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The abuse and misuse of alcohol or drugs was once considered a problem only among the young. Unfortunately, substance abuse has become a growing problem among older adults as well. Community surveys suggest that misuse of alcohol or other drugs is a common cause of physical and mental health problems in older Americans, especially older men. Older adults are particularly vulnerable to the mental and physical effects of these substances, because of the changes that happen in our minds and bodies as we age. In fact, negative health consequences are sometimes seen in older adults at a level of alcohol or drug use that would be considered light to moderate in younger people. Substance abuse has clear and profound effects on the health and well-being of older adults in all aspects of life. Many different organ systems can be damaged by substance abuse. The social and economic impact is also tremendous. Substance abuse has negative effects on self-esteem, coping skills, and interpersonal relationships, which can add to other losses that are common in the later stages of life. Many terms are used to define different levels of substance misuse, including dependence, abuse, problem use, and at-risk use. The medical definitions for these terms vary, but they all refer to the use of chemical substances in ways that lead to problems or disability, or to an increased risk of problems or disability. The first step is realizing that substance abuse is occurring, which can be difficult in older adults. The warning flags of abuse are less obvious in older adults than in younger ones. For example, many older adults are retired and drink at home by themselves, so they are less likely than younger drinkers to be arrested, to get into arguments, or to miss work because of drinking. Also, many of the diseases caused by substance misuse (eg, high blood pressure, stroke, dementia, or ulcers) are common disorders in later life, so healthcare providers and family members may not be thinking of substance abuse as an underlying cause. In addition, the guidelines and screening tests that healthcare professionals use to diagnose substance misuse are often designed for younger people, and may not be easily applied to older adults.
Alcohol Misuse or Abuse The terms "light," "moderate," and "heavy" drinking can mean different things to different people. In medical terms, one drink per day is defined as one 12-oz beer, one 4-oz glass of wine, or one 1-oz shot of liquor. A bottle of wine or a six-pack of beer should not be considered as "one" drink. A good definition of "low to moderate" drinking for older adults is "drinking that falls within the recommended guidelines for consumption and is not associated with problems." Older adults in this category drink an amount that falls within recommended guidelines and are able to set reasonable limits on their alcohol consumption. For example, they do not drink when driving a motor vehicle or boat, or when taking certain medications. A good definition of "problem drinking," or the level of drinking that begins to be linked with mental health or physical problems, is more than one drink each day for older women, or more than two drinks each day for older men. However, drinking that causes problems is problem drinking, regardless of the amount.
Causes Many older adults with alcohol problems are simply continuing a pattern of behavior or addiction that began earlier in life. Often, they have a family history of alcoholism, are not well-adjusted socially, and may have had previous legal problems related to alcohol. Alcohol abuse that begins in later life is often due to the stresses and losses associated with aging. People in this category often point to life events as the cause for their drinking. However, early retirement, premature health problems, and other life stresses can also be caused by alcohol abuse, rather than be the cause of it.
Problems associated with alcohol abuse
Alcohol can affect every part of the nervous system, either directly or indirectly (eg, by using up nutrients such as B vitamins). Long-term alcohol dependence can cause significant problems with the nervous system, including confusion, clumsiness, muscle problems, coma, and deterioration of the brain and spinal cord. Some experts estimate that 5-10% of dementia is caused by alcohol abuse. Some people who abuse alcohol have additional psychiatric problems. In fact, older adults with alcohol abuse or dependence are nearly three times more likely to have another mental disorder. Alcoholism has been linked to mood disorders, suicide, dementia, anxiety disorders, and sleep disturbances. Alcohol is sometimes used by older people for self-medication, to ease the emotional pain of psychiatric or physical illness. People with alcohol abuse and dependence also tend to smoke, which further compromises their health. Sleep problems can be a sign of alcohol misuse or abuse. Alcohol may help someone fall asleep, but it actually decreases the amount of restful sleep throughout the night. This in turn increases anxiety and irritability. People who abuse alcohol are also lighter sleepers who wake up early in the morning, which can result in feeling tired and sluggish during the day. People with insomnia should never use alcohol as a way to fall asleep. Another major problem associated with alcohol misuse in older adults is the danger of interactions between alcohol and other drugs, including over-the-counter medications. Of the 100 most frequently prescribed drugs, over half interact with alcohol. Alcohol slows the metabolism of some medications, resulting in the drug having stronger effects on the body. However, alcohol can weaken the effects of other drugs, including blood thinners, drugs used for seizure disorders, and some of the oral medications used to treat diabetes. Alcohol also increases the effects of sedatives, which can decrease alertness and the ability to move around. Frequent use of alcohol also increases the likelihood of bleeding in the intestines among people taking arthritis medication or aspirin.
Withdrawal
Identifying alcohol abuse Healthcare providers use several screening questionnaires to identify people at risk of alcohol abuse. Four key questions can provide a quick way to gauge alcohol abuse:
Your healthcare provider will likely ask about past alcohol use, to find out if you stopped drinking or cut down because of previous problems. People with a history of alcohol problems may need to be monitored in case new stresses cause them to "fall off the wagon." A history of at-risk drinking or alcohol dependence also increases the risk of developing other mental health problems in later life, such as depression or confusion.
