September 26, 2018
Central Massacusetts Health

Substance use a growing concern among older adults

Substance abuse has been very much in the news for several years, with coverage often focused on young people struggling with opioid addiction.

But more quietly, older adults in Central Massachusetts and across the nation are also suffering from the misuse of drugs—most commonly alcohol but also prescription medications and even street drugs like heroin.

Between 2014 and 2017, the number of Massachusetts residents over age 65 admitted for substance use treatment grew by 27 percent, according to the U.S. Substance Abuse and Mental Health Services Administration. The number admitted for heroin abuse, though much smaller in total, grew by 83 percent.

While some of this growth may reflect positive public health messages resulting in more people seeking treatment for their problems, Central Massachusetts providers say there appears to be a growing problem of substance misuse among older adults.

Vic Digravio, president and CEO of the Natick-based Association for Behavioral Healthcare, said providers who his group represents report that that problems with both mental health and substance abuse seem to be on the rise across all age groups and across the state.

"They've been saying for years they're seeing increased acuity levels on the mental health side as well as the substance use disorder side," he said. "I don't think anybody has a real good answer to what's causing that phenomenon."

Dr. Romas Buivydas, vice president of clinical development at Worcester-based behavioral health agency Spectrum Health Systems Inc., said one reason more older people are being diagnosed with substance use disorders is simply that the population of older adults is growing fast. But he said it's also important to look at the specific patterns of addiction among older people.

Dr. Buivydas said some people have longstanding issues with alcohol, pain medications, or other drugs that can get worse over time. Others, though, may begin misusing substances as a result of life events that become more common for people in their sixties and above. The death of a friend or spouse can trigger unhealthy drinking or drug use. Boredom and loneliness, which often become bigger problems after someone retires or when their mobility is reduced, can also contribute.

Older people, and those around them, may not realize the effect alcohol or drugs are having on them, Dr. Buivydas said.

"Symptoms could be negated by simply saying 'they're old, they're lonely, they're depressed," he said. "But if a memory problem is happening after drink— coordination problems, falls, failing to bathe or keep clean—these are all symptoms of abuse of alcohol."

Dr. Buivydas said another issue is that people may not realize that their old habits are affecting them differently as they age.

"The same dose of any medicine, the same dose of alcohol, is now going to be different than when you were younger," he said. "It's going to hit you harder."

Mary Fierro, vice president for behavioral health at the Edward M. Kennedy Community Health Center in Worcester, said that, even if people suspect their use of a drug may be slipping into unhealthy territory, the social stigma around addiction can make it hard to seek help.

"Of course the older someone is, the more aware they are of the kind of reaction to using substances that other people typically have," she said. "Additionally, I think older folks have—stereotypically—less awareness that prescription medicines also can be misused."

When it comes to alcohol, Fierro said, some people may have absorbed ideas years ago that don't fit with more recent research, or that no longer apply to their current situation.

"Sometimes people heard way back that a glass of wine with every meal is going to improve your health," she said. "That's not necessarily untrue for every single person, but it may not be true for every person."

That's a particular issue for people who face one health issue or another. Alcohol can interact with other drugs in ways that reduce their efficacy, and it can also exacerbate health problems like depression in ways that may not be obvious.

"What is challenging to convey to people is because alcohol is a depressant it's going to have an effect on your mood," Fierro said. "Before, it helped you to relax and get to sleep, but ultimately what it does is become incredibly disruptive to the sleep process."

For people living with debilitating chronic pain, she said, things can be even more complicated.

"The more research that is done about chronic pain, the more we recognize it is a situation that is incredibly damaging to health and not straightforward to solve," she said.

Just as with many health issues, including diabetes and depression, Fierro said the best treatment for pain involves a combination of medicine and lifestyle changes. Drugs that temporarily relieve pain can help people gather the energy to exercise or do mindfulness or breath exercises—therapies that don't produce immediate results but that can help over time. But the effect of medication alone declines over time, so, when something that seemed miraculous at first becomes less so, people may be tempted to take more.

Another complicating issue is the way that medical institutions and insurance systems are set up to deal with addiction. In some cases, Fierro said, insurance may cover intensive detox treatment for people with acute substance abuse problems, but it may limit behavioral health visits for those who need less intense support over a long time period.

In the case of Medicare, the main health insurance provider for most older Americans, Digravio said there are some specific gaps in coverage. For example, Medical typically won't cover methadone maintenance therapy delivered on an outpatient basis, or other intensive outpatient treatment.

Medical professionals are working hard to improve care for older people dealing with substance use disorders. Dr. Buivydas said medical facilities frequently request his help teaching doctors, including gerontologists, to identify symptoms of the disorders.

"At least that's opening up, reducing some of the barriers to understanding how to treat older adults," he said.

Dr. Buivydas said facilities like Spectrum are also learning how to serve their older patients better. For example, standard interventions like behavioral therapy and motivational interview techniques, can be more useful to seniors if they're conducted at a slower pace.

Fierro said many people facing a number of concurrent medical issues may not see their substance use as a problem at first. But once medical professionals work with them to address issues like chronic pain, depression, or anxiety, they may begin to realize that their use of drugs is making it harder to recover.

Fierro said her advice to older adults is "don't underestimate how much control you actually do have to feel better in your life." Particularly for people with chronic illnesses, she said, "it's kind of easy to let that life get more and more shut in. the more that happens, the bottom line is, the less healthy somebody can be."


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