Drug rehab for older adults: Assessing the needs, challenges and solutions
Finding a drug rehab for older adults is no easy task, but not for the reasons you might think.
There are plenty of facilities and programs that have something to offer in the way of addiction treatment for 50 and older, but sometimes, it’s difficult for members of that population to accept that it’s something they need. After all, they may have gone their entire lives without a substance abuse problem until now, and the idea of finding a drug rehab for older adults is beyond stressful.
It’s embarrassing. It’s demoralizing. It’s hard to imagine, because for many individuals, “drug rehab” is a place for young people whose get caught up in drugs and alcohol and never got a productive life off the ground in the first place. But addiction treatment for 50 and older individuals? Recognizing that it’s needed, and then making the determination to get it, can sometimes feel humiliating.
Here’s the thing: It doesn’t have to be. Employees and clients at a drug rehab for older adults don’t look down on anyone seeking addiction treatment for 50 and older individuals, because the very nature of addiction is that it levels the playing field. It’s not about how old you are or how long you’ve gone without serious consequences. It’s not about how much or how little you’ve accomplished in your life.
It’s about what drugs are doing to you right now, and what you want to do about it.
Drug Rehab for Older Adults: How Big Is the Problem?
While most people think of overindulgence in drugs and alcohol as youthful folly, the National Institute on Drug Abuse (NIDA) paints a more realistic picture of the fact that it can and does affect older Americans: “Nearly 1 million adults aged 65 and older live with a substance use disorder (SUD), as reported in 2018 data. While the total number of SUD admissions to treatment facilities between 2000 and 2012 differed slightly, the proportion of admissions of older adults increased from 3.4% to 7.0% during this time.”
And, according to researchers who authored a 2012 paper in the Journal of Addictive Behaviors, Therapy and Rehabilitation, that number is only expected to grow: “Due to the large number of individuals in the emerging cohort of older adults in the United States, known as the Baby Boom generation, rehabilitation professionals from all disciplines should expect to deal frequently with older individuals in the upcoming years.”
For years, according to a 2014 article in the journal Clinics in Geriatric Medicine, the potential for addiction problems in older Americans was an area that was understudied. However, with the first wave of Baby Boomers turning 65 a decade ago, the need to examine this age group has as much to do with the cultural and social norms among them as it does anything else: “Baby boomers are distinct compared with past generations as they came of age during the 1960s and 1970s, a period of changing attitudes toward and rates of drug and alcohol use. The prevalence rates of substance use disorder (SUD) have remained high among this group as they age, and both the proportions and actual numbers of older adults needing treatment of SUD are expected to grow substantially.”
In considering Baby Boomers as those needing addiction treatment for 50 and older individuals, it’s worth noting that those who came of age during the 1960s have much more lax and accepting attitudes about marijuana use than generations before them. And while the caricature of the aging hippie smoking weed while the grandchildren are napping sounds cute, researchers from the National Institute on Drug Abuse, in combing through data from the National Survey on Drug Use and Health (NSDUH), found that while “marijuana use was three times as prevalent in those age 50 to 64, compared with those age 65 and older,” in the 2015-2016 NSDUH, “additional analyses showed that older marijuana users had twice the odds of alcohol use disorder, nearly 8 times higher odds of cocaine use, and twice the odds of prescription opioid misuse, compared with nonusers of the drug. Older marijuana users also were more likely to be dependent on nicotine and to have had major depression in the past year.”
In other words: weed is often a drug that makes up a polysubstance abuse problem, and for many individuals inquiring about a drug rehab for older adults, the realization of the toll such long-time recreational use has taken on them is the catalyst that has nudged them toward seeking help.
Can It Be Sudden?
Not all those seeking a drug rehab for older adults are long-time drug users who blaze up while reliving their Woodstock glory days. As the NIDA points out, “Chronic health conditions tend to develop as part of aging, and older adults are often prescribed more medicines than other age groups, leading to a higher rate of exposure to potentially addictive medications.” A 2008 article in the Journal of the American Medical Association polled more than 3,000 older Americans, and an astounding 29% of them reported taking 5 prescription medications.
As the Clinics in Geriatric Medicine article observes, not only does the increase the risk of a major drug interaction, it also increases the likelihood, because of the number of medications available at the disposal of older adults, that prescription medications may be used for purposes other than what they’re originally intended: “In 2012, 2.9 million adults aged 50 years and older reported nonmedical use of psychotherapeutic medications in the past year,” the article reports.
In addition, the NIDA warns, because older adults don’t fit the stereotype of a drug addict, physicians often discount the possibility that prescription narcotics can cause problems in that population: “The U.S. population of adults 55 and older increased by about 6% between 2013-2015, yet the proportion of people in that age group seeking treatment for opioid use disorder increased nearly 54%.” Why? “From 1995 to 2010, opioids prescribed for older adults during regular office visits increased by a factor of nine,” the NIDA continues.
And it’s taking a toll on that age group, highlighting the need for effective addiction treatment for 50 and older adults: According to the journal Innovation in Aging, “ED (emergency department) visits by older adults with opioid misuse identified in the ED increased sharply from 2006 to 2014, representing a nearly 220% increase over the study period. Opioid misuse was associated with an increased number of chronic conditions, greater injury risk, and higher rates of alcohol dependence and mental health diagnoses.”
Fortunately, as the opioid epidemic has been recognized on a national level, trends toward long-term prescriptions of narcotic pain relievers to older adults are being curbed: Three physicians, writing in 2018 for the journal Psychiatric Times, stated that “there is no evidence to support the long-term use of opioids for the treatment of chronic pain in the elderly. Rather, there is extensive literature that shows possible harm from long-term opioid use. For acute pain management, 3 days of opioid treatment is sufficient. In rare cases, this may be extended to 7 days.”
