National Recovery Month 2023 - Recovery is Possible at Any Age
By Don Drake, Connelly Law Offices, Ltd.
Since 1989, the month of September has been dedicated to National Recovery Month, an annual national observance that aims to promote and support new evidence-based treatment and recovery practices. This month-long event celebrates the strong and proud recovery community in the United States and recognizes the dedication of service providers and communities that enable recovery in all its forms.
The objective of Recovery Month is to increase public awareness about mental health and addiction recovery. The Substance Abuse and Mental Health Services Administration (SAMHSA) leads the way by announcing new initiatives and grant funding during Recovery Month. SAMHSA works in collaboration with private and public organizations to celebrate the success of individuals who have achieved long-term recoveries.
Recovery Month is an opportunity to educate the public about prevention, treatment, and recovery services. It highlights the importance of seeking help and support for mental health and addiction issues. The month-long observance features various events, such as rallies, walks, and candlelight vigils, across the country to celebrate the achievements of those who have overcome addiction and mental health challenges.
Recovery Month has been crucial in promoting evidence-based treatment practices and reducing the stigma surrounding mental health and addiction. It is an occasion to celebrate the resilience and strength of individuals in recovery and to show support for them.
A Focus on Senior Substance Abuse
Substance abuse is not just a problem for the young generation anymore. A growing number of middle-aged and older adults are now misusing alcohol, opioids, benzodiazepines, heroin, and marijuana, which has led to the emergence of what experts call the "invisible epidemic." However, there are ways to protect yourself and your loved ones from the dangers of drug addiction.
According to the National Institute on Drug Abuse, rates of substance use among middle-aged and older adults have been increasing over the past decade. This problem has become more prevalent than ever before, and it is crucial to know the signs and symptoms of substance abuse to identify the problem early and get the necessary help (we will discuss this in a future blog).
It is alarming to learn that drug addiction affects nearly one million adults aged sixty-five and older, as per a 2018 report. Although drug use tends to decline as people age, the increase in the number of older adults seeking treatment for substance abuse from 3.4% to 7.0% between 2000 and 2012 is a significant concern for everyone. This trend shows that substance abuse is not just a problem for the younger generation, it can affect anyone regardless of age. It is essential to address this issue and seek professional help to prevent drug addiction from becoming a more significant problem.
Aging Influences the Effects of Substances
As we age, our bodies and brains change in ways that can make us more susceptible to drug and alcohol misuse. Even though we don't know much about how substances affect older adults, studies suggest that their bodies process these substances more slowly, and their brains can be more sensitive to their effects.
For instance, research has found that people who were addicted to cocaine when they were younger may experience more brain shrinkage and decline as they get older, which can make them more vulnerable to the harmful effects of cocaine.
As we age, our bodies become more vulnerable to various health issues such as mood disorders, problems with the lungs and heart, and cognitive decline. When we take drugs, these problems can get worse and can have grave consequences on our health. Some drugs can affect our judgment, coordination, and reaction time, which can lead to accidents like falls or car crashes. For older adults, these types of injuries can be more dangerous and take longer to recover from.
Who is at Risk?
In the fifty and up age group, men are more likely to struggle with alcohol abuse, while women are more likely to struggle with prescription drug abuse. It is important to note that there are several risk factors that can increase the likelihood of drug or alcohol abuse in later years. These can include a history of substance abuse, chronic pain or illness, loneliness or social isolation, and depression or anxiety.
Additionally, certain life changes such as retirement, loss of a spouse or loved one, or financial difficulties can also contribute to the development of substance abuse problems. It is crucial to seek help if you or someone you know is struggling with substance abuse, as it can have severe consequences on physical and mental health, as well as relationships and overall quality of life. Let's discuss some of the substances that are abused and the consequences that occur as a result.
As individuals age, they are more likely to develop chronic health conditions that require medication to manage. As a result, older adults are often prescribed more medicines than other age groups, which can lead to a higher risk of exposure to potentially addictive medications. For instance, a study of 3,000 adults aged 57-85 showed that many individuals mix prescription medicines, nonprescription drugs, and dietary supplements. In fact, more than 80% of participants used at least one prescription medication daily, with half using more than five medications or supplements, putting at least 1 in 25 people in this age group at risk for a major drug-drug interaction.
Apart from the risk of drug interactions, there are other dangers associated with medication use among older adults. One such risk is the possibility of accidental misuse of prescription drugs, which can have dire results. Moreover, the use of certain medications can exacerbate existing mental health issues among older adults. For example, a 2019 study of patients over the age of fifty noted that more than 25% who misuse prescription opioids or benzodiazepines expressed suicidal ideation, compared to 2% who do not use them. This underscores the need for careful screening and monitoring of medication use among older adults to ensure that they receive the appropriate treatment and avoid adverse effects.
