The number of senior citizens in the United States is soaring. And so too, is this group’s rate of both alcohol use disorders (AUD) and substance use disorders (SUD). According to the National Institute on Drug Abuse (NIDA), more than 1 million U.S. citizens over the age of 65 had a SUD in 2018. And what’s more, many of these millions suffering from SUDs go undiagnosed and therefore untreated.
However, treatment for seniors with an alcohol problem or drug problem works, and thousands have recovered. If you think that you or someone you love or take care of may have a problem with alcohol or another type of drug, Futures Recovery Healthcare can help. With three different addiction treatment programs—each offering something a bit different—Core, Orenda, and Rise, Futures knows that each person’s treatment needs are unique and aim to provide individualized, comprehensive treatments for all who come for help.
For many, the hardest part of recovery from alcohol or drugs is taking the first step and asking for help. And while this is true for seniors with addiction issues, diagnosis of an AUD or SUD in this group is sometimes the most challenging part. Many times when the elderly have an issue with alcohol, or legal or illicit drugs, it goes overlooked by well-meaning health care providers.
Diagnosing Addiction in the Elderly
The NIDA also reports that between 2002 and 2012, the rate of seniors in clinical treatment for an AUD or SUD increased from just 3.4% to 7%. And while this increase is positive, it’s important to realize just how few of the seniors who need help for a problem with alcohol or another substance are getting that help.
One of the reasons this number is low is because so many are misdiagnosed or undiagnosed when it comes to seniors and addiction. Generally, both alcohol issues and substance abuse issues are diagnosed based on the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, when it comes to seniors and addiction, these criteria may be less applicable due to common social and biological factors specific to later life years.
One example of this is tolerance. One of the criteria for diagnosing an AUD or SUD includes the growing tolerance for a substance. This means the user needs to consume more of the substance to achieve the same ‘high’ or relief. Due to the senior populations’ age-associated physiological changes, seniors tend to experience the opposite. This group tends to be more susceptible to the effects of alcohol and drugs and their bodies often don’t build a tolerance.
In addition to this example, is the criteria around social problems with an alcohol or drug use problem. Many in this aging population have already retired, aren’t in school, and tend to be more isolated than other age groups. For this reason, it is difficult to see if their alcohol or substance use is interfering with these items.
These are just two examples of how diagnosing seniors with addiction problems can be a challenge. As a result of these criteria in the DSM not applying in the same way to older adults, those who work with seniors with addiction issues have suggested de-emphasizing sole reliance on these criteria for diagnosing an AUD or SUD in this age group which now makes up about 30% of the U.S. population.
Instead, they suggest using a 2-Tier categorical classification system with the two categories being ‘at risk’ and ‘problem use of substances’. The ‘at risk’ category includes the following:
- Drinking more than safety guidelines of seven drinks per week and no more than two drinks on one occasion
- Drinking alcohol with medications that are not to be mixed with alcohol
- Using over-the-counter or prescription medications in ways not intended—either intentional or unintentional
- Taking medications not prescribed for them (even if only on occasion)
- Using illicit substances
As you can see, these are a bit different from the standard DSM criteria for both AUDs and SUDs.
The suggested criteria for the ‘problem use of substances’ includes the following:
- Using any substance to a degree where it causes social, psychological, or medical consequences regardless of how often and how much is consumed
It’s important to note that the amount consumed and the frequency of consumption are not as important as the outcomes or consequences of the consumption. For example, a senior adult may be particularly susceptible to issues when consuming alcohol because of other medical issues like gout or pancreatitis. They may consume very little alcohol or consume it very infrequently but each time they do they experience negative outcomes such as medical complications.
Although awareness of the differences in identifying substance and alcohol abuse in older adults has increased, there remain obstacles in properly diagnosing issues in this aging population. In a study in which 400 primary care physicians were given a list of symptoms associated with substance abuse in relation to an older female patient, only 1% of these providers considered substance abuse.
