Recovery Challenges among Older Adults (Bill White and Randall Webber)

Sergii Gnatiuk

Multiple factors can interact to increase vulnerability for the development of alcohol and other drug-related (AOD) problems in older adults. Those same factors can pose threats to older adults in long-term addiction recovery. In the former situation, older adults who did not experience such problems during their formative and maturing years develop AOD problems late in life. In the latter situation, individuals with years or decades of stable recovery experience a recurrence of such problems with potentially profound or fatal consequences. (The shame from losing long-held sobriety and elder status within a recovery community can be a significant obstacle to recovery re-stabilization.) We have observed four root causes of such vulnerabilities in both circumstances.

1. Physiological factors: Changes in drug metabolism (e.g. decreased tissue tolerance, atypical drug actions and interactions), co-occurring medical/psychiatric conditions, and the use of multiple medications have the potential to amplify untoward effects of alcohol and other drug consumption in older adults. These same factors may escalate the speed and severity of addiction reinstatement in the older adult who resumes AOD use after prolonged sobriety. Sleep disturbances and the onset of acute and chronic pain increase the vulnerability of both groups for patterns of self-medication. Age-related cognitive impairments increase AOD vulnerability due to age- and AOD-related effects on memory and judgment. Some older adults who have used medications to support their recovery--medications such as acamprosate (Campral) or disulfiram (Antabuse)--may also no longer be able to take these medications due to problems with liver or kidney functioning, leaving them at increased vulnerability for recurrence of alcohol-related problems.
2. Emotional Factors: Aging requires the management of multiple losses: the loss of functional capabilities; the loss of family members and friends due to death and relocations; the loss of meaningful roles, activities, power, and status; and the potential decline in one's standard of living. We have witnessed AOD problems developing among older adults in the context of such losses. These grief response sometimes morph into the clinical conditions of depression or anxiety and increase the propensity for and risks of self-medication with alcohol and other drugs.
3. Social Factors: The disruption of long-standing social networks in older adults due to retirement, relocation, and deaths can heighten vulnerability for AOD problems. We have also witnessed older adults falling prey to such problems when they enter new social groups (e.g., retirement communities) in which heavy alcohol or other drug use is the norm. Losing a sponsor to relocation, sickness, or death is also a potential source of recovery destabilization.
4. Spiritual Factors: Although growing older can result in a strong desire for connection to a greater being, for some older adults, aging is accompanied by a lost connection with their religious or spiritual roots. The resulting loss of meaning and purpose and a sense of hopelessness can increase vulnerability for a wide range of excessive behaviors, including AOD use. We have seen some older adults, fearing they are running out of time, commence risk-taking behavior similar to that seen in adolescence. We have also witnessed aging adults who, feeling they have fallen far short of their life goals, simply give up and commence drinking themselves into oblivion or death--until some event or new relationship rekindles a zest for living.

Erik Erikson characterized this final stage of life as a tension between ego integrity and despair. Within this tension, older adults resist or develop AOD problems and maintain or compromise recovery from such problems. The good news is that, in spite of such threats, most older adults, including those in recovery, meet these challenges and maintain their health.

It is our belief that older adults constitute a unique population, on par with adolescents and transition age youth, who require specialized, developmentally appropriate prevention, early intervention, treatment, and recovery support services. As the aging of the U.S. population continues, we expect to see remarkable breakthroughs within this service continuum aimed at the special circumstances and needs of older adults.

In reviewing the above sources of vulnerability for the development or recurrence of AOD problems in older adults, one could get the mistaken impression that aging is itself a pathological process. But there are other oft-ignored dimensions of aging that challenge such a view. Increased time for self-care. Changes in lifestyle that improve physical and emotional health. A shift in focus from doing to being. Acceptance of imperfection and limitation. Letting go of past resentments. Seeking forgiveness and forgiving. Deepening gratitude for one's blessings. More meaningful personal and family relationships. Discovering previously hidden resources within and beyond the self. The gift of time for pleasurable pursuits and quiet reflection. Exploration of new forms of service to others. Such rarely acknowledged dimensions of aging can enhance resilience and the quality of personal and family life in long-term recovery.