Made possible through funding by the Michigan Department of Community Health - Division of Substance Abuse Quality and Planning - Michigan Older Adult Substance Network Grant

Network Profile 1998

Articles

Under The Rug: Substance Abuse And The Mature Woman

On June 4 1998, The National Center on Addiction and Substance Abuse at Columbia University (CASA) released its study, Under The Rug: Substance Abuse and The Mature Woman, the first comprehensive analysis of substance abuse and addiction involving alcohol, prescription drugs and tobacco among 25.6 million American women 60 and older. As part of this two-year study, CASA conducted an analysis of health care costs attributable to substance abuse in this population and a unique survey of 400 primary care physicians.

A 60 year-old woman in America today can expect to live at least into her eighties with a quality of life that has increased dramatically in recent decades. Yet millions of these women suffer from substance abuse and addiction that robs them of their health, independence and life, and triggers some $30 billion in Medicare, Medicaid, and private health care charges a year. Because of the rising number of mature women, the health care costs of the failure to face up to this problem will top $100 billion in the next 20 years.

According to this report, women over 59 experience problems related to alcohol and psychoactive prescription drugs and get addicted faster than any other group of adults because their tolerance for alcohol and prescription drugs falls with age; and women of any age are more vulnerable to the effects of alcohol, and preliminary evidence suggests, to the effects of some psychoactive prescription drugs than are men.

The most alarming finding of CASA's physician survey is that hardly any primary care physi8cians – 1% of the sample – even considered a substance abuse diagnosis when presented with the typical early symptoms of alcohol and prescription drug abuse in an older woman. Instead, physicians were likely to consider the diagnosis of depression, which might lead to prescriptions of sedating psychoactive drugs. While the recognition of symptoms that could indicate depression is commendable, physicians who prescribe sedating psychoactive drugs to an alcoholic could aggravate her substance abuse and even threaten her life.

The study made recommendations to improve early detection by physicians of substance abuse among older patients and increase awareness so that friends, family and communities who see signs of trouble in loved ones will help women get the treatment they need. CASA is working hard to disseminate information from the report so that older women learn of their vulnerability to this problem and become their first and best caretaker.

Startling Statistics On Substance Abuse In Older Women

Source: Reuters 18:45 06-04-98

Of 26 million women in the U.S. aged 60 or older, 1.8 million abuse alcohol and 2.8 million abuse or are addicted to prescription medication. About 23% of women in that age group with incomes over $40,000 drink heavily compared with 8% with incomes less than $40,000.

However, less than 1% of women in this age group are treated for alcoholism, according to the report. "Under the Rug: Substance Abuse And The Mature Woman." (see article, page 1). Such substance abuse costs $30 billion a year in hospital, nursing home, and healthcare costs.

Adult* Women & Men Who Drink Heavily**

* = Adults are age 19 and older
** = Drinking Heavily is having at least 60 drinks in the past month.

Age	Women	Men
19-30	2.4%	13.0%
131-40	2.4%	11.7%
141-59	1.8%	11.9%
160+	4.1%	16.5%
All	2.6%	13.1%

The Forgotten Woman

By Joseph A. Califano, Jr., L.L.B.

Editor's Note: The following editorial was originally published on June 23, 1998 in several newspapers. Joseph A. Califano, Jr., L.L.B. is President of the Center on Addiction and Substance Abuse at Columbia University (CASA); see related article on page 1.

"There's a gaping hole in the medical system's handling of mature women with substance abuse problems."

Washington is a Babel of talk of tobacco legislation, patients' rights, taming aggressive managed care companies and reforming Medicare and Medicaid. In this cacophony of political concern about health care, let's hope the administration and Congress don't drown out what former first lady Betty Ford calls "America's hidden epidemic': substance abuse among older women.

Prevention and treatment of substance abuse and addiction have long been relegated to the back of America's health care bus. What's so disturbing about the recent report of the National Center on Addiction and Substance Abuse at Columbia University ("Under The Rug: Substance Abuse and the Mature Woman") is its revelation that women age 60 and over are seated in the last row.

