What does it mean to be elderly?
I remember being at an age when forty-years-old seemed elderly to me. To give you an idea of how long ago that was, there was something in the news many years ago about Donald Trump being a billionaire at forty. I remember thinking to myself, “he’s so rich and too old to really enjoy it.”
These days, forty seems young to me. When I look at people who are older than I am now, people in their sixties and seventies, they don’t seem so old. Many are mentally sharp, active people who are living full lives with no sign of slowing down.
So what about people in their eighties, nineties and older? For the most part, they still seem elderly to me, but my perspective may change in another ten years.
While more people are living active lives at older ages than ever before, it is a fact of life that as we age, we are at risk for more health problems. And, our reserve capacity diminishes, so we are not able to handle physical strains placed on our bodies that we could handle at a younger age.
Is substance abuse in the elderly a serious problem?
Addiction is a complex condition with a variety of risk factors that predispose certain people to becoming addicted to substances or certain behaviors. While a person could possibly become addicted for the first time later in life, they likely had risk factors for addiction all along.
There are people who seem to have addictive personalities, but they do not use drugs or alcohol. People who are driven to be successful in business or in their profession are possible examples.
They may have chosen to channel their energy in a different direction rather than getting held back with a substance addiction. Yet, if they had chosen to try substances at some point in their life earlier on, they likely would have become addicted.
A person who fits that description and avoids a substance use disorder for the early decades of their life may succumb to addiction later on, when they decide to slow down and enjoy life. For example, they may start to drink more at social events and find that they really enjoy the effects of alcohol.
Another example might be a person with a predisposition to become addicted who is prescribed opioids later in life. It is possible to go for an entire lifetime and not get a prescription for opioids. Then, later on in life, there might be pain from a car accident, or an old back injury flaring up.
Most people who take prescription opioids do not become addicted. Yet, there is always the risk that a person who is prescribed opioids at any point in their lives might become addicted.
It is also possible that a person who tried alcohol or other substances did not become addicted at a young age, yet they become addicted later in life. Addiction can be like an allergy in that way. You may not be allergic to something, and then at any point in your life, you can develop an allergy that you never had to worry about before.
Relapse can happen at any time, no matter how long a person maintains their sobriety.
People who have found recovery and remained substance-free for many years may still relapse at some point. Relapse is, unfortunately, a part of the process of addiction recovery for many people.
It is very possible that a person who used drugs or alcohol at a younger age and then stopped will resume use again when much older. I have met people who were drug or alcohol free for decades and then relapsed.
In the 12-step programs of Alcoholics Anonymous or Narcotics Anonymous, relapsing after many years of being clean is especially difficult. The reason why is that these programs place great emphasis on the value of “clean time.”
Clean time is a sort of a status symbol in the major 12-step fellowships. Many service positions in the groups, such as being secretary, treasurer, or chairperson, require a minimum of clean time.
A person who relapses, even if it is a brief slip, such as having a glass of wine at a family dinner, is considered to be reset to zero clean time, even if they have been in recovery for many years without using any alcohol or drugs.
Imagine going from having ten years, or even twenty years of clean time in the program and suddenly, you are reduced to the status of a newcomer because of a slip that the group considers to be a relapse. You no longer qualify to serve in many group positions and you are expected to announce to the group that you are just coming back as you go up to claim a white chip.
As you can imagine, many people who relapse in this situation get the idea that they might as well keep going with the drugs or alcohol. As long as they are starting over, why not enjoy it for a while? Of course, relapse never works out for the best, and the enjoyment will be short-lived.
Can relapses happen to elderly people?
Relapse can and does happen to people at all ages. It can even happen after many decades. A person who used cocaine in their twenties or thirties could possibly relapse in their fifties or sixties.
This sort of relapse emphasizes the danger of relapsing at an older age. Drugs such as cocaine or meth are not nearly as physically dangerous to a young person. For a young person, the danger of these stimulants lies more in the lifestyle surrounding the drug.
There is a danger of getting a disease, such as HIV, from risky sexual behavior, or being in a dangerous situation where there is risk of a stabbing or gunshot wound. As a person ages and has less reserve capacity, the risk of health issues from the drug itself is greatly increased.
Cocaine can cause heart attacks or strokes at any age, but the risk is much higher for people in their fifties and up. Using the same amount of cocaine or meth that caused no issues earlier in life can have tragic consequences for a person who is a bit older.
Part of the problem is that people in their fifties often do not feel old. They may have found some success in business or in their profession and they feel like they deserve a reward for years of hard work. Yet, resuming an old cocaine or meth addiction is not a good idea for a middle-aged man or woman looking for a way to relax in their free time.
Is it possible for an elderly person who gave up opioids in the past to relapse on opioids again?
Quitting opioids is hard. In most cases, there is no easy way to do it. Fortunately, we have medication-assisted treatment to make the process easier.
