The Changing Face of Older-Adult Addiction

Every hour, thousands of leading-edge Baby Boomers turn 61. By 2030, 33.5% of the U.S. population will be 55 and older. The “Youth Generation,” those born between 1946 and 1964, is aging, and with this age wave comes a surge in older-adult addiction.

At Hanley Center, we already are seeing a new pattern in age 50-plus or “young older adult” addiction that differs from what we see in individuals ages 65 and older. Traditional older adults tend to suffer from alcoholism or prescription medication addiction. What we are finding with older Baby Boomers reflects national statistics. According to a Substance Abuse and Mental Health Services Administration (SAMHSA) study conducted between 2003 and 2005, illicit drug use by people in their 50s increased by more than 60%. But we are also seeing patients in their mid-60s with heroin or cocaine addictions.

Recently, a 66-year-old CEO was admitted to a local trauma center emergency room for severe symptoms of abdominal pain, vomiting, nausea, and diaphoresis (excessive sweating). When his medical work-up showed only slight dehydration, he received a diagnosis of viral syndrome. His next visit was to the Hanley Center admissions department. He was admitted with a diagnosis of heroin dependency, intranasal route. The hospital ER did not test him for this, because staff couldn't conceive of a 66-year-old executive doing illicit drugs.

This man's story isn't unique. As Baby Boomers age, we'll see more of them turning to illicit drugs, just as they did in their 20s. We are diagnosing more comorbidities such as hepatitis C in this group, as symptoms surface after decades of dormancy.

In pursuit of health, youth, and happiness over a lifetime, Baby Boomers also have been widely dubbed the “Me Generation.” They embrace a complex set of values, including a great belief in the quick fix for anything from rocky marriages (the divorce rate is three times higher for Baby Boomers than for their parents) to physical discomfort. “Living Well Through Better Chemistry” sounds like a jest but it became a reality for many who grew up in the ‘60s and ‘70s. Many were introduced to the psychedelic age by ‘60s LSD guru Timothy Leary, who entreated his followers to “turn on, tune in, drop out.”

Young people at the time also were influenced by rebellion against their parents' generational values, as well as the war in Vietnam and the nation's civil rights crisis. Their idealism and energy were rewarded in social change and the creation of the country's wealthiest generation.

The poly-pharmaceutical profile

Baby Boomers demand services of all kinds and, with this, choice and answers for their questions and problems. They can be “health nuts” who link eating organic foods and running 10 miles a day to optimum health, but at the same time millions in this age group are poly-med users. The pharmaceutical industry reinforces this group's very low tolerance for discomfort with consumer advertising for pills that promise to solve everything.

These patients are coming to Hanley Center with an average of 4.5 prescription drugs and 3.5 over-the-counter medications being taken concurrently. When Baby Boomers visit their physicians, 60% leave the office with a prescription. The most commonly prescribed class of drugs is the benzodiazepines. We don't see the patient present to treatment with just one medication, however. Virtually every “young older adult” is admitted to Hanley with a poly-pharmacy issue.

The addiction profile for Baby Boomers is usually complex, with dependency on both alcohol and prescription pain medications, and prescription meds with illicit drugs. Increasingly, a significant number of Baby Boomers are revisiting their old habits of illicit drug use. This is no doubt linked to a number of factors, including more available leisure time. They may find themselves face to face with issues such as loss of youth. This can be staggering for both sexes, as it encompasses losing a sense of purpose, feeling unattractive, facing end of career, and coping with diminished physical abilities and stamina. Increasingly, health becomes an issue. Many have suffered the loss of a spouse or family member, or are caring for an older relative.

The effects of addiction

There are jarring juxtapositions in Baby Boomer attitudes: health, vitality, and self-help versus demand for service and instant relief. We need to remember that in aging, there is angst associated with losing control, a sense of purpose, and power. Baby Boomers have been confident that they would be “younger” at advancing age and would live longer than their parents, and now they are experiencing in growing numbers tangible arthralgia (joint pain), diabetes mellitus Type II, and other chronic conditions. These young older adults profoundly feel the impact of social, physical, and mental changes in their lives.

The significant increase we have found in dual diagnoses among those from age 50 to 65 includes a prevalence of anxiety, depression, and bipolar conditions. Are bipolar disorders on the rise in this age group as a result of better diagnosis or because of poly-drug and illicit drug use? We can't be sure, but with better diagnosis we can more effectively treat the individual holistically.

Physical changes occur in the aging process, and they are exacerbated significantly with addiction. Other conditions that are not generally associated with addiction are also related to alcohol and drug abuse. At Hanley Center, Axis 3 diagnoses are seen repeatedly, including hypertension, diabetes, cardiac disease, cancer, lung disease, chronic pain, and liver disease.

