Black Studies: Social Issues Alcohol

Black Studies: Social Issues

Alcohol And Drugs Among Elderly

The focus of this work in writing is to examine alcohol and drug use among elderly individuals and specifically in regards to historical information, demographics, culture, strengths weaknesses, current issues and advocacy issues, public policy, options or suggestion for change and other practical views on this area of study.

Numbers and Demographics

" Substance Abuse Among the Elderly Population" reports that 58,000 individuals who were the age of 55 years or older "were admitted to publicly funded substance abuse treatment." (Reach of Louisville, SIG, 2009) In addition it was reported in the work of Brennan & Moos (1991) that "a sizeable portion of elderly people" or approximately 11% to 33% "develop alcohol use disorders with late onset." (Reach of Louisville, SIG, 2009) It is reported that illicit drug admissions for older adults increased between 1994 and 1999 approximately 25% for males and 43% for females in the elderly age population.

Substance abuse treatment admissions for those who are 55 years of age or older has been found to differ very little from substance abuse treatment for younger admissions in terms of the racial and ethnic composition. Both of the age groups were stated to have been:

White -- 60%

Black -- 24%

Hispanic -- 12% (DASIS Report, 2004 in: Reach of Louisville, SIG, 2009)

II. Risk Factors

Stated to be conclusive in risk factors for elderly individuals were those as follows:

(1) being of the male gender;

(2) being socially isolated

(3) being single

(4) being separated or divorced;

(5) Substance abuse earlier in life;

(6) Co-morbid psychiatric disorders (especially mood disorders);

(7) Family history alcoholism; and (8) Concomitant substance abuse of nicotine and psychoactive prescription medicines. (Reach of Louisville, SIG, 2009)

III. Early Onset vs. Late Onset

Early onset is stated to provide a description of individuals who have "a lifelong pattern of drinking, have probably been alcoholic all their life and are now elderly." (Reach of Louisville, SIG, 2009) The individual with early onset consumption of alcohol is one that is more likely to have "...alcohol-related medical problems such as cirrhosis, organic brain syndrome, and co-morbid psychiatric disorders." (Reach of Louisville, SIG, 2009)

Late onset is stated to describe individuals who have for the first time and ate in life have "become alcoholic in their drinking pattern." (Reach of Louisville, SIG, 2009) This is stated to result from stressful life events and to be "generally represented by milder case with fewer accompanying medical problems. Finally, the late onset alcoholic elderly individual is "More amenable to treatment, more likely to have spontaneous recovery, but also more likely to be overlooked by health care professionals." (Liberto & Oslin, 1995, in: Reach of Louisville, SIG, 2009)

IV. Recommendations of NIAAA

Stated as recommendations of NIAAA is that individuals over the age of 65 years of age "consume no more than one drink per day." (2003, in: Reach of Louisville, SIG, 2009) As well, changes in the composition of the individual's body which are due to age result in the equivalent amounts of alcohol consumed producing higher blood alcohol concentrations in older people. (Reid and Anderson, 1997, in: Reach of Louisville, SIG, 2009)

V. Issues

Issues that must be addressed include those as follows:

(1) In 1999, adults aged 55 or older comprised approximately 58 million people in the United States.

(2) The aging of the baby boom generation (those born between 1946 and 1964) will cause that number to almost double by 2030, reaching 108 million (DASIS Report, 2001);

(3) Aging of populations worldwide means that the number of older people with alcohol use disorders is on the increase, and health services need to improve their appropriate screening and treatment methods and services (O'Connell, Chin, Cunningham, Lawlor, 2003);

(4) The baby boom generation has higher rates of lifetime alcohol and drug use than did the previous generation, and evidence suggests that these higher rates will persist as the group ages (NHSDA, 2000). Thus, the need for substance abuse treatment among older adults is expected to increase;

(5) Media attention and public health initiatives tend to focus on younger age groups (Reid & Anderson, 1997);

(7) Social workers who work in the field of addictions lack knowledge about geriatric health and related problems, and geriatric service providers lack knowledge about substance abuse and related problems;

(8) Rates of physical illness among elderly alcoholics are higher than would be expected in a non-drinking population of similar age (Hurt, et.al., 1988).

(9) Saunders et.al. (1991) showed that a history of drinking in elderly men leads to a fivefold increase in the risk of developing a psychiatric disorder.

(10) Prevalence of alcohol abuse is generally higher for elderly inpatients than elderly people in the community (Goldstein, Pataki, Webb, 1996, in: Reach of Louisville, SIG, 2009).

(10) Serious medical disorders among elderly people who misuse alcohol are much more common than among the overall population of a similar age (Hurt, Finlayson, Morse, & Davis, 1988 in: Reach of Louisville, SIG, 2009).

There is likely an underestimation of alcohol and drug use disorders in the elderly population due to the failure to properly diagnose these patients and the failure to detect such disorders. Not only are the elderly less like to relate a history of excessive drug or alcohol use but the problem is further complicated "...by the fact that healthcare workers have a lower degree of suspicion when assessing older people." (Reach of Louisville, SIG, 2009) In addition, healthcare workers are less likely to refer elderly people for specialist treatment. Healthcare workers may perceive alcohol use disorders in older people as being understandable in the context of poor health and changing life circumstances." (Reach of Louisville, SIG, 2009)

