Boomers’ drug challenge

Arlene claims she wasn’t a typical teen of the ‘60s and ‘70s – mostly because in those days she was against doing drugs during the era of “Turn on, tune in, drop out,” the counterculture phrase about doing LSD popularized by Timothy Leary in 1966. Arlene, 58, is part of the baby boomer generation, that ubiquitous group of over 76 million American children born between 1945 and 1964. Now part of a large and aging demographic, baby boomers grew up in a time of abrupt and climactic social change, when the recreational use of drugs, in an effort to alter their state of consciousness, was a key part of their youth. Then the ‘80s hit, and boomers grew up, got “mature” and responsible jobs, had kids, began to take care of aging parents, and paid their bills. Most stopped getting high, and drinking became less Boone’s Farm and more cocktails or a glass of wine. But today, baby boomers are increasingly the demographic turning, or returning, to drugs in an effort to feel better, against the aches and pains of aging, as well as from depression, economic loss and the loss of parents and partners. According to government researchers, nationally, more than 5.7 million people over the age of 50 will need substance abuse treatment by 2020. Already, those treating substance abuse are seeing an increase in baby boomers with increased needs for drug-related health problems. “By the year 2020, the population of aging baby boomers will double,” said Scott Masi, outreach and referral specialist for Brighton Center for Recovery. “Over the age of 60, they have greater access to doctors, and they’re seeking more appointments on average. Eighty percent of all office visits to a doctor will result in a prescription being written. It could be for a statin, blood pressure pill, or a pain pill. The majority being written are for pain pills.” “I didn’t party a lot as a teen. I was really against drugs,” Arlene (not her real name) said. She said that as an adult, “I experimented with drugs a little – a couple of pain pills, coke now and then, maybe once a year at a party. And I drank socially. Not daily, maybe once a week, I drank with a bunch of friends.” Arlene, a single mother, was a professional office worker. “I always worked. I was able to buy a new home in West Bloomfield at 40,” she said. “My son got married a few years later, and suddenly I was alone. I was alone and ran into people I thought were my friends. They got me to try crack cocaine and heroin. “I was lonely and depressed. I never thought anyone could convince me to put a needle in my arm.” Yet, that is what happened to her. Seeking an escape from melancholy and her perception of feeling unloved, she said at the time she misread the intentions of the crowd she was with, thinking they were friends. At the time, she was still working full time, at a job she said was wonderful. After being against drugs, she was injected with heroin in her own living room, where the gang of friends would hang out because she was the one who had a house. “When you’re hanging out with people who don’t have your best interests at heart, things can go awry,” she recalled. “They convinced me it would make me feel great. After the first injection, I was basically hooked, because it feels like the answer to your depression. It was just like all of the problems disappeared, and you felt like Superwoman – like you had no problems. It was like this amazing feeling of calmness and well-being.” Initially, Arlene thought she could keep her heroin use recreational. “It was days before I tried it again. But then it was a fast spiral down. “It only took me 15 months to get to my bottom. My use would gradually increase until I was doing it twice daily, as well as crack cocaine, and not paying any of my bills, including my house payment. It was such a fast spiral down. It was like a hurricane. After a year, I lost my job, my house, and most of my possessions. In that short time, I lost everything, including my friends and others very close to me.” She said the turning point was “I was lucky to have lived an adult life drug free as a productive person, so I knew I could have a better life. I chose recovery, because I had nothing else, unless I wanted to live on the streets or in jail.” According to Nora D. Volkow MD, director of the National Institute on Drug Abuse, the percentage of Americans 50 to 59-years-old who have reported having abused illicit or prescription drugs has more than doubled, from 2.7 percent to 6.2 percent between 2002 and 2009, the last year they have compiled that data. “Not coincidentally, by the end of that period, baby boomers had filled out that age cohort. Baby boomers’ histories of illicit drug use, and their relatively tolerant attitudes toward it, along with the fact that they now comprise nearly 30 percent of the nation’s population, have raised the stakes on understanding and responding effectively to drug abuse among older adults,” Volkow said. Arlene, who now lives in Commerce Township and once again holds an office job, is part of what is believed to be a huge potential mental health crisis. In 2010, six to eight million older Americans, or 14 percent to 20 percent of the senior population, had a substance abuse problem or