However, it’s important to acknowledge that the prescription rate of narcotics to that age group is a driving force in the need for effective drug rehab for older adults.
Drug Rehab for Older Adults: When Is It Necessary?
While drug rehab for older adults with substance abuse problems may be necessary, experts stress that before it gets to that point, primary care physicians can play a role in helping steer their patients away from a potential addiction. According to geriatric psychiatrist Susan Lehmann, in an interview with the Johns Hopkins School of Medicine, “it’s common for primary care providers, specialists and emergency physicians to prescribe opioids and benzodiazepines on a long-term basis. That practice, she says, can lead to dependence as well as negative cognitive effects.”
The article continues: “Lehmann also expresses concern about what she calls ‘benevolent ageism.’ She explains: ‘Physicians may worry about being perceived as disrespectful if they confront older patients about potential substance abuse.’ Similarly, children of these older adults may hesitate to intervene. More than once, Lehmann has heard family members say, ‘He’s not driving anymore. What harm can a few drinks do?’ Or, ‘Drinking is the last pleasure he has!’”
In other words, there’s a tendency on the part of family members and caregivers to dismiss drug problems in older individuals because of the tendency to stereotype addiction as a younger person’s disease. It’s not, and it’s not limited to overuse of prescription medication or weed holdouts reliving the glory days of their youth, according to the NIDA: “Between 2012 and 2015, the number of first-time admissions of U.S. adults age 55 and older who were using heroin doubled, from 2,725 to 5,636. In fact, heroin users accounted for almost the entire doubling of opioid treatment admissions in this population in those years … moreover, the prevalence of intravenous heroin administration in the older adults was greater, at 49 percent, than that among those under age 55.”
Of course, not everyone seeking addiction treatment for 50 and older individuals wakes up one morning to find that grandpa is shooting up or that grandma is crushing and snorting her oxycodone. As the Geriatric Mental Health Foundation points out, “Problems with alcohol and medication misuse can start without anyone realizing it, but it is important to recognize problems before things get too serious. You or your family and friends might think some symptoms are just a normal part of getting older or an illness, but cutting down on drinking or stopping substance misuse can improve many conditions.”
Concerned individuals should consult with their primary care physicians, or at the very least seek out self-assessments for potential drug and alcohol problems online. It’s all too easy to dismiss patterns of drug use as the last thing someone 50 and older should be worrying about, but they can and do cause problems that can make life unmanageable, difficult and downright miserable. And while the idea of going to addiction treatment as an older adult may be stressful, there’s reason to take heart, according to the foundation: “The good news is treatment works for older adults. Older adults tend to recover from substance abuse problems even better than younger adults in treatment. Many older adults will have better physical and mental health and less illness and disability after dealing with alcohol and medication misuse problems.”
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What Does a Drug Rehab for Older Adults Entail?
One of the biggest obstacles to finding addiction treatment for 50 and older individuals is meeting the needs of their particular age group. Effective treatment, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), recognizes that older adults often feel something of a community imbalance when they’re part of a population that includes younger individuals.
“’Elders are in a different stage of life and grew up in a time when having an addiction or mental illness received a great deal of stigma,’ explained Nicole MacFarland, executive director of Senior Hope, Inc., an elder-focused outpatient substance use program in Albany, New York. She noted that seeking help or talking about trauma, substance use, or mental illness may even have been discouraged.
“Many of the people receiving care at Senior Hope have told MacFarland and her staff that they feel like the ‘mom’ or ‘dad’ in mixed-age group therapy sessions and feel like they end up catering to the needs of younger participants. They may also be uncomfortable with use of profanity by other group members.”
One way that some facilities correct that imbalance is to funnel patients ages 18 to 26 into a specific Young Adult Treatment track. That allows them to receive treatment alongside peers their age, while older adults join treatment communities better geared toward their specific needs. SAMSHA, in fact, has outlined a number of different “principles of care for older adults” that include:
- “Considering how the physical environment, as well as staff skills, services, abilities, and policies, can be tailored to overcome any age-related barriers.”
- Addressing the values, needs and preferences of older adults and that “age-sensitive approaches include those that are tailored to older clients’ physical needs (e.g., difficulties with mobility, hearing, vision, or a combination of these), cognitive problems (e.g., memory and attention difficulties), learning needs (e.g., using a slower pace, repeating information), and age-related preferences (e.g., desiring age-specific rather than mixed-age group treatment).”
- Recognizing that “no two older clients are alike,” and that “To give older clients the best opportunities to access and benefit from substance use treatment and services, you must acknowledge, respect, and respond to differences among populations of older individuals.”
- Providing a list of community resources and social support networks to benefit older adults, as well as including caregivers and family members in the treatment process through family therapy in order to provide them with the resources they need to offer post-treatment support.
It’s also important to ensure that a drug rehab for older adults can provide long-term support, the NIDA points out: “research shows that older patients have better results with longer durations of care,” meaning that not only should addiction treatment for 50 and older individuals include residential inpatient programming, but outpatient treatment as well. In addition, a sober living facility — housing affiliated with a treatment program that allows older adults to spend a transitional period with peers working toward the same sober goals — can provide another layer of support.
But does drug rehab for older adults work? Study after study show that it does. One published in 2004 in the journal Addiction examined five-year treatment outcomes of older adults, and the results revealed that “Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two percent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults.”
The key, of course, is finding the right addiction treatment for 50 and older individuals that takes all of these things into account. Whether you’re looking for yourself or a loved one, however, know this: There is a drug and alcohol treatment facility for older adults that can not only meet the needs of their age, but the needs of their recovery.