Drug Addiction Among Senior Citizens: A Growing Crisis

Drug addiction and abuse among seniors has risen steadily over the last decade. This is partially because Baby Boomers have always had comparatively high rates of substance use and abuse. As they age, prescription drug use also becomes more prevalent among this group, increasing the risk of addiction. For example, a person who initially takes a prescription painkiller to deal with the pain of arthritis can quickly become addicted.

A 2015 AARP Public Policy Institute analysis found 1.2% of seniors admit to abusing prescription painkillers. The actual prevalence rate of abuse may be even higher. As with most age groups, however, the leading source of addiction among seniors remains alcohol.

Facts About Substance Abuse in Older Adults

According to the United States Census Bureau, there were 43.1 million seniors over the age of 65 in the U.S. in 2012. According to 2007-2014 National Survey on Drug Use and Health data:

• An estimated 5.7 million seniors will have a substance addiction by 2020.
• In an average day, 6 million seniors use alcohol, while 132,000 use marijuana and 4,300 use cocaine.
• On an average day in 2011, 2,056 seniors visited the emergency room for drug-related reasons. Prescription and nonprescription pain relievers were the leading cause of these visits.

The U.S. has seen a surge in opioid use and abuse over the past two decades. Opioid overdoses now kill more people than breast cancer. Seniors are not the age group most likely to abuse opioids, though they may be more vulnerable to opioid-related health issues than other groups. Seniors with health issues may be less physically resilient, increasing their risk of opioid overdose. When opioids interact with other drugs, the results can be lethal.

Recognizing Addiction in Elders

A number of risk factors increase a senior’s likelihood of abusing and becoming addicted to drugs and alcohol. Those include:

• Use of prescription painkillers. Addiction is especially likely if the senior uses multiple painkillers over a long period of time.
• A prior history of drug or alcohol abuse. Baby Boomers have higher rates of substance use than most generations that came before them. As they age, their substance abuse is predicted to escalate.
• Social isolation. For some seniors, drugs and alcohol are a way to escape feelings of isolation and boredom. Isolation also allows an addiction to fester and go unnoticed.
• Mental health issues. There is a significant correlation between mental health diagnoses and substance abuse, particularly in people who have not sought mental health treatment. Some seniors use addictive substances to self-medicate. For example, an elder might use amphetamines to fight the low energy and motivation that accompany depression.
• Access to potentially addictive drugs. Seniors who receive many prescriptions may save the leftover drugs. Those drugs can become a tempting alternative to boredom and other unpleasant emotions, increasing the risk of addiction.

The symptoms of addiction in elders may resemble dementia. Loved ones who do not know the senior is abusing drugs may even dismiss addiction symptoms as signs of normal aging. Moreover, addiction can be a factor in some forms of dementia. For example, Korsakoff syndrome is a dementia that is usually prompted by alcoholism.

Loved ones should not dismiss personality or mood changes in seniors, since these are not part of normal aging. Other warning signs of addiction include:

• Confusion, forgetfulness, and poor decision-making.
• Seeming drunk, high, or out of it.
• Using many prescription pills.
• Taking prescription drugs without a prescription.
• Loss of interest in previously enjoyed activities.
• Mood swings.

If you know a senior with these symptoms, urge your loved one to see their doctor.

Nursing Homes and Stigma

Addiction is a medical condition, not a personal or moral failing. In some cases, an addiction is the inevitable result of being prescribed too many addictive drugs for too long. Despite this, many senior care communities, including some nursing homes, refuse to admit seniors receiving addiction treatment.

Addiction is a medical condition, not a personal or moral failing.In Ohio, a trade group that represents more than 900 skilled care facilities released a statement saying that none of its members admit seniors with addictions. Some legal experts say this is a violation of the Americans with Disabilities Act (ADA). The ADA is a federal law that prohibits discrimination on the basis of disability, including mental health disabilities such as addiction.