mental disorder. As boomers age – known as the Silver Tsunami, because boomers do everything with force and numbers – experts project the number of adults 65 and older needing treatment from the mental health care system across the country to increase to 73 million by 2030. In Oakland County, Christina Nichols, manager of the Oakland County Mental Health Authority’s Office of Substance Use Services said 30 percent of adults first seeking substance use treatment through Oakland County’s public mental health system are 40 years and older. Determining drug or alcohol problems among older adults can be a particularly difficult problem for family and medical professionals. Who wants to ask Mom or Grandma if she swigs the bottle or pops too many pills? Often, alcohol and drug misuse and abuse is misinterpreted as memory loss or dementia associated with advancing age. Older boomers, even those who believe they have acquired a tolerance to recreational drugs from their youth, have a significantly reduced ability to metabolize different drugs, notably prescription pills. As the brain ages, it becomes increasingly sensitive to drugs and alcohol. “The longer you’re on pills, your body builds up a tolerance. You need more more and stronger doses,” said Brighton Center’s Masi. “The potency of the drugs will be more potent. Also, the older you get, physiologically, the blood flow to your organs changes and the metabolism slows, especially to the liver. It’s not flushing the toxins out. The half-life in your system is much longer as you get older.” As one expert said, if you have a trigger, and your youth was caught up in the ‘60s, you’re going to revert back. When taking drugs is how you once coped, it’s likely how you’ll try to cope once again. D rug treatment programs are now dealing with a spike in boomers with drug and alcohol problems. While certain treatments are universal regardless of age, some treatment centers, addiction specialists and psychologists are finding they need to adapt and tailor their treatment for older addicted patients. Masi said for people over the age of 60, about 70 percent are on two or more medications; and over 50 percent are on four or more medicines, including prescription pain medications. “I think overall, from that era there was a more cultural acceptance of drug use, that post-Woodstock, Vietnam era,” said Elizabeth Bulat MD, Service Chief of Addiction Medicine, Henry Ford Maplegrove Center. “As they age, they are prescribed more anti-anxiety medications, like Ativan, Valium, and Xanax, and benzodiazepines. There has been more prescribing of these medications over the last 10 years. A lot of these people were placed on these medication for valid reasons, but lots of doctors don’t know they’re still on them. Now, as they age, there’s aches and pains too, so they’re getting pain medications, prescription opioids, like Vicodin and Oxycontin. This push to prescribe pain pills has become an epidemic. Alcohol has always been there for this age range. The combination of Vicodin, Oxycontin plus alcohol, it’s not good. “Then, for some patients, it goes from being a physiological dependence to a substance use dependence,” Bulat continued. “Some patients who cannot continue to get those prescription pain medications from doctors, transition to heroin. It’s a rising percentage, and it’s a reality.” Masi said a large problem happens among doctors who don’t adequately check to see what patients are receiving from other doctors. “Many patients are doctor shopping,” he said. He said family members need to know just what family members are using, and possibly abusing. “Where we’ve seen the largest increase in use since 2007 is in prescription opiates, such as Vicodin and Oxycontin, which has subsequently caused a large spike in the use of heroin,” said Nichols. “The largest increase in services for the county has been for heroin and opiates. It’s been the biggest trend in the last five years. The average age is 26 to 39, with 36 percent of those seeking treatment in that age range falling into that category. But consistently, across the board, we see that everyone began with the misuse of prescription pills, opiate abuse, and then graduated to heroin. Individuals, as they get older, have a greater need for more medications,” which can lead to their potential misuse. She said the county does not have specific number for those over 65. “By the nature of the patients I take care of, I see a number of patients that are addicted,” said Dr. Jim Honet, a pain management physician with Pain Care Associates in Bloomfield Hills. Honet is not sure aging boomers are using pain medication more, “but certainly I am seeing a consistent number of patients. However, we’re able to catch more of them because of MAPS – Michigan Automated Prescription System. If you’re a patient and had a narcotic prescription, at the pharmacy, you have to show your ID. Then they take your information to put it in the state system. I can order MAPS on a patient, and it shows the person’s name, address, prescriber, which pharmacy it went to, how the patient paid for it. When you look at it, you can see if someone is getting multiple scripts. “You’re also able to identify the people who may have photocopied our