Shining a Light on Substance Use Disorder in Elders

Pittsburgh, Penn. I’m sure that brings to mind images of a booming industrial city, championship sports teams and our many, many bridges. Four hundred and forty-six, to be exact. More than any other city in the world. (Are you picking up on our Pittsburgh pride?)

There are other characteristics, however, that make the “Steel City” unique. For me, one of the more notable is our large and ever-growing older adult population. According to the University of Pittsburgh’s Center for Social and Urban Research, Allegheny County has the second highest concentration of older adults in the country.

While this figure reflects an important difference between our county and other counties across the nation, as one might expect, we face a number of shared issues, including but not limited to challenges tied to substance use disorder (SUD) in our older adult population.

The National Survey of Drug Use and Health suggests that nearly 4 million older adults had a SUD in 2022, a condition rising in prevalence as our nation’s baby boomers age. As a result of the growth of this population, human services providers across the nation are facing new and highly complex challenges. Education is critical.

The Substance Abuse Mental Health Service Administration (SMHSA) estimated that by 2020 4.4 million older people needed substance use disorder treatment, an increase of 259% since 2003.

This figure is troubling in its own right, but even more so when one considers the fact that Medicare limits payments for SUD and many SUD providers are having trouble sustaining their treatment offerings with the current reimbursement schedule.

How, Why Do SUDs Happen in Later Life?

The word “addict” generally evokes a specific image—much like the imagery of “Pittsburgh, Penn.” For many, this mental picture is of an individual using “Illicit” drugs. Or someone who knowingly indulges in substances known to be harmful to the body and mind. But what of those struggling to manage a broad range of medications following hospital discharge? What about those older adults leaving what undoubtedly was a difficult and disruptive stay at the hospital with a fistful of pills prescribed by several different doctors? Are they “addicts”?

According to a report by the Centers for Disease Control and Prevention, 83% of U.S. adults in their 60s and 70s used at least one prescription drug in the previous 30 days and about a third used five or more prescription drugs.

Imagine this: You’re an older adult and your eyesight is failing. As a result of your vision loss, you quickly confuse which pill to take and when. Following a few accidental doses, you become dependent upon the pain pills prescribed to you to support your post-hospital recovery process. Or perhaps your dependency arises as the result of a very real need to suppress a pain so intense it has prevented you from finding the rest you truly need for full restoration. Or maybe you’re an older adult who has relied on substances over the years to help you cope with life’s many challenges. Whatever the path to SUD, those living with this condition—individuals found in every corner of our community—need and deserve our support.

Substance use disorder does not indicate that one has a weak or flawed moral compass.

Undoubtedly, SUDs and the many effects associated with them have the potential to negatively affect the person with the SUD as well as their families and the communities in which they live. In my family, I have witnessed the highs and lows of untreated mental health issues that ultimately led to the development of SUD. The SUD then led to physical health issues requiring prescription pain relievers, further exacerbating the problem. This occurred in middle America, in a loving home. All above board. All legal.

The DSM 5 classifies substance use as a disorder. This disorder is not an active and intentional choice and does not indicate that one has a weak or flawed moral compass. Instead, this disorder reflects an individual’s desperate attempts to find the answer to their “dis-ease.”

The Allegheny County Department of Human Services Area Agency on Aging (AC DHS AAA), in close collaboration with the Pennsylvania Department of Aging’s PA Link Aging and Disability Resources Center and Jade Wellness Center (a local outpatient SUD program) have begun their work attempting to tackle the stigma associated with SUD via providing educational resources to professionals working in our network of service providers in Western Pennsylvania.

We have begun the process of engaging with professionals in the field of aging, with the goal of building knowledge surrounding SUD, SUD stigma and SUD treatment possibilities. The end goal would be equipping our workforce with the knowledge and skills necessary to effectively support those living with SUD.

Being an older adult with SUD or a family member of an older adult with SUD can be scary. From personal experience, I can tell you that there can be “light” in the future. There is hope. Our job now is to develop a more effective support strategy. We can’t afford to wait. But accomplishing this task requires deepening our understanding of the unique needs and strengths of this population.

Jennifer Georgulis is an information and referral/intake supervisor at the Allegheny County Area Agency on Aging in Pittsburgh.