Never Too Old to Get Help

[Jaunty Guitar Music]

Mike: Welcome everybody. This is Avoiding the Addiction Affliction brought to you by Westwords Consulting and the Kenosha County Substance Abuse Coalition. I'm Mike McGowan.

Mike: We've heard numerous times here about the need for additional substance use disorder resources for underserved populations.

Mike: Believe it or not, that includes the population we're going to talk about today, one of the largest population groups in the country. Ironically, older adults. My guest today is Alexandra Plante. Alexandra is a Senior Advisor of Substance Use Disorder in the Strategy and Growth Office of the National Council for Mental Well Being.

Mike: She is a recipient of a Fulbright Specialist Award in Substance Use Disorder, leads the National Substance Use Interest Group, and volunteers her time. Can't believe she has any, with the Maine Recovery Advocacy Project. She has served as a consultant to U. S. federal agencies and state policymakers, international agencies such as the United Nations Office for Drug Control and Crime, and private entities such as Google.

Mike: Her writing has been featured in outlets such as Harvard Health Publications, Scientific American, and Psychology Today. She holds a master's in arts and quantitative research and communications and previously served as a director at the Massachusetts General Hospital and Harvard Medical School Recovery Research Institute.

Mike: Welcome, Alexandra.

Alexandra: Thank you so much for having me.

Mike: Well, I, I want to start first with before we get into the topic, tell us about the National Council for Mental Well Being for those who haven't heard about it.

Alexandra: Yeah, thank you. So the National Council for Mental Well Being is a non profit behavioral health organization out of Washington, D. C.

Alexandra: We represent substance use treatment providers and mental health providers around the country. And we do a lot of work in advocacy, policy, research, and education on substance use and mental health. And I do substance use specifically. We're a staff of a little bit over 250 right now, and we work all across the country and yep.

Mike: Outstanding. You know, I came across an article you wrote entitled substance use challenges in older adults. I love the topic. I've talked about it for a long time. Older adults represent a large demographic. I don't even know how to put this, but a hidden one. I think a fairly hidden one when it comes to to drug use.

Mike: Correct?

Alexandra: Yes. And I think it's just a very overlooked population. It's a big population in the U. S., but I think especially when it comes to substance use disorder people kind of look the other way or don't think it's important or don't think that people can change or recover when, you know, they reach a certain age.

Alexandra: And so we kind of just turn a blind eye to it when there is a lot of suffering and a lot of change and positive things that could happen in that population around substance use if we were to pay a little bit more attention.

Mike: Well, this is the two generations, really, right? I mean, if we name them baby boomers right now, I'm one of them.

Mike: And what is the next one? Gen X?

Alexandra: Gen X, yeah.

Mike: Yeah. And they have different views on drugs. I mean, I grew up around them. So as you get older, do you find that their views on drugs treatment differ from the population that preceded them?

Alexandra: You know, I Yes, I mean, I think it is though somewhat individual by individual, so there are generational things, you know, having gone through the 60s, having gone through times in American history where, for example, psychedelics were easier to obtain and use and had kind of some positive I don't know, forces behind them, I guess, at certain times.

Alexandra: You of course have Vietnam Vets. who, you know, went over to Vietnam and most,, really high numbers tried heroin and other illicit substances over there, but then amazingly came back and a lot of them did not develop substance use disorders out of that. So you definitely see different experiences with different people and different generations.

Alexandra: And they're one of the things that. We have to think about too, though, is this rise of therapy and formalized treatment for substance use disorder. It didn't really exist it had kind of collapsed after prohibition for, for example, like with alcohol use disorder. And so when you look at the 1940s, 1950s, 1960s into the 70s in the United States, It's a lot of these informal peer support alcoholics anonymous groups operating as the de facto substance use treatment in America, and it's not really until more recent decades that you really see this formalization and kind of normalization of psychology, mental health, substance use treatment, medications, that kind of thing.

Mike: Do we have the numbers for how many people make it into later life, weathering substance use all through life, as opposed to developing it as they get older?

Alexandra: Yeah, we do. So it's estimated that about 1 million adults 65 and older have a substance use disorder. And so within that number, about two thirds, so let's just say.

Alexandra: About 650,000 Americans have had what they call a persistent condition. So that means they have basically gone through their whole life with a substance use disorder and kind of aged into it. And then you have about a third, so around 300,000 older adults who have developed their substance use disorder later in life.

Alexandra: And that's actually the contingent that is pretty interesting to look at kind of what has happened there, given they may not have had some of the traditional risk factors that occur during adolescence or the twenties.

