Older women & substance abuse: there are no age limits when it comes to substance abuse. Girls as young as 10 or 11 can be found in treatment centers, as can women in their 70s and 80s.

"Addiction among older women is hidden in their own shame, swept under the rug of denial of family members and lost in the shadows of medical practice," says Susan Foster, director of policy research for the National Center on Addiction and Substance Abuse (CASE) at Columbia University in New York City. "We aren't looking for the problem, and we don't recognize it when it stares us in the face."

Neither do doctors. A two-year survey of 400 primary care physicians found that less than 1 percent even considered a substance abuse diagnosis when typical signs of alcohol or drug abuse in older women were described to them. Instead, they were more likely to diagnose women with depression and prescribe medications that could aggravate any existing substance abuse. (23)

"Symptoms of substance abuse in mature women are attributed to other conditions such as anxiety or depression, hidden by women who are in denial, ashamed or afraid of being labeled a 'junkie,' and tolerated by friends and family who let granny have her tranquilizer because it makes her feel good and easier to be around," says Linda Simoni-Wastila, PhD, director of the Lamy Center on Drug Therapy and Aging at the University of Maryland in Baltimore.

In older women, the most commonly abused or misused substance is not alcohol, but prescription drugs, primarily pain relievers and sedatives. More than one in 10 women 50 and older say they've used prescription drugs for nonmedical purposes, with women 65 and older slightly more likely to have misused legal drugs than men. (1,24) Meanwhile, a CASA survey conducted in the late 1990s found that as many as 2.8 million mature women may be abusing psychotropic drugs (mood-altering drugs such as sedatives), 44 percent of the nearly 6.4 million women for whom such drugs are prescribed. (23)

Part of the problem is that older women are more likely than men to be prescribed potentially addictive prescription drugs like pain relievers and sedatives, notes Dr. Simoni-Wastila. "Simple misuse, however, can easily progress to abuse and dependence if a woman continues to use a medication non-therapeutically for the desirable effects it provides," she says. (5)

Unfortunately, many women misusing prescription drugs are also abusing alcohol. One study found that 53 percent of older female alcoholics said they were "unable to keep from using" tranquilizers, compared to 23 percent of their male counterparts. (25) Plus, about half of all alcohol addiction in women begins after age 59, notes Ms. Foster, compared to about a quarter of all cases in men.

The consequences of prescription misuse and abuse differ between elderly women and their male counterparts, says Dr. Simoni-Wastila. "Older women are more susceptible to the cognitive impairment and sedation associated with most abusable prescription drugs," she says. "These issues, in turn, can increase risk for falls and other injury, depression and suicide, and increase risk of dangerous interactions with alcohol and other drugs. Prescription misuse and abuse can also needlessly rob an elderly woman of a quality of life in her golden years."

Yet while older women are more vulnerable to the addicting effects of alcohol and drugs, they're significantly less likely to receive or even look for treatment, says Ms. Foster, with less than one percent of older women who need help receiving it.

"Older women often don't tell their health care providers that they may have a substance abuse problem (if they recognize them as such), because this generation has a large stigma attached to both abuse and mental health issues," said Dr. Simoni-Wastila. "And providers may not recognize symptoms and signs of prescription abuse in older women, because they attribute them to other things, such as mental health issues, side effects of drugs or dementia. There is a pervasive impression that older folks, regardless of gender, are too old to need treatment."

For more on prescription drug misuse in older women, see "Ask the Expert" on page 7.

References

23 National Center on Addiction and Substance Abuse. Under the Rug: Substance Abuse and the Mature Woman. 1998. www.casacolumbia.org. Accessed Dec 1, 2006.

24 Ray, WA. Psychotropic drugs and injuries among the elderly: A review. Journal of Clinical Psychopharmacology, 12(6), 386-396.

25 Gomberg, ESL. Factors for drinking over a woman's life span. Alcohol Health and Research World, 18(3), 220-227.