Of 1.8 million women 60 and over whom need treatment for alcohol abuse and alcoholism, only 11,000 – less than one percent – receive it. A convicted felon has far better chance of getting such treatment than an older adult.

Presented with a classic description of a mature woman in the early stages of alcohol abuse, only one percent of surveyed primary care physicians with a significant proportion of mature female patients even considered alcohol abuse as a diagnose. More than 80 percent suggested depression, a diagnosis likely to lead many doctors to prescribe sedating psychoactive drugs that can exacerbate the condition of an alcoholic woman and even kill her.

Half of the prescriptions for benzodiazepines – tranquilizers and sleeping pills – given to mature women are inappropriate. Contrary to standards set by expert panels, they either should not be prescribed for these women or should be prescribed for shorter periods of time. No wonder 2.8 million women in this age group abuse psychoactive prescription drugs.

There are 25.6 million women 60 and over in the United States. With a life expectancy of 83 and climbing, a 60-year old woman has more than a quarter of her life ahead of her. Yet our medical system, perhaps reflecting attitudes of society at large, sees these women as though they are within walking distance of the grave. How many of us have said, "What's the point of trying to get mother to quit smoking? She's old and set in her ways." Or, "Let grandma get tipsy at night. She's lonely and has so few pleasures." Or, "At that age what difference does it make if she's taking too many tranquilizers and drinking while she uses sleeping pills. It makes her feel better and she's easier to get along with."

It makes a big difference. In good health these women have many years ahead as productive workers and loving parents and grandparents.

Within three years of quitting, former female smokes are no more likely to have heart attacks than women who have never smoked, and they are less likely to die from smoke-related cancers than current female smokers. Congress has given plenty of attention to discouraging smoking among young girls. But most members are oblivious to the needs of the 4.4 million mature women whose smoking threatens them with premature death and loss of years of independent living. As Congress frets about the financial future of Medicare, it ignores the hefty costs that substance abuse by older women imposes on the trust fund, costs certain to increase as the number of women over 59 explodes with the baby boomers moving into senior status.

Though medical science has demonstrated that one drink generally has the impact on a woman that two drinks have on a man, most physicians treat a woman more like a man. When asked what they considered excessive drinking for mature women, primary care physicians set the standard at 2 ½ drinks a day. The National Institute on Alcohol Abuse and Alcoholism set that mark at more than one drink daily. A woman faces significant risk of liver cirrhosis if she consumes two drinks a day; that risk doesn't become significant for a man until he belts down more than six drinks a day.

Doctors blame their failure to identify substance abuse in women age 60 and older on their lack of knowledge and time, patient denial and physician and patient discomfort in discussing the problem. Medical schools and continuing education (and some female-focussed research) can fix the knowledge gap. States should require individuals seeking licenses to practice medicine or certification as specialist to demonstrate their understanding of how to spot and treat substance abuse and addiction.

The gaping hole in the medical system's handling of mature women with substance abuse problems is its failure to provide appropriate reimbursement. Three of the top health problems that women age 60 and over face are smoking, psychoactive prescription drug abuse, and alcoholism and alcohol abuse. Many of the others such as cancer, heart disease and osteoporosis are caused or exacerbated by substance abuse.

Medicare- and Medicaid-eligible mature women are three to five times likelier to be hospitalized for substance abuse-related ailments than for non-substance-abuse related heart attacks. Yet 98 percent of hospital charges for mature women go to threat the consequences of substance abuse; only tow percent go to treat the abuse itself. Of physicians who have referred mature women for substance abuse treatment, 20 percent say that a private or public health plan denied coverage.

Medicare and managed care and insurance companies should pay doctors to talk to these women, not just to cut, stick, image and slip pills to them. And, as a bill introduced by Sen. Paul Wellstone would require, these programs should accord to treatment for substance abuse the same status they give treatment of others.

