Substance abuse, aging and baby boomers.

The number of Americans age 50 years or older in need of substance abuse treatment is expected to nearly triple over the next 20 years, from 1.7 million in 2000 to 4.4 million in 2020. These findings were published in 2003 by Joseph Gfroerer and colleagues in the journal, Drug and Alcohol Dependence, based on an analysis of data from the National Household Survey on Drug Abuse. This not-so-pretty picture is not solely due to the aging of the baby boomer generation, which refers to individuals born between 1946 and 1964. (Baby boomers will swell the 50 and over group of Americans from 75 million in 2000 to 113 million in 2020.) The percentage of these older individuals in need of substance abuse treatment will increase from 2.3% in 2000 to 3.9% in 2020. This will require healthcare providers to pay more attention to the treatment of older adults with substance use disorders. It will also increase the costs of healthcare for employers and insurers, since substance abusers have higher than average health care costs and are prone to develop chronic medical disorders with long-term, continued use.

People with substance abuse problems have higher health care costs, but these costs are significantly reduced by treatment. A 14-year study, by Holder and Blose (1992) of 3,729 alcoholics, found that their health care costs decreased from 23% to 55% following treatment. People often don't connect these higher costs directly with substance abuse, since these costs show-up as higher rates of hypertension, liver disease, workplace injuries, and co-occurring mental disorders.

As adults get older, they need to be careful as to how much alcohol they consume. Most adults find that as they age, they can't drink the same amount of alcohol they used to consume, due to a greater sensitivity and decreased tolerance to alcohol. This is because as lean body mass decreases with age, total body water also decreases while fat increases. Since alcohol is water-soluble and not fat-soluble, this change in body water means that, for a given dose of alcohol, the concentration of alcohol in the blood system is greater in an older person than in a younger person. Also, alcohol is metabolized more slowly with age, so the alcohol stays in the body for a longer period of time.

Consumption of alcohol in older adults can trigger or exacerbate serious medical conditions, including high blood pressure, ulcers, liver and heart disease, and diabetes. Adults report poorer memory as they get older, and alcohol can only make this problem worse. Sleep disturbances are made worse by drinking alcohol. Slips and falls, including fractured hips, increase with alcohol consumption. Most problematic may be the mixing of prescription drugs with alcohol, since the average person over the age of 65 takes at least two medications daily. Increased fatigue and drowsiness can occur and serious medical problems can result, even when mixing alcohol with some over-the-counter drugs on a regular basis.

Older adults who abuse alcohol are more likely to misuse prescription medications. The two classes of addictive medications often misused and abused are tranquilizers (known as benzodiazepines) used for sleep or to reduce anxiety. Included in this group of medications are Valium, Xanax, Ativan, and Klonopin. The other major misused and abused medication group is opiates, often used to control pain. Medications that fall into this group include Vicodin, Oxycotin, Codeine, and Darvon.

Small amounts of alcohol can provide some health benefits, but it is important to always add that abstinence is recommended for anyone who: (1) has a history of alcoholism or drug abuse; (2) who is taking certain medications that adversely interact with alcohol; or (3) is diagnosed with certain chronic diseases such as diabetes or congestive heart failure. Studies based primarily on male samples show that consuming one or two drinks per day may reduce the risks of coronary heart disease. However, this cardiovascular benefit may not apply to adults already diagnosed with heart disease. Also, heavy drinking will greatly increase the risk of cardiovascular disease, including coronary heart disease. Research shows that alcoholics tend to misinterpret these recommendations, by in a sense saying "if one drink is good, five drinks must be better!"

Loss of a spouse or loved one can often trigger the misuse and abuse of alcohol and prescription medications. People may drink or turn to medications to deal with both depression and anxiety. As people age, they usually will lose close friends and eventually their spouse, have more medical problems, and decreased mobility. As a result, they will become more isolated. They may turn to drinking and medication misuse when alone, and it may be more difficult to even know there is a problem until they have an accident or medical crisis.

Education and awareness of these risks can go a long way in preventing problems with alcohol and prescription medications. A small percentage of older adults will need help with substance abuse problems, and this percentage will grow as the Baby Boomer generation ages.

Ken Bachrach. Ph.D. is Clinical Director of Tarzana Treatment Centers. His e-mail address is [e-mail]. For more information, contact Patti Moody at 818 654-3995 or visit www.tarzanatc.org.