Age Matters: Substance Use in Older and Younger Women
by Hope Rehab Team
Why Age Matters
Women may abuse alcohol, prescription medication or illegal drugs across their lifespan, but the why and what of their use changes with age. In addition, addiction affects the lives of young women, those in their reproductive bloom, and those bracing themselves for the onset of golden age differently.
Addictions research is finally acknowledging gender differences between men and women regarding the effects of alcohol and drug misuse on body and brain. Unfortunately, most of these studies tend to focus on ‘women’ as if they were a homogenous group of people that are similar, if not the same in most aspects of their bodies, brains and in their life circumstances. Needless to say, this is not so. Fact is, addiction affects women differently based on a variety of factors including ethnicity, socio economic background, and age, just to name a few.
Why Age is Such an Important Factor
Age in particular is increasingly becoming an important point of focus, given that substance misuse among the so called baby boomers -those age 50 and older – is on the rise. This is significant, as it constitutes a marked shift from previous evidence suggesting that alcohol and drug abuse among older folks is minor compared to that in younger age groups. Consequently, prevention, education and treatment approaches may have to shift from targeting a mainly younger audience to including those who are no longer in their prime.
Meet a Baby Boomer
Take Gwen. Recently retired at the age of 65 after a long career in nursing, Gwen looked forward to retirement- or so she thought. Gwen believed she finally would have time to pursue dormant interests she didn’t have time or energy for while working full time. Once retired, Gwen quickly came to miss the lively exchange with her students, the occasionally challenging encounters with parents, and the fun-filled chats with colleagues during breaks or after work. Her intention to travel and visit far away exotic destinations got dampened by the prospect of having to do so on her own, as her husband recently passed away after a long struggle with cancer. With her grown kids busy living their own lives, and many of her friends older than herself or deceased, she found herself often lonely and at times at a loss of how to fill her days. Efforts to follow her doctor’s recommendations to become more physically active met with increased pain levels due to chronic sciatica and hip problems that she now managed mainly with opioid painkillers.
While Gwen always enjoyed a guiltless ‘nightcap’ to help her fall asleep, she gradually relied more and more on sleep medication to achieve any amount of sleep. Gwen had no second thoughts about pharmaceutical aids, alcohol or the occasional joint to help her relax or forget, having grown up in the sixties observing her parents and their friends frequently having alcohol, LSD, and marijuana-infused parties. As a retired person, she had no fixed responsibilities, and her gradual descent into prescription medication and alcohol abuse thus remained both undetected and unchallenged by others. Her children, neighbors as well as her GP attributed observed memory loss, mood changes and accidental falls to aging, rather than seeing them as telltale signs of a slowly growing dependency.
Is Gwen an exception? Unfortunately not. In fact, as aforementioned, addictions research suggests that alcohol and substance use among baby boomers is on the rise, and will continuously increase. Alcohol is among the most used substance among older males, while older women show greater vulnerability to prescription drug misuse. Research also indicates that older adults often do not self-refer for treatment. Instead, they are referred either by concerned others who finally catch on something is wrong, or by health or community professionals, and by the criminal justice system.
The New Face of Addiction: White Middle-Aged Women
Perhaps most surprising of all, middle-aged women -and most often white women between the ages of 45 and 54- show the greatest increase in drug overdose deaths in the US. Since 1999, these deaths among women increased more than 400% compared to 265% in men. As in Gwen’s case, dependence on opioid prescription medication initially prescribed to alleviate chronic pain is often the culprit. These types of medications are baby boomers’ second most preferred choice of substance following marijuana. Taken together with benzodiazepines- medication often prescribed to ease anxiety or aid sleep- opioid medication is most frequently involved in overdose deaths among older women. Unaware of the danger, women may mix these medications, making for a deadly concoction.
This begs the question as to why white middle-aged women, for most of us a rather puzzling fact. Explanations are twofold: for one, studies show that doctors are more hesitant to prescribe opioid painkillers to minority patients. This does not mean that this population actually suffers less pain than their white counterparts. Doctors are apparently reluctant to prescribe these types of medications based on a prejudice that minorities will misuse or sell these drugs. The latter does not match with the facts, as studies have shown that alcohol and illegal drug abuse, as well as prescription medication misuse, is much more prevalent among white men and women. Secondly, many family physicians and other healthcare providers are poorly trained when it comes to alcohol and drug addiction, and they, therefore, may not see the signs of increasing dependency until it is in full bloom. The stereotypes of addiction being mainly a problem among young black or minority men may further cement healthcare professionals’ failure to examine their older white female patients more carefully regarding their use of prescription drugs, or other mood altering substances such as alcohol or illegal drugs.