Substance Abuse: Older Adults At Serious Risk

Source:The Center for Substance Abuse Treatment

Abuse of alcohol and legal drugs – prescribed and over-the-counter – is a serious health problem among older Americans. This "invisible epidemic" affects up to 17 percent of adults age 60 or older, a rapid-growth segment of America's population.

Substance Abuse Among Older Adults, a report produced by the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT), was released on May 7, 1998, to alert health care providers that substance abuse in the older population is a serious problem. This new SAMSHA publication, one of a series of Treatment Improvement Protocols (TIPS), is designed to assist the health care community to better detect and treat alcohol and medication abuse among older patients.

According to the report, it is more difficult for health care providers to diagnose alcoholism in older patients because a third of those with problems had not abused alcohol in their earlier years, nor did they have health problems, trouble with the law, or difficulties with family relationships associated with problem drinking. These older problem drinkers typically begin abusing alcohol and medications following the death of a spouse, a divorce, retirement, or some other major life change.

Citing recent studies, the report stated that 15 percent of male alcoholics report that their first symptoms of alcoholism occurred between ages 60 and 69; and 14 percent report that their first symptoms occurred between the ages of 70 and 79. For women the percentages are even higher, with 24 percent reporting their first signs of alcoholism between ages 60 and 69; and 28 percent reporting their first signs occurred between ages 70 and 79.

The report also states that "Prescription drug misuse and abuse is prevalent among older adults, not only because more drugs are prescribed to them, but also because, as with alcohol, aging makes the body more vulnerable to drugs' effects." The report further states: "Any use of drugs in combination with alcohol carries risk; abuse of these substances raises that risk; and multiple drug abuse raises it even further."

"As sharp growth in the elderly population is anticipated with the aging of the baby boomer generation," said SAMHSA Administrator Nelba Chavez, Ph.D., "we must begin now to educate health care providers on the need to carefully screen their older patients for signs of alcohol abuse and medication misuse and abuse."

"As we age, there are physical changes in the body that lead to a lower tolerance for alcohol," CSAT Acting Director Camille Barry, Ph.D., R.N. explained. "Often relatives of older individuals try not to notice if they see signs of inebriation. However, that cocktail or two may be taking away a loved one's independence and health."

The report looks at adults age 60 and older. The effects of aging on the body vary from person to person. Many individuals may not be affected at age 60, but others will be impacted earlier, the report said. "The age at which such changes occur varies from person to person, but invariably they do occur. Because many of the definitions, models, and classifications of alcohol consumption levels are statistics and do not account for age-related physiological and social changes, they simply do not apply to older adults," the report said, explaining why older adults cannot continue to drink the equivalent amount of alcohol consumed safely in earlier years.

"We encourage older people, families, and service providers to understand the effect that alcohol and drug abuse can have on older people and how open discussion of this issue can benefit everyone, said James Firman, President and CEO of The National Council on Aging. "This report offers great hope for older people who need to seek treatment of substance abuse: It is never too late to change."

"The problems inherent in untreated alcohol abuse among older Americans is a concern for AARP because of the health problems and potential loss of independence that often accompany alcohol abuse," said C. Anne Harvey, Director of Program Services for the American Association of Retired Persons (AARP).

Substance Abuse Among Older Adults (TIP 26) adds another volume to CSAT's Treatment Improvement Protocol (TIP) series. The series is a compendium of best practice guides produced for health care and substance abuse treatment providers. TIPS are produced by non-federal consensus panels composed of clinical, educational, research and administrative experts. These volumes are key information tools and are used to improve treatment services available to people in need through the Substance Abuse Prevention and Treatment Block Grant and other programs.

The Center for Substance Abuse Treatment (CSAT) is part of the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA, a public health agency within the U.S. Department of Health and Human Services, is the lead Federal agency for improving the quality and availability of substance abuse prevention, addiction treatment and mental health services in the United States.

TIPS are available on the CSAT web page at www.samhsa.gov or they can be ordered by contacting the National Clearinghouse for Alcohol and Drug Information (NCADI) at 1-800-729-6686; TDD (for hearing impaired), 1-800-487-4889.

