Many people would not consider the Senior population to be especially high risk for developing dependency and addiction to drugs and alcohol. Unfortunately, new data indicates that the number of senior citizens with drug problems is on the rise for a variety of complicated reasons. Understanding senior drug abuse and dependency can help you to be prepared to secure help for your loved one should you suspect a substance problem.
Pain Medications or Opiates
The abuse of prescription painkillers is on the rise in all age groups. In 2010, over 5 million Americans admitted to being prescription painkiller abusers, while nearly double that admitted to having used prescription painkillers inappropriately within the previous year.
Frequently, dependency and addiction start with an appropriately written prescription for an ailment that requires escalated pain management. Examples of this include joint replacement, compression fractures, acute or chronic back pain, fractures, or soft tissue injury related to falls. Each of these is a harrowing condition requiring a pain management plan.
While Americans over the age of 65 only make up 13% of the country's population, they consume roughly one-third of all prescription drugs. Frequently prescribed drugs include medicines like oxycodone (or OxyContin - the long-acting form of this medication), hydrocodone with acetaminophen (Vicodin), oxycodone with acetaminophen (Percocet), and hydromorphone (Dilaudid). These medications can be utilized safely, but if taken inappropriately, addiction can develop.
Seniors’ risk for adverse events related to opiate use is increased due to the maturity and natural degradation of their liver and kidneys. As the body ages, organ function decreases. If an individual has any history of liver injury (say in the setting of alcohol abuse) or kidney disease, these organs' ability to process medications is diminished. If this occurs, toxins are not filtered out of the body at the optimal rate, allowing for more prolonged exposure to the toxin (in this case, opiates). This can result in longer-duration adverse effects such as drowsiness or overdose.
See the links below for further information about opiate dependency and abuse:
- How to Prevent an Addiction to Pain Killers — Helpful tips on how to avoid a painkiller addiction.
- Prescription Painkiller Dependency Warning Signs: What to look for if you suspect your elderly loved one has a painkiller addiction?
- Recognizing and Preventing Prescription Drug Abuse: The National Institute on Drug Abuse provides tips on how to both prevent and recognize prescription drug abuse.
- Safe Pain Management and the Elderly — How to safely manage older adults' pain.
Antidepressants
Antidepressants have assisted millions of people of all age groups in coping with sometimes debilitating conditions, including depression, anxiety, social phobia, panic disorder, and obsessive-compulsive disorder. Medical providers are conflicted on the topic of dependency as it pertains to antidepressants.
Antidepressants do cause withdrawal symptoms when the medication is stopped, especially abruptly. The withdrawal syndrome is a result of physiologic dependency on the antidepressant. In other words, the body has become accustomed to the antidepressant, and if it is removed, symptoms related to its absence will occur.
The withdrawal syndrome is the cause for controversy on whether these medications can be described as "addictive." While opinions are conflicted, there is unequivocal evidence to support that abrupt discontinuation of antidepressants can result in severe symptoms of withdrawal. Withdrawal symptoms may include trouble sleeping, dizziness, nausea, vomiting, diarrhea, mood swings, suicidal ideations, muscle tremors, and difficulty coordinating speech and movement.
Antidepressants require tapering down before stopping the medication; this involves slowly decreasing the dose over time until you completely stop. If tapered correctly, withdrawal side effects are less likely to occur.
There is a growing number of people who believe antidepressants have addictive effects. If you feel that your loved one may have developed a dependency on their antidepressant and are concerned, discuss your concerns with their medical provider and implement the strategies listed below.
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Ensure that the appropriate dose is prescribed. Your loved one may not require the same dose they did in the past. As with all prescribed substances for older individuals, prescription medications should be revisited frequently. As bodies change with aging, dosages may require adjustment.
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If you're concerned that their medication isn't being taken correctly, you may need to control their access. Utilize pre-portioned containers and fill them for them each week.
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If you wonder what “as needed” means, clarify with their provider when exactly it should be taken. Keep an eye on the as-needed prescriptions – if these medications are being refilled frequently, they may be taking more than they should. Again, discuss any concerns with the medical provider.
See the links below for additional considerations for the management of depression:
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Explore alternative and holistic solutions that may help ease your loved one's depressive symptoms.
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Consult with treatment facilities about antidepressant addiction programs, specifically those that cater to older adults, if possible.
