Mindfulness-Based Recovery for Alcohol Abuse in Elderly Adults

Introduction: Substance Abuse in the Elderly

The increase in substance abuse among people over 60 years of age is understandable from several perspectives. The Baby Boomer generation grew up in a society that was experimenting with controlled substances and in, or on the margins of, a culture that viewed the use of drugs as normative. Indeed, much of the rhetoric about drugs and alcohol emphasized that these substances could enhance life experiences, provide deeper insights into one's life—transcendence, if you will—and ease the suffering brought about by life transitions and everyday pressures. This generation found self-medication for personal angst and genuine disorders such as depression or post-traumatic stress syndrome acceptable.

While many life challenges are universal and do not occur in higher percentages according to particular demographics, other challenges are clearly linked to demographic factors. People in their 60s and beyond do experience an uptick of physical and emotional challenges, and often must also deal with diminished resources with which to address those challenges. In addition to age-related problems, significant life transitions may result in emotional shifts with the potential to influence the ability of elderly people to cope with stress. Depression, loneliness, social isolation, and diminished cognitive capacity can signal increased use of controlled substances. In particular, a substantive rise in the excessive consumption of alcohol to deaden the experience of actual or perceived suffering is now observed in elderly people.

The Perfect Storm: Three Contributing Factors

The three legs of this "perfect storm" of alcohol abuse in the elderly—although certainly more complex than this brief model—can be conceptualized for purposes of discussion as follows:

New research using a version of cognitive therapy referred to as Mindfulness-Oriented Recovery Enhancement (MORE) has been shown to assist patients at risk for opioid misuse to redirect their attention toward natural rewards. For example, study participants in the MORE intervention were taught to use mindfulness meditation to direct attention to the sensory features of a pleasant experience, image, or object. The study participants using the MORE approach showed greater attention to natural, emotionally salient images than to neutral images. Attention to images was measured through brain activity (late positive potential, or LPP), with greater LPP responses associated with self-reported reduced craving for opioids.

Mindfulness-Oriented Recovery Enhancement and Natural Rewards

The basis for this research is that people who are dependent on drugs exhibit decreased behavioral and brain reactivity to naturally occurring rewards when compared to people who do not use drugs for mood enhancement or stress reduction. Indeed, people who use drugs tend to increasingly devote their energy and attention to obtaining drugs, and in the process, shut out opportunities to respond to naturally occurring rewards.

The generation of people commonly referred to as "Boomers" may be particularly open to the use of mindfulness and meditation as a means to deal with the emotional, physical, and social drivers of their abuse of alcohol. Cognitive behavior therapy (CBT) has been shown to be an effective approach to mediating undesirable behaviors, and the MORE approach has demonstrated promise with people who misuse opioids. One hypothesis that emerges from consideration of the MORE research follows.