This is not to say that prescription of such medications is always unjustified, or their misuse always intentional. Research indicates that older women tend to experience multiple problems, including chronic pain, medical conditions (eg diabetes II, high blood pressure or osteoporosis), hormonal imbalances and chronic insomnia, which may make reaching into the medication cabinet at some point likely, if not inevitable. Among these issues, insomnia may be one of the most common complaints and the reason for prescriptions in this age group. Additionally, women this age are undergoing surgery in greater numbers, for example for hip or knee replacements, subsequently taking opioids to counter post-op pain. Surgery is said to be a “gateway to persistent opioid use and potential misuse”, and women were found to be almost twice as likely than men to become chronic opioid users. Finally, it is also important to note that misuse can occur accidentally, as older patients may forget they already took their medication, therefore mistakenly doubling up the dosage.
Substance Use in Golden Age
Similar to prescription drug misuse among elderly, the use of illegal drugs is also on the rise. Studies indicate that this is also associated with aforementioned factors, and found that being widowed, less educated, in poor health, socially isolated and experiencing a number of stressors make for more frequent use of psychoactive substances. Fear of declining health or functioning, a family history of problematic alcohol or substance use, psychiatric illness such depression or anxiety contribute further to increased vulnerability. For example, more than six million Americans age 65 and up suffer from depression, and most of them are women. In turn, depression is closely related to substance abuse and disability, and is known to increase the risk of cognitive impairment and suicide.
Lifelong users of alcohol or marijuana may find that their recreational substance use affects them differently due to aging, or it may escalate due to dwindling engagement with occupational or social pursuits. Those who have used rather heavily across their lives may find themselves in grief over lost opportunities and relationships. Women considered ‘hardy drinkers’- women who have been drinking alcohol to some degree their whole lives- are more likely to experience negative consequences compared to those only starting to drink later in life.
While older women are typically not as vulnerable to alcoholism compared to younger women or compared to men their age, even drinking in moderation has shown they are at greater risk for alcohol-related health problems. Research has shown that medical and psychiatric problems can lead to, and are aggravated by alcohol use in older women. Depression, accidental injuries, cognitive changes, memory problems, sleep problems, malnutrition, and medication interactions are common consequences of prescription medication or alcohol misuse in older women. With the exception of Alzheimer’s Disease, all forms of dementia were found to be higher in people age 65 or older with problematic alcohol use. Alcohol use in older women was in fact found to cause greater impairment in day to day functioning compared to smoking, age, anti-anxiety medications or stroke. Alcohol was also shown to increase the age-related higher risk of traffic accidents, resulting in greater injuries to older folks. Unfortunately, most elderly women abusing alcohol do not seek treatment, whether based on denial, lack of knowledge as to what is available, or due to shame.
The Younger Ones
Jessica started to use alcohol at age 10, trying to escape her parents’ constant fighting in any way possible. By age 13, and together with her friends, she was drinking regularly, gradually accompanied by other substances such as inhalants or marihuana. At age 16, she was sexually assaulted at a party, not telling anyone as feeling it was somehow her fault. By 18, she had been to the ER several times due to alcohol poisoning, at that point drinking until blackout and using so many different substances that she was often not able to remember what she did and how much she did. At age 19, Jessica discovered she was three months pregnant. Not sure if she wanted an abortion or not, Jessica finally reached out for help.
Substance use looks different in younger women. For starters, young women typically start using alcohol or illegal drugs in the context of relationships with others, most often males. Many adolescents and young adult women report escalating alcohol or drug use following the encouragement of boyfriend, or while immersed in subcultures fostering drinking or drug use, such as being in College. A family background marked by family violence, parental substance use or mental illness also increases teenage girls’ likelihood of problematic alcohol or drug use. Mental health problems such as social anxiety or depression are typically more common in women, contributing further to young women’s initial or escalating substance use.
Sadly, female teenagers make up the only age group among women who exceed their male counterparts in terms of frequency and amount of alcohol consumed. Girls and women seeking help often show a history of violence, such as child abuse or sexual assault as triggers for initial use of alcohol or drugs. Violence also plays a role in the increased amount and frequency of use: intimate partner violence and sexual violence are unfortunately common experiences in the lives of substance using women. For example, alcohol is said to play a role in over 90% of all sexual assault or rape cases, most of which remain unreported and unprosecuted.
Young, younger, youngest
Research also confirms that substance use occurs at alarmingly young ages. Studies in Canada and Australia have shown an increasing number of girls in grade six report drinking alcohol more than once per week. Although perhaps not quite as frequently, the use of intoxicating substances such as marihuana or inhalants also shows increase in middle school years. Youngsters’ access to social media may play a role here. Readily available for purchase over the internet, drugs sourced this way are said to pose increased risk levels given that the ‘disconnect between buyer and seller’ makes for greater uncertainty as to what exactly the drugs contain.
