Elderly Substance Abuse
The following information is extremely helpful for me. I was unaware of the drug and OTC interactions and metabolization problems.
The entire article reminds me of my parents drinking, particularly my mom, who was sober some 12 years or so, and returned to drinking, which killed her rather quickly.
She went back to drinking when the kids were out of the house, and she and my father divorced, I believe, because she felt abandoned by her children.
She may have had an AA connection then, because they pulled me aside for a "chat" after my freshman year of college.
Hope you are well Virgie and Mary Grace. You would be about 90 now.
Seven Counties Services Inc.
Elderly Alcohol and Substance Abuse New York State Office of Alcoholism and Substance Abuse Services
Alcohol and substance abuse among the elderly is a hidden national epidemic. It is believed that about 10% of this country’s population abuses alcohol, but surveys revealed that as many as 17% of the over-65 adults have an alcohol-abuse problem. In his work at the University of Kentucky, Dr. Hays found that 2.5 million older adults and 21% of older hospital patients had alcohol-related problems.
Elderly alcohol abusers can be divided into two general types: the "hardy survivors," those who have been abusing alcohol for many years and have reached 65, and the "late onset" group, those who begin abusing alcohol later in life. The latter group’s alcohol abuse is often triggered by changes in life such as: retirement; death or separation from a family member, a friend or a pet; health concerns; reduced income; impairment of sleep and/or familial conflict. Because alcohol has a higher absorption rate in the elderly, much like it does in women, the same amount of alcohol produces higher blood alcohol levels, causing a greater degree of intoxication than the same amount of alcohol would cause in younger male drinkers.
Alcohol abuse in this generation is complicated by the use of prescription and over-the-counter (OTC) medications. The elderly spend over $500 million yearly on medications. Combining medications and alcohol frequently result in significant adverse reactions. Due to a reduction in blood flow to the liver and kidneys in the elderly, there can be a 50% decrease in the rate of metabolism of some medications, especially benzodiazepines. Additionally, chlordiazepoxide (such as Librium) and diazepam (such as Valium) have such long half lives (often several days) in the elderly that prolonged sedation from these drugs, combined with the sedative effects of alcohol, can increase the risk of falls and fractures. The benzodiazepine user may become confused and take extra doses or other medications, causing overdose or death.
Serious consequences can result solely from OTC medication use, as well as combining them with alcohol. Laxatives, for example, can cause chronic diarrhea, which can lead to sodium and potassium imbalance and cause heart rhythm irregularities. Antihistamines, another popular OTC medication, can cause confusion; cold medications can elevate the blood pressure and lead to strokes. Caffeine is frequently added to OTC medications and can cause anxiety and insomnia. Often, mixing alcohol and the OTC medications increases the occurrence of side effects and can intensify negative consequences.
Nicotine dependence is also a significant problem in the elderly, due both to their addiction and boredom. Use early in life sets the stage for morbidity and mortality from this addiction. Over 400,000 people in the U.S. die each year from smoking-related diseases. Elderly smokers not only continue to impair their respiratory systems, but are also more apt to die from respiratory diseases. Nicotine replacement products work successfully in this group, especially when combined with behavioral, supportive and other therapies.
What do you look for?
The problem of elderly substance abuse may be difficult to detect when the elderly live alone. Friends and family may be reluctant to even consider that there may be a problem and medical evaluations often do not reveal substance abuse. Consideration should be given to the presence of a drug and/or alcohol problem if there is memory loss, depression, repetitive falls and injuries, legal problems, chronic diarrhea, labile moods, malnutrition and recent isolation. Elderly women are more likely to have a diagnosed or undiagnosed depression. According to Dr. Hays, prescription drugs, particularly benzodiazepines, may be abused by these women.
The Center for Substance Abuse Treatment published a list of signals that may indicate an alcohol or medication - related problem in the elderly:
Memory trouble after having a drink or taking a medication
Loss of coordination (walking unsteadily, frequent falls)
Changes in sleeping habits
Being unsure of yourself
Irritability, sadness, depression
Unexplained chronic pain
Changes in eating habits
Wanting to stay alone much of the time
Failing to bathe or keep clean
Having trouble concentrating
Difficulty staying in touch with family or friends
Lack of interest in usual activities
What To Do?
A family’s attention to the elderly family member’s daily life can be extremely helpful in identifying medical and social problems. It is important to develop a medication inventory for an elderly person. This inventory is a list of all of his or her prescribed and OTC medications. The final inventory usually uncovers a surprising number of OTC medications (some studies have shown as many as nine different medications used per month). This list of medications can be brought to a local pharmacist where a drug - drug interaction list can be generated.
Another worthwhile consideration would be to try to increase the activity level and social interactions of the elderly family member. Senior groups and volunteer work are examples of ways to increase companionship and self esteem.
Clinical treatment may need to be considered, as well as pharmacological interventions as a possible adjunct to clinical treatment. Naltrexone appears to work as well in the elderly as in other groups of alcohol -dependent patients to decrease the craving and feeling of elation related to alcohol use. Antabuse should probably be avoided because the elderly cardiovascular system may not be able to handle possible cardiac events that could occur with an alcohol - antabuse reaction.
Twelve-Step, self-help and support group participation should be considered.
If you believe an older family member or friend may be abusing substances, an open discussion is important. While the individual may not admit to abusing substances, it is important that you raise the issue, expressing concern for his or her well being, and pointing out the interactions between medications which could cause problems. Discuss your concerns with other family members and friends and your family member/friend's physician. It can help if you provide more social activities for the individual, and check in regularly.
Seven Counties is here to provide assistance to you and any friend or family member who may be abusing substances. Our Crisis and Information Center can provide you with options for treatment groups for yourself (Al-Anon) and the individual about whom you are concerned: 502-589-4313 or 1-877-589-4259. If your friend or family member is willing to enter treatment, they should call the Seven Counties’ Access Center at 501-589-1100 or 1-800-264-8799 for more information on where treatment is available.
Elderly Substance Abuse Recovery
I know that recovery or sobriety is possible at any age. I have seen folks begin the journey of sobriety at age 70 and at age 15.
I am sure there are both younger and older stories.
The 12 steps of AA work fine for any age person as a cognitive and emotional and spiritual guide.
In fact, one of the sections of the Big Book that I have always found important and useful is the part that says focus on the solution and you will get more of that, focus on the problem and you will get more of that.
The section to which I refer is found near the Promises of AA, and offer thought by thought guidance to creating sobriety.
Of course, one must always do all the steps, including the 11th Step of Daily Prayer and Meditation to discover your Higher Power's will for you.
I believe part of that will is to be of service in the 12th step, and I can speed up that process both for my own and the communities good by learning a skill like HeartMath which allows me to get into a quiet, listening, receptive physiology on any given heart beat. Try it out. HeartMath opens your brain's higher perceptual centers for your brain fitness work. No reason not to increase your IQ, right?
Would You Share Something That You Are Grateful For?
When I was beginning my personal growth journey, a wise person told me that when I was feeling resentful or afraid or sad, that I should remember the phrase "gratitude is the attitude" when I was ready to feel better. That phrase has helped me feel better tens of thousands of times.
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