Information for Doctors & Employers:
The Chemically Dependent Older Adult
In the last decade there have been growing concerns within the chemical dependency field about the status and direction of services for older adults. This interest can be attributed to the increasing age of the Baby Boomer population, the amplified need of older adult chemical dependency services, and the rising clinical belief in specialized treatment for older patients with chemical dependency.
Regarding substance abuse among older adults, recent literature has described this problem as a hidden epidemic. The difficulty in assessment, diagnosis, and referral amongst this population, coupled with the shortage of services available for older adults prevents this issue from getting the attention it deserves. Further, there have been few empirically-based studies leaving most statistics shrouded in estimation and under reporting.
Older adults are a subset of the US population who are entering the age range of fifty years of age and older. Whereas some studies use the cut off of 55, and others 65 years of age, the predominant age used in the literature is fifty years old. This is due to the greater number of commonalities and/or characteristics persons aged 50-64 share with the 65-plus age group compared to 40-49 year olds.
In 2004 there were approximately 35 million adults over the age of 65 in the United States. By the year 2030 this population will represent 20% of the total US population. Baby Boomers, those born between 1946 and 1964, are the largest age group represented in the U.S population. Based on estimations from the literature, approximately 15-20% of the current older adult population, or approximately 2.5 million people, suffer from alcohol and/or drug problems. Baby Boomers, with their past experience with alcohol and drug use as children of the ‘60s and ‘70s, have become a unique population within the chemical dependency field. As they near older adulthood there has been speculation that the need for age-specific services will increase.
Despite the limited research, older adults have been shown to benefit from treatment and possess several factors that aid them in relapse prevention and treatment adherence. A variety of treatments have been found to work exceedingly well with older adults including cognitive behavioral therapy, encouragement-based therapy, and social support. This group’s greater financial security and good support systems help prevent relapses.
However, older adults are also subject to age-specific risk factors such as dementia, isolation and chronic illness. There is still a question among researchers and clinicians whether treatment needs to be delivered in age-specific or mixed-age groups.
By far alcohol has been the drug of choice for the older adult population in the last decade. It is also the primary focus of the majority of older adult substance use research. However, in recent years there has also been a growing subset of drug users among the older adult population, largely due to their prior use during their teen years, as well as their familiarity with drug culture and the increasing availability of illegal substances. Average substance use rates amongst older adults are: 10.2% drugs only, 85.8% alcohol only, and 4% dual-use illicit substances. This trend in substance preference can be found and supported in the literature.
Despite the obvious need for treatment, older adults are often underrepresented in treatment settings. As of 1998 only 7% of admissions to publicly-funded substance use programs were age fifty and older. This could be due to the scarcity of programs that offer specialized treatment for older adults. Less than one in five of the current substance abuse programs in the US offers age-specific programming. In one study by Schultz, Arndt, & Liesveld (2003), 13,749 substance-abuse facilities were surveyed and of these, only 17.7% (or 2,374) reported offering services that were specific to older adults. The authors also found that even with some agencies offering age-specific services, there was still no correlation between the total population of persons age 65 and older in a state and the number of age-specific services offered in that state. This paucity of services within the chemical dependency field may act as a barrier to referral, leaving physicians and clinicians with no referral resources after intake and diagnosis.
There is a tidal wave approaching the United States in terms of older adult chemical dependency needs. Providers and researchers need to address all stages of substance use treatment beginning with motivation to seek treatment, diagnosis, assessment, referral, gender differences in risk, and after care. Each stage offers an inlet into recognizing and addressing the differing needs of the chemically dependent older adult as a unique and complex population.
Currently, Residence XII offers a specialized clinical track for older adults in our Residential Treatment Program. This valuable set of classes is lead by our Senior Specialist Greta Kruger, who has been working in the field of chemical dependency for over 20 years. Included in the curriculum are topics that address issues pertinent to older adults such as grief and loss, spirituality, and beginning recovery later
in life.
If you have any questions or comments, please feel free to contact Allison Kristman-Valente, BS, MSW, our Research Coordinator. References used in the above article are available upon request.