Mike: What happened?

Alexandra: What happened? Exactly. What happened? And so, yeah, I think there are some different, I don't know, do you want me to get into it?

Mike: There are some risks you get get older, right?

Alexandra: Yeah, so there are some really unique risk factors to being an older adult. You have an increase in loneliness and social isolation that can be due to a lack of mobility. Maybe you don't have a license anymore to drive around. Things can happen to stable relationships. You could be single, divorced, widowed, you have prolonged states of bereavement and grieving as an older person, more of your friends and family and folks that you know are passing away.

Alexandra: There are some really big transitions that happen to older adults. It's not just teenagers going off to college, but you're an older adult and maybe you are retiring. So where you've worked for 30 years and the folks and the socialization you got there doesn't exist anymore. You're trying to find meaning in retirement, which is actually becoming their retirement coaches nowadays to help people figure that out. But you may downsize in transition housing you also just list off a few more, it's like there's chronic pain, there's can be complex health conditions, cognitive decline yeah, just kind of lots of forces all going on at once that can really make folks vulnerable to developing a substance use disorder.

Alexandra: And that's not even sort of taking into the account that 54 percent of adults 65 and older have four or more prescription drugs that they're taking every day. So there's also just sort of a cocktail of prescription drugs in there.

Alexandra: Yeah, to complicate things further.

Mike: Wait, did I hear you right? Over half of the population, 65 and above, have four or more prescriptions they take daily?

Alexandra: Yeah, that they take every single day.

Mike: And there has to be drug interactions then?

Alexandra: There's definitely drug interactions.

Mike: Wow. You know when you talked about loneliness I think about COVID, right? And we saw drinking especially go through the roof and across the board in populations. I assume, do we know, did that also apply to older adults?

Alexandra: Yeah, it did. You know, I don't think, you know, COVID was something that affected everyone. And so, you know, adults 65 plus were not you know immune to that, and if anything, I think may have been hit even harder because they were more susceptible to COVID, more at risk for long COVID, more at risk for, you know, fatalities around, you know, COVID, you know, catching a case where you don't recover from it.

Alexandra: And so there is even more risk in that population. And so even more kind of isolation that needed to happen and fear and anxiety around it. And so, yeah.

Mike: And how do we even know if you're isolated that you're coping by using substances?

Alexandra: We don't. And I think especially when it comes to alcohol use, the numbers are always widely underreported.

Alexandra: One of the reasons for that is that alcohol use disorder often isn't a cause of death as it is for like an opioid use disorder you die of an overdose Without alcohol, you know, it often takes the form of 26 different cancers or liver disease or something like that. And so we often don't really have accurate numbers around alcohol use, alcohol use disorder, et cetera.

Mike: Oh, that's so a little self disclosure. When my father died and he was chronic, my uncle came to the funeral home cause he was with me. He was so afraid that I would say to the funeral director, did it end up in the paper. That my dad had a drinking problem. So instead it read heart disease.

Alexandra: Yep. And that's the classic scenario is, you know, you want to honor your loved ones.

Alexandra: They still meant a lot to you. They still could have, that did leave meaningful lives. They were people and, you know, wanting to give them the respect of not putting what's a very stigmatized condition on a death certificate. You know, it happens all the time, but it also makes, you know, the data very, very skewed.

Mike: Well, you know, we used to hear all the time about older adults sharing prescriptions with one another. Is that still an issue?

Alexandra: You know, it could be sharing prescriptions. I think another thing we get these days is sort of this rise of online pharmacies and you know, drugs can be really expensive, not all drugs are covered, wanting to find cheaper options, older adults potentially getting preyed upon or not understanding that a pharmacy is real or kind of just a front. Yeah, so it's complicated.

Mike: You just made me think of that. I've read tons of articles about pharmacies setting up getting bulk prescriptions in saying that they're servicing nursing homes And you don't really know where the drugs are going.

Alexandra: Yeah, you don't really know who you're buying from online.

Alexandra: It's it's complicated because there are some real pharmacies online, there are some fake ones, there are black markets. But there are also are some online industries that are regulated, but we don't even know about because they're not well known that just sort of sell compounds, and you don't really know who you're buying from or what you're buying, and it's kind of an area that's probably going to see a lot more federal, you know, state regulation in the next decade as people get savvy to all the risks associated with buying counterfeit stuff offline.

Mike: Well, as long as you mentioned that, late last year, the U. S. Senate Special Committee on Aging released a report entitled, The Silent Epidemic, Fentanyl and Older Americans. Where are we with opiates and older adults?

