Enough of the Media Distortions: Senior Citizens Are at Low Risk of Addiction
Much media coverage depicts an epidemic of addiction among over-65s. The evidence shows that this picture is a false one.
Something about addiction among senior citizens really seems to capture news editors’ imagination. One Huffington Post article, for example, was titled “Binge Drinking: Seniors Engage Most Often, Says Study.” More recently, Next Avenue ran one called “America’s Surprising Binge Drinkers: People Over 65.” We’ve also seen USA Today’s scare head, “Older Americans hooked on Rx: ‘I was a zombie’,” while websites like AgingCare.com give dire warnings about “Seniors and Prescription Drug Addiction.”
These stories go viral on social media and leave us with a picture of addicted seniors everywhere. There’s just one little problem: The data does not back up claims that the ranks of America’s senior citizens are dominated by those struggling with addiction. Quite the contrary: Senior citizens show the lowest addiction rates of any age group in the US over the age of 12, just as you always suspected.
Such stories are not only distortions, but harmful distortions. For example, as the Wall Street Journal reported last week, doctors are unethically making money by conducting unnecessary drug tests on seniors. Public perceptions that addiction is common among seniors make it easier for the doctors to get away with this.
Let’s address those Huffington Post and Next Avenue pieces about binge drinking among seniors. Both of them, among many others, cited as the source of their data the CDC report Binge Drinking Prevalence, Frequency, and Intensity Among Adults—United States, 2010. Binge drinking is defined by the CDC and other government agencies as five or more standard drinks in a day for a man—going on a bender morning-to-night for days on end is not required. For women, the definition is four or more standard drinks in a day.
The CDC report does indeed say that those senior citizens who binge drink do so an average of 5.5 times per month, as compared to 4.2 times per month for the 18-24 year olds. However, a far more striking and important bit of data mentioned in the report is that only 3.8% of senior citizens binge drink at all, compared to 28.2% of 18-24 year olds. More than seven times as many young adults binge drink as do seniors—a fact which was glossed over at best in our two sensationalized stories. What’s more, those seniors who do binge drink have far fewer drinks per episode than do young adults: 5.7 drinks on average for those over age 65—only just qualifying as binge drinking—compared to 9.3 for 18-24 year olds. This data is summarized in Figures 1 through 3.
Next let’s take a look at nonmedical use of prescription drugs among senior citizens. To do that we’ll need to be aware of the difference between nonmedical use of a drug and a Substance Use Disorder—a topic I wrote about in some detail in my previous Substance.com article.
Only a small percentage of nonmedical use of Rx drugs falls into the category of Substance Use Disorder, as defined by the American Psychiatric Association. Between 75% and 90% of nonmedical use, depending on the drug in question, is recreational and not clinically defined as a disorder.
Reading our sample stories in USA Today or on AgingCare.com would leave you with the impression that disproportionate numbers of senior citizens are foaming-at-the-mouth dope fiends, desperate for their next fix. But again, the actual data do not bear this out at all.
The very survey cited in the USA Today article, the Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Survey on Drug Use and Health (NSDUH), tells us that the peak age group for nonmedical use of prescription drugs (including painkillers) is 22-year olds, 16.7% of whom use prescription drugs non-medically. The age group with the least amount of non-medical prescription drug use is the over-65 crowd, who come in at a scant 1.1% and are easily beaten out by even the 12-year-olds (3.0%).
All of this is spelled out graphically in Figure 4. An asterisk next to an age group marks a significant increase in drug use from 2011 to 2012. There was no significant increase in non-medical drug use for the over-65 crowd from 2011 to 2012.
We see similar results when we look at nonmedical use of just painkillers: 22-year-olds once again come out on top, with 12.4% using painkillers non-medically; the over-65 group comes in dead last at a mere 0.8%. This is shown in Figure 5.
Finally, let’s take a look at the numbers of people that the US government felt needed to get treatment for a Substance Use Disorder in 2012. For over-65s it is 0.1%—massively lower than for any other age category, as we can see in Figure 6.
None of these results should come as a surprise to the well-schooled student of Substance Use Disorders. Contrary to the scare stories one sees everywhere, the science tells is that Substance Use Disorder is not a chronic, progressive disease and that its most common outcome is spontaneous remission—also known as “natural recovery”—a process of maturing out as one gets older. The following illustration from the National Institute on Alcohol Abuse and Alcoholism (NIAAA)’s Alcohol Alert 76: Alcohol and Other Drugs gives us an excellent picture of this “maturing out” process.
It is true that there have been increases (starting from a very low base) in substance use in the senior population in the last decade, and that the large size of the aging baby boomer demographic will present some challenges. But we need to weigh carefully the costs and benefits of such substance use and devise strategies to maximize benefits to seniors, as well as minimizing harms.
Substances can be a boon as well as a bane. Sometimes, for older people, it can come down to the issue of quality of life vs. length of life. If an 80-year-old, long-retired person enjoys drinking a six-pack on a Saturday night, what right do we have to moralize about this small pleasure? Can’t a person legitimately decide that five happy years are worth more than six less happy ones?
There is nothing inherently immoral about using a substance or even being dependent on a substance—countless diabetics are dependent on insulin and we see no need to censure them or take their drugs away. It is only the harms which accompany drug or alcohol use that should be the target of our interventions, not the drugs and alcohol themselves.
But just as some drugs, when used in combination with one another, are far more dangerous than when they’re used on their own, the concepts of addiction and old age, when combined, seem to bring out the very worst in journalists, tempting them to throw away objectivity and journalistic integrity. It may earn some cheap page views or sell a few more copies—and self-interested sections of the addiction treatment industry may be only too happy to go along with it—but telling the public more lies about drugs and alcohol will never solve society’s problems.
We need a firm grip on the facts if we’re to set and meet goals of both harm minimization and benefit maximization—not only with regard to seniors and substances, but with regard to all human behaviors that entail risk.
Kenneth Anderson is the founder of HAMS Harm Reduction for Alcohol and the author of How to Change Your Drinking: A Harm Reduction Guide to Alcohol. He has a master’s degree in Mental Health and Substance Abuse Counseling from the New School for Social Research and has worked in the field of harm reduction since 2002, including “in the trenches” doing needle exchange in Minneapolis. He served as online director for Moderation Management and as director of development at the Lower East Side Harm Reduction Center. He hosts a harm reduction podcast and writes a blog for Psychology Today called Overcoming Addiction. His last piece for Substance.com asked Addiction Treatment:Who Gets It and Who Needs It?
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