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August 27-2, 2014

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Changing profile of substance abuse

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The idea of Grandma or Granddad in rehab may seem incongruous, but it is not as unlikely as one might think. According to Patrick Arbore, Ed.D., founding director of the Center for Elderly Suicide Prevention and Grief Counseling in San Francisco, many older persons “self medicate.”

“Substance abuse is a hidden epidemic,” he said in a seminar this fall at the American Society on Aging’s East Coast Conference on Aging. “Denial plays a part – families don’t want to see it.”

Between 1992 and 2008, the number of people age 50 or older admitted to substance abuse treatment facilities in the United States more than doubled, according to the Substance Abuse and Mental Health Services Administration.

The numbers themselves may not seem staggering: an increase from approximately 102,700 in 1992 to 231,200 in 2008. But these numbers only represent those who sought treatment. And some of the underlying data indicates that the nature of substance abuse among older Americans is changing.

Over the same 16-year period, the proportion of alcohol abuse among those seeking treatment decreased from 88.3 to 71.9 percent, while heroin, cocaine and marijuana use increased.Those who had recently become engaged in substance abuse (as opposed to those who started at a younger age) were primarily using prescription pain relievers.
Almost 40% were using multiple substances, compared with 13.7 percent in 1992.

Dr. Frederic Blow, in his book “Substance Abuse and Aging,” says the combination of alcohol and prescription drug abuse among those age 60-plus is one of the fastest-growing health problems in the United States.

The effects can be far-reaching, from increased risk of falling and cognitive impairment to negative interactions with a variety of medications, including those for diabetes, congestive heart failure and depression.

Arbore cited a 2004 national survey on drug use and health that found 4.6 million adults who had serious psychological distress also had a substance abuse problem. “If you are a drinker and you are depressed, you have a 32 times greater chance of committing suicide than the general population,” he said.

“Depression affects 15 percent of older adults living in the community,” he said. The stigma associated with depression and mental health issues can prevent older adults from being candid with their physicians. But, he said “depression is treatable if it is recognized. We can prevent suicide deaths if we can treat depression.”

So what can a family member or friend do? First, he said, is to break through denial and shame, and not give up if initial efforts are rebuffed. He also said that aiming for harm reduction may be more effective than looking at complete abstinence as the goal.
He offered these tips:

Sit beside the person, not in front of him or her; you need to establish yourself as a collaborator, not a dictator.
Don’t start by talking about alcohol – talk about other health habits, such as adding vegetables and fruit into the diet, and getting more exercise.
When you bring up alcohol, ask the person how many drinks a week he or she has – and ask if they could cut back by one.
Create a conversation rather than a confrontation.

Arbore said it is important to recognize that “you can’t save them – you can help them. You might have to repeat the conversation many times.”