Michigan Selected As One of Six National Sites For New Center To Promote Minority Aging Research

The United States Census Bureau estimates that by the year 2050, the nation's elderly population will more than double, creating a more racially and ethnically diverse population than ever before. In response to this growing need, the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the Office of Research on Minority Health (ORMH), and the National Institute of Health (NIH) recently provided funding to create six new Resource Centers for Minority Aging Research. Within Michigan, Dr. James S. Jackson from the University of Michigan' Program for Research on Black Americans and Dr. Jeffrey W. Dwyer from Wayne State University's Institute of Gerontology, have taken the lead in combining resources from both of their institutions and disciplines to form the Michigan Center for Urban African American Aging Research (MCUAAAR). The new Michigan resource center has a two-fold objective: (1) to provide training and opportunities for minority individuals in aging research, thereby mentoring scholars and researchers who are committed to conducting African American aging research; and (2) to develop community ties and relationships, thereby contributing to the improvement of the quality and quantity of research conducted within the African American community.

To learn more about MCUAAAR, Profile spoke with one of its co-principal investigators, Dr. James S. Jackson, Director of the U of M Program for Research on Black Americans. During his 22 years as Director, Jackson has gained much experience and expertise in the area of minority aging research. The Program also has been a training environment for many prominent scholars. Following are excerpts for our conversation.

Profile: Can you tell us more about MCUAAAR?: Dr. Jackson: MCUAAAR was founded in September of 1997, and over the next five years, the NIA, NINR, and ORMH will provide the six centers collectively with approximately $20 million. Annually, our Center plans to fund three pilot studies at our respective institutions of up to $20,000 each. To date, MCUAAAR has begun developing training opportunities for college graduate students, postdoctoral scholars and junior faculty members. Our major focus has been and will continue to be on investigating the health problems faced by aging African Americans. In doing so, we hope to gain a greater understanding on how to deal with these problems and eliminate the disparity between elderly African Americans and other older adults.
Profile: What types of disparities have you encountered between African Americans and other older adults?: Dr. Jackson: There are disparities both in terms of health needs and actual research involvement. In terms of health care needs, disparities exist in terms of access to care and care required. More needs to be done in terms of chronic and acute care, as well as preventive care for elderly African Americans. With respect to research projects, there tends to be a disproportionate number of African Americans participating in research projects versus other older adults. This is because older African Americans do not tend to volunteer or be selected for research projects.
Profile: How does the Center plan to involve more older African Americans in its research projects?: Dr. Jackson: We are going into communities and working with the local service agencies that provide health care to African American older adults. By forming relationships, we hope to encourage greater involvement. We also plan to develop a new generation of researchers who have expertise and skills in working on issues of health and health promotion among African American elderly in urban centers. Furthermore, we have formed a community board made up of individuals from various community agencies, and we have an advisory board comprised of service providers and academia.; We also are conducting research of our own on why African American elderly do not involve themselves in clinical research studies. One of our first pilot research projects addresses this issue.
Profile: Can you us more about this pilot project?: Dr. Jackson: Donna L. Cochran from Wayne State University is the investigator on the Pilot, ‘Developing Strategies for the Recruitment and Retention of Older African Americans in Epidemiological, Clinical and Psychosocial Research.' We've found that despite the advantages of being involved in a clinical research project – such as qualifying for medications and gaining access to quality medical care – older African Americans may feel like they are "guinea pigs." Also, there may be financial barriers to participating, such as lack of transportation. The goal of this pilot project is to determine how to design clinical studies that will include African American elderly and in turn help reduce the health disparities we are currently experiencing.
Profile: Do you conduct research on substance abuse issues as they relate to the older adult African American population?: Dr. Jackson: Another one of our pilot projects, ‘Using Pharmaceutical Care to Improve Medication Compliance and Health Outcomes Among Minority Elderly with Hypertension' is being investigated by Stephanie D. Taylor from the University of Michigan. This study examines the role of the community pharmacy in working with the older adult African American population. We've found that the pharmacist is an often overlooked health professional, despite the fact they the pharmacist interacts and offers advice on medications to older adults more often than a physician. (Note: Our next issue of Profile will feature an article on this study). Part of this study will examine the problem of misuse and abuse of medications by older adult African Americans. We know a number of problems exist – such as not following directions properly, taking other peoples' medications, skipping doses to save money, mixing alcohol with medications, and suffering from interactions with other medications. One of the objectives of this study is to maximize on the pharmacists' role as advisor so that older adult African Americans receive the proper care they need.
Profile: What are your plans for disseminating the results of your studies?: Dr. Jackson: We plan to make our findings available to hospitals, healthcare providers, and community-based older adult service organizations. Our primary interest is to develop the capacity within organizations to address the disparity issues so they in turn can individually develop strategies within their organizations to address the problems we identify.
Profile: How can our readers find out more about MCUAAAR?: To reach Dr. Jackson and Dr. Dwyer:; Dr. James S. Jackson at
University of Michigan
P.O. Box 1248
Ann Arbor, Michigan 48106-1248
(734) 763-2491
(734) 763-0044 (fax); Dr. Jeffrey W. Dwyer at
Wayne State University
87 E. Ferry
Detroit, Michigan 48202
(313) 677-2297
(313) 875-0127 (fax)