Opioid Pain Medicines
Persistent pain is a complex issue, especially for older adults who may be dealing with other health conditions. Studies show that up to 80% of patients with advanced cancer experience pain, and 77% of heart disease patients report the same. Additionally, pain affects up to 40% of outpatients aged sixty-five and older. To manage their pain, between 4-9% of older adults use prescription opioids. Shockingly, from 1995 to 2010, opioids prescribed to seniors during regular medical appointments increased by a factor of nine.
In recent years, the U.S. population of adults aged fifty-five and older has increased by around 6%. However, the proportion of people in this age group seeking treatment for opioid use disorder has increased by nearly 54%. Even more concerning is the fact that the proportion of older adults using heroin, an illicit opioid, has more than doubled between 2013 and 2015. This is partly because some people who misuse prescription opioids switch to heroin due to its lower cost.
According to the Centers for Disease Control and Prevention (CDC), smoking rates among adults aged 65 and older were reported to be around 8 out of every 100 in 2017. This habit increases the risk of developing heart disease and cancer, which are two of the leading causes of death among older adults. While this rate is lower compared to that of younger adults, research has shown that older adults who smoke have an increased risk of becoming frail.
However, the good news is that smokers who have quit do not appear to be at higher risk. In fact, quitting smoking after the age of sixty-five can add two to three years to an individual's life expectancy. It is worth noting that quitting smoking also reduces the risk of coronary heart disease by half within a year of stopping the habit. Despite the fact that smoking-related deaths among people aged 65 and older are estimated to be around 300,000 per year, the risk diminishes significantly in older adults who quit smoking.
Although vaping nicotine (e-cigarettes) has gained popularity among younger individuals, there is little research on its effects among older adults. It is important to note that certain risks exist in all age groups, including the potential for addiction to nicotine, which is a highly addictive drug.
While some research suggests that e-cigarettes might be less harmful than cigarettes when people who regularly smoke switch to vaping as a complete replacement, the evidence is mixed, and the FDA has not approved e-cigarettes as a smoking cessation aid. Additionally, it has been observed that many individuals continue to use both delivery systems to inhale nicotine, which can lead to a higher risk of addiction and other health concerns. Therefore, further research is necessary to determine the long-term health effects of vaping nicotine, particularly among older adults.
In recent years, there has been a noticeable increase in the number of older adults using marijuana for medicinal and recreational purposes. According to a survey conducted in 2015-2016, 9% of adults aged 50-64 reported using marijuana in the past year, compared to only 7.1% in 2012-2013. Similarly, the use of cannabis by adults aged 65 years and older has also increased significantly from 0.4% in 2006 and 2007 to 2.9% in 2015 and 2016.
While marijuana is still illegal under federal law, many states have legalized its use for medical and/or recreational purposes. Medical marijuana has been shown to alleviate symptoms related to chronic pain, sleep hygiene, malnutrition, and depression, or to help with side effects from cancer treatment. In fact, one U.S. study found that nearly one-quarter of marijuana users aged sixty-five or older reported that a doctor had recommended marijuana in the past year.
It is important to note, however, that the marijuana plant has not been approved by the Food and Drug Administration (FDA) as a medicine. As such, the potential benefits of medical marijuana must be weighed against its risks, particularly for individuals who have other health conditions or take prescribed medications.
Regular marijuana use, whether for medical or recreational purposes, has been linked to a number of potential health risks. These include chronic respiratory conditions, depression, impaired memory, adverse cardiovascular functions, and altered judgment and motor skills. Additionally, marijuana can interact with several prescription drugs and complicate already existing health issues, particularly in older adults who may experience common physiological changes. Therefore, it is important for individuals considering marijuana use to speak with their doctor to determine whether it is a safe and appropriate treatment option for their specific health needs.
Alcohol is a commonly used substance among older adults, and it is concerning that a significant percentage of people aged 65 and older report high-risk drinking. High-risk drinking is defined as exceeding daily guidelines at least weekly in the past year. In fact, research has found that about 65% of older adults engage in this behavior. Furthermore, binge drinking, which is defined as consuming five or more drinks on the same occasion for men and four or more drinks on the same occasion for women, is also prevalent among older adults. More than 10% of adults aged 65 and older currently engage in binge drinking.
