctor.
Prevention Takes Many Forms
One potential trigger by itself might not cause a senior to drink or take drugs. Nor might two reasons or three. Four could be the tipping point, though.
Preventing addiction and substance abuse is usually an effort that requires action on multiple fronts. For example, loneliness and loss of purpose are two reasons that might cause someone to develop an unhealthy relationship with alcohol. Many techniques could help prevent or minimize loneliness and loss of purpose. Even just one could. Here's a sprinkling of examples:
- Taking a class at the community college
- Creating a visiting schedule for your family to visit the loved one
- Going to the gym
- Setting goals such as participating in a walk or run
- Helping care for a child
These solutions may give seniors a purpose and restore joy to their lives.
Above all, what should help is to keep the lines of communication open. Listen to your loved ones when they complain or when they express concerns. Encourage them to seek solutions. Give solutions or choices of your own instead of asking open-ended or yes/no questions. For example, when you visit to take them out, ask, “Do you want to go to the mall or see Cousin Bart today?” instead of “Do you want to go out today?”
Giving choices grants seniors control over their lives. It also encourages them to take steps such as socializing that they might not otherwise have.
Of course, “solutions” sometimes are not practical or don't work quickly. It can be incredibly frustrating for a senior to talk about feeling lonely to an adult child and for the child to say, “I'll make it over when I can,” or “Call Annie to come over.” Sometimes, a listening ear is the best approach. Seniors may just need to vent and to feel like someone cares.
It can also feel very dismissive for seniors who are in chronic pain to be told a solution such as, “Try acupuncture again,” or, “Go to counseling.” Such pain is impossible to describe to anyone who has not experienced it. The process of getting out of bed, dressed, on the bus, off the bus, and walking a few blocks to an appointment can be excruciating and exhausting. The solution with chronic pain may lie in exploring remedies such as medical marijuana or low doses of opioids in conjunction with non-medication approaches such as exercise.
Catch Substance Misuse Early
Signs of senior citizens misusing substances include:
- Senior constantly smells like the substance
- More of the substance is in the senior's home
- Empty liquor bottles in recycling bin or trash
- Doctor shopping/constantly looking for new doctors
- Multiple prescriptions from multiple pharmacies
- More incidences of falls
- Memory issues
- Financial problems
- Legal issues
- Sleep disturbances
- Mood swings
- Unexplained bruises
If you suspect your loved one is addicted or well on the way there, remain calm for the conversation about it. If you cannot do that, turn the conversation over to someone who can. There's absolutely nothing wrong if you must do that—it's actually a sign of strength if you can recognize this weakness in yourself.
In fact, even if you can remain calm, there may be better people to initiate such discussions. One possibility is the senior's doctor. The doctor can listen to the senior's concerns and help with an authoritative solution. Other options are counselors, the seniors' friends, and relatives they look up to.
A common scenario is parent-child in which an adult child is the main person looking out for a senior citizen. No doubt it can feel extremely strange for you, as an adult, to have to talk about substance abuse to your parents. You may also feel like your parents won't take your concerns seriously or see you as an authority. That's why it can be useful to turn a serious discussion over to someone else whom your loved one may perceive as more authoritative.
In any case, withhold judgment. It may be OK to ask questions such as, “What's up with all the liquor bottles in the recycling?” (depending on the situation and on your loved one). Keep a few things in mind:
There are four general forms of treatment. One method may be enough in some cases, while other seniors may need all four.
- Treatment of other medical issues: Since many seniors have other issues going on such as chronic pain, anxiety or social isolation, these issues must be treated as well. After all, it's often because of these problems that seniors turned to the substances they did. Non-drug treatments will likely be investigated first.
- Support groups with same-aged peers: Seniors generally don't enjoy attending support groups with younger peers. For one thing, seniors grew up in an era where mental illness and addiction were much more stigmatized than they are today. It can be hard for seniors to identify with younger peers' experiences and vice versa. Seniors may also feel like they have to step into a caretaker role with younger peers. Profanity and slang also make some seniors uncomfortable. In addition, the spaces that cater to general groups might not be accessible to folks with limited mobility and other disabilities (not wheelchair accessible, no materials in large print, meeting leaders who talk quietly, etc.).Some treatment centers, both inpatient and outpatient, offer senior-focused programs. Ask about these if researching centers.
- Reducing medications: “De-prescribing” medications is the process of eliminating medications seniors no longer need to take and lowering dosages when possible. Medication lists should be re-evaluated on a regular basis.
- Open lines of conversation: Anyone can become addicted. Anyone can misuse substances. Teens and young adults hear a lot about these issues. Seniors rarely do, and there needs to be more conversation about the issue at home, at doctors' offices, in publications and in many other places. Seniors will feel more comfortable seeking help if they don't feel that there is an excessive stigma attached to their substance use.
Addiction and Substance Abuse Prevention among Seniors
Opioid abuse doubled among seniors from 2002 to 2014. It rose from about 1 percent to 2 percent, and it's likely growing even more. While 2 percent doesn't seem like a lot of seniors, there are other substances such as alcohol and marijuana that seniors turn to. Because of substance abuse, seniors can seriously injure themselves and others, and develop long-lasting problems in organs such as the liver.
Prevention isn't a black-and-white matter, but the news is good on several fronts. Doctors are more aware now about opioid misuse. However, it can be a struggle to find the balance between overprescribing and prescribing medication in appropriate amounts to those who truly need it. In addition, the lines of conversation are open in places where they were nonexistent before.
Seniors' friends and family members can help prevent an addiction by having a good relationship with their loved ones (giving them a judgment-free person to talk to). It's important to do what you can to keep seniors active and engaged, as loneliness and isolation are major risk factors. Also, keep in mind that substance use in moderation can be OK. It's normal for a senior to want to drink a couple of glasses of wine a week.
Sometimes, in the end, the solution lies in choosing the lesser of the evils. For example, many seniors have weaned themselves off opioids by using cannabis to treat chronic pain. It's a balancing act to weigh legitimate medical interests against the potential for addiction. Look at the big picture, and seek medical advice for clarification when necessary. Check that non-drug treatments for chronic pain have been tried or are being attempted.
- Opioid Addiction: A Senior Problem in Orange County
- 12 Ways Opioid Addiction and Treatment Differ in Older Adults: Seniors Who Need Drug Rehab Are Far from Alone
- Senior Hope: Compassionate Chemical Dependency Care for Seniors and Their Families
- Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)
- A Day in the Life of Older Adults: Substance Use Facts