Recognizing Substance Abuse in Seniors

Advice on Aging
By Toni Lynn Davis MHA, CNHA, FACHCA

Recognizing Substance Abuse in Seniors

Growing old in today’s society means elders customarily are on a number of prescription medications. Add to these medications, a life-long alcohol, drug habit or addiction and a senior’s lessening ability to metabolize drugs and alcohol, and you have a prescription for dangerous substance abuse.

78 million baby boomers are coming of age into their elder years who grew up in a culture from the 60’s and 70’s of increased drug experimentation, alcohol abuse, as noted in an April 29, 2013 article by Richard A Friedman, MD writing for the NY Times, referencing an Institute of Medicine report.

Friedman wrote “2011 study by the Substance Abuse and Mental Health Services Administration found that among adults aged 50 to 59, the rate of current illicit drug use increased to 6.3 percent in 2011 from 2.7 percent in 2002. Aside from alcohol, the most commonly abused drugs were opiates, cocaine and marijuana……… that in 2010 the best estimates are that six to eight million older Americans — about 14 percent to 20 percent of the overall elderly population — had one or more substance abuse or mental disorders.”

As a culture we don’t look for, or recognize, substance abuse in our elders. More often we notice signs that age related memory loss and/or judgment impairment may make taking the appropriate medications at the correct times problematic. We certainly don’t ask our elders about substance abuse. While recognizing a substance abuse problem is difficult enough for younger people, for the senior citizen self-recognition may be further complicated by age related cognitive issues.

Little has been studied as to how to work with seniors of varying mental acuity to help them overcome their own addictions. It is clear that elders are more highly driven for physical stimulation from sources such as physical contact, food and music. It is not a far leap to recognize that mediations that stimulate dopamine in the system like many regulated pharmaceuticals create the same euphoria for seniors. But studies show that more often seniors abuse drugs and alcohol as a way to alleviate physical and emotional pain brought on by medical issues, and social isolation.

Denial is as strong for seniors with cognitive mental acuity as it is in the general community. It’s often difficult to recognize that medications prescribed by a physician can be the cause of an addiction. Those who recognize the symptoms of substance abuse can gain support by participating in group therapy and work with their physician to reduce their dependence. Those elders with less mental acuity should not have access to their daily medications and caregivers should work with a physician to reduce and eventually eliminate any unnecessary medication their elder is taking.

At Green Hill we store all medication in a special lock box in the resident’s room. Blood is routinely drawn on physician visits that would be indicative of excess drug levels, or side effects from excess drug use. Medication for nursing and rehabilitative residents is given by nursing staff as per a physician’s orders. Elders who choose to self-medicate are evaluated routinely. Staff is trained to recognize behavior associated with substance abuse, and to work with the administration to provide the support services the elder needs. Ultimately, drug use is a choice, and drug addiction a psychological and behavioral issue that requires buy-in from the user to overcome. What we can do is closely monitor elders that we provide medications to for signs of addiction. For those who self medicate we can recognize the behavior, and its symptoms and educate our elders as to the consequences of drug abuse on their health, and their quality of life.