Treatment People with long-standing alcohol problems usually need more forceful treatment. Fortunately, research has shown that older alcoholics do not have to hit "rock-bottom" before accepting treatment. When an alcohol problem is identified, people important in the affected person's life need to seek instruction from experienced counselors to learn how to correctly motivate the person to begin treatment. Counseling can offer ways to deal with the negative behaviors of an alcoholic person, as well as ways to reduce or stop personal behaviors that might actually be encouraging alcohol intake or making it possible. Sometimes well-intended family members do not realize that their own behavior allows (or even ensures) that the person's addiction to alcohol continues. Confrontation the problem drinker as a group-an intervention-is one way to get the problem into the open and, if all goes well, to begin treatment. However, it is important to learn how to handle this situation in a supportive way, rather than being antagonistic. Many options are available to treat problem drinkers, including the following:
Medical support People with a long history of alcohol use should take multivitamins daily. Healthcare providers may also prescribe additional B vitamins, because levels often become dangerously low in alcoholism. People with very poor nutrition, mental difficulties, or nervous system problems may need to have their vitamin B12 level checked. Vitamin K supplements may be needed for people with bleeding problems. Many people report symptoms of depression when they are not drinking. These symptoms usually get better after 3-4 weeks of a treatment program. Antidepressant medications are sometimes useful and are given after about 4 weeks of abstinence.
Treatment of withdrawal
Rehabilitation Rehabilitation programs for alcohol (and other drug dependence) use many strategies. Individual therapy can help a person overcome denial that he or she has an alcohol problem and can work on underlying problems, such as grief or difficulty in adjusting to retirement. Group therapy provides education on alcoholism, additional assistance in overcoming denial, and can help people develop other ways of coping. Groups also provide emotional support and can give a person a sense of belonging and renewed self-respect. Medication can also help during rehabilitation. For example, people with underlying psychiatric problems may benefit from drug treatment for depression or anxiety. In addition, a drug called naltrexone can help people who have stopped drinking avoid a relapse. In younger alcoholics, a drug called disulfram is used sometimes. If someone drinks alcohol while taking disulfram, they will get sick to the stomach. Disulfram is not typically used in older adults because of possible side effects involving the heart. Joining AA helps many older adults. AA is a worldwide group of recovering alcoholics who assist others in their recovery. About a third of the people in AA are 50 and older. Each step of AA's 12-step program is important for successful treatment. Family members or others who may have unknowingly allowed or encouraged the older person's alcohol abuse should also become involved in the treatment process. Involvement in groups like Al-Anon (a companion group to Alcoholics Anonymous) can help these family members and friends recognize and change their own harmful patterns of behavior. Al-Anon also offers relief and support to family members or caregivers who have been stressed, mistreated, or even victimized by an alcoholic. Other community and volunteer resources, such as senior citizens groups, visiting nurses, church groups, halfway houses, etc, are also available. Some retirement communities have developed their own support groups for people with alcohol problems.
Drug Abuse Tolerance develops when the body needs a higher dosage of drug to get the same effect. Over time, the body adapts to each higher dosage, creating a vicious cycle of needing more and more drug while getting less and less effect. Tolerance can develop to many kinds of drugs, some of which can become addicting (eg, anti-anxiety drugs and sleeping pills). The drugs most likely to be abused by older adults include anti-anxiety drugs, oral narcotics (eg, codeine), and sleeping pills. However, abuse of illegal drugs (including marijuana, cocaine, hallucinogens, and intravenous narcotics) has also been reported among older adults. Some older adults have lifelong histories of addictive behavior, while others have never had a drug problem before. Many people with drug addiction also have another problem, such as a major psychiatric illness. Addiction to more than one drug is also common. Many older people with chronic pain avoid taking effective medications in adequate doses for adequate periods of time because they are afraid they may become addicted. It is important to keep in mind that undertreatment of pain is a significant problem, and that true addiction does not often arise in this situation.
Identifying drug abuse
Most people who abuse drugs (or alcohol) experience the psychological symptoms of denial, minimalization, rationalization, defocusing, and enabling. Denial of addiction can sometimes be extreme, to the point that the person denies even taking any drugs. In less extreme circumstances, the person might minimize the amount of drug taken or the effect that the drug is having on his or her behavior and life. In rationalization, addicted people come up with reasons other than addiction for their drug use. Older adults commonly blame their physician for prescribing the medication. People addicted to medications also try to focus on other reasons why they need a "boost," such as problems in their marriage of a major medical illness. Just like in alcohol abuse, family and friends may unconsciously support the behavior of the addicted person. These "enablers" may also show the symptoms of denial and rationalization, and try to focus the discussion away from the addiction. Blood or urine tests can sometimes identify drug misuse or abuse. Urine drug screens can be used to identify traces of illegal drugs or to monitor recovering addicts. Blood or urine tests can also be used to measure the level of prescribed drugs in the body, to see if misuse or tolerance has developed.
Withdrawal
Treatment and prevention Often, drugs are needed to treat withdrawal symptoms or to act as substitutes for the abused substance. For example, methadone can be used to wean people off of narcotics. This drug substitutes for the narcotic, without providing the "high" that drives the addiction. All addictive medications are usually stopped once detoxification is completed. If the person needs treatment with narcotics for severe pain, such as from surgery or injury, they are given only under controlled circumstances and usually only in the hospital. People should be encouraged when they have made progress in cutting down their drug use, even if they haven't been able to completely stop it. This may be particularly important for some types of medication misuse, such as overuse of antianxiety drugs.
Rehabilitation Also as with alcoholism, family members should be counseled regarding the process of addiction. A discussion of their roles as enablers should be part of treatment. One focus of rehabilitation among older adults is managing time. Keeping busy is important, both to reduce the free time available for drug-seeking behavior and to remove boredom that can increase the risk of relapse. Day programs and senior centers can be helpful. Supervised living arrangements (eg, halfway houses, group homes, nursing homes, and living with relatives) should also be considered.
Prevention |
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Published: 6/6/2005