Drug Abuse

Drug abuse or misuse is seen in people of any age, sex, race, nationality, or socioeconomic class. Among older adults.

Abuse, Prevention, Addiction

The problem is often with inappropriate use of prescription or over-the-counter medications. Commonly misused drugs include sedatives, hypnotics, pain relievers, diet aids, decongestants, and a wide variety of over-the-counter medications. Many medications used by older adults can lead to tolerance (see below), withdrawal syndromes, or harmful medical consequences. Medical problems from misuse can include

mental changes, kidney disease, liver disease, and injuries from falls.

Tolerance develops when the body needs a higher dosage of drug to get the same effect. Over time, the body adapts to each higher dosage, creating a vicious cycle of needing more and more drug while getting less and less effect. Tolerance can develop to many kinds of drugs, some of which can become addicting (eg, anti-anxiety drugs and sleeping pills).

The drugs most likely to be abused by older adults include anti-anxiety drugs, oral narcotics (eg, codeine), and sleeping pills. However, abuse of illegal drugs (including marijuana, cocaine, hallucinogens, and intravenous narcotics) has also been reported among older adults. Some older adults have lifelong histories of addictive behavior, while others have never had a drug problem before. Many people with drug addiction also have another problem, such as a major psychiatric illness. Addiction to more than one drug is also common.

Many older people with chronic pain avoid taking effective medications in adequate doses for adequate periods of time because they are afraid they may become addicted. It is important to keep in mind that under treatment of pain is a significant problem, and that true addiction does not often arise in this situation.

Identifying drug abuse

 
Older people who are addicted to medication rarely admit it. Instead, they exhibit various signs and symptoms that may be related to the substance abuse, including the following:

• anxiety (eg, from tolerance or withdrawal)
• memory loss
• depressed mood
• agitation
• falls
• changes in blood pressure
• pain in the upper abdomen
• fatigue
• sleep disturbance
• appetite and weight loss
• weakness
• confusion

Addicted individuals commonly show drug-seeking behavior by visiting several doctors, getting several copies of the same prescriptions, and then filling them at different pharmacies. 

 

Most people who abuse drugs (or alcohol) experience the psychological symptoms of denial, minimalization, rationalization, defocusing, and enabling. Denial of addiction can sometimes be extreme, to the point that the person denies even taking any drugs. In less extreme circumstances, the person might minimize the amount of drug taken or the effect that the drug is having on his or her behavior and life. In rationalization, addicted people come up with reasons other than addiction for their drug use. Older adults commonly blame their physician for prescribing the medication. People addicted to medications also try to focus on other reasons why they need a "boost," such as problems in their marriage of a major medical illness.

Just like in alcohol abuse, family and friends may unconsciously support the behavior of the addicted person. These "enablers" may also show the symptoms of denial and rationalization, and try to focus the discussion away from the addiction.

Blood or urine tests can sometimes identify drug misuse or abuse. Urine drug screens can be used to identify traces of illegal drugs or to monitor recovering addicts. Blood or urine tests can also be used to measure the level of prescribed drugs in the body, to see if misuse or tolerance has developed.

Withdrawal Drug addicts experience withdrawal symptoms similar to those experienced by alcoholics. Withdrawal symptoms vary from drug to drug, but can include shaking, sweating, feeling hot or cold, delirium, convulsions, and acute heart problems. Just like with alcohol withdrawal, the symptoms of drug withdrawal are possibly life-threatening and must always be monitored closely by a physician. 

Treatment and prevention
The treatment for drug addiction is similar to that for alcoholism, with detoxification and rehabilitation phases. Detoxification usually requires hospitalization, where constant supervision can prevent the person from "sneaking" in drugs. Detoxification is a slow process, sometimes taking 8-10 weeks. After detoxification, symptoms of other illnesses should be treated. Frequently, other symptoms decrease on their own once the drug abuse is addressed. 

Often, drugs are needed to treat withdrawal symptoms or to act as substitutes for the abused substance. For example, methadone can be used to wean people off of narcotics. This drug substitutes for the narcotic, without providing the "high" that drives the addiction.

All addictive medications are usually stopped once detoxification is completed. If the person needs treatment with narcotics for severe pain, such as from surgery or injury, they are given only under controlled circumstances and usually only in the hospital.

People should be encouraged when they have made progress in cutting down their drug use, even if they haven't been able to completely stop it. This may be particularly important for some types of medication misuse, such as overuse of anti anxiety drugs.

Rehabilitation
As in recovery from alcoholism, recovery from drug addiction is considered an ongoing process rather than a cure. Rehabilitation programs for drug addiction include Alcoholics Anonymous, Rational Recovery, and Narcotics Anonymous. Older adults with drug problems often feel more comfortable participating in programs like AA, even if their addictions do not include alcohol because they are more likely to relate to the people who attend AA meetings than to the typically younger people who attend Narcotics Anonymous or other community programs for drug addiction. 

Also as with alcoholism, family members should be counseled regarding the process of addiction. A discussion of their roles as enablers should be part of treatment. 

One focus of rehabilitation among older adults is managing time. Keeping busy is important, both to reduce the free time available for drug-seeking behavior and to remove boredom that can increase the risk of relapse. Day programs and senior centers can be helpful. Supervised living arrangements (eg, halfway houses, group homes, nursing homes, and living with relatives) should also be considered.

Prevention The best methods of prevention involve education along with the careful use of drugs that have the potential for misuse or abuse. Medication use among older adults should be monitored carefully. Older adults taking drugs that might be abused should visit their healthcare provider regularly (eg, at least every 3 months) for monitoring symptoms and medication use.