Age and addiction

DEFINITION: There is no age limit for addictions. Babies are born addicted to the illicit drugs and prescription medicines that their mothers abused while pregnant, and addiction to a wide range of substances and behaviors is endemic among teenagers and young adults. Although not as widely recognized, older adults may also have addictions.

A Hidden Problem

In the early twenty-first century, the proportion of admissions to substance abuse treatment programs of people over fifty-five increased from 3.4 to 12 percent by the 2020s. While the majority of these admissions were for alcohol abuse, that proportion declined slightly, while the proportion of admissions for substances like cocaine, marijuana, heroin, and other opioids went up. Some medical professionals in the early 2000s predicted this increase. They asserted that the number of older Americans needing substance abuse treatment was predicted to increase as the baby boom generation aged and substance use patterns changed. However, the increase was only predicted to reach 4.4 million by 2020, which was far exceeded. Overall, around 6.5 percent of American adults over twenty-six are estimated to have a substance abuse disorder.

The scope of the problem of addiction among older adults is not clear, largely because many cases go unreported. In addition, older adults and their families often deny the problem. For example, family members might excuse an older relative’s gambling addiction as a harmless hobby, or they might argue that heavy alcohol use is an entitlement for a relative after a long, hard life. Also, many older people rarely admit they have a problem. They rationalize that they are experienced, wise, and able to handle any situation. This way of rationalizing is especially true for people addicted to prescription medications. The symptoms of addiction are often less evident in older people than they are in younger people. For example, many older adults addicted to alcohol or drugs indulge at home, so they are less likely to drive a vehicle and to risk arrest while intoxicated. Also, many older persons live alone, making it difficult for others to notice problems with drinking or with drug abuse. Furthermore, many older persons are retired, so common determiners of addiction, such as work absenteeism or poor job performance, are poor determiners of addiction.

Addiction in older adults often goes unrecognized, even by health professionals. Symptoms of addictions are mistaken for diseases common to old age, such as high blood pressure, dementia, stroke, Parkinson’s disease, and sleep disorders. Moreover, most of the medical and psychological screening tests for addiction are designed for younger people, making the tests inadequate for older adults.

Similar increases in patterns of substance abuse and addiction were observed for young, teenage, and adult individuals in the early twenty-first century. In young adults and adolescents between thirteen and fourteen, the use of illicit substances increased by 61 percent between 2016 and 2022. Many experts assert this age group is at an exceptionally high risk concerning drug use and addiction because the earlier a child tries a drug, the more likely they are to become addicted to it later in life. Ensuring young individuals are not exposed to harmful substances at this age is critical to preventing addiction in society rather than trying to treat it.

In general, individuals between eighteen and twenty-five experience the highest rate of addiction. They may have struggled with substances or behaviors for many years but finally address it at this age. Others recognize their addictive behaviors when they are between eighteen and twenty-five but do not address them for ten or twenty years. Some individuals in this age range begin addictive behaviors as a result of life stresses like leaving home to go to college, renting an apartment, finding a work-life balance, and financial struggles. Alcohol and drugs are a tempting escape from these pressures and are often abused.

Substances and Behaviors

Using a working definition of addiction as “a physiological or psychological dependence on a substance or behavior to the extent that its withdrawal causes extreme distress to the user,” addictions in older adults are the same as those in younger people. However, two substances, alcohol and prescription medications, and two behaviors, gambling and watching television, appear to be particularly troublesome for older adults.

Alcohol is the drug most often abused by older adults. A 2017 study published in JAMA Psychiatry found that 55 percent of Americans over sixty-five had drank in the past year, and, more notably, that 3.8 percent of them engaged in "high-risk drinking"—a 65-percent jump over the period of the study, which was from 2001 to 2013. In many cases, alcohol addiction leads to other problems. Older adults addicted to alcohol are three times more likely to already have or to develop another mental disorder.