When a person takes Suboxone, they are able to quit using opioids quickly and resume life as if they had never been addicted. After a period of time ranging from 1-3 years, longer in some cases, the patient may taper off of Suboxone and complete therapy. Most patients who take Suboxone long enough do not have opioid cravings when they stop.
What happens after Suboxone treatment is finished? Is the patient cured?
While it is possible to overcome opioid addiction, the addiction is never really cured and completely gone. It is similar to telling an HIV patient that the virus is undetectable. We all know that it is still there, latent and waiting to possibly come back.
In many cases, a person who completes Suboxone therapy will go on with life and not have any future issues with opioids. For other people, they may find that even the smallest dosage of an opioid or opioid-like substance can trigger intense cravings and lead them back to active opioid addiction.
The incident could be a dentist prescribing even a mild opioid, such as tramadol or codeine. Or, it could be after a surgery where the surgeon gives out a small prescription of percocet.
Even if the Suboxone doctor gives strict instructions to avoid opioid use if at all possible, after many years, the patient may feel as if they are cured and want to test themselves out to see if they can now handle it. A relapse might happen a few years after completing treatment, or it could happen decades later.
Is there Suboxone for seniors?
Suboxone is a relatively safe medication and it is prescribed to patients who are in their fifties, sixties, and seventies, and possibly older. There is nothing wrong with restarting treatment if a patient has a relapse. It is better to catch the problem early before it gets too out of hand.
A patient who is older might feel bad about relapsing and having to go back to get medical treatment for addiction again. Yet, it is never too late to get back on track and start over again. I often find myself telling patients who are in their fifties or sixties that they have many productive years remaining and that now is a perfect time to get treatment so they can get back to living.
Even if the patient is retired, they will enjoy their retirement far more by getting free from active addiction. They may have young grandchildren or plans to travel the world, or even go back to work and spend time around people again. For someone with an addiction challenge, everything is better in recovery, free from active addiction.
If you are wondering if there are special rehab centers for elderly individuals, in most cases, it is not an issue, because you can get the medical treatment you need from a local addiction treatment doctor. In fact, you may be able to see a concierge telemedicine addiction treatment doctor without having to leave the comfort of your own home.
What about the elderly and alcohol abuse? Is it possible to quit drinking at an old age?
Excessive drinking is more common than you might think for older people. Even people in their eighties often drink more than they should. It is surprising how much alcohol some people can handle, even at an advanced age and with existing health issues.
Alcohol is not good for anyone, at any age. The American Cancer Association has recently made a statement that there is no safe or healthy amount of daily alcohol. Cutting back or quitting is important for anyone who drinks regularly.
The good news is that it is possible to reduce alcohol consumption or quit at any age and at any level of drinking. A person does not have to be a full blown alcoholic to benefit from reducing or quitting alcohol.
Many elderly people fall in a category known as “gray area drinkers.” Gray area drinking is a level of drinking alcohol that falls short of being an alcoholic, but is more than a minimal amount of drinking.
A person who has a sip of wine or champagne once or twice a year is probably not even at the level of gray area drinking. Yet, someone who binge drinks on the weekends, but not at all during the week is likely a gray area drinker.
Many gray area drinkers will eventually progress to being alcoholics with a diagnosis of alcohol use disorder. They will eventually have blackouts, arrests for driving drunk, and health issues from excess alcohol intake.
The Sinclair Method (TSM) is a harm reduction protocol to help people reduce their alcohol consumption with the goal of quitting altogether. TSM is particularly effective for gray area drinkers. And, it works for alcoholics as well.
The way it works is that patients who are prescribed naltrexone take the tablet one hour before drinking. The effects of the medication help the patient to not want more alcohol and it trains their brain to lose interest in alcohol. The name for the effect is pharmacological extinction.
It is also possible for a doctor to prescribe naltrexone tablets for daily use, or a monthly injection of naltrexone, with instructions that the patient not drink at all. There are also other medications, such as acamprosate (campral) and disulfiram (antabuse) to treat alcohol use disorder.
Elderly patients can greatly benefit from seeing their doctor for help to stop drinking, or at least help in reducing their alcohol consumption. Quitting is a good idea at any age, but the health risks of alcohol are much higher for older people.
How well does medical treatment work for treating addiction in older Americans?
The elderly population responds very well to the same medical treatments that work for younger patients. Overcoming alcohol dependence, prescription drug abuse, or misuse of illicit substances is possible, even for the older individual.
When a doctor is evaluating aging adults, they should not assume that cognitive impairment is due to dementia or even the effects of normal aging. A substance abuse problem should always be considered. Elderly substance abuse is a significant issue and must be detected and addressed.
When an elderly individual learns of the treatment options available and how effective they can be, they will likely be very open to the idea of quitting alcohol, an addictive medication, or an illicit substance. It is just as possible for an elderly patient to quit drugs or alcohol as a younger person.
Listening to the best recovery podcasts about medical addiction treatment can help the elderly individual to learn more about available treatment options. I recommend our podcast, The Rehab, for learning about the latest and most useful information on the subject of substance abuse in older adults and how to treat it.