- Doctors Overprescribe Antidepressants to the Elderly— AARP investigates the overprescribing of antidepressants to older adults.
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Geriatric Depression — Information about depression among older adults and possible treatment options.
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Going Off Antidepressants — How to safely stop using antidepressants.
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Seniors and Prescription Drug Addiction — Helpful information about seniors and prescription drug abuse.
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Using Antidepressants Successfully (PDF) — Tips for how to successfully use antidepressants without dependency or addiction.
Sleep Medications
According to the National Sleep Foundation, approximately 44% of older adults experience at least one nighttime symptom of insomnia several nights per week. Prescription and over the counter (OTC) solutions have become popular remedies.
About one-third of older Americans take sleeping pills. Prescription sleeping pills come in multiple forms; these include benzodiazepines, non-benzodiazepine hypnotics, orexin receptor antagonists, melatonin receptor agonists, sedative-hypnotics, and antidepressants. Nonprescription sleeping aides include melatonin and valerian root, which can be purchased OTC. Each sleep aide (prescription or not) affects the sleep/wake cycle differently. All sleep aides aim to help individuals get longer and more restful sleep at night.
Barbiturates are sedative-hypnotics and are not frequently prescribed any longer due to their risk for dependency and high potency. In lieu of barbiturates, providers frequently prescribe benzodiazepines or benzos. These, too, have a risk for dependency. Examples of benzos include lorazepam (Ativan), temazepam (Restoril), alprazolam (Xanax), diazepam (Valium), and clonazepam (Klonopin).
There are age-related changes to the body's circadian rhythms that make it more difficult to fall asleep and stay asleep. As mentioned above, the processing of medication is altered by the aging process, increasing the risk of adverse effects for seniors. Older bodies break down and eliminate medications more slowly.
The American Geriatrics Society recommends that older adult's trial non-drug treatment options for their insomnia before trying a prescription drug. The adverse effects associated with prescription sleep aides are significant and are increased with seniors. Frequently experienced side effects include memory alteration, confusion, falls, and disorientation.
See the links below for more information regarding insomnia and sleep aides for seniors:
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Aging and Sleep — Important information from the National Sleep Foundation.
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Sleeping Pill Side Effects — The consequences of using and abusing sleeping pills.
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Sleep Problems and the Elderly — Tips for overcoming insomnia and other sleep issues.
Alcohol Use
Alcohol abuse among the senior population is grossly underestimated. According to a survey conducted by the Substance Abuse and Mental Health Services Administration, approximately 11% of persons aged 65 and older had participated in at least one episode of binge drinking in the month leading up to the survey. Additionally, research from the University of Kentucky indicated that 2.5 million older adults have an alcohol-related problem.
Older alcohol abusers can be divided into two main categories: those who have a history of alcohol use/abuse earlier in life and those who previously did not abuse alcohol but have increased alcohol consumption later in life. The later adopters may have increased their consumption due to life changes associated with this time period. These may include the death of a loved one (or multiple loved ones/friends), retirement (resulting in an altered schedule), health concerns, or medical problems.
Older adults tend to be more sensitive to the adverse effects of alcohol than younger individuals, again due to the changes associated with aging as well as the presence of multiple comorbidities. These individuals are often taking numerous medications, many of which interact with alcohol.
Dehydration is a frequent issue for seniors, and alcohol exacerbates this. Symptoms of dehydration may include loss of coordination and stability with walking, altered mental status, drowsiness, confusion, and headache. Signs to watch for if you are concerned about a loved one's consumption of alcohol include changes in eating habits, failure to maintain personal hygiene, difficulty staying in touch with friends and family, and lack of interest in usual activities. These signs may indicate that your loved one is struggling with alcohol use and may require help.
See the link below for further information regarding alcohol abuse in seniors:
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Alcoholism in the Elderly — Exploring the risks of chronic drinking as a person ages.
References
Reviewed By: Katie Pescatello
Katie Pescatello, RN, MSN, FNP-C Katie Pescatello earned a Master of Science in Nursing from Simmons University, where she also taught pharmacology in the Master's program for several years. She has worked as a nurse practitioner in skilled nursing facilities, outpatient clinics, and hospitals. She is passionate about providing individuals with the tools to make informed decisions. While working as a Hospitalist in several Boston area hospitals, she enjoys writing health content for several online publications, focusing on aging in place and preserving dignity at the end of life. She also acts as a content reviewer for Parentgiving.com.