What is even more concerning is that research published in 2020 shows that the increase in alcohol consumption in recent years has been greater for people aged fifty and older relative to younger age groups. This is a worrying trend, as alcohol use disorders are already a significant problem among older adults. In fact, most admissions to substance use treatment centers in this age group are related to alcohol.
One study has documented a staggering 107% increase in alcohol use disorder among adults aged 65 years and older from 2001 to 2013. This is particularly alarming, as alcohol use disorder can put older people at greater risk for a range of health problems, including diabetes, high blood pressure, congestive heart failure, liver and bone problems, memory issues, and mood disorders. Therefore, it is crucial to raise awareness about the risks associated with alcohol use among older adults and take steps to prevent and address alcohol use disorders in this population.
Hard Problem to Detect
As people age, it can become difficult for family, friends, and even doctors to identify when they are struggling with alcohol or drug abuse. The symptoms can often be confused with normal signs of aging, which can make it harder to detect the issue.
Additionally, once someone retires from their job, problems with alcohol or drug use may no longer interfere with their daily routines, leading to further concealment of substance use. As older individuals may spend more time alone, it can be easier for them to hide their addiction from others. In some cases, even if someone notices the problem, they may choose to ignore it, thinking it is best for older people to continue doing what makes them happy, rather than addressing the issue.
Treatment in Older Adults
As people age, substance use disorders (SUD) can have a greater impact on their overall health and well-being. However, there are many behavioral therapies and medications that have been successful in treating SUD in older adults.
Despite this, there is still much to be learned about the best models of care for this population. Research has shown that older patients tend to have better outcomes when they receive longer durations of care. Ideal models of care should include not only diagnosis and management of SUD, but also of other chronic conditions. It's also essential to rebuild support networks, improve access to medical services, enhance case management, and provide staff training in evidence-based strategies tailored for this age group.
One of the challenges that providers face when treating older adults with SUD is that they may confuse SUD symptoms with those of other chronic health conditions or with natural, age-related changes. This underscores the need for more research to develop targeted SUD screening methods that are appropriate for older adults. In addition, integrated models of care for those with coexisting medical and psychiatric conditions are also needed.
Despite these challenges, it is important to note that once older adults are in treatment for SUD, they can respond well to care. Given the growing number of older adults in need of SUD treatment, it is critical that we continue to improve our understanding of how to best serve this population.
Ten Guiding Principles of Recovery
SAMHSA has developed a working definition and set of principles for recovery. A standard, unified working definition will help advance recovery opportunities for all Americans, and help to clarify these concepts for peers, families, funders, providers, and others. Below is SAMHSA's Ten Guiding Principles of Recovery:
1. Recovery emerges from hope
The belief that recovery is real provides the essential and motivating message of a better future—that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies, and others. Hope is the catalyst of the recovery process.
2. Recovery is person-driven
Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) toward those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.
3. Recovery occurs via many pathways
Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds— including trauma experience — that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery pathways are highly personalized.
They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches. Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks. Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families.
Abstinence from the use of alcohol, illicit drugs, and non-prescribed medications is the goal for those with addictions. Use of tobacco and nonprescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.
4. Recovery is holistic
Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing: self-care practices, family, housing, employment, transportation, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, and community participation. The array of services and supports available should be integrated and coordinated.
5. Recovery is supported by peers and allies
Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Through helping others and giving back to the community, one helps one’s self.
Peer operated supports and services provide important resources to assist people along their journeys of recovery and wellness. Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths. While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.
6. Recovery is supported through relationship and social networks
An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.
7. Recovery is culturally-based and influenced
Culture and cultural background in all of its diverse representations—including values, traditions, and beliefs—are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.
8. Recovery is supported by addressing trauma
The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
9. Recovery involves individual, family, and community strengths and responsibility Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves.
Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery. Communities have responsibility to provide opportunities and resources to address discrimination and to foster social inclusion and recovery. Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.
10. Recovery is based on respect
Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems— including protecting their rights and eliminating discrimination—are crucial in achieving recovery. There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in oneself are particularly important.
A Final Word
Recovery is a complex process that depends on multiple factors, including age, culture, and individual needs. To ensure the effectiveness of recovery services and supports, they must be tailored to the age of the individual and offered throughout their life. Recovery support services should also be flexible enough to ensure cultural relevancy, as what works for one person or group may not work for others. For instance, promoting resiliency in young people is essential and requires a different approach than recovery support services for older adults and seniors. By understanding the unique needs of each population, treatment can be optimized to help individuals achieve lasting recovery and improve their quality of life.
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