VI. Diagnosis

The features of alcohol use disorders which are identified through use of screening questionnaires including CAGE, MAST-G, AUDIT, etc., and which are biophysical screening measures and diagnostic classification systems (DSM) may not be applicable to the elderly due to their changing roles, life circumstances and differing health characteristics." (Reach of Louisville, SIG, 2009) In addition it is stated that the "...presentation of elderly people with alcohol use disorders may be atypical (such as falls, confusion, depression) or masked by co-morbid physical or psychiatric illness, which makes detection more difficult." (Reach of Louisville, SIG, 2009)

Furthermore, it is related that one of the stated criteria for substance abuse in the DSM-IV is recurrent alcohol use in failure to fulfill major role obligations at work" is a criteria that may be quite difficult in its application to older adults "...who are often retired or isolated from frequent social interaction. Stated as another erroneous criteria in the DSM-IV is that of "...giving up activities" as the retired elderly have much fewer activities that are regular and much less in the way of responsibilities to give up. (Reach of Louisville, SIG, 2009)

It is stated to be a "...lack of focus on those elderly people whose drinking pattern, while not fulfilling criteria for alcohol misuse or dependence, may be putting their physical or psychological health at risk. For example, an older person on anticoagulant treatment with a moderate intake of alcohol may be unknowingly putting their health at risk (Reid & Anderson, 1997, in: Reach of Louisville, SIG, 2009).

VII. Use of Illicit Drugs

Facts that are stated concerning the elderly population and their use of illicit drugs in clued those as follows:

(1) Non-alcohol substance disorders in the elderly can be divided into illicit drug abuse and prescription drug abuse.

(2) Although cross-sectional data indicate a low prevalence of illicit drug use among the elderly, longitudinal data from the National Survey on Drug Abuse suggest some interesting trends in geriatric substance abuse. In 1979, when baby boomers were aged 21 to 33 years, 27% reported using any illicit drug in the past month. As these baby boomers age, much larger numbers of older drug users, particularly cannabis abusers, are expected by some researchers." (Reach of Louisville, SIG, 2009)

VIII. Prescription Drug Use

It is related in regards to the elderly population and prescription drug use that individuals who are 65 years of age or older "...consume more prescribed and over-the-counter medications than any other age group. Whereas older adults constitute 13% of the U.S. population, they account for 30% of prescription drugs and 40% of over-the-counter medications sold in this country." (Reach of Louisville, SIG, 2009) It is further stated that more than 50% of all residents at intermediate care facilities were prescribed psychoactive drugs and that 25% of these were prescribed a regularly schedule sedative-hypnotic and a third were prescribed long-acting medications not recommended for use by the elderly population. Furthermore, older adults are stated to be "....more likely to continue to use psychoactive drugs for longer periods than their younger counterparts." ( ) Complicating matters is the fact that 15% of older alcoholic patients also abuse or are dependent on other substances, particularly benzodiazepines." (Reach of Louisville, SIG, 2009)

IX. Treatment

Older adults are stated to be more likely to be referred to treatment than are younger adults and are "less likely to enter treatment through the criminal justice system (DASIS Report, 2001, in: Reach of Louisville, SIG, 2009). Additionally stated is that substance abuse treatment admission rates among adults aged 55 or older "tended to be highest in northern and northeaster states...in 1999. (Reach of Louisville, SIG, 2009 ) It is reported that study findings have demonstrated that the most benefit from counseling and treatment for substance abuse is that which elderly people "may derive most benefit from..." (Reach of Louisville, SIG, 2009 )

X. Case Study Review

The work of Welte and Mirand (1995) entitled: "Drinking, Problem Drinking And Life Stressors In The Elderly General Population" relates that it is shown in research that while "...heavy drinking in the United States is less prevalent among older persons, some maintain or increase heavy drinking. Late-onset heavy drinking is believed to be related to stressors of aging such as retirement or bereavement, particularly when coping resources or social supports are inadequate. This study investigated that relationship." (Welte and Mirand, 1995)

Heavy drinkers were oversampled in this study. Questions included such as "...demographics, drinking quantity-frequency, alcohol dependence/problems, stressful life events, chronic stresses, coping resources and social supports." (Welte and Mirand, 1995) The analyses conducted in this study examined the relationship "between drinking and stress" and states as results that there were "...no bivariate correlation between average alcohol consumption and acute or chronic stress. Logistic regressions with interaction terms show that stress has no relationship to heavy drinking (average alcohol consumption of 2+ drinks/day) regardless of coping style or social supports. Logistic regressions predicting late-onset heavy drinking also produced negative results. Chronic stress was, however, positively related to alcohol dependence and problems." (Welte and Mirand, 1995)

Welte and Mirand (1995) state conclusions which include an argument that the treatment and prevention programs for the elderly should focus on other than the simple assumption that "life stresses are a direct cause of drinking, although they may exacerbate consequences of drinking.: (Welte and Mirand, 1995)

Welte and Mirand (1995) state the existing need which is great for coordination of education relating to health problems of the elderly and specifically as associated with substance abuse. Specifically, it is noted by Welte and Mirand (1995) that

"...if social workers in the field of addictions provided education about substance abuse issues and interventions to the geriatric service providers who frequently work with elderly people, such as the visiting nurse, staff of hospital emergency wards, and social service outreach workers, then perhaps the appropriate interventions would be used by these service providers. Same for the training of social workers in addictions. Learning about geriatric health and related issues are paramount when developing an intervention." (Welte and Mirand, 1995)

The work of Adams (1996) entitled: "Alcohol Use In Retirement Communities" reports two studies conducted previously that indicate that there is a high prevalence of heavy drinking in retirement communities. The study reports the objective of providing either verification or refutation this findings as well as to identify "characteristics associated with heavy drinking in retirement communities." (Adams, 1996)