Substance misuse before the human brain is fully developed at age 24 is said to have a significant impact on brain and personality development. Developmental tasks such as forming individual identity, developing maturity regarding acceptable and goal-directed behaviors, deciding on and pursuing a career may remain unfulfilled in the midst of increased alcohol or substance use. Research indicates that alcohol use before age 15 increases the chances of developing alcohol abuse or a dependency later in life five-fold. Continued substance use tends to affect women negatively long before it reaches full addiction, with liver damage, cardiovascular problems and irregular and more painful menses constituting only the tip of an ever-growing iceberg.
Meth, Heroin, and Benzodiazepines: Three Nails in Younger Women’s Coffins
Poly-substance use, the consumption of more than one type of drug and alcohol- is more common among younger women as compared to their older counterparts. While more than half of women across the lifespan started using substances by smoking marihuana, younger women also include inhalants in their repertoire, which older women do typically not use. Unlike older women, young women may feel pressured into consuming intoxicating substances by friends, not yet knowing how to assert themselves and set healthy boundaries. The latter is found the case as it pertains to growing heroin use among young women, who are typically introduced and encouraged to do so by their male partners.
Among the most commonly misused class of drugs among young and middle-aged women are methamphetamines. Frequently used to increase energy during exam times or during especially demanding periods at work, methamphetamines use among women is on the rise. Young women may aim at curbing their appetite and control their weight by taking methamphetamines, while middle-aged women are said to dip into their children’s ADHD medications to counter the routine of their mundane suburban lives. Prescriptions for ADHD medications have seen a startling 700% increase among women aged 25 to 29, and a 560% increase among the 30 to 34-year-olds, by no means reflecting actual prevalence of ADHD.
Methamphetamines are said to be the second most frequent drug involved in drug-induced deaths among women in their twenties, surpassed only by heroin. Opioid prescription medication is said to have paved the way for heroin use for many female users. Teen girls between the ages of 12-17 increasingly misuse opioid medications, usually prescribed to family members or older friends. Sometimes, prescriptions may have been issued to these young women directly, most often following sports-related injuries or surgeries, or following complicated or painful dental procedures.
Benzodiazepines, a type of medication most commonly prescribed to quell anxiety, were found the most common prescription medication involved in women’s drug-related deaths, accidental or intentional, affecting women from across the lifespan. Middle-aged and older white women make up the majority of prescriptions for benzodiazepines, often and unjustifiably long-term.
The Big Question: Why?
Women aged 20-40 may face challenges that make them more vulnerable to problematic alcohol or drug use. Increasing costs of living and mounting student loan debts may prompt women to push themselves over the limit in their attempts to reach income equal to that of men. Additionally, women continue to work ‘double days’, still shouldering greater responsibility for child or elder care compared to men, or compared to older women whose children are grown, and whose parents are deceased or taken care of in nursing homes. While this pressure may not directly translate into problematic alcohol or drug use, it can cause increasing mental and physical problems such as anxiety or depression, insomnia or physical pain. These conditions, in turn, are well known to provide a fertile soil in which dependency can gradually grow, often starting with a harmless glass of wine at the end of the day to unwind, or a couple of sleeping pills to aid sleep.
Women also face significant hormonal changes throughout their lifespan that may no longer be an issue for older women. For example, women’s menstrual cycle has been linked to increased vulnerability not only in regards to the effects of alcohol and drugs but also as it pertains to increased cravings and urges to use. Needless to say, pregnancy and motherhood are times of great change, sometimes accompanied by ambivalence and significant stress. While some pregnant women may be able to stop using intoxicating substances, those with a history of chronic use or poly-substance use are likely not able to do so. Pregnant women taking illegal drugs or consuming large amounts of alcohol may be at risk to contract a range of serious health conditions, affecting both themselves and their unborn children. Problematic substance use among mothers affects their lives, as well as their children, families, and communities, leaving a painful vacuum among loved ones.
Implications for Treatment: One Size Does Not Fit All
Younger women are more likely to seek help and enter treatment, while older women tend to deny problematic prescription medication, alcohol or substance use. Most women 55+ have started using substances before age 30, and many older women are referred to treatment by loved ones, health care professionals or through the criminal justice system. Older adults may experience harder detoxification, given the lengths of use and declining health. Nevertheless, studies show that treatment for older women that take medical, mental health and social issues into account is typically successful in addressing problematic use.
While denial seems to be one of the biggest barriers to treatment in older women, younger women face more practical barriers such as finances or childcare. These women are also likely to face significant challenges regarding affordable housing and employment following treatment completion. Pregnant women and mothers may deal with added stressors such as dealing with child protection authorities, or child custody proceedings. Treatment for young female substance users ought to address such barriers, offer specialized treatment for trauma, and provide a supportive environment that helps young women build self-esteem and skills for life.
Naturally, in an ideal world, concerted efforts to prevent alcohol, prescription medication and illegal drug use in young girls and women would suffice to solve the problem. They don’t. As such, gender and age-specific treatment ought to be available, easily accessible and affordable for all ready to embrace change.
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