I did not mention alcohol in my previous post on drugs. I looked at this in a blog about a year ago, quoting the 2012/13 New Zealand Health Survey (Older People and Alcohol in New Zealand, July 2017). This showed high levels of use, especially among 55 to 64-year-olds. The majority of older men and women drink safely. But, given their greater vulnerability to the physical effects of alcohol, their greater risk of chronic medical conditions and use of medicines incompatible with alcohol, there are still hazards and, in their more recent report, the Royal College of Psychiatrists questions whether hazardous drinking thresholds should be lower for older people.
As with illicit drug users, some older people fall into the ‘Early-onset’ problem drinkers category. These have been drinking harmfully for much of their adult lives, and continue to do so. Although I do not have any concrete evidence, it is possible that fewer older people actually start illicit drug use in their later years, but more may start to drink alcohol much more heavily, for reasons often associated with grief and loss, anxiety, depression, boredom, isolation, loneliness and chronic pain.
An issue with alcohol is its use in social environments. The RCP cover it in their report with an interesting conclusion -“Prevention of alcohol misuse needs to be balanced carefully against the role played by alcohol in maintaining social cohesion among older people.” Older people drink to be social, to enhance social situations or special occasions, and this may be beneficial for wellbeing and participation. How to find a happy medium?
The link between alcohol use and health is important. Apart from obvious effects such as intoxication, a wide range of health conditions have been linked to drinking, including liver disease, pancreatitis, cancer, stroke and high blood pressure. Some of these may result from the cumulative effects of a lifetime of alcohol use. For the baby boom group (ages 50-69) alcohol rose from 16th to 5th among risk factors for years of life lost to disability in England between 1990 and 2013.
Which brings me to the issue of prescribed drugs. In England and Wales, the number of deaths related to opioids (used for pain relief and including drugs containing codeine and morphine) rose by 192% for people aged 50-69, as against 40% for people aged 30−39 over the last ten years. There was also a, less striking, rise for poisoning from cocaine, amphetamines and benzodiazepines. Legal amphetamines are used for weight loss and to treat ADHD. Benzodiazepines are prescribed as sleeping pills, muscle relaxants, and to help treat anxiety and epilepsy . Repeat prescribing of benzodiazepines is a common problem encountered in general practice. Misuse is associated with multiple risks, including falls and road traffic accidents. Dependence can lead to anxiety, depression and cognitive impairment.
Analgesics (a broad term for a variety of pain killers) can be either prescribed or over-the-counter medicines and are therefore fairly easily available – use is especially high for combatting back pain. Their misuse includes people taking too-high doses; ‘borrowing’ from friends or relatives; combining them with alcohol and taking them over a very long period, resulting in physical and psychological dependence.
But is this abuse, or is it that pain is not being properly treated? How should health services react? The RCP report concludes that substance misuse in older adults constitutes a significant challenge to both public health and existing services. Addressing the problem will require raising public, professional and political awareness. Drug use, whether legal or illegal, is another of those “lifestyle” factors which can damage wellbeing in later life, like smoking, poor eating habits and lack of exercise. Am I being too optimistic by suggestions that it may be easier to tackle?
I give the last word to the RCP. They suggest that the ideal approach is supportive, non-confrontational, and flexible. Treatment must be sensitive to gender, given physiological differences in the metabolism of alcohol and other drugs between men and women. Cultural differences must also be taken into consideration, and there should be a focus on client social skills and social environments.
“Diverse approaches are required to minimise the health, social and economic consequences for a population of “baby boomers” who have the fastest increase in rates of substance misuse in the population. These include raising awareness, limiting availability of, and access to, substances, and improving access to care. Approaches to treatment and rehabilitation need to be tailored and adapted from those found to be effective in younger people, and development of novel approaches need to be prioritised.”
 Royal College of Psychiatrists (2018) Our Invisible Addicts, 2nd edition. College Report CR211, London. Smoking remains the top risk factor in this age group