Alcohol, drug use up among older patients

Drug and alcohol abuse is becoming a big problem for an unexpected population: people older than 55, according to Substance Abuse & Mental Health Services Administration data.

Within the past year, the agency has launched several patient-targeted campaigns to address this trend, and experts and policy-makers are urging physicians to be alert to the fact that substance abuse can be even more dangerous for this age group than for those who are younger.

"Physicians need to ask everybody about drug and alcohol use regardless of age or gender," said H. Westley Clark, MD, MPH, director of SAMHSA's Center for Substance Abuse Treatment. "But when you're dealing with this demographic, you have got confounding medical problems. They're taking multiple medications. Their physiology is changing. They're more vulnerable to the negative consequences."

According to SAMHSA figures, the rate of older people seeking substance abuse treatment is increasing at a pace far greater than that of the general population. This development is attributed to several factors. The most obvious is that the number of older people is growing as the first wave of baby boomers hits 60 this year.

But this generation also has several unique characteristics that make drug and alcohol problems more likely, experts say. For example, baby boomers already might have experimented with illicit drugs in their early years and could return to them as they age. They also are more likely to turn to pills or other substances -- legal or otherwise -- to deal with mental and physical health problems. Sometimes the use is legitimate, but other times it might not be.

"This is a cohort for whom 'better living through chemistry' was, in a way, a mantra," said Stuart Gitlow, MD, MPH, chief of the Annenberg Physicians Training Program in Addictive Disease at the Mount Sinai School of Medicine in New York. "And this population tends to be fairly demanding. When things are going wrong, they may start to look for the quick fix, and it can be a potentially addictive fix."

Attending to different signs

But while the problem is gaining more attention, experts also acknowledge that detecting and treating older substance abusers is not easy. While most screening tools are believed to be effective for older patients, some of the usual telltale signs are more geared to detecting problems for younger people. For instance, erratic behavior on the job or an arrest for driving while intoxicated are less likely occurrences among senior citizens.

"Seniors tend to drive a lot less, so there's less likely to be a DWI," said Gary J. Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in the Bronx, New York. "The way to work with seniors is to inquire about health problems that alcohol may be making worse. Are they keeping up with their medications? Is their diabetes or hypertension not well controlled? Can they sleep?"

Experts also note that seniors' substance-use patterns could be less frequent or in smaller numbers than what would be considered addictive behavior, but for them it can be a problem. This is particularly true for alcohol, the most abused substance by older adults. With age, the body's ability to metabolize liquor can change. Older people also tend to be on more prescription medications that can conflict with alcohol or intensify its impact.

"As we age, our physiology changes. A little bit of alcohol goes a long way," said Dr. Kennedy, who is also chair of the board of the Geriatric Mental Health Foundation.

Treatment is a challenge, too. SAMHSA is trying to increase the number of senior-focused programs. Currently, experts complain that once a problem is detected, few age-appropriate resources are available to which they can refer patients.

Alison Moore, MD, MPH, associate professor of geriatric medicine at the University of California, Los Angeles, recommended that a female patient with substance abuse problems go to a support group. Decades older than other participants, the patient gave up on the meetings because she had nothing in common with the others. "There are almost no treatment programs for older adults," Dr. Moore said. "The sheer numbers that are going to be coming up are huge, and health care is ill-prepared to deal with this."

Still, while there are difficulties, treatment for seniors can be easier in some ways. According to SAMHSA data, those older than 55 are more likely than those who are younger to abuse only one substance, rather than many. They are more likely to be insured. Specialists also say older patients can be more motivated to change than younger counterparts.

"You can do some good interventions with older individuals that may be more effective than with younger people," said Frederic Blow, PhD, professor in the Dept. of Psychiatry at the University of Michigan. "No one wants to die a drunk. They're ready for a change before they pass."