Addiction and Recovery for Older Adults

America's older generations are increasingly at risk of developing substance use disorders. Listen in as Brenda Iliff, executive director of the Hazelden Betty Ford treatment center in Naples, Florida, joins host William C. Moyers to discuss the growing prevalence of addiction among older adults.

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0:00:16 William Moyers
Hello and welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on issues related to substance use prevention, research, treatment and recovery from addiction to alcohol and other drugs. My name is William Moyers I'm your host for today and I've worked for Hazelden Betty Ford for the past 23 years. But before that I was a patient in 1989 and 1991 and so I know about these issues both professionally and personally. And I certainly know about the issues as they relate to our topic today and our guest Brenda Iliff. Brenda is the executive director of our operation in Florida, down in Naples specifically. And today, Brenda is here to share with us her expertise on addiction and treatment issues in the 50 plus population, meaning those who are older than 50 years old. Why is that an issue?

0:01:09 Brenda Iliff
Well as people age, we become at greater risk for chemical use, misuse and abuse. You know we know that young people are at greater risk because of the developing brain. But we don't talk about much that as we age also, we're at increased risk. In fact there's estimates that about 17 percent of people 50 and above have a chance of chemical use, misuse or abuse. And the reason for that just like with the young people it's about physiologically the brain is different with the young people, with older people physiologically the way we metabolize the chemicals are very different. So that one or two drinks that we've had our whole life with no problem really all of a sudden the body starts to slow down and that one or two drinks can become like four or five in our systems. And then we might be retiring and we might have trouble sleeping or we might have anxiety, or we might have losses, or we might have our hip replaced and get on pain pills. So, people are at much greater risk as they age.

0:02:15 William Moyers
Is there a stigma around addiction in older adults? How so?

0:02:19 Brenda Iliff
Oh yes, absolutely. We're really talking about two different groups. One would be the traditionalists, the old or older adults. And there's a huge stigma there because think about that, those are folks that were growing up during prohibition. And so it was really very much a moral issue for those folks. And then the baby boomers, those are folks who were sex, drugs and rock 'n roll. And they're not opposed to goin' back to sex drugs and rock 'n roll. But a lot of times there's the stigma of how could this happen to me? I've had a whole life of wonderful life and now the chemicals are causing a problem?

0:02:57 William Moyers
You know it's interesting the baby boom generation was born between 1946 and 1964 and that was the first generation that really had recovery as an option because Alcoholics Anonymous is only founded in the late 1930s and so suddenly baby boomers, a subset of those baby boomers, came of age in recovery. They had an avenue out of their hopelessness. They had an avenue out of their addiction and recovery. So there's certainly a lot of us, I'm being one of them, who's been in recovery and is now getting older. What is it that older adults, particularly older adults who are already in recovery, what do we have to watch out for as we get older in recovery?

0:03:39 Brenda Iliff
Oh wow, there's oh that's a great question, William. There's several things that we've seen you know at Hazelden Betty Ford in Naples half the people we work with are 50 and older.

0:03:39 William Moyers
Half.

0:03:50 Brenda Iliff
So we're seeing a lot of people who are entering into treatment at a little bit later in life. They might even have years of recovery and then they move, or they retire and AA is not the same as it was in Cleveland, or Texas, or Minnesota or whatever. And so they start to get a little complacent. Because I don't really belong, so people really need to watch out for resting on their laurels if you will. But they also need to watch out for medications. As people age, we have our hips fall apart, our knees fall apart, or whatever, and people are exposed to medications that they may not have been exposed to before such as the pain pills, the benzodiazepines, the anxiety pills and that can bring people back into addiction also.

0:04:42 William Moyers
The role that we have as recovering people who are getting older in recovery we have a responsibility to let our doctors know this, don't we?

0:04:50 Brenda Iliff
We do. we do. And not only that, but we have a responsibility for what we put in our mouths. Because you may hear from a doctor or health care provider 'You need this for the pain.' And you might, but you might not need it for three months. You might need it for three days or one day. So we have the responsibility to talk to people who know about medications in recovery too. 'Cause the benzodiazepines and the opiates are highly addictive.

0:05:17 William Moyers
What would be an example of a benzodiazepine for example?

0:05:20 Brenda Iliff
A sleeping pill.

0:05:22 William Moyers
Sleeping pill. Yeah.

0:05:22 Brenda Iliff
Yeah. Or an anxiety pill. And you know as people get older, the anxiety does increase because just like everything else slows down in our bodies, so do those chemicals in our brains. So people are more susceptible to anxiety, to depression, the serotonin's not working as well and for many folks, so.

0:05:43 William Moyers
You talked about opioids or pain medication and of course we know we've chronicle in these podcasts and we see it every day at Hazelden Betty Ford the impact that opioids or pain medication had on the population, we have an epidemic. How has that epidemic manifested itself in the population that you work with?

0:06:00 Brenda Iliff
Hugely. In the—in the county that Hazelden Betty Ford is located in, half our overdoses are people that are older but we don't talk about it. We talk about the people that are younger. Those are the people that are hittin' the papers, you know, the opiate epidemic.

0:06:13 William Moyers
Yes.

0:06:15 Brenda Iliff
But we've got a lot of people who are older who are dying. Usually though what's different is there's alcohol in the system and there's benzos in the system.

0:06:24 William Moyers
So they're mixing all three?

0:06:25 Brenda Iliff
Yeah absolutely. There's a trifecta. And you know we get a lot of I mean thank goodness we're getting a lot of information about the opiate epidemic. But generally we need to talk about the addiction epidemic that we're facing.

