When No Means No: Addiction In Senior Citizens
Many senior citizens are addicted to alcohol, cigarettes, prescription drugs or substances. They want to quit but are afraid of the withdrawal symptoms. Sandhya Rajayer speaks to Dr Anand Jayaraman on addiction in senior citizens and how to tackle it the right way.
An elderly relative recently died of complications arising from an overdose of iron and calcium supplements. While clearing out his room, his children found three separate stashes of prescription medicines that were potentially fatal if consumed in a cocktail. They had no idea for how long he had been consuming this cocktail. Even though all his medicines were bought by the family, apparently the friendly neighbourhood pharmacist had been more than obliging to supply his prescription medicines without a prescription. “We had no time to undo the damage,” his daughter rued.
Across the globe, including India, addiction to cigarettes, alcohol, prescription medicines, opoids, morphine, cocaine and painkillers among seniors is on the increase and presents huge danger.
A community based study reported 10 % prevalence of alcohol use in the 60 plus population. Similarly, a study done on 1117 elderly in North India, 16.3% showed regular consumption of alcohol. A study done at a de-addiction treatment facility in Chandigarh reported 60 % abused alcohol while 35 % were addicted to opoids.
According to reports, addiction to a cocktail of prescription medicines is common among senior citizens. “By law, the pharmacist should sell medicines only on a fresh valid prescription and also maintain copies of the prescription,” says Dr Anand Jayaraman, Consultant Psychiatrist & De-addiction Specialist, People Tree Maarga Hospital, Bangalore.
“In my practice as de-addiction Specialist, I have seen that patients who were prescribed Benzodiazepines (drugs that act as tranquilizers) in their 40s, continue to have these even in their 60s and they don’t even realise they have got addicted. They will swear on anything you ask that they cannot sleep without these, they quietly admit that occasionally they have one in the morning and one at night, on further questioning they admit that on a bad day they have up to four or five a day…even when their system is not as robust as in their 40s. At that time, the doctor has prescribed these medicines to alleviate the patient from their suffering but somewhere along the line, they find these drugs are helping them in some other way and they drop out of treatment. And the friendly neighbourhood pharmacist is helping them.”
According to Dr Jayaraman, “As we age, our body is not able to physiologically tolerate the same amount of drugs or alcohol that it used to be able to. Lot of things are not at their optimum efficiency – starting from brain, liver and renal excretory function. In addition, you may have other risk factors such as hypertension, diabetes, cardiac disease and hypothyroidism…which make you even more vulnerable to fatal conditions.”
What Is Addiction & How do you know you are addicted?
Three of the following six criteria are all you need to fulfil for labelling consumption as addiction. These are:
*The individual must have been using a drug or substance over an extended period of time and continue to use it despite him/her getting psychologically and/or physically harmed.
* Prolonged use of the drug
* Developing drug tolerance
* Withdrawal symptoms
* Seeking the drug over alternative pleasure/interests constantly
* Craving the drug and having either physical or psychological harmful effects as a result. The activity of procuring and using the drug takes precedence over all other activities.
Can Addiction In Senior Citizens Be Cured?
Yes. Dr Anand Jayaraman cites a case study: “Not long ago, I had a patient who was a senior Scientist with a very successful business who had been using a mood elevating drug for two-and-a-half years. It had been prescribed for him when he had suffered a bout of depression earlier. He had a number of highly qualified people working under him but the buzz created by this drug was far more powerful than the work he was doing. And to settle down at the end of the day he would use a sleeping tablet. Unfortunately, his prolonged consumption of the medicines resulted in several mental issues such as mood changes, lack of anger control, sleep disturbances, getting agitated easily, restlessness, unable to concentrate.”
The patient was gradually tapered off the stimulants and his sleep rhythm was sorted out. “I made doubly sure that I did not prescribe any medicines which can be addictive. In order to ensure that he did not get back into the same patterns he also got extensive psychological counselling along with Cognitive Behavioural Therapy (CBT). To the patient’s credit, he’s worked out a way to manage himself while staying drug free. It took us six to eight months for the whole process. The initial three months were spent in getting him drug free then I gave him medicines so that his mood remained consistent without ups and downs; in the second stage he underwent psychological treatment. Now he drops in for follow-up visits just to make sure that he is doing fine. This is just one case I’m sharing here but there are umpteen numbers of stories of successful de-addiction,” emphasises Dr Jayaraman.
The Family’s De-Addiction Strategy
De-addiction cannot be achieved by force you must first take the individual into confidence. Educating people is of utmost importance. Since people fear the withdrawal symptoms, doctors try to keep it as bearable as possible.
*The most common challenge for families of addicts is getting him or her to a physician for the initial screening. Take the elderly person to a physician to check on some health issue and bring up the topic of addiction. E.g., telling the doctor, ‘I also think he has a drink problem, he may not acknowledge it but I think he has one and can anything be done about it?’ The doctor can then suggest a screening process. At least 20-30 per cent individuals make an attempt to quit at the screening stage because this advice comes through a trained professional.
*If this step doesn’t help, families can approach a counsellor or a psychiatrist. These two strategies usually help because you are trying to engage the individual rather than forcing him to change.
*Patient mindset: ‘This habit has worked for me all these years, why should I stop now?’ can be changed with education and counselling techniques. “Once you create an element of doubt, the patient’s resistance begins to crumble bit by bit. This process is called the ‘Cycle of Change’ wherein you drive the individual through a cyclical process that kick- starts the action phase.
Prescription drug abuse symptoms
The elderly usually have a long list of medicines; from a physician here, an urologist in a different hospital or a gastroenterologist somewhere else. Ideally, the primary physician should monitor who is prescribing what. Or at least the pharmacist should pick it up. But as that rarely happens. consuming a cocktail of prescription medicines could be harmful, even fatal. Here’s what families need to watch out for:
* Changes in sleep-wake up cycles and/or eating habits.
* Are the medicines that were prescribed being taken as prescribed?
* Are the medicines running out very quickly?
* Is the patient getting agitated, angry, unable to carry on with day to day activities?
* Have any long standing prescriptions been stopped abruptly?
* All these are reasons to consult a doctor immediately.
Should you get that drink in your retirement years?
Elders are at an age and stage when anything and everything can easily upset their system. “Smoking one or two cigarettes a day may be as harmful as smoking 10 or 20 a day at an younger age; ditto with alcohol,” says Dr Jayaraman. So what should the limit be? “Zero,” says Dr Jayaraman emphatically. “That is because anybody over the age of 60 has a very low threshold of alcohol consumption. Although people wiggle their way around saying it is cardio protective, but the general experience is putting a stop or controlling the urge is far more powerful because invariably people fail to control themselves once they get started. People usually start drinking in their prime, and if their system has had several decades of coping with alcohol then it is already worn out by 60 and they really have got to watch their backs. If not, the system will very easily decompensate. Likewise, tobacco; there are at least 120 carcinogens in cigarettes, why expose yourself to poison in your senior years?”
So should the drink at the retirement party be the last one? “No,” says Dr Jayaraman, “much before that. If you are knocking the doors of retirement, you are planning post-retirement years and that is already a difficult period to cope with. So well before your retirement think of completely coming clean, don’t have any source of dependence chugging along with you into your retirement years.”
Need to know more? Dr Anand Jayaraman can be reached at firstname.lastname@example.org