Alcohol Abuse and Dependence Among the Elders

Benshoff, John J. & Laura K. Harrawood, Darwin Shane Koch. (Apr-May 2003) "Substance abuse and the elderly: unique issues and concerns." Journal of Rehabilitation. Journal article retrieved from Find Articles Health & Fitness database on 25 Oct 2005 athttp://www.findarticles.com/p/articles/mi_m0825/is_2_69/ai This article by John J. Benshoff, Laura K.

Harrawood, and Darwin Shane Koch entitled "Substance abuse and the elderly: unique issues and concerns," attempts to understand why alcohol abuse amongst the elderly (defined as individuals over the age of 65 for the purposes of the article) has gone largely ignored in issues pertaining to rehabilitation and the field of geriatric medicine. The article also attempts to gain inkling upon the scope of the problem of substance abuse in the elderly population.

The article admits while "various sources of data suggest that alcohol problems are ordinary events, but largely unrecognized in this population, and estimates of the prevalence of heavy drinking or alcohol abuse range from 2% to 20% for this population," a strikingly and unhelpfully wide range for individuals involved in the field of substance abuse treatmentand prevention. (Benshoff, Harrawood, Koch, 2003, p.1) The article concludes that there is virtually no hard data exist to quantify drug use, abuse, and dependence patterns amongst the elderly.

However, the sheer size of this population means that the size of potential problems for society and families can only grow, given the elderly's longer lifespans in the age of modern medicine. Also, the current generation of elderly has been more exposed to drugs and alcohol, at earlier times during the collective maturing process of the 'baby boomers.' This means that there may be a higher rate of long-term alcoholics and drug users, with more ingrained health problems that the health care system must deal with in the future.

Article Summary Several reasons have been suggested for the lack of information and attention about alcohol abuse in the elderly. Drug abuse and dependence research tends to be driven by the federal agenda to limit crime, causing a focus on younger populations who deal as well as use drugs. The media also tends to focus on education of young people, as a preventative technique.

While this is commendable, it cannot be ignored that drug use appears to negatively affect the health of the elderly at a higher rate than other populations. "Data suggest detrimental drug reactions occur 3 to 7 times more often for older adults." (Benshoff, Harrawood, Koch, 2003, p.1, citing Crandall, 1991). 12% to 17% of acute hospital admissions for adverse drug reactions occur in the elderly population (Benshoff, Harrawood, Koch, 2003, p.1, citing Crandall, 1991). Also, yesterday's young users have become today's elderly.

"Two-thirds of elderly individuals with alcoholism problems are early onset drinkers" and individuals who survive the rigors of alcoholism problems in earlier life often have significant mental and physical health complications Yet the focus of law enforcement, treatment, and the media remains on popular illicit drugs, often to the exclusion of other drugs and other drug related behaviors.

(Benshoff, Harrawood, Koch, 2003, p.2) The elderly do not fit the traditional profile of illicit drug users, as they often turn to the legal drug of alcohol, even if they used illicit drugs earlier in life. This is called 'aging out' into alcoholism. (Benshoff, Harrawood, Koch, 2003, p. 1) Abuse of prescription drugs, which can be mixed with alcohol is another way the elderly can abuse narcotics. "Extensive data exist about prescription and over the counter drug use by the elderly.

Although elderly individuals make-up 12.4% of the population, they consume 25% to 30% of all prescription drugs (Benshoff, Harrawood, Koch, 2003, p.1, citing Ondus et al., 1999). However, far less reliable data exists in terms of how unnecessary or problematic this use might be. Personal Thoughts At times, the authors of this article seem to make assertions to 'protect' the elderly population they are describing, with little support for their conclusions.

Despite increased publicity about prescription drug abuse and misuse in society overall, they assert intentional abuse of prescription medications to get high amongst the elderly population is thought to be rare. Then, in their next paragraph the authors admit overuse does occur among the elderly population. "Often this over-use is related to multiple chronic health conditions being treated by several physicians. For example, an individual may be seeing a family practice physician for general health needs and specialists for specific diseases or illnesses.

If these physicians are not communicating, the patient can be over-medicated and end up in serious difficulty." (Benshoff, Harrawood, Koch, 2003, p.1) However, the use of multiple doctors to obtain prescription drugs, or the mixing of such drugs with alcohol for an intentional effect goes unremarked upon.

In fact, perhaps out of concern for the poor and elderly who may skimp on health care costs, whom the authors do not wish to show in an unflattering light, they note that "a more common adverse drug event among elderly persons who are poor is the under use of medication. ." (Benshoff, Harrawood, Koch, 2003, p.1) But might some of this underusing population also use the cheaper 'medicine' of alcohol to self-medicate their physical and psychological complaints? This critical question is unasked.

While the problem of unintentional over or undermedication may be extant in the elderly population, this does not mean that some elderly patients may not also use prescription drugs, with or with alcohol to self-medicate, or use prescribed drugs in a self-medicating fashion -- in a way that he or she may not wish to admit to him or herself. This attempt to deny one's addiction is characteristic of the nature of addiction in both young and elderly populations.

The authors bring up the potential for self-medication amongst the elderly with alcohol, noting that late onset abusers of alcohol, who did not use alcohol earlier in life "typically are individuals who begin their substance abuse after 65 usually in response to a negative life situation or event such as retirement, death of a spouse, decline in status in the community, or health setbacks." But the use of alcohol to treat such complaints to the point of abuse in a way that is easy for society to ignore is mentioned, but not fully explored outside of the causal factors for alcohol abuse.

(Cited by Rigler, Benshoff, Harrawood, Koch, 2003, p.2) The article, because of the variety of the data it cites, tends to waver about its ability to make either sweeping or specific conclusions about the extent of the problem, despite the article's stated purpose, and tends.