Resource Centers for Minority Aging Research

Michigan Center for Urban African American Aging Research
- University of Michigan and Wayne State University
- Directors: Drs. James S. Jackson and Jeffrey W. Dwyer
Advancing Minority Aging Research Efforts
- University of North Carolina, Chapel Hill
- Director: Dr. Elizabeth J. Mutran
Center for African American Aging Research
- Henry Ford Health System
- Director: Dr. Barbara C. Tilley
Columbia Center for The Active Life of Minority Elders
- Columbia Presbyterian Medical Center
- Director: Dr. Rafael A. Lantigua
Native Elder Research Center
- University of Colorado Health Sciences Center
- Director: Dr. Spero M. Manson
Resource Center for Aging Research in Diverse Populations
- University of California, San Francisco
- Director: Dr. Eliseo J. Perez-Stable

NETSOURCES

Following is a listing of sites on the Internet that provide substance abuse prevention and treatment information. The inclusion of a site on this list does not indicate endorsement by the Network Profile.

Addiction Resource Guide: Addiction Resource Guide is a new Internet company whose mission is to help professionals and consumers find resources dealing with addictive problems.
Michigan Resource Center (MRC): Michigan Resource Center (MRC) is an official resource center for the state of Michigan and has been in operation since 1984. Their mission is to promote alcohol, tobacco and other drug prevention/treatment, health awareness, and traffic safety education information. Publications and videos are available at low cost or free of charge for Michigan residents, businesses, churches, community organizations, substance abuse prevention and treatment programs, health and mental health professionals, school personnel, law enforcement, court systems, traffic safety programs, and statewide volunteer networks.; MRC is operated by the Traffic Safety Association of Michigan (a private, non-profit association) through a contract with the Michigan Department of Community Health (MDCH), Mental Health and Substance Abuse Services, including funding from the Substance Abuse Prevention and Treatment Federal Block Grant. Funding is also provided by the Michigan Office of Highway Safety Planning, a division of the Michigan State Police.
National Center on Addiction and Substance Abuse at Columbia University (CASA): The National Center on Addiction and Substance Abuse at Columbia University (CASA) is a unique think/action tank that brings together under one roof all of the professional disciplines (health policy, medicine and nursing, communications, economics, sociology and anthropology, law and law enforcement, business, religion and education) needed to study and combat all forms of substance abuse – illegal drugs, pills, alcohol and tobacco – as they affect all aspects of society.
National Institute on Drug Abuse: The mission of NIDA is to lead the Nation in bringing the power of science to bear on drug abuse and addiction. This web site includes an area on Women and Gender Differences. The mission of this area of NIDA's web site is to promote the conduct and dissemination of research on women's health and gender differences.
National Policy and Resource Center on Women and Aging: The National Policy and Resource Center on Women and Aging serves as a national focal point for issues related to older women. The Center conducts research, provides policy analysis to those working in the field, and provides training and technical assistance to the aging network, women's organizations, and policymakers. The Center's objectives include: identifying issues and expanding knowledge on income security, health, caregiving, housing, and the prevention of crime and violence as they relate to older women; educating and empowering women themselves; and promoting greater national understanding of older women's issues.
National Women's Health Information Center: The NWHIC provides a gateway to the vast array of Federal and other women's health information resources. This site can help you link to, read, and download a wide variety of women's health-related material developed by the Department of Health and Human Services, the Department of Defense, other Federal agencies, and private sector resources.
National Women's Resource Center: This interagency resource center provides information about women's substance abuse and mental health issues. The Center aims to reach undeserved groups of women and their children, and bring together organizations to advocate for a broad range of issues that affect women's lives.
Project Cork Institute: The Project Cork Institute at Dartmouth Medical School promotes locally, regionally and nationally, the education and training of health care and human service professionals in issues related to substance abuse. The Institute supports educational efforts trough its online database of substance abuse information, the preparations of curriculum materials, and involvement in curriculum development efforts.

