When you think of a drug addict does the image of an octogenarian come to mind? Probably not. But this is becoming more common all of the time.

For older adults, drinking too much and misusing medications are the major substance use problems, affecting as many as 20 percent of them. They are particularly vulnerable to the mental and physical effects of alcohol and drugs because of physiological and cognitive changes that take place with age. And, even if they are not addicted to alcohol or illegal substances, they are at risk for serious problems including:

• Adverse drug reactions, including fatal overdoses,
• Accidents -- including falls and traffic accidents,
• Exacerbation of health problems,
• Social isolation,
• Sleep disturbances,
• Inactivity,
• Loss of cognitive capacity and
• Suicide -- which is more likely among older adults than any other age group.

In general, substance abuse and misuse vastly limit the potential to live well in old age.

During the elder boom there will be tremendous growth of the number of older adults with substance use problems, in part because of the growth of the population of older adults, but also because baby boomers use substances -- including illegal substances -- much more commonly than their parents' generation.

For example, a study done by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) projects the growth of people 60 or over who need substance abuse treatment from about 700,000 in 2000 to about 2,300,000 in 2020 (2). Recent surveys (3) confirm that this is already happening, with marked growth of the use of marijuana.

In addition, the CDC recently released a report projecting a vast increase in addiction to prescription painkillers and in deaths due to overdoses, which already kill more Americans than heroin and cocaine combined (4).

Will you, a member of your family, or a close friend be among the older adults with serious substance use problems? Here are a few signs that should cause concern (5).

• Getting unusually high without an increase in use
• Use of alcohol or drugs to sleep and then finding it difficult to get going in the morning
• Reliance on opiates to manage pain in doses that exceed a doctor's prescription
• Going from doctor to doctor to get additional prescriptions
• Using over-the-counter drugs in amounts or in combinations of medicines that are not recommended
• Cognitive or memory impairments, difficulty concentrating, or confusion
• Slurred speech
• Increased isolation
• Difficulty participating in ordinary activities
• Weight loss and/or poor nutrition
• Increased fatigue and/or weakness
• Poor personal hygiene
• Unusual restlessness or agitation
• Persistent irritability or altered mood
• Balance problems and/or frequent falls

These symptoms can, of course, have causes other than substance abuse or misuse, but if a person is using alcohol or other drugs and has these symptoms, substance use may be a major cause. I would recommend a good online drug class. 

Just about every day you can find a story about the elderly and how it is finally coming out that they have drug and alcohol problems too.

Government inspectors told Medicare officials need to do more to stop doctors from prescribing powerful psychiatric drugs to nursing home patients with dementia, an unapproved practice that has flourished despite repeated government warnings.

So-called antipsychotic drugs are designed to help control hallucinations, delusions and other abnormal behavior in people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the U.S. to pacify aggressive behavior related to dementia. Drugs like AstraZeneca's Seroquel and Eli Lilly's Zyprexa are known for their sedative effect, often putting patients to sleep.

But the drugs can also increase the risk of death in seniors, prompting the Food and Drug Administration to issue multiple warnings against prescribing the drugs for dementia. Antipsychotics raise blood sugar and cholesterol, often resulting in weight gain.

An inspector has challenged that the Medicare program should begin penalizing nursing homes that inappropriately prescribe antipsychotics. The Centers for Medicare and Medicaid Services provides health coverage to nearly 80 million senior, poor or disabled Americans.

HHS Inspector General Daniel Levinson proposed that Medicare force nursing homes to pay for drugs that are prescribed inappropriately, and potentially bar nursing homes that don't use antipsychotics appropriately from Medicare.

A report issued in May found that 83 percent of Medicare claims for antipsychotics were for residents with dementia, the condition specifically warned against in the drugs' labeling. Fourteen percent of all nursing home residents, nearly 305,000 patients, were prescribed antipsychotics.

Doctors are permitted to prescribe drugs for off-label uses, though it is illegal for drug companies to promote uses that haven't been cleared by the FDA. In recent years several pharmaceutical companies have paid huge fines to the Department of Justice in cases involving off-label marketing of antipsychotics.

