No One Is Immune: Older Adults, Jews and Substance Abuse

We’ve all heard the statistics: Between now and 2030, the number of adults aged 65 and older in the United States will almost double from around 37 million to more than 70 million (20% of the population). The impact of the growth of the aging Baby Boomer generation (those born between 1946 and 1964) will dramatically affect addiction statistics. Researchers from the National Institutes of Health predict that due to a “baby boomer effect,” cases of substance abuse among this age cohort will increase proportionally (Duncan et al, 2010). A large, retroactive study of the State and Federal Substance Abuse and Mental Health Data Archive (2002-2013) tracked the hospital admission records of almost one million persons 55 years of age and older. The study showed that the number of admissions for drug addiction had increased steadily and substantially, while, over this same time, the number of alcohol addiction cases remained relatively stable. It appears that unless something changes, we will be faced with a large wave of older persons addicted to drugs very soon.

Indeed, according to Maxwell in the Drug & Alcohol Review (2015), the number of older adults age 50 and older in need of substance abuse treatment will increase from 1.7 million in 2000 to 4.4 million in 2020, a 70% increase in the addiction rate of older adults. An article in Clinics in Geriatric Medicine (Kuerbis et al, 2014) attributes this to: ubiquitous marketing, incorrect prescribing, a proliferation of legal and illegal drug sources, inadequate government responses and increases in the number of written prescriptions.

It cites actions to counter this trend, including prescription drug monitoring programs to deter “doctor shopping”; more authority over manufacturers given to the Food and Drug Administration; and the introduction of options for proper disposal of leftover medications. There is also an increased emphasis on responsible prescribing, including risk assessments, treatment plans and training for clinicians. The authors warn, however, that if these methods don’t work, clinicians may lose the ability to use some drugs for effective pain management, or there will be so many barriers to obtaining prescriptions that pain will go untreated.

Too Many Pills? Prescription Interactions?
MedUseQ Can Sort It All Out

Rebecca Berman, Senior Co-Investigator at CJE’s Leonard Schanfield Research Institute, along with former Director Micki Iris, developed a brief self-administered screening tool called the “MedUseQ.” The tenminute survey was designed to help older adults assess medication use problems. It can also be used by healthcare professionals one-on-one and in group settings. The survey was validated with a study published in the Journal of Pharmacy Practice and can be found at journals.sagepub.com/doi/pdf/10.1177/0897190018766789

The Schanfield researchers also published a flyer entitled “Strategies for Managing Your Medications.” It offers ways to deal with medication issues, such as changes in its appearance, changes in one’s normal routine or because the instructions are complicated.

In examining substance abuse, researchers believe that older adults are different from younger adults in these areas: cognitive function, biological factors, psychological factors, and social factors. Kalapatapu and Sullivan claim that the aging process itself can affect the underlying neurological and physiological systems involved in substance abuse (The American Journal of Addiction, 2015). For example, neuro-transmitters involved in the brain’s reward system can be affected by aging. Also, older adults are more sensitive to medications and have more chronic health conditions that can overload their aging body. Plus, they tend to have fewer social or familial connections due to recurrent losses.p The authors state that without children and careers, older adults often let go of previously self-imposed controls. Thus, the cause, treatment, outcomes and prevention strategies for substance abuse in older adults are different.

Medication Abuse by Older Adults

A recent JUF News article by Jenna Cohen (July, 2018) reported that the loss of some Jewish Chicagoans to opioid drug overdoses has made the Jewish community even more aware of the problem. The Jewish Center for Addiction (JCA) was established in 2014 as a program of Jewish Child and Family Services (JCFS) to support those families facing this problem. Nina J. Henry, LCPC, CADC, Addiction Specialist at JCFS, was quoted as saying that “people with substance use disorders assumed they were not welcome in synagogues.” The author cited the Bible story of Hannah, who was “nearly cast out of the temple when her fervent prayer was mistaken for drunkenness.” This is not a very welcoming message for contemporary substance abusers.

Many people are relieved to discover that their addiction is not a moral failing or weakness on their part but rather, according to Beth Fishman, PhD, Program Manager of JCA, “a complex process with biological, genetic, psychological, sociological and spiritual components.” Fortunately because of education about the issue, attitudes have changed and Henry says “the conversation has become more open in the Jewish community.” Now many local synagogues hold recovery meetings in unused classrooms or other rooms.

What To Do If You Suspect Substance Abuse

If you are concerned about your or a loved one’s substance abuse problem, talk to one of our professional therapists who has experience in dealing with the issue. Call 773.508.1000 for more information.

In the article in Clinics in Geriatric Medicine, the authors offer these suggestions for providers and family members:

  1. Be aware that the older adult may put up barriers to effective screening.
  2. Be mindful of the older adult’s lower threshold of sensitivity to substances.
  3. Consider that substance abuse may be a contributing factor in other illnesses.
  4. Use a urine test as a screening tool.
  5. Pay attention to any psychiatric and medical illnesses and age-related limitations.
  6. Utilize individual, family and group therapies as interventions.
  7. If necessary, admit the older adult to an inpatient facility for detoxification.

CJE: A Source for Information about Substance Abuse

CJE SeniorLife has been in the forefront of the substance abuse issue among older adults, with many sources of support including counselors who are experienced in the field of addiction. Rosann Corcoran, Manager of Counseling Services, says, “We collaborate with staff at the JCA to provide ongoing support and training for CJE staff. CJE is a member of the Illinois Coalition on Substance Use and Aging. Lieberman Center, our long-term skilled nursing care residence, has strict pain management protocols to avoid the development of dependence. Also, our Research Department developed a medical use and questionnaire called the MedUse Q (download here).

CJE Counseling Services is planning a special community program with the Illinois Coalition on Substance Abuse and Aging in the spring. It will have speakers and focus on substance abuse, addiction and medications and will offer private consultations with a pharmacist to review medications, as well as private consultations for assistance in completing the MedUse Q screening. Watch for more details.

A recent development is the establishment of the Jewish Addiction Awareness Network (JAAN). According to JCA’s Fishman, who serves on its Advisory Council, it is “a national nonprofit with a mission to increase understanding of the disease of addiction and decrease stigma by connecting individuals, families, and professionals across the Jewish spectrum in order to explore the intersection of Judaism and recovery, exchange resources, and support those in crisis.”

More information can be found at the following links:

Afraid you’re taking too many drugs or worried about drug interactions? Answer our Medication Use Questionnaire and learn about strategies that can help with different medication issues. The questionnaire and strategies flyer is located at cje.net/research-education/ lsri/meduseq