Academic journal article The Journal of Rehabilitation

Substance Abuse and the Elderly: Unique Issues and Concerns. (Substance Abuse and the Elderly)

Academic journal article The Journal of Rehabilitation

Substance Abuse and the Elderly: Unique Issues and Concerns. (Substance Abuse and the Elderly)

Article excerpt

Substance use, abuse, and dependence are elusive constructs when it comes to assessing problem behavior among individuals who are elderly (defined as individuals over the age of 65 for this article). While it is clear that drug and alcohol use, abuse, and dependence occur among this age cohort, the extent, types and outcome of use, abuse, and dependence are speculative, at best. Individuals over the age of 65 make up roughly 12.4% of the total U.S. population (about 35 million people) and they represent the fastest growing age cohort; by 2030 this group will nearly double in size to over 70 million individuals and will represent 20% of the U. S. population (Administration on Aging, 2002). Various sources of data suggest that alcohol problems are ordinary events, but largely unrecognized in this population and estimates of the prevalence of heavy drinking or alcohol abuse range from 2% to 20% for this population (Menninger, 2002; Ondus, Hujer, Mann, & Mion, 1999; Pennington, Butler, & Eagger, 2000; Rigler, 2000). However, virtually no data exist to quantify drug use, abuse, and dependence patterns. The sheer size of this population cohort will mean that the size of potential problems will grow. Moreover, there is some suggestion that the baby-boom generation is more likely than earlier generations to have been exposed to drug and alcohol use and may drink or consume drugs at greater rates after age 65 (Levin & Kruger, 2000; Marks, 2002; Ondus, et al.). If so, the need for treatment and rehabilitation services will multiply.

The rehabilitation, substance abuse, and gerontology literature pay scant attention to alcohol problems of the elderly and largely ignore drug problems all together. Several reasons have been suggested for this lack of information and attention. First, drug abuse/dependence research tends to be driven by the federal agenda and the popularity of drugs at a given time, to the exclusion of other drugs and other drug related behaviors. Initially, research centered on the problems created by dependence on illicit narcotic drugs with recent shifts in attention to cocaine and illicit stimulant drugs. As aging individuals are thought to be among the least likely to use these drug types, little information is known about incidence or prevalence or about the effects of these drug on the elderly population.

Second, as Winnick (1962) suggested, individuals "age out of" drug use and relatively few individuals maintain illicit drug use beyond his or her thirties or forties. Peterson (1988) reported that individuals who begin substance abuse after age 65 are more likely to abuse alcohol and rarely turn to illicit drugs.

Third, stemming from the massive drug problems that began in the 60s, the emphasis in the literature and treatment has been on drug and alcohol problems presented by adolescents and young adults. Indeed, some have argued that the substance abuse treatment system and treatment literature have been strongly biased towards young males to the neglect of not only the elderly, but women, some minorities, and people with disabilities (Benshoff & Janikowski, 2000). As a consequence, little is known or empirically reported about the unique needs presented by individuals who are elderly and experiencing drug and alcohol problems.

Finally, Levin and Kruger (2000) called substance abuse among older adults an "invisible epidemic" (p. 1) noting that older adults, relatives, and caregivers tend to downplay the existence of substance abuse problems in this population. Levin and Kruger asserted that the symptoms of alcohol and drug abuse are often mistaken for the symptoms of aging problems such as dementia, depression, or other problems commonly seen in older adults.

Extensive data exist about prescription and over the counter drug use by the elderly. Although elderly individuals make-up 12.4% of the population, they consume 25% to 30% of all prescription drugs (Ondus et al. …

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