When I joined a community mental health team for older people 20 years ago, addiction wasn’t a central part of our work. One of our first referrals was for an alcoholic patient threatened with eviction. It was rejected – it wasn’t relevant to our service, or so I thought. But over the years the referrals combining social problems and addiction kept coming. We would bat the problems back to the GP, yet the same patients would be referred years later for depression and dementia. Their issues hadn’t gone away; if anything, they had worsened.
It was a salutary lesson that led me to join forces with a group of professionals and delve more deeply into the problem of drug and alcohol addiction in older people. As we dug into the data, a pattern began to emerge of substance misuse among those born between 1946 and 1964: the so-called “baby boomers”. Their higher rates of addiction than in older or younger generations are coming home to roost, with implications for public health and clinical services.
New analysis of NHS figures shows that the numbers of older people using addiction services have pulled away from other age groups at an alarming speed. Cannabis remains the most widely used illicit drug, with the number of people aged 55 and over under the care of drug treatment services rising by nearly 800% over the past 15 years – the figure for the over-65s is more than 1,000%. This compares to a drop of more than 25% among 18- to 19-year-olds. But it doesn’t stop there. For alcohol, opioids, cocaine, crack and amphetamines, there has been a drop of more than 25% in the number of 18- to 19-year-olds under addiction services, compared with a rise of more than 200% in the 55-and-over group over the same timeframe.
There are many reasons for this trend. Baby boomers had considerably more exposure to alcohol advertising in their youth, socialising without a drink was looked upon askance and there was a more permissive attitude to “recreational” drug use, with little awareness of the potential harms of drugs such as cannabis. As they have grown older, this age group has also cut down on its drug and alcohol use less than previous generations. Indeed, some people may even have cut down previously, only to increase their use during retirement. And their problems may be masked. One of my female patients presented with recurrent falls until, after a year, she told me that she was drinking half a bottle of whiskey a day. A male patient of mine complained of constant tiredness and poor sleep until he told me that he smoked cannabis four times a week. In this context, it’s encouraging that the figures suggest more older people are seeking help.
I have been making sense of data on drug and alcohol use in older people for years and putting it under the noses of policymakers. Some of these efforts have borne fruit. The £25m Big Lottery-funded Drink Wise Age Well project provided an evidence base for what can be done to prevent, protect and intervene so that the physical, psychological and social harms from alcohol can be mitigated among older people.
However, drug addiction in older people is still flying under the radar. In 2019, a letter from the Advisory Council on the Misuse of Drugs to the then home secretary, Sajid Javid, drew attention to the needs of an ageing cohort of drug users. The council recommended that a “particular focus should be the availability and knowledge of staff to address the complex physical and mental health issues of older drug users”. Yet in the second part of Dame Carol Black’s Independent Review of Drugs older people were conspicuous by their absence.
We ignore the startling trend in treatment for drug and alcohol addiction among older people at our peril. Older people not only have distinct problems that reflect the physical and psychosocial consequences of ageing, but are also at risk of distinct mental disorders such as alcohol-related dementia. Looking to the future, truly integrated care will mean joining together public health and the NHS to rebuild addiction services. That will come at a cost, but one that will undoubtedly improve the lives and livelihoods of our invisible addicts.
Tony Rao is a consultant old-age psychiatrist and author of the book Soul Trader