Some of the challenges remaining are:
- Time limit providers have for screening for multiple illnesses or conditions
- Discomfort and stigma in both assessing and discussing an AUD or SUD with a senior patient
- Symptom similarity between symptoms of AUD and SUD and other illnesses common in the elderly
- Misbelief by seniors that symptoms associated with AUD and SUD are part of the normal aging symptoms
As you can see, there are some real challenges when it comes to diagnosing seniors with addiction issues whether to alcohol or an illegal or legal substance. However, with some education about what specifically to look for, effective diagnosis can be made and seniors can recover.
Signs of Seniors with Addiction Issues
Just as there are differences in symptoms and diagnosing seniors with addiction issues, there are also differences in treatment for this group. When it comes to treating seniors for an alcohol problem or a substance use problem there are some approaches that work better than others.
Research shows that older adults should be approached about a potential AUD or SUD in a nonconfrontational, supportive way. In addition, older adults are more likely to open up to a healthcare provider who seems sincerely interested in their wellbeing and health. Seniors respond best when the assessment comes as part of an overall health assessment aimed at improving overall health rather than singly targeting their concerning use of alcohol or another substance.
If you are concerned about potential substance or alcohol abuse in yourself or a senior you know, take a look at the following symptoms of alcohol and substance abuse in the elderly:
- Chronic pain
- Poor eating habits and nutrition
- Falls, slips, and bruises
- Poor hygiene or issues with self-care
- Idiopathic seizures
- Memory loss
- Difficulty making decisions
- Cognitive decline or impairment issues
- Mood swings
- Sleep issues
- Relationship or family issues
- Legal problems
- Financial issues
- Medications running out too soon
- Medication ‘borrowing’ from others
When seniors are assessed for addiction it should be done in a way to gather information rather than accusatory statements such as “You have a problem with alcohol”. Questions posed in manners such as, “Do you find yourself having trouble falling asleep and taking more of your medication to do so?” rather than “If you are taking more than what is prescribed for sleep you have a problem.” are suggested approaches.
In addition, the CAGE questionnaire has proven to also be helpful in diagnosing seniors with addiction issues. This assessment includes four main questions. These are:
- Have you ever thought you should Cut down on your alcohol or drug use?
- Have you been Annoyed by others’ comments or criticism about your drinking or use of another substance?
- Have you ever felt Guilty about your drinking or drug use?
- Have you ever used alcohol or drugs first thing in the morning (Eye-opener) to calm nerves or ease a hangover?
The CAGE questionnaire can be used as an effective support tool in diagnosing the risk for dependence as well as dependence itself. It’s important to note that this should be used in conjunction with a comprehensive assessment of seniors for addiction issues.
Treatment for Seniors with Alcohol Issues or Drug Issues
Once a diagnosis is made—either professionally or otherwise—finding the right treatment program is the next step. Although seniors are often reluctant to seek treatment, particularly for alcohol issues, research shows that when seniors get treatment for an issue with alcohol or another substance the outcomes are very good. In fact, a study published by The National Library of Medicine indicated that seniors tend to have better outcomes from addiction treatment than their younger counterparts.
However, due to the lack of awareness of the problem with seniors having addiction issues, there is not a great deal of research into treatment outcomes and the best treatments for seniors with addiction issues. Additionally, treatment options aimed at seniors are currently very limited. It’s important when seeking treatment for seniors with addiction issues to be sure the treatment facility treats adults and not youth. Seniors have been shown to be more reluctant to participate in treatment programs with younger counterparts.
Futures Recovery Healthcare treats adults with alcohol use issues, substance use issues, and mental health problems. At Futures, our caring staff gives their utmost to see that each person who comes to us for help gets exactly what they need. If you or a loved one need help with a problem with alcohol or drugs contact us today online or call us at 866-804-2098. And remember, it’s never too late to get help for addiction—no matter how old you are.
Learn more about seniors and addiction here.