Steven T. Dekosky M.D.- Member, RiverMend Health Scientific Advisory Board for Addiction & Psychiatry. Professor of Neurology, Director, Alzheimer’s Disease Research Center, University of Virginia School of Medicine, Charlottesville, VA USA Dr. DeKosky addresses the RiverMend Health Scientific Advisory Board on substance abuse in older generations and the growing need for treatment. For more information visit: http://www.rivermendhealth.com/scientific-advisory-board-addiction.html

1. Substance Abuse in the Elderly:
The Boomers Change Things Again
Steven T. DeKosky, MD, FAAN, FACP, FANA
Professor of Neurology
Director, Alzheimer’s Disease Research Center
University of Virginia School of Medicine
Charlottesville, VA USA
Recovery Centers of America
Scientific Advisory Board Meeting
Malibu Beach, CA
September 30, 2013

2. Disclosures
• Consultant/Advisory Boards :Consultant/Advisory Boards :
– Elan/Wyeth, Genzyme, Lilly, Janssen, Merck,Elan/Wyeth, Genzyme, Lilly, Janssen, Merck,
Novartis, PfizerNovartis, Pfizer
• Clinical Trials:Clinical Trials:
– Baxter, Elan, Janssen, Novartis, PfizerBaxter, Elan, Janssen, Novartis, Pfizer

3. Signs of the Apocalypse
• Cheech Marin is 67 years old
• Tommy Chong is 75.

4. Demographics
• Over the next 35 years there will be significant increases in the
US elderly population as the Boomers move into late life
• Substance abuse in this cohort is different from both the
Greatest Generation cohort and the younger generation (Gen
X)
• More alcohol and prescription medication abuse in the Boomer
population
• Boomers have less illicit drug use, Cheech and Chong
notwithstanding

5. Challenges
• Majority of funded research has been focused on cocaine,
other narcotics, and illegal stimulant drugs
• Target population has been younger adult males
• Less direct applicability to the elderly population
• Many Boomers came of age in the 60s and early 70s and
are more willing to take prescription drugs
• Questions about adequacy of screening methods for
elderly (most screening tests devised for younger cohorts)

6. Medical and Psychiatric Issues
• Aging is a time of loss: friends, spouse, career,
vigor, health
• Higher rates of depression
• Use of stimulant medications
• Multiple co-morbidities: systemic diseases,
increased frailty

7. Social Issues
• In our mobile society, concerned children
and social supports may not be present
• Children have moved away or elderly
have moved to retirement communities
with loss of support systems and friends
• Families reluctant to bring up substance
abuse issues if they note it

8. Medical Disease and Predilection for
Substance Abuse
• Arthritis leads to chronic use/abuse of
prescription pain medications
• Opiates and alcohol used for mood elevation in
depressed elderly
• Sleep disruption due to arthritis and other pain
leads to sleep medication abuse, other
sedative/anxiolytic abuse
• OT sleep aids frequently have anticholinergic
side effects and
interfere with cognition

9. Medical Disease and Predilection for
Substance Abuse
• Geriatric depression and anxiety lead to
prescription for benzodiazepines
• Busy physicians dealing with medical
comorbidities may not be as vigilant
concerning medication abuse
• Slowed metabolism increases half-life of
medications and increases fatigue, slowed
reaction times, increased driving risk, falls

10. Cognition and Substance Abuse
• Alcohol abuse may lead to irreversible
cognitive decline
• Sedative/narcotic abuse and slowed
metabolism may lead to cognitive
impairment/incorrect diagnosis of dementia
• Amnestic mild cognitive impairment and
dementia (most commonly Alzheimer disease)
lead to confusion in dosing and potential
overdosing of many medications

11. Dual Diagnoses
• Geriatric depression may predispose to alcohol
abuse in late life as attempt at self-medication
• Both diagnoses need to be treated
• Altered cognition in one or both of these
disorders may lead to premature diagnosis of
dementia, with decrease or cessation in
therapeutic efforts
• Dementia diagnosis cannot be confirmed until
both are treated

12. Conclusions
• Growing need for effective screening methods
specific for geriatric population
• Education programs for physicians, patients, and
families regarding use of psychoactive drugs and
alcohol
• Research to address most effective treatment for
(more frail) elderly for alcohol and drug abuse
• Best practices for diagnosis and treatment with
appropriate referral for the medical comorbidities