Oh,how the world has changed. Wasn’t it just easier in the old days (around 1900) - when men died around the age of 44 years of age and women around the age of 46. Life was much simpler. You grew up faster, you took on more responsibilities for family earlier and then you died. Could it get any easier than this? And then medical intervention and prevention strategies had to intervene - driven by scientific breakthroughs. And now look at the outcome - extended spurts in longevity with approximately 10,000 per day turning age 65 and the fastest growing demographic are people turning age 100. Now, it is projected that on average men live to the late 70’s and women to the early 80’s - on average. The fascinating thought is that the longer you live - the chances are that you will live longer. So, if you reach age 40 - chances are you will live to age 60 and if you live to 60 - the probability is that age 80 is in your future - and if you live to age 80 - “Hello, 100!” - is very feasible. What a gift! But with every gift comes the task of ‘unwrapping’ - and here is what we find when we focus on the landscape of increased longevity - that yes, people are living longer - however, they bring to this arena new issues and concerns. You see development is never over. So, the problems, concerns and needs of the individual continue on - throughout life. And today, we have a new cohort that has pressed the ‘envelope of time’ - and with them they bring new concerns - that at one point were only issues being addressed by a much younger group - for instance, substance use and addiction.
The reality of substance use and addiction can be traced to the early accounts of the human species. Early historical accounts address the issue of substance (alcohol and drug derivative) being introduced in religious, medical and societal practices and ceremonies. Modern day accounts have typically integrated themes, narratives and stories about abusive patterns of drug and alcohol use in adolescent and young adult developmental stages. But what we all know, as individuals, family members and practitioners is that maladaptive behaviors (driven by substance use and misuse) occur well into adulthood. However, the new revelation is that these patterns can present themselves not only into adulthood but into the late stages of adulthood. The outcome is a new cohort requiring specialized treatment, as the traditional intervention techniques were crafted for the adolescent and young adulthood cohort.
Mary, age 63
Mary is a professional woman - now retired. She is a wife, mother and grandmother. However, she is also lost. She was forced to retire - without planning. Now with no opportunity to employ her skill - and her children /grandchildren living 500 miles away - she begins to spend her time sullen and drinking excessively. When rehab treatment is recommended - she balks...and then eventually agrees. She arrives at the Treatment Center for the intake process. She is then introduced to her ‘treatment partners’ - two 22 year old female Crack addicts. Mary becomes indignant and leaves the Treatment Center - 1 hour after she arrives. She is angry, very angry - she is flooded with thoughts of: “what do I have in common with those girls?” Mary went home and continued to isolate and abuse alcohol excessively. Six months later - she was charged with a DWI; 9 months later she died.
Charlie, age 68
Charlie is a very successful CEO - now out of work. He was discharged, by his Board of Directors, due to his opioid addiction. First , it started as a pain medication - for a back injury. Quickly, he was using pain relief medication in an abusive pattern. He is presently on Suboxone - and desperately looking for a Treatment modality that: “understands who I am - my experience - I need help that appreciates my value and worth as a person”.
Mary and Charlie are the tip of the iceberg. As people continue to age and live longer lives - the patterns of behavior that were predominantly nestled in early development are appearing across the lifespan. As a Field, we better be listening. We are completely kidding ourselves if we believe that standard treatment interventions (crafted for adolescents and young adults) are appropriate for older adults. To continue to introduce older adults to interventions that are not ‘age-sensitive’ is a form of benign malpractice - to say the least. One intervention does not meet the needs of all individuals. This is a new territory and one where we need begin some ‘fireside chats’ to shape dialogue, practice and policy. Welcome to the new universe - we need to act accordingly.