The physiological changes experienced with aging by adults who do not suffer from addictions include:

• Changes in gastrointestinal tract function;

• Total body water percentage for men declines from 60% to 54%;

• Total body water percentage for women declines from 54% to 46%;

• Muscle mass decreases by 30% for men and women;

• Taste bud sensitivity decreases by 70% for men and women;

• Cardiac reserve decreases from 4.6 to 4.4 times resting cardiac output;

• Maximum heart rate decreases from 195 to 155 beats per minute;

• Lung vital capacity decreases by 17%;

• Renal perfusion (blood flow to the kidneys) reduces by 50%;

• Cerebral blood flow reduces by 20%;

• Bone mineral content reduces by 25 to 30% in women and 10 to 15% in men;

• Brain weight reduces by 7%; and

• Amount of light reaching the retina diminishes by 70%.

Add to this profile of aging the following effects of alcohol and drug dependency in aging:

• Less volume distribution/decreased renal clearance;

• Cognitive impairment;

• Stroke;

• Cancer;

• Atrial fibrillation/flutter;

• Insomnia and problems with restorative (REM) sleep;

• Disease interactions; and

• Psychiatric disorders.

Meeting challenges with effective therapies

When Baby Boomer patients enter Hanley Center, they face a powerful obstacle. Educated and often professional, these patients are cognitively oriented, and they're fighting the loss of personal control over their lives. They want and expect instant cures. To be back in control seems to be an overwhelming priority as they begin primary treatment. In this respect, it is paramount that we help these patients understand the neurobiological and biochemical consequences of addiction that they must now face, accept, and integrate into a long-term recovery process.

Treatment of older adults at Hanley Center has had a strong medical component from its inception, and entails a longer detox and slower primary treatment program than that for other age groups. Generational values are consistently addressed, including the recognition that traditional older adults judge illicit drug dependency as immoral.

As we address the new generation of older adults, we have developed an innovative holistic treatment model that is medically and psychiatrically intensive while fully engaging the individual in his/her own recovery. Detox can be a challenge because of a complex drug profile, as well as a “quick-fix” mindset. Treatment requires an educated approach. We know that while choice is a priority with Baby Boomers, it is critical that the patient does not self-direct treatment. For example, we have seen formerly fit patients engage in obsessive and risky physical exercise.

Because of the prevalence of poly-drug use, and the high incidence of dual diagnosis, a 90-day primary treatment program is recommended, with aftercare. Baby Boomers are generally not averse to therapy; in fact self-help is familiar to most of them. After a thorough medical and psychiatric evaluation, patients respond to developing a personalized care plan with their professional team that includes wellness, spiritual, medical, and psychological components.

Group therapy has proven to be more effective with young older adults than with those over 65, who do better with more one-on-one counseling sessions. We have found that interactive therapies such as Dialectical Behavioral Therapy are especially effective in addressing comorbid diagnoses such as bipolar disorder and borderline personality disorder, as they emphasize mindfulness and coping with disruptive and functionally impairing mood swings.

Meditation and yoga are skills that are helpful for lifelong recovery and balance. Menopausal and post-menopausal women find hormonal shift assessment and self-care plans insightful, supportive, and therapeutic as well. The loss of a spouse often requires grief therapy.

Treatment of patients with psychiatric conditions requires appropriate treatment with psychotropic medications in primary care, balanced with holistic therapies rooted in the 12-Step philosophy that will make a difference in coping, in interpersonal relationship development, and, perhaps most importantly, in spirituality (including finding a sense of purpose).

In treatment, gaining tools to explore one's purpose is as vital to life as getting out of bed in the morning. What were the ideals of this person when he/she was young? How has this changed over the years? Accomplishments of life may not seem as fulfilling when one's career is waning, or the children live far away.

We also know that wellness therapies such as therapeutic massage are more appealing when offered in an aesthetic setting that helps build self-esteem and recognizes the person as an individual first, not just a patient. What is attractiveness as we age? Learning to value life on a daily basis and to savor the moment, as well as to nurture and express individual talents, build relationships, and explore how to contribute meaningfully are powerful components of real recovery for this age group.

Continuing care

Is continuing care an option? I strongly suggest that continuing care, whether it is intensive outpatient, outpatient care with transitional housing, or extended primary care, is vital for almost every young older adult patient who has completed primary treatment, in conjunction with support group participation.

We also have found that our family program, a three-day participatory model, is an integral part of recovery for both the individual and family members. And finally, patient follow-up is important on several fronts. This encompasses tracking recovery and the needs of alumni, as well as offering a lifeline of support and concern.

Baby Boomers have profoundly affected American society and institutions since the 1960s, from the sexual revolution to consciousness raising to the Internet age. Today, marketers are scrambling to reach this generation effectively and health care providers are forecasting ballooning future needs. Addiction treatment for aging Boomers must be holistic in its approach, addressing not only complex substance use histories but also generational attitudes and values. Dynamic human resources are at stake.