Alexandra: Again, there's just a really strong connection here with older adults. I think overdose deaths within the older adult population have quadrupled in the past two decades. I think folks that have historically used illicit substances don't always realize to what extent the current U. S. drug supply has been poisoned. Or tainted with fentanyl or now xylazine, which is a tranquilizer. Of course, when you buy counterfeit pills, they are most likely to be tainted with fentanyl at this point. You can't buy heroin anymore. Heroin is usually code for fentanyl. There's a lack of drug checking equipment in the United States that stood up. So a lot of times. Yeah, folks just won't know what exactly they're getting, but we, it's very fair to assume that they are getting fentanyl and we don't know how much you're getting or what other drugs are mixed in as well.

Mike: And one of their recommendations was to raise awareness among seniors. Well, how do you do that?

Alexandra: I think, you know, I always see primary care providers as one of the best conduits to reaching folks because people are usually coming in annually for a physical or coming in when they don't feel well, and so doing screeners and talking to folks about that, I think there also needs to be awareness within the medical community about what substance use disorder can look like in older adults, because it's often conflated with normal signs and progression of aging.

Alexandra: So things like forgetfulness, losing words, feeling tired or fatigued, feeling confused, you know, all these things could just be normal signs of aging or they could be a drug interaction or that the individual has a substance use disorder. And that's what's causing these effects. And we need to start just being a little bit more in tune and asking these questions and looking across all the medications that folks are taking for these interactions.

Mike: You know, that's interesting you say that because I just had a physical and so I was asked that whole battery of questions, but it's just me answering them. So it's like, Hey, are you feeling despondent? Are you being abused? Oh, it's easy enough. No, no. You know, do you have a, no. And there's no cross check, so how would any, how would a physician know that I wasn't just making it up?

Alexandra: Yeah, I, you know, there are a, there are special skills that can be used in an older adult population and are designed to be used with an older adult population. And so that would be the first step is making sure that age appropriate tools are being used to screen folks, but additionally. And this is actually something that I'm hoping that AI technology will help with is being able to track patients over time and being able to really know what somebody's baseline is, what is their normal, and you know, how quickly have they moved away from a normal or, you know, if they said that they had substance use, you know, 10 years ago, that that still is something that's on the radar today.

Alexandra: There also is a lot of misnomers at this point around being denied coverage or insurance being more expensive if you were to tell your physician or your health care provider that you do smoke, that you do drink. There's a lot of secrecy around it. I think we need to work on rapport building around.

Alexandra: Patients feeling comfortable enough to share, not worrying that there's going to be stigma, not worrying about their insurance premiums going up as a result. Because it's going to be within that sort of safe therapeutic rapport that, you know, providers can really treat patients.

Mike: I think people are afraid to list it, that it follows them then.

Alexandra: Yeah. Yeah. And there's, Yeah, I mean, I think it comes back to stigma, and you especially get this stigma in an older generation that, you know, it's some kind of a moral or character flaw. We know today that substance use disorder is a chronic condition, that there are biological underpinnings to it and it's a chronic condition like asthma or diabetes or heart disease, and we need to treat it as such, but stigma can take a long time to kind of I guess, get out of the, the cultural nomenclature.

Mike: Well, you know, speaking of stigma, you, you may think of something I thought about this morning. The mental health component is similar to this. You know, I, we're re stigmatizing older Americans in mental health. I was watching, this is no sides, I was watching a political discourse and both sides are hurling insults towards the two candidates about their mental acuity.

Mike: That's not helping. older adults say, Hey, I may be having a problem. That's isn't it right. They'd be much more like this. Say, I don't want the shaming that comes with all this.

Alexandra: There's a lot of masking that I think needs to happen in our society or that that does happen in our society as a result of ageism.

Alexandra: This idea that people can't change, that they're too old, that they're over the hill, that they're not of use to society anymore, or I mean, it's just very deep seated and you know, I have so much and I hope that we do kind of replace that stigma at some point with respect because we're all gonna get there.

Alexandra: We're all gonna be old at some point and the truth of the matter is that getting older is really the creative challenge of a lifetime. To me, I think it's gonna be the, the biggest creative challenge that I face in my life because what do you do when you can't do the things that you used to do anymore?

Alexandra: So maybe you're a runner and you can't run because of health conditions. What are you shifting to? Maybe it's pickable. You know what I mean? But you know, what do you do when your spouse passes away and you kind of need to start over? What do you do when you can't, you can't drive anymore? How do you still find a sense of freedom and independence?

