Old Age and Addiction

Carol Aronberg’s drunkalogue is common: she grew up outside New York City in a privileged family full of drinkers; both her parents were alcoholics, and her father was a mean drunk whose verbal abuse damaged her self-esteem. Still, she went to college, got married, had kids and started a successful business. And then, eight years ago, her mother died, and Carol’s drinking blossomed, and she expanded her repertoire to include drugs. Finally, after three overdoses on booze and benzodiazepines and a pharmacopeia of other pills (“the ‘Cets,” she calls them—Percocet, Fioricet, the combinations of painkiller or sedative with acetaminophen), she checked into rehab. Now she has 18 months clean and sober.

Here’s the biggest difference between Aronberg’s story and that of most alcoholics: She was 69 years old when she became an addict.

Aronberg is part of what some analysts have described as an approaching tidal wave of addiction in America: older adults and members of the baby-boom generation now in their late 40s to their mid-60s, who develop addiction and get sober late in life.

Many of the growing number of older adults who need help can’t get it because of the simple, shocking fact that Medicare does not pay for addiction treatment.

report issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) has warned that the aging of the baby-boom generation is leading to huge increases in levels of addiction among adults over 50—a fact that, SAMHSA says, will require double the availability of treatment services by 2020. And many of these people, having come of age in the drug-friendly culture of the 1960s and 1970s, have little hesitation about popping painkillers and other pills to deal with the physical and emotional stresses of aging.

“I call it ‘Pharmageddon,’” says Barbara Krantz, D.O., M.S., CEO and medical director of the Hanley Center, a nonprofit addiction treatment facility located in West Palm Beach, Fla. Hanley’s Center for Older Adult Recovery was the first treatment center to pioneer programs specifically designed to help elderly and baby-boom adults recover from addiction. Krantz says Hanley’s older-adult programs are always at full capacity with patients who come from the entire East, because so many older adults need treatment. “If you look at the SAMHSA data,” she says, “the prediction is that five million older adults will need treatment in 2020.” That’s twice the number requiring treatment in 2000.

Another SAMHSA study found that drug abuse (including prescription drug abuse) among adults 50-59 jumped from 2.7 percent of that population in 2002 to 5.8 in 2010, and that among those 55 to 59, the rate roughly doubled from 1.9 to 4.1 percent.

Aronberg traveled from her New Jersey home to spend 60 days at Hanley. She admits she was fortunate to have the resources to pay for private rehab services (at a cost of nearly $50,000). Not everyone is so lucky. Many older adults who need treatment are unable to get it due to the simple, shocking fact that Medicare does not pay for addiction treatment, says Neil Capretto, medical director of Gateway Rehabilitation in Pittsburgh, Pa. Capretto’s region has the highest concentration of elderly people outside the Florida retirement communities. “I’d take Medicare, but Medicare won’t take us,” Capretto says. “Medicare would recognize us if we were still hospital-based.” But many treatment facilities that offer “medically-monitored” detox are free-standing and independent of hospitals.

When Aronberg completed the 30-day program, she says, “I was no more ready to get out than the man in the moon,” and she re-upped for another month. She had arrived not just with her alcohol addiction but also with 30 bottles of prescription drugs—after her third OD, she says, “When they swept my house, you could have sold them on the street to pay your mortgage off. The doctors never told me to stop taking anything—they kept giving me more. My daughter went to the doctor and said, ‘My mom’s been taking too much,’ and he said, ‘That might be true, but it would be harder to get her off.’”

According to Krantz, at least half of patients like Aronberg arrive at Hanley with prescription drug problems, with painkillers being the primary drug of abuse, then sedative-hypnotics (usually benzos like Xanax and Ativan). And a common misconception doctors have about addiction in older people is that you can’t teach an old dog new tricks—that older folks just can’t recover from addiction or deal effectively in their later years with their underlying psychological problems and life-stresses.

It’s true that older folks are experiencing more stress. A 2011 “Stress in America” survey conducted by the American Psychological Association (APA) found that older adults are trying to cope with more life-stress than ever before. The results show stress is impacting health in particular among adults 50 and older who have to care for both parents and children, and also those who have been diagnosed with obesity and/or depression.

Loneliness and isolation can contribute to depression, and elderly people are increasingly vulnerable. A recent study at the University of California, San Francisco, found that while the number of older adults who say they feel lonely hasn’t changed much, the quality of health of lonely older adults has decreased: those who felt isolated said they had a harder time bathing, dressing, eating, and just getting around than those who felt connected to others. And loneliness can contribute to shame.

“Shame is the number one issue for older adults,” says Carol Colleran, an international certified alcohol and drug counselor, author of a sourcebook on aging and addiction, and pioneer of Hanley’s older-adult program in the 1990s. Retired from Hanley, Colleran is now helping to establish a brand-new program for those over 60 at Pine Grove Behavioral Health and Addiction Services, headquartered in Hattiesburg, Miss. “The reason for [their shame], I’ve realized, is that they grew up in a generation where alcoholism was not a disease—it was the town drunk, the man under the bridge. And to them, for a grandmother to be an alcoholic is a very shameful thing.”

Pine Grove is implementing secure, high-definition online videoconferencing as part of its intensive outpatient service to help the increasing numbers of older adults who reach out for help with addiction. According to population projections from the U.S. Department of Health and Human Services’ Administration on Aging, by 2030 nearly one in five U.S. residents will be 65 or older. “The nation is bracing for the impact of providing health care services to these 72 million adults,” the APA survey reports, “but what may be lacking is concern about the impact on caregivers.” The survey shows that these caregivers report higher levels of stress, poorer health and a greater tendency than the general population to use unhealthy behaviors—including drinking and drug-use—to relieve stress. Older adults usually report lower stress levels, but people with caregiving responsibilities say they have more stress and poorer physical health than the rest of us.

“Talk about stressors,” Krantz says: “Baby-boomers statistically come in with three to four times more emotional disorders. Anxiety, depression and chronic pain are the three stressors in their lives that are the most significant.” Hence the painkiller problems. Baby-boomers in particular, Krantz says, are interested in using chemicals to treat their stress—they comprise the generation of “the quick fix, better living through better chemistry.”

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