Boomers, Older Adults, and Addiction Treatment

Unique Treatment Challenges Posed by Elders

A new frontier is opening in the world of addiction recovery. The population of those seeking treatment is getting older, with increasing numbers coming from the baby boom and even earlier generations.

One example of this increase can be found in southwest Florida at Hazelden in Naples, a part of the Hazelden Betty Ford Foundation.

"Last year, 40 percent of our population, in all programming, was 50 years and older," said Brenda Iliff, executive director of the facility. "As of today, we're at about 44 percent, so the numbers are continuing to grow. This shift is literally changing the face of our facility. At least once a week, clients will stop me to say that they came to Hazelden in Naples because of the special boomers programming. And I recently overheard a rare complaint—a young adult male in our residential treatment program was commenting to staff that he was having a hard time finding peers his own age to connect with."

The ripple effect of these changes is resulting in adjustments to treatment protocol—both in mindsets and in the applied treatment approaches.

"In our training and workshops, we are exploring new ways of sensitizing our team to the unique physical needs of these patients," said Iliff. "This may involve donning glasses that distort their vision but actually mimic the various conditions people may experience as they age, or putting on heavy gloves to understand what it feels like to complete tasks with arthritic or stiff hands. Also to accommodate some physical concerns, we have a relationship with a home health care agency that can assist with Activities of Daily Life (ADLs) if someone needs assistance during their first few days of treatment."

What's Causing the Increase in Addiction Among This Population?

The increased accessibility to prescription medications has resulted in a medication generation and has contributed to the opioid epidemic across our country. According to recent studies, the use of hydrocodone, a narcotic painkiller, increased by 52 percent from 2007 to 2015. Carol Collaran's and Debra Jays' book, Aging and Addiction, shows that the generations of boomers and older adults consume one-third of prescription drugs in the U.S. and purchase three-fourths of all over-the-counter medications. In addition, 83 percent of people over age 65 use prescription medications.

However, for some in this group, the reality of addiction may have caught them by surprise. A primary factor in this age group is the decreased ability of the body to metabolize medications or substances and to rid itself of toxins. People who have had a drink or two each evening for several years may now be faced with the symptoms of addiction.

Early- and Late-Onset Addiction

A key indicator in defining addiction and determining the appropriate treatment option is whether the individual struggling with addiction falls into the early-onset group or the late-onset group.

"The first group is the early-onset group and includes about two-thirds of all alcoholics or addicts—those who have been addicts or alcoholics most of their lives," said Iliff. "We see more men in this group and more severe consequences—medical, cognitive, legal, and social. These individuals may have had problems on and off throughout their lives and may even have had long periods of recovery, but in all cases there were signs of addiction concerns early in life."

Because of the longer history of the addiction, the symptoms of early-onset addiction may also be more severe, including minimal to significant cognitive loss and/or a higher incidence of impulsiveness or aggressiveness.

The second group is late-onset addicts. While there may have been no indication of a problem earlier in life, the individual may have come through a "perfect storm" of events that led to a loss of control. In addition to significant metabolic changes and access to medications, other factors may include loss of structure or relationships, acute loneliness, surgery, chronic pain, depression, or anxiety. Alone or in combination, these factors could contribute to the onset of addiction.

"These are people with substance use disorders who we refer to as 'accidental addicts,'" said Iliff. "When a patient learns about late-onset addiction and hears the term 'accidental addict,' the shame decreases, and they realize they are not alone."

"In this late-onset group, we see more women than men, higher education or economic levels, more emotional losses, shame, and grief, but fewer medical complications," continued Iliff. "In general, this group is more receptive to treatment once they get treatment. They may, however, be harder to identify."

Recovery@50 Plus Program

The Recovery@50 Plus program at Hazelden in Naples is specifically designed for those in today's active baby boom generation and older.

"As we expand to meet the needs of our population, we are focused on providing the best care possible," said Iliff. "With the majority of our clients living full lives and using their insurance, we continue to move from a perspective of 'programming' to the mindset of 'What does the client need?' and 'How can we help?'"

One of the motivating factors for older adults is the importance of thriving and living independently. And for the majority of boomers in treatment, their individual plans may need to be tailored to provide the appropriate level of care while accommodating the demands of their lifestyle. This may involve adjusting the treatment schedule to accommodate a full-time job or caregiving responsibilities.

"Working with the boomer, family, health care provider, and support people can be key in recovery and relapse prevention," said Iliff. "Make decisions before treatment ends about 'next steps' and what to do in case of lapses. There are case management services that support people in ongoing recovery through many organizations."

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