Prescription medications rank as the second most commonly abused substance among older adults and include sedatives, antidepressants, sleeping pills, and pain relievers, especially the narcotic analgesics. The National Institute on Drug Abuse (NIDA) reported that people aged sixty-five years and older received over 30 percent of all medications prescribed by doctors in the United States, yet this group makes up less than 15 percent of the US population. According to NIDA, some 18 percent of adults aged sixty years and older abuse prescription drugs. Older adults take prescription medications three times more frequently than the general population and are more likely to disregard dosing directions, often choosing to self-medicate instead. To compound the problem, NIDA reported that, in general (for some drugs), older adults receive prescriptions with higher doses and with longer dosage times than younger adults receive.

Gambling has become a popular pastime for older adults. In one survey, 73 percent of study participants said they had engaged in some form of gambling in the previous year. Studies have revealed that throughout North America, about 4 percent of all adults who gamble are addicted to gambling, about the same percentage as older gamblers. However, considering that the older adult segment is the fastest-growing segment of gamblers, the actual number of addicted gamblers (known as pathological gamblers) is greater than ever. Researchers in New Jersey found that 4 percent of gamblers age fifty-five years and older are problem gamblers and that 2 percent are pathological gamblers. Nearly 11 percent of persons aged sixty-five and older in primary care facilities in Pennsylvania are at-risk gamblers. In Missouri, 4 percent of participants in that state’s compulsive gamblers program are older than age sixty-five years.

Television watching, too, can become an addiction, according to many mental health professionals. Most older adults watch television regularly, more so than any other age group. For many older adults, especially those living alone or with limited mobility, television is a companion, and watching television is an activity that helps them cope with their problems. Watching television is considered an addiction when a viewer cannot stop watching at a chosen time, when they want to but cannot watch less when they complain that watching replaces other activities and takes up too much time, and when they are uneasy and experiences withdrawal symptoms when not watching for a time.

Age-Related Factors

Some adults carry an addiction into their later years. Most baby boomers with an addiction to illicit drugs, for example, continue a pattern of abuse that began for them in the 1960s and 1970s. However, not many individuals with substance use disorder live to old age because of the devastating physical effects of lifelong addiction.

Other adults switch addictions when they get older. Studies of the chemistry of addiction are helping to explain why some people and not others become addicted. A seminal study prepared for the National Academy of Sciences in 1983 identified certain personality traits that can contribute to the onset of addiction. A person with an addictive personality, for example, might have been addicted to heroin when young but may have switched to prescription drugs later in life.

Other adults become addicted only in their later years. Many older persons turn to substances and behaviors that become addictions as a way to cope with growing older. The factors that contribute to addiction at any age are complex, but certain circumstances and elements are unique to older people.

In general, as people reach their sixties, they are more vulnerable to compulsive behaviors such as gambling. Older people experience many more types of loss than do younger people—loss of physical and mental capabilities; loss of older family members, of spouses, and of friends in the same age group; loss of earning power; and loss of status in society, especially following retirement and particularity in a society that reveres youth. Older adults deal with more serious medical conditions, such as heart disease, Parkinson’s disease, hearing loss, and dementia. Following retirement, many people are unsure how to spend their time and are unaware of social opportunities and community resources. Boredom and loneliness plague many older people.

The consequences of addiction are, in many cases, more serious for older people than for younger people. The aging body processes substances differently than the young body. The level of alcohol or drug use, for example, considered light or moderate in the younger body, is often dangerous to the organs and systems of the older body. Recovery from substance abuse takes longer in the older body. Older people, on average, are more likely to be taking more medications than younger people and, thus, risk serious problems when combining medications with alcohol or illicit drugs. Finally, financial losses are more difficult to recoup for persons, such as older adults, who often live on fixed incomes.

Addiction affects a person’s self-esteem, coping skills, and relationships, which, when combined with the other losses common in later life, can lead to other serious mental illnesses. Clinical depression, although not specifically a disease of age, afflicts many older people. The link between clinical depression and addiction is well established.

Treatment for addictions in older people is similar to treatment for younger people, with the exception that most older individuals receive treatment for co-occurring disorders (two or more diseases present at the same time). On the positive side, health professionals report that once older adults enter treatment, they achieve greater success than any other age group.

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