Substance abuse is a growing problem in Maine, and its effects are felt both privately and publicly. The cost of substance abuse to Maine in 2010 was $1.4 billion, according to the Maine Office of Substance Abuse. For Penobscot County, the cost reached $166 million.
Rates of alcohol and narcotics abuse in Maine are higher than national averages, but one group is largely left out of public discussion about the issue: older Mainers.
A 2012 National Institutes of Health report explored the growing trend of substance abuse among older adults, a group it acknowledges for the most part has not been examined in substance abuse research until recently.
Aging pains
The National Institutes of Health reported that older adults consume 25 to 30 percent of all prescription medications in the United States, even though they currently make up less than 20 percent of the population. On average, they may consume anywhere from 6 to 28 medications daily, often for pain and other complications from aging.
“As we age, our metabolism changes, and some bodily functions aren’t as efficient [as they were],” said Lee White, with the Eastern Area Agency on Aging in Bangor.
Besides physical pain, Lee noted “older adults experience more loneliness [and boredom],” as they lose social supports, family and friends. The loss of social support can lead to a lack of engagement with the community, a risk factor for substance abuse.
“As people age, we tend to see less substance abuse,” said Dr. Vijay Amarendran, medical director of outpatient services at Acadia Hospital in Bangor. But Amarendran noted that since 2007, he has seen an increase in older adults seeking treatment for opiate addiction, from 1.5 percent in 2007, to 3.4 percent in 2010, to 5 percent in July 2014.
The Maine Office of Substance Abuse reported in 2010 that 235 Mainers 65 and older sought treatment for substance abuse, while 2,190 Mainers age 50 to 64 sought treatment. According to the National Institutes of Health, substance abuse affects as much as 17 percent of older adults, but only a fraction seek treatment.
Among the most heavily prescribed substances for older adults are benzodiazepines, such as Valium and Ativan. They reduce anxiety, depression and insomnia. Due to the risk of misuse, benzodiazepines usually are recommended for only short periods of use, but that’s not always the case.
“Adults in long-term care and assisted living communities have been prescribed benzodiazepines longer than they should,” said Lenard Kaye, director of the University of Maine Center on Aging in Bangor and professor in the UMaine School of Social Work in Orono. “[Benzodiazepines] are probably the most commonly used and misused medication among older adults.”
Ahead of benzodiazepine use among older adults is alcohol consumption, which Amarendran said remains the more prevalent abused substance. And incidences of opiate and benzodiazepine abuse are rising.
Negative effects of alcohol are more pronounced in older adults. Changes to metabolism, and a decrease in body water and tolerance mean “that same three or four drinks you could handle when you’re younger, at 60 or 70 can do you in,” Kaye said.
When mixed with other substances, such as prescription drugs like benzodiazepines, alcohol “alters the intended effects [of the substance], and can be a deadly mixture,” Kaye said.
For older adults who abuse substances, there are a number of health consequences exacerbated by their age, including an increased risk for falls, which are the leading cause of fatal injuries.
Quiet epidemic
While older adults in Maine are still a minority among those seeking treatment for substance abuse, it’s a group many doctors and counselors see as poised to grow as baby boomers reach old age.
As one of the largest generations in recent history, baby boomers represent a population of nearly 77 million, the first of whom began to retire in 2011. According to the U.S. Census Bureau, the number of Americans 65 and older will double to a population of 84 million by 2050, from a 2012 population of 43 million.
The effects of this age boom will be readily felt in Maine, which already holds the title of oldest state in the nation. As Mainers age, the rates of substance abuse among older Mainers is set to rise.
The biggest predictor for substance abuse among older Mainers is whether they used a substance when they were younger. In fact, most older adults with addiction had problems with substances in their youth. They may have overcome the problems as they aged, but later in life find themselves returning to old habits, Amarendran said.
One problem facing doctors and counselors combating substance abuse is that many people stay quiet about their addiction. The report from the National Institutes of Health recognizes that substance abuse in older adults is under-reported because of shame and the stigma associated with addiction.
“Older adults tend to not seek help. They are independent and proud, value privacy and they are not necessarily going to seek help,” Kaye said, adding that family members may sweep the substance use under the rug and accept it as a fact of life.
Another factor complicating treatment is what Wellspring Clinical Director Bruce Campbell calls “precontemplation,” which occurs when the user doesn’t think about the substance abuse or recognize its harmful effects, leading to a reluctance to seek treatment. Often it’s a person’s family that ends up initiating treatment.
According to White, the biggest obstacle to addressing the epidemic of substance abuse among older adults is the tendency to neither trust, talk nor feel. Creating an open, shame-free environment is the way to “bring air into the room” and deal with the addiction.
Road to recovery
Rather than simply retire, more and more baby boomers and older adults continue to thrive as volunteers, as nontraditional students and in the workplace. But substance abuse threatens to reduce the value older adults bring to a community.
“Substance abuse takes away from engagement,” White said. “It’s like dropping out of society.”
But an older adult’s substance abuse isn’t a be-all and end-all. “A healthy elder is going to live longer and have a satisfying life,” Kaye said. “The community will benefit from their engagement in keeping a community alive and robust.”
According to Kaye, there’s a prevailing attitude that older adults won’t respond to treatment and that it may be too late for them to change. However, the National Institutes of Health report suggests otherwise. “They have the capacity to benefit as much as any age group from drug treatment programs,” Kaye said. “The difficulty is getting them to walk through the door.”
Though older Mainers lack access to the specialized treatment needed to kick addiction, many resources are available for maintaining a clean and sober life. The Bangor Area Recovery Network provides a safe, substance-free space for Mainers of all ages who have coped with substance abuse.
For others in need of information and advice for talking with their doctor about substance use, the Eastern Area Agency on Aging urges older Mainers to reach out. The UMaine Center on Aging also has information about medication management and safe medication disposal.
Encouraging primary care providers to suggest “ green prescriptions” may be the best option for addressing the causes underlying substance abuse and misuse, Kaye said. A green prescription is a nonchemical alternative treatment, such as regular exercise, diet changes, joining senior centers and support groups, or taking a college class.
“Keeping older adults engaged in social relationships is more effective than medication,” Kaye said.
Protecting older adults from substance abuse requires family, friends and neighbors to be vigilant, because “recovery is a social responsibility,” Campbell said.
Christopher Burns is a BDN intern and University of Maine student.