In January 2009, Eli Lilly & Co. Inc. agreed to plead guilty and pay $1.4 billion for illegal promotion of Zyprexa, including marketing to nursing home doctors.

Protest Wall Street that! Doctors need to treat patients not medicate them.

When you think of a drug addict does the image of an octogenarian come to mind? Probably not. But this is becoming more common all of the time.

Gladys of Miami, FL became a drug addict at the age of 82 when the pain of arthritis got to be too much for her and she became dependent on opiates to get through the day and to sleep at night.

Frank of Los Angeles, CA became a dangerous, problem drinker at 66 after he retired from his job as a maintenance man in a local school. Every day he drove to a bar where he hung out with a few buddies and drank a few too many beers before he drove home.

Samuel of Houston, TX grew up during the era of drugs, sex and rock and roll. Throughout his adult life, he smoked marijuana after work without problems at work or at home. After he retired at 65 he smoked more often and getting high began to interfere with the life he had hoped for when he retired.

For most of her adult life, Joan of San Jose, CA had had two or three glasses of wine with dinner. In her mid-60s her physical tolerance for alcohol diminished. She drank no more than usual, but by the second glass she began to slur her words and to find it hard to think clearly. She frequently fell asleep right after dinner.

These are just a few of the faces of substance abuse or misuse among older adults. They are not the images that ordinarily come to mind when we think of substance abuse, and this is a major reason why these problems often go undetected in elders.

Of course, there are older adults who are alcoholics and/or addicted to illegal drugs such as heroin, but fewer and fewer as people age, in part because so many people addicted to alcohol or drugs die prematurely and in part because some survivors turn their lives around.

If you or someone you care about has substance abuse issues seek help immediately. There are also online drug classes.

An often forgotten segment of the population when it comes to substance abuse is senior citizens. Perhaps it is because people think they are “older and wiser,” and would not be addicted to chemical substances. That certainly is not always the case.

Part of the Problem

Seniors, who often take multiple medications prescribed by different doctors, are at risk for prescription drug abuse and may be subject to overdose and interaction side effects from those medications.

People aged 65 and older comprise 13 percent of the U.S. population, yet account for a third of the population using prescription drugs, according to the National Institute on Drug Abuse.

Nearly 20 percent of the 125 unintentional prescription drug deaths last year in Montgomery County, Maryland were people age 55 and older.

Some of those deaths were accidental but others were not so benign, said Russel Falck, a Wright State associate professor.

More Stats                                         

Between 1997 and 2008 the rate of U.S. hospital admissions for conditions related to prescription medication and illicit drug use grew by 96 percent for people ages 65 to 85, and increased 87 percent for people age 85 and older, according to the Substance Abuse and Mental Health Services Administration.

Seniors abusing controlled substances, either prescription or off the street, represent a very small percentage of our elderly population, nevertheless, they are there and many need help.

Overdose deaths from prescription painkillers have skyrocketed in the past decade and are a public health epidemic, according to the Centers for Disease Control and Prevention. One in 20 people in the U.S., ages 12 and older, used prescription painkillers without a prescription or just for the “high” they cause in 2010, the CDC said.

The use of narcotic pain relievers such as OxyContin and oxycodone has increased nearly 1,000 percent on a per capita basis since 1997, said Orman Hall, director of the Ohio Department of Alcohol and Drug Addiction Services.

About 80 percent of seniors have at least one chronic health condition and 50 percent have at least two, according to SAMHSA.

The use of multiple medications, or “polypharmacy,” can increase a person’s risk for bad interactions and unintended side effects, especially in older patients who metabolize drugs differently than younger people.

Taking opioids for pain in conjunction with benzodiazepine drugs such as Xanax and Valium for sleep or anxiety disorders can be a dangerous combination. Nearly 60 percent of Montgomery County’s (Ohio) unintentional prescription drug deaths last year involved a combination of opioids and benzodiazepines.

Education is important. Seniors are becoming more technologically proficient and I think a good online drug class.