Alexandra: You know, there's just folks you know, once you get to a certain age, I mean, there's just so much respect, respect there for kind of what they're dealing with on a daily basis. But our society is not kind about aging. And that flows through substance use disorder, mental health, physical health, politics, all of it.

Mike: Yeah, well, I was laughing because you just talked to somebody who just had a knee replacement. So that was one of them. But then I think of the phrase that's being tossed around now. Which totally discounts the whole generation. Okay, boomer. Like we have nothing of value or just shut up, you know

Alexandra: Yeah, it's dismissive and yeah, I mean we've seen this throughout history.

Alexandra: I think right now it's like you see it very, you know But it's been done to different racial ethnic groups. That's been done to women and done to minorities and you know, I, I remember in the early 2000s, there was just lots of dumb blonde jokes, you know, and it's just that same vibe of writing people off because of a specific characteristic about them.

Mike: Getting back to respect would be a great, great idea. Well, speaking of that, you can you sort of mentioned it, you can get better. I think, I looked this up and I had never heard of this actually. Medicare says it covers treatment and something called Structured Assessment Brief Intervention Referral to Treatment, SBIRT.

Mike: What are the obstacles to older adults getting treatment?

Alexandra: Yeah there are a lot of you unique obstacles to this age group. Stigma is a barrier. There's a lack of programs that are tailored to the older generation. And I think having more specific programs could be really helpful. For example, there may be different sensitivities around gender mixing, you know, feeling more comfortable just being with women or just being with men.

Alexandra: I think as we've talked about, there can be different sort of stereotype beliefs, experiences that they're bringing into treatment that, you know, might just be able to be better served with their own cohort or in a program that's specific. The last one I'll bring up as just sort of a very known barrier is that older adults often have co occurring physical ailments. And one of the issues that we see with addiction treatment is that if you have anything physical going on, they won't accept you into treatment because they can't treat that physical ailment. So recouping from a knee replacement or having a co occurring sort of mental health are getting better at incorporating, but if it's something like dementia or whatnot, they wouldn't really know how to, how to, well, they just don't have the resources to, to treat that alongside sort of a whole person health kind of vibe.

Alexandra: So, a lot of times, older adults just can't get into treatment. And I'm just going to make a parallel here that we're seeing a similar situation with xylazine. So xylazine is a horse tranquilizer that has made its way into the U. S. Drug supply and creates open wounds on the body. As a result, treatment centers will not accept, you know, xylazine addicted patients because they can't treat the open wounds.

Alexandra: But if the folks can't get into treatment, they can't stop their xylazine use. And so they can't stop the open wounds. And it's kind of this vicious cycle. So, I think moving forward, one of the takeaways here is that we need substance use disorder treatment that's able to do whole person health and include mental health services, include physical health services, community supports, the whole gamut.

Mike: Great. Well, what a wonderful topic. I want to end this though with a little bit different way. We've been talking about older adults for the half an hour, but, and I couldn't believe it when you responded to me because you're on maternity leave. So you gave up part of your maternity leave to do this with us today.

Alexandra: I love talking about this topic and was excited to, yeah, to talk with you today, but I have a 10 week old little boy and we're just over the moon.

Mike: You named him Michael, right? (laugh)

Alexandra: Close. Nash.

Mike: Oh, that's a cool name. Very cool. Is this your first, your twentieth, or what?

Alexandra: This is my second. So, we actually have a little boy named Knox who turned three yesterday.

Alexandra: Yeah, and then Nash is ten weeks. So, I am officially a boy mom and loving every minute of it.

Mike: That's great. What does Knox think of Nash?

Alexandra: He loves him. Yeah, he's actually really leaning into it. And you know, I think at first we had to really work with him on how he's helping mommy with the baby, you know, just because a three year old is lacking in fine motor skills, patience and gentleness, but he tries. (laugh)

Mike: Well, those of us older Americans listening to this, we know those times really well. So,

Alexandra: Yes, and I hear that actually being a grandparent is really where it's at. So. (laugh)

Mike: Well, I wouldn't know that yet, so.

Alexandra: (laugh)

Mike: Alexandra, thank you. Your council, the National Council for Mental Well Being has some incredible resources and all of you know who listen to this and if it's your first time, we have a link to that, to their website on this podcast and feel free to use it.

Mike: For everybody else who is listening join us anytime you're able.

Mike: Till then we hope you can stay safe and remember it's never too late to get well.