For seniors who need acute or long-term nursing care, this presents a conundrum: either conceal the addiction, thereby avoiding addiction treatment to get necessary nursing care, or pursue addiction treatment and miss out on nursing services. These options can leave caregivers trying to fill care gaps that skilled nursing facilities typically fill.

Even when nursing homes do accept seniors, stigma can color the treatment they offer. Staff may harbor negative views about people with addictions or treat addiction medications such as methadone as an unnecessary luxury.

How to Find the Best Senior Rehab Center For Your Needs

Not all elders necessarily need senior-specific addiction treatment. For most seniors, the cycle of addiction is identical to that of younger groups. However, some seniors may need help with medication management or with finding alternatives for managing chronic pain. Seniors (or their caregivers) can partner with their doctor to find a rehab facility or outpatient treatment provider that can address the senior’s medical needs.

If you are a caregiver looking for treatment on behalf of a senior, here are some questions to ask before agreeing to any specific treatment:

• What treatment methods do you use, and what is the evidence supporting them?
• Can you help manage other conditions, and if not, will you partner with the senior’s doctor to manage these conditions?
• Can you provide a safe environment for vulnerable seniors, such as those with osteoporosis or dementia?
• How long does treatment typically last, and what is your success rate?
• What do you do if there is a medical emergency?
• Do you offer therapy, group counseling, family support, or other services to ensure seniors get comprehensive help?
• What is the specific cost of the program, and are there additional costs for additional services?

Which Addiction Treatments Do Medicare Cover?

Federal law mandates mental health and substance abuse parity. This means Medicare and other insurance programs must offer similar coverage for mental health conditions as they do for physical health conditions.

Medicare covers outpatient, inpatient, and partial hospitalization programs when it deems these treatments “reasonable and necessary.” A senior may first have to be diagnosed with an addictive disorder before Medicare will cover treatment. In most cases, a senior must pursue outpatient treatment before Medicare will approve coverage for inpatient treatment.

Additionally, Medicare does not pay for bundled inpatient addiction treatment services. It instead approves services on an individual and case-by-case basis. So some treatments, such as therapy and withdrawal medication, may be covered, while other treatments—especially experimental and alternative treatments—may not be covered. Medicare will not pay for training or educational services unless they directly contribute to treatment (as opposed to recreation or diversion).

A compassionate counselor can help seniors manage their addiction. When addiction has impacted family members, family therapy can help loved ones sort through their options. There is no shame in seeking help.

References:

1. Benson, W. F., & Alrich, N. (2017). Rural older adults hit hard by opioid epidemic. Aging Today. Retrieved from https://www.asaging.org/blog/rural-older-adults-hit-hard-opioid-epidemic
2. Bond, A. (2018, April 17). Nursing homes routinely refuse people on addiction treatment—Which some experts say is illegal. STAT News. Retrieved from https://www.statnews.com/2018/04/17/nursing-homes-addiction-treatment
3. Dean, O. (2017). Prescription drug abuse among older adults [PDF]. AARP Public Policy Institute. Retrieved from https://www.aarp.org/content/dam/aarp/ppi/2017/07/prescription-drug-abuse-among-older-adults.pdf
4. Fueled by aging Baby Boomers, nation’s older population to nearly double in the next 20 years, Census Bureau reports. (2014, May 06). United States Census Bureau. Retrieved from https://www.census.gov/newsroom/press-releases/2014/cb14-84.html
5. Korsakoff syndrome. (n.d.). Retrieved from https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/korsakoff-syndrome
6. Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance abuse among older adults. Clinics in Geriatric Medicine, 30(3), 629-654. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146436
7. Mattson, M., Lipari, R. N., Hays, C., & Van Horn, S. L. (n.d.). A day in the life of older adults: Substance use facts. Retrieved from https://www.samhsa.gov/data/sites/default/files/report_2792/ShortReport-2792.html
8. Medicare coverage of substance abuse services [PDF]. (2016, April 28). Department of Health and Human Services Centers for Medicare and Medicaid Services. Retrieved from https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se1604.pdf

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