Editor's note: See related article, "Under the Rug: Substance Abuse and the Mature Woman," page 1.

Calendar of Events

12th Annual Great Lakes Conference On Addictions & Mental Health

September 20-23, 1998
Adams Mark Hotel
Indianapolis, Indiana

Sponsor: Great Lakes Training Associates, Inc. & Community Addictions Services of Indiana, Inc.

This conference addresses treatment, prevention and employee assistance issues, and is intended for addictions counselors, educators, clergy, employee assistance, criminal justice, psychologists, social workers, and others interested in addictions treatment and prevention.

Contact: (317) 283-8315 or e-mail: qr8lkstr@aol.com or tapefolks@aol.com

Women Healing: Redefining Strength and Courage

October 2-3, 1998
New York, New York
Sponsor: Hazelden Institute and the Betty Ford Center
Contact: (612) 231-4093 or e-mail: bweiner@hazelden.org

The American Public Health Association Annual Convention

"Public Health and Managed Care"
November 15-19, 1998
Washington, D.C.

The APHA Annual Meeting is the oldest and largest gathering of public health professionals in the world. Highlights of the meeting include:

Over 1,000 scientific sessions, awards, programs, poster sessions and workshops;
The APHA Exposition featuring over 450 booths;
Full and half-day continuing education programs;
The video festival showing back-to-back educational videos; and
An opportunity to enhance your professional network with more than 13,000 public health colleagues.

Contact: (703) 531-0894.

The Gerontological Society of America 51st Annual Scientific Meeting

November 20-24, 1998
Philadelphia Marriott
Philadelphia, Pennsylvania

The Gerontological Society of America holds this meeting to share information for professionals on aging research, education and policy.

Contact: The Gerontological Society of America at (202) 842-1275

Chicago Women Healing: Redefining Strength and Courage

December 4-5, 1998
Chicago, IL

Sponsor: Hazelden Institute, Betty Ford Center at Eisenhower, College of San Mateo, Alcohol and Other Drug Studies (regional sponsor)

This conference is designed to promote new perspectives and models for dealing with women's issues and concerns. The first day is for professionals in the helping field. The second day is for women in recovery and will focus on learning, sharing, and celebrating.

Contact: Patricia Guzzi at (612) 257-1055 (fax) or e-mail: pguzzi@hazelden.org

Network Profile is published with support from the Michigan Department of Community Health - Division of Substance Abuse Quality and Planning, and in cooperation with the Michigan Office of Services to the Aging and members of the Network Leadership Council, Older Adult Network Project. Quotations from or reproductions of articles contained in this publication are permissible as long as the source is cited.

Since 1979, Gerontology Network (GN) has been helping older adults maintain or increase their independence and restore meaning to their lives. GN provides many programs designed to serve the older adult, their families, and their care providers.

For further information, please call Regina McClurg at (616) 977-3300.

Michigan Older Adult Substance Abuse Network