prescription,” he continued. “I write tons of narcotics. There’s a problems with insurance coverage, and what they’re willing to cover, so people are turning to heroin. There a combination of things. It gives them a high and it’s cheap, and it’s a narcotic, so it relieves the pain. So people are using illicit narcotics because they can’t get the real stuff. Some people aren’t really addicts, they’re just trying to find pain relief in a way they can afford.” Masi said a large problem happens among doctors who don’t adequately check to see what patients are receiving from other doctors. “Many patients are doctor shopping,” he said. He said family members need to know just what their family members are using, and possibly abusing. “We at Brighton must go on MAPS,” Masi said. “It’s part of our protocol, part of our admissions process. There’s is some talk about legislation to require doctors to participate in MAPS, but it’s not there yet.” Bulat said for boomers, “alcohol is always there, and always will be, the number one addiction. Benzodiazepines are now number two.” Benzodiazepines are a form of tranquilizers or anti-anxiety medication, more familiarly known as Valium or Xanax. According to Louis A. Trevisan MD in Psychiatric Times, addiction specialists and organizations for the elderly anticipate a tidal wave of baby boomers who will need help fighting addictions, often from different substances and with different attitudes toward treatment than the generation before them. Because baby boomers experimented more with alcohol and illicit drugs than previous generations did, he notes boomers have a more lenient attitude toward the use itself of alcohol and drugs. He said scientists studying addiction also have found a difference among addiction to pain medication between men and women, as well as to alcohol, still the number one source of addiction among this age group. Among those 65 years and older, 2.36 percent of men and just under half a percent of women met the criteria for alcohol abuse according to the National Epidemiological Survey on Alcohol and Related Conditions. Further, of those 60 and older, half of the men and 39 percent of women were daily drinkers, with 5.9 percent of men over 60 and 1 percent of women over 60 reporting binge drinking once a month or more. The National Institute of Alcohol Abuse and Alcoholism recommends that men and women 65 and older have no more than three drinks on any one day, and no more than seven drinks per week. According to the Centers for Disease Control (CDC), in 2010 binge drinking was reported by one of six U.S adults – 38 million people. While younger adults have much higher percentages, “older adults who binge drank reported engaging in this behavior more frequently than their younger counterparts – an average of of five to six times a month. They also reported consuming an average of about six drinks when they did, thereby increasing their risk of developing many health and social problems,” the CDC reported. Further, they reported that it accounts for more than 21,000 deaths among older adults a year, and costs the U.S. economy $223.5 billion a year in 2006 dollars. “Although data is scarce on illegal drug use or prescription medication misuse among the elderly, evidence suggests that misuse and abuse of prescription drugs by older adults is a growing problem,” Trevisan wrote, noting that up to 11 percent of older women misuse prescription drugs, and that non-medical use of drugs among adults older than 50 is expected to increase to 2.7 million by the year 2020. “There is growing evidence that (the) female sex is a major risk factor for problems associated with prescription drug abuse,” Trevisan continued. “Older women are more likely than men to consume benzodiazepines. This may be associated with recent divorce or widowhood, lower education level, lower income, poorer health status, depression, and/or anxiety.” “The social and physical changes that accompany aging may well increase vulnerability to drug-related problems,” National Institute on Drug Abuse’s Volkow said. “The loss of loved ones, juggling of multiple roles, and retirement or other alterations in employment and income may cause some older people to use illicit drugs as self-medication for anxiety or depression, especially if they have a history of taking drugs to cope. Slowing metabolism can increase sensitivity to the effects of drugs. Furthermore, the effects of drugs of abuse in older adults may be influenced by age-related health conditions and medications – contingents that are more problematic when patients hide their drug abuse.” Henry Ford Hospital has been treating alcohol and drug addiction in its varying forms for almost 100 years. In 1977, they opened Maplegrove Center on W. Maple in West Bloomfield to help with chemical dependency treatments associated with drugs, alcohol, gambling and other addiction issues, both for inpatient and outpatient care. Their website states, “We treat the whole person, not the addiction...we offer effective, appropriate care for every patient, whether you are unsure if you have an addictive disorder or if you have been struggling with one for many years.” Brighton Center for Recovery is another local location working with both