Substance Abuse And Overdose Deaths Among Older Adults

Published on December 27, 2018

Who is most at risk for drug overdose death in the United States?

Most people assume that it is young, intravenous drug users. What many people are surprised to learn is that the most at-risk age group for drug overdose death in the United States is actually 45–54-year-olds.

According to a study conducted in 2015, the number of older adults with substance use disorders is expected to reach 5.7 million by 2020.

Why Are So Many Older Adults Dying From Overdoses?

Why are so many older adults losing their lives to overdose? Multiple reasons.

First, 90 percent of older adults use prescription and over-the-counter medications. Many of these drugs interact negatively with alcohol or other illicit substances.

Second, 25 percent of older adults use psychoactive medications or drugs that primarily alter brain function, which results in mood changes. These drugs have the potential for abuse if not taken as prescribed. Examples of these types of drugs include anti-anxiety medications, sleeping medications, and antipsychotics.

Third, older adults are more likely to experience emotional and social problems such as loneliness, bereavement and social isolation, all of which may lead to substance abuse as a coping mechanism.

Medical Problems Increase The Risk Of Death

Medical problems can also play a role. Disorders such as chronic pain, insomnia, dementia, depression, and anxiety can all make someone more likely to develop a substance use disorder or alcohol use disorder.

These medical conditions often worsen as a result of substance use. This vicious cycle often leads to even more substance use or alcohol use, which makes them more at risk for significant medical consequences.

What makes this problem even more difficult in this age group is the fact that substance use disorders often go undiagnosed, undertreated or untreated entirely.

Recognizing Substance Abuse Among Older Adults

It is important for health professionals to avoid overlooking the possibility that the individual they are treating may be suffering from a substance use disorder. Health professionals often overlook this, mistakenly attributing the patient’s symptoms as something else, such as dementia-related symptoms, general depression or other problems that may mask the underlying condition.

Self-report, or information obtained solely from the individual presenting in a one-on-one setting, may not be entirely accurate or may contain multiple omissions. People have many reasons for avoiding or hiding certain truths from healthcare professionals.

Patients may feel guilt or shame regarding their substance use. They may be afraid of losing their prescription if they are honest with their provider about the difficulties they are experiencing.

When possible, it can be beneficial to seek alternative sources of information from family or friends when appropriate, as this may shine light onto a bigger problem.

Addiction Treatment For Older Adults

Drug and alcohol treatment programs in the United States are not typically tailored toward this population. A 2006 study found that only 7 percent of treatment centers in the United States had a program designed specifically for this age group.

This is partially due to the fact that older adults are less likely than their younger counterparts to seek treatment for substance use disorders or alcohol use disorders.

This is an important fact to consider when seeking treatment, as older adults have been shown to respond well to age-specific, supportive, non-confrontational individual and group therapy.

Substance Abuse Rates Fluctuate Between Age Groups

Substance abuse in the older adult population is a growing concern. The number of adults over 50 with a diagnosable substance use disorder is projected to reach 6 million by 2020.

The consequences of substance use in this population are placing a tremendous burden on the United States healthcare system, their families and our society.

People born between 1946 and 1964 (baby boomers) have much higher rates of substance use disorders than people born before them. Additionally, the baby-boomer age group is much larger than the generations before them.

Addiction Treatment Outcomes Among Older Adults

For healthcare and mental health workers, it is important to dispel the myth that older adults are “stuck” or set in their ways and are therefore unable to change. Research shows that older adults do as well or better than those in treatment in younger age groups.

Increased access to treatment that is specifically tailored to this age group is necessary to:

• Improve treatment outcomes
• Strengthen patients’ commitment to treatment
• Increase the social acceptability of participating in treatment

Unfortunately, utilization of mental health and substance use disorder treatment services is lower in older adults than any other age group.

To tackle this issue, barriers to accessing treatment need to be overcome. Obstacles such as stigma and shame, isolation, inability to pay for treatment and transportation difficulties all make it difficult for older adults to get the treatment they so desperately need.

Therapies And Tools For Substance Use Disorders

Brief interventions for substance use disorders have been shown to be effective and can be done in primary care settings. These interventions can vary in length from 15 minutes to an hour. These types of interventions are based on the tenets of motivational enhancement Therapy and are considered to be client-centered and non-judgmental.

The purpose of these interventions is to meet the person where they are by enhancing motivation for change, providing education and connecting patients with treatment options. Enhancing internal motivation for change in this population can center around maintaining independence, improving overall physical health and improving mental acuity.

Case management may be another effective tool for addressing substance use disorders. Case management models offer a comprehensive approach by focusing on co-occurring medical and psychiatric conditions. This model also focuses on reducing the isolation that many older adults are susceptible to by connecting them to community resources.

These and other interventions should focus on addressing the whole person—physical and emotional health, housing needs, transportation needs, etc.—while attempting to lessen stigma and improve the overall quality of life for parents and grandparents.

The Need For Age-Specific Treatment Tracks

Older adults must not be forgotten about when it comes to assessing for, treating and providing access to high-quality treatment for substance use disorders and alcohol use disorders.

Treatment programs should be aware of the need for specific tracks designed for older adults. Programs should adjust their approach based on the needs of this specific population. Through awareness, research and knowledge, clinicians can make a difference for the country’s aging population, which will help to restore lives and families across this great country.

Author

Dr. Ted Bender, Ph.D., LCDC