For the most part, substance misuse among people age 65 and older is under-identified and under-treated. Our health statistics reveal that nationally 43% of this age group consume alcohol, 14% use tobacco, 4% use marijuana, and 2% misuse opioids. 3.5 % of older adults are living with an alcohol use disorder and 1% with a drug use disorder.
Vermont statistics reveal that 25% of older Vermonters drink alcohol at an unsafe level, and this includes 10% that are binge drinkers.
Because so many older adults, about 80%, have one or more chronic medical conditions that are made worse by alcohol consumption and take alcohol-interactive medications; the most prevalent substance use problem among older adults is unintentional misuse.
For example, drinking alcohol and taking prescribed medications for pain, sleep, or anxiety is a high risk for negative medical outcomes. Drinking alcohol while taking alcohol-interactive medications either interferes with the therapeutic effects of the medication or increases the intoxicating effects of the alcohol. 25% of older Vermonters drink at a risk level; this is having three or more drinks in one day.
Older adults are more sensitive to alcohol and less tolerant of it. This is because of the effects of aging on the body, meaning it takes less alcohol to become intoxicated. Most older adults drinking at a risk level or drink while taking alcohol-interactive medications need educational intervention to reduce this risk.
A few older adults, of course, have a substance use disorder and would need substance use treatment.
The good news is that research shows that older adults respond well to educational intervention from health care providers prepared to give this education in a non-judgmental, harm reducing, and person-centered approach. Also, older adults with substance use disorders benefit well from age-sensitive or age-specific addiction treatment. The not-so-good news is that too few health care providers are prepared to provide this educational intervention and too few addiction treatment programs offer geriatric tailored services. The overall result is a critical gap in addressing this problem. Additionally, this situation is made worse by the COVID-19 pandemic because both instances of risky substance use and mental health problems are increasing significantly during the pandemic. The increased social isolation associated with the pandemic is believed to be the primary influence for the increased behavioral health problems, including suicide. Even before the pandemic, only 2% of all adults treated for addiction in Vermont-funded programs were older adults whereas older adults represent 20% of our adult population. The recent data from Vermont’s recovery centers, e.g. the Turning Point Programs, shows them doing a little better with 7 % of the individuals served in these programs are older adults.
The Area Agencies on Aging have done some substance use screening and have participated in the Home Medication Safety Program.
These efforts are helpful but need to be delivered to more older adults. The SASH program does universal substance use screening and alcohol and Opioid use risk reduction.
Aging services in Vermont are making an effort, but this effort needs to be expanded in aging services. And more importantly in primary medical care because this service sees, even more, older adults and are in a position to provide educational intervention regarding the health effects of substance use.
Others can provide this kind of intervention, especially if trained.
Two of the greatest problems challenging the improvement of this situation are stigma and stereotyping older adults as unable to change their use of substances. These attitudes need to be changed and access to substance use services needs to be enhanced for older adults.
Guest Blog Written by Charles Gurney, LICSW, LADC
Substance Use and Aging Specialist
Vermont AHS Department of Disabilities, Aging and Independent Living, and Vermont Department of Health, ADAP Division
Offices at Division of Alcohol and Drug Abuse Programs
State of Vermont Department of Disabilities, Aging & Independent Living (DAIL)