inpatient and outpatient individuals needing addiction treatment. Founded in 1948 in Brighton, it was one of the first in America that was an actual addiction treatment hospital. Its founder, Harry Henderson, was helped in establishing Brighton from Bill Wilson, the co-founder of Alcoholics Anonymous, making it a pioneer in the treatment of addictions. “It was open and actively treating soldiers returning home with serious drinking problems and suffering from post-traumatic stress from World War II,” their website relates. The adult inpatient psychiatric program at Havenwyck Hospital in Auburn Hills provides 24-hour skilled nursing care for those who exhibit serious psychiatric/substance abuse problems led by physicians in a safe, therapeutic environment. Havenwyck did not return calls relative to their programs for baby boomers. Stonecrest Center on Gratiot in Detroit offers inpatient treatment programs for behavioral and mental health issues and substance abuse problems, and in addition to work with adolescents and adults, promotes their work with seniors. The center is a 104-bed acute psychiatric inpatient treatments center that not only helps individuals get sober, but maintain their freedom from chemical dependency. They recognize the impact depression, memory issues and psychiatric disorders contribute to addiction. The CDC notes that while depression affects millions of people, keeping them from living normal, happy lives, the highest risk group for depression are middle aged adults aged 45 to 65, especially women. “Substance abuse is common among people who are battling a depressive disorder,” states an article by Canyon Malibu, a treatment center for addictions. “Because alcohol is a central nervous system depressant, the use of this drug tends to trigger depression symptoms like lethargy, sadness, and hopelessness. However, many depressed individuals reach for drugs or alcohol as a way to lift their spirits or to numb painful thoughts. As a result, depression and substance abuse feed into each other, and one condition will often make the other worse. Depression can also suppress the immune system and weaken the body, making you more susceptible to physical ailments and chronic disease. Depression is all too often a gateway drug into drug and alcohol use.” Maplegrove’s Dr. Bulat said some patients need inpatient detoxification, and some are fine going through an outpatient protocol. “Some patients, if they’ve been on pain or anxiety medications, can taper off of them by working with their own physicians in an outpatient setting,” she said, sometimes by working with other medications. “A lot of the big issues with baby boomers, empty nesters, is it’s polysubstance, benzodiazepines and opiates. They’re coming in with both, and alcohol too. It’s a very, very tough detox and rehab, both physically and mentally,” Masi said. He said they are learning to treat them differently from their 18-25 year old heroin abusing population. “The 18-year-old has been through trauma; the 60-year old is dealing with depression. We have to identify different kinds of treatments and not put them into the same groups.” “Once someone has been identified with having a substance abuse problem, especially in this age group, it’s critical to maintain a recovery program to maintain their sobriety, as well as to manage their pain and anxiety, which can be tricky,” Bulat said. “Once someone has had 10 Vicodin a day, it’s hard to convince them to do PT.” She emphasized that pain management programs, physical therapy, anti-inflammatories, exercise, and adjunct therapies are critical to not only maintain their sobriety and keep them off pain pills and opiates, but to improving their physical well being. “Some patients actually improve just coming off of the medications,” she said. Honet, the pain management physician, agrees. Once people have achieved their sobriety over their narcotic, alcohol, or opiate addiction, he said they can help them achieve their pain relief with a whole different tool box. And the tools are perfect for aging boomers. “We have a whole gamut of modalities available to them and to us,” Honet said. “There are injections (steroid and non-steroid), physical therapy, medicine, some narcotic, some not, psychology, and even surgery when appropriate.” Bulat said incorporating therapy, and giving patients all the tools to maintain their sobriety, coupled with the issues that got them there in the first place, is critical. “Maintaining their sobriety is key, but we also have to deal with all the medical consequences to long term addiction issues. Lots of people who come to Maplegrove haven’t seen a doctor in maybe 10 years. We’re helping them deal with the aftermath of the addiction, as well as coping with the divorce.” Arlene has been clean and sober from her abuse for several years, and while she says she still dreams about drugs, “it was such a hell, I will find any other answer and continue recovery.” Today, she has more aches and pains, a bad knee, an aging body, as well as a chronic battle with depression. “I go to a pain doctor, and am honest with him about my problem with opiates. That’s the way I stay clean,” she said. “I don’t want to hide my past because it’s what made me who I am today.”