May 18, 2006
Substance Abuse a Senior Problem, Too
When Amy Kaplan heard about Betty (not her real name), a Jewish Family Service client in her early 70s who said she couldn't afford all of her medications, Kaplan suspected there was more to the story. Kaplan, a social worker and addiction specialist, visited Betty's home and confirmed her suspicions: Betty was taking 24 prescription medications, some of which were duplicates or even triplicates. Betty was drowsy, unsteady, financially strapped -- and addicted.
"The numbers are astronomical," Kaplan said. "I'd say 90 percent of our clients are affected by addiction in some way, either themselves or through a family member, a close friend or a neighbor."
According to the Substance Abuse and Mental Health Services Administration, prescription drugs and alcohol abuse among adults 60 and older is one of the fastest growing health problems in the country, affecting up to 17 percent of older adults. With baby boomers beginning to turn 60 this year, the incidence will continue to climb without intervention.
"This is a significant problem which has been underidentified and under-recognized," said Karen Leaf, director of Jewish Family Service of Los Angeles' (JFS) Valley Storefront in North Hollywood. "Given the scope of the problem, we decided we needed to be better equipped to deal with it."
With grants from the Archstone and Jewish Community foundations, JFS instituted the Senior Substance Abuse and Mental Health Initiative last summer. Kaplan, who had previously worked at the Betty Ford Center in Rancho Mirage, was recruited to develop programs for JFS. The agency's first priority involved educating and training its own social workers and case managers -- who deal with thousands of seniors in the course of a year -- to better recognize and assist clients with substance abuse problems.
Kaplan now leads a weekly Alcoholics Anonymous meeting at the Valley Storefront location, and JFS hopes to add more locations in the future. Dr. Alan Schneider, a psychiatrist specializing in the elderly, has given presentations about mental health and medication management during brown-bag lunch sessions at area senior centers. To increase public awareness of the issue, Kaplan and others have made presentations at health fairs, meetings and other community events.
Older adults are usually "accidental addicts," according to Carol Colleran, director of older adult services at the Hanley Center in West Palm Beach, Fla., and co-author of "Aging and Addiction" (Hazelden, 2002). She said that seniors often develop problems when they continue to take prescription medications that were intended for short-term use. This is common with a class of drugs called benzodiazepines, medications prescribed for insomnia and anxiety. Benzodiazipines, which include Valium and Xanax, are addictive.
Colleran said that late-onset addiction can be triggered by loss, such as the loss of a spouse, a job or a sense of purpose. To cope with these losses, individuals may self-medicate with prescription drugs and alcohol.
Problems are compounded because the body processes alcohol and drugs less efficiently as it ages. Older adults may find that they can no longer tolerate the same amounts of alcohol that they consumed in the past. And alcohol's effects are intensified when it is mixed with prescription or over-the-counter drugs.
"Safe drinking for older adults is one drink per day," Colleran noted. One drink equals a 12-ounce beer, 1 1/2 ounces of liquor or 5 ounces of wine.
Underdiagnosis of alcohol and prescription drug abuse among older adults is common because symptoms -- including fatigue, depression, irritability, insomnia, frequent falls, chronic pain, impotence and congestive heart failure -- are often misinterpreted as signs of other medical conditions. Symptoms may be attributed to dementia, Parkinson's, depression or simply products of aging.
Addiction is not on the radar screen for most physicians, according to the National Center on Addiction and Substance Abuse at Columbia University (CASA). In a CASA physician survey presenting a hypothetical case of a mature woman who showed the typical early symptoms of alcohol and prescription drug abuse, only one percent of the doctors considered substance abuse as a possible diagnosis.
"We need to get the word out about this," said Colleran, who believes ageism and sexism are additional barriers to recognition of the problem.
On the positive side, she said that older adults have the highest success rate in treatment of any age group.
Jews and Addiction
Although JFS is a nonsectarian organization, addiction specialist Kaplan estimates that 50 percent of the agency's senior clients who suffer from addiction are Jewish. The perception that Jews don't drink, she said, is a myth. Further, a 2001 study published in the Journal of Addictive Diseases refuted the perception that Jewish alcoholics have lower educational, financial or religious levels.
While the JFS initiative does not incorporate Jewish content, there are programs that address addiction through a Jewish lens. Unlike the JFS initiative, however, they are not targeted exclusively to older adults. New York-based Jewish Alcoholics, Chemically Dependent Persons and Significant Others (JACS), which offers numerous resources on its Web site, holds programs in several Los Angeles locations. Beit T'Shuvah, which provides both residential and out-patient treatment, addresses addiction using Jewish spirituality, the 12-Step program originated by Alcoholics Anonymous and psychotherapy.
Congregation Or Ami in Calabasas has offered a variety of programs addressing addiction, including Madraygot (Steps), a monthly program that looks at the intersection of Judaism and the 12-Step program. The synagogue commissioned a rabbinic intern, Rebecca Hoffman, to develop a curriculum designed for congregations to offer their own Jewish 12-Step program.
"I've worked at three Los Angeles area synagogues, and the minute I started talking about addiction, people started coming out of the woodwork," Or Ami's Rabbi Paul Kipnes said. "My goal is to break down the walls of silence and talk about it ....Individuals who are suffering from addiction have a place in the community and the community needs to respond."