0:06:38 William Moyers
So how do we treat older adults 50 plus? It's hard to believe that we talk about 50 plus being an older adult but that's a reality. How do—what's the treatment modality, how do we approach treatment for somebody who's older? For example, they might be in a wheelchair they might have some cognitive issues, they might be set in their ways. How do we do it?

0:06:59 Brenda Iliff
We do it the same way we do with everybody else.

0:07:01 William Moyers
Really.

0:07:01 Brenda Iliff
Yeah. Looking at, holistically, what does this person need. So first off, we're gonna make sure that they get a safe detox. Because detox goes a little bit slower as people age.

0:07:13 William Moyers
Oh.

0:07:14 Brenda Iliff
So yeah we wanna make sure they get a safe detox. But then we need to look at their needs. What are their medical needs? What are their mental health needs? What are their addiction needs? A lot of the pieces of treatment for someone who's older that we find so helpful and they just eat it up is education. Learning about what happened? What happened? How did a 61-year-old like me who's had a full life cross the line into addiction?

0:07:40 William Moyers
Yes.

0:07:41 Brenda Iliff
So these are folks that are very responsive to learning more about addiction and learning more about—about the solution. Which we believe is the Twelve Steps of Alcoholics Anonymous. And a lot of times, with the older, older, older adults, those are folks who've had purpose in their life. So it's just helping them get back to some sort of purpose. With the boomers, sometimes they're still searchin' for purpose. They've never found it. But what more can really be helpful for people is connecting 'em with others, finding a purposeful and meaningful life through the Twelve Steps.

0:08:14 William Moyers
So let's talk about the family for just a minute here. I know that I've had many adult children come to me and say you know my mother or my father isn't right. Dad's retired and he's playing golf every day and we want him to play golf but he's comin' home tipsy at five o'clock. Or mom's lost her husband of 65 years and so she's filling that void with a little bit of alcohol. On the one hand we don't see anything wrong with that but on the other hand something's going on here. Talk about how—what would be the advice to an adult child?

0:08:46 Brenda Iliff
Well obviously start with empathy, dignity and respect. You know? I wouldn't use the words alcoholic or addict.

0:08:54 William Moyers
Ohhhh.

0:08:54 Brenda Iliff
I'd stay away from those words totally. Generally with the older, older adult, things that can be really helpful are tying it back to independence. So dad I'm worried about all your falls, you know. If you wanna stay independent we have to do something about your falls. Could we talk to somebody about how alcohol or the benzos might be affecting your falls? Also tying it back to health issues can be really helpful. Mom, I'm worried about your diabetes, we're not getting—we're not getting your diabetes under control, I'm wondering if we can talk to somebody about how the drinking impacts your diabetes. But clearly stay away from labeling words like alcohol and alcoholic.

0:09:35 William Moyers
What's your response though to those adult children who say you know it's too late, dad's 80 years old, mom is 86.

0:09:44 Brenda Iliff
You know some of the myths of—of aging and the myths of addiction are they're too old, they won't change, let 'em enjoy their life. When we're talking with people that have crossed the line, they're not enjoying life anymore. They're falling, they're hurting themselves, they're isolating. One of the—the key piece, things that I've seen really motivate people is getting 'em back to enjoying their life. And it a lot of times one of the differences for older adults is it can be a minimal intervention. It doesn't have to be I mean if they're lucky and they can come to Hazelden Naples or Hazelden Betty Ford in any of our sites good for them. But a lot of times a conversation with the clergy can do it. Just educating about the effects of the drugs. Or a conversation with a health care provider can do it. It doesn't a lot of times a minimal intervention can do a lot with an older adult.

0:10:42 William Moyers
So then you touched on something that I hadn't even thought about which is the importance of education around these issues in the community at large, be it in the medical field or in the church or in the civics association, right? You do some of that community work too.

0:10:56 Brenda Iliff
We do, we do some education through Hazelden Betty Ford about older adults, but it's important to—to look at all the people that influence this person's life. Like the person that may spot it is the home health care person. Or the trash person. Or the neighbor. Or the parish nurse. You know? It's not just the typical, we think the families are gonna see it. In fact many times the families don't see it because they're livin' all over the country.

0:11:28 William Moyers
Sure.

0:11:29 Brenda Iliff
You know? And mom and dad are retired in Florida. So, who might be. We go out and we educate sometimes social communities. Some of the older adult retirement villages where social hour starts at noon sometimes and there are some real problems there.

0:11:45 William Moyers
I know you've been open in your writings and in your teachings and your lectures about being a woman in recovery and also a woman who is a 50 plus, just like I'm a 50 plus. I wanna just to end our podcast by having you share a little bit about how your perspective on your journey has evolved through these years and through these decades. How do you see recovery today compared to when you found recovery twenty-some odd years ago?

0:12:11 Brenda Iliff
Oh it's so—you know they say the road narrows and the road gets broader. You know at first it was about staying sober, now it's about living life. A life beyond my wildest dreams. And I get to, I mean, to think that I can watch women, men, older adults, younger adults, find recovery, what a gift. 

0:12:33 William Moyers
Well thank you, Brenda, for sharing your life with us today and your life in the communities that you live in and that you work in. Brenda Iliff the executive director of Hazelden Betty Ford's operations in Naples, Florida. Thank you for joining us today and thanks to all of you, our constituents at the Hazelden Betty Ford Foundation for tuning in to another edition of Let's Talk. On behalf of our executive producer Lisa Stangl, I'm William Moyers and we hope you'll join us again for Let's Talk, a series of podcasts on the issues that matter to Hazelden Betty Ford and matter to you, too.