Why Are So Many Seniors Addicted?
A look at a growing crisis in Southwest Florida.
Terror-stricken. That’s the very best word to describe Clare Mannion on the very worst day of her life. She’d been in a car accident—a minor one—but severity doesn’t matter when you are caught driving drunk for the second time in five years. Mannion, businesswoman, volunteer, adventurer and seeker of all things new and intellectually stimulating, was going to jail. At age 64. With a bitter reality: She had become addicted.
“I had become a hostage to that disease, but I didn’t know it. Its voice just kept getting bigger and bigger and bigger,” she says.
Mannion has settled at a table at a south Fort Myers restaurant and is spinning her life’s story: a Canadian upbringing; a rise through the hotel and real estate industries in the United States; a search for new experiences in the Southwest; and then a birthday, a death, an opportunity lost, a gnawing restlessness—and an alcohol problem.
“No birthday to that point had been significant, but 60 felt insurmountable,” says Mannion (pictured above), who voluntarily entered rehabilitation at Hazelden Betty Ford in Naples and hasn’t touched a drink since.
For most people, the standard face of a substance abuser is probably young and probably hovering on society’s fringe. And that’s because people in their late teens and early 20s have traditionally been the most prevalent abusers, according to federal statistics. But substance misuse and abuse among older adults is on the rise, affecting up to 17 percent of people aged 50 and older. Some of them have abused substances their entire lives, the effects magnified as the body changes and tolerance declines. Yet many, like Mannion, are successful adults who shift from socially acceptable use to abuse unexpectedly and often in tandem with the issues that accompany aging: retirement, grief, physical changes, loss of purpose, isolation, health ailments and other life changes that their younger selves never anticipated.
In Southwest Florida, the issue may be especially pronounced—not simply due to the sheer number of retirees or the factors listed above, but because of a country club culture where booze flows freely from golf lunches to happy hours to dinner outings.
“What happens, sadly, is nice people come down here newly retired, and every night is Saturday night,” says NCH Healthcare System CEO Dr. Allen Weiss. A community assessment commissioned by his health system warns that 12.6 percent of the 65-plus population in Collier in 2010 was engaged in heavy or binge drinking. The higher the income, the study found, the more prevalent the overconsumption. “They’re out six, seven nights a week,” Weiss continues. “They don’t have to get up in the morning.”
Add to that America’s penchant for medicating its ailments. One in six Americans uses three or more prescribed medications, Weiss says. Prescriptions for hydrocodone, the heroin-like painkiller, spiked 52 percent between 2007 and 2012 among Medicare beneficiaries, according to federal data. Between 2004 and 2008, there was a 121 percent increase in emergency room visits for prescription drug misuse by older adults, according to a 2012 report by the Substance Abuse and Mental Health Services Administration.
And, then, the final tipping point: Woodstock-era boomers who grew up experimenting with mind-altering substances and highs that the brain never quite forgot. One study, in the Journal of Mental Health Counseling, predicted substance abuse among those 50 and older will triple by 2020.
And all of that is what caught Brenda Iliff’s attention.
Brenda Iliff, the executive director of Hazelden Betty Ford in Naples, launched one of the nation's only substance abuse programs for older adults.
Iliff moved to Southwest Florida from Minnesota five years ago to open the Hazelden Foundation’s new treatment center in Naples. Her undergraduate degree was in geriatrics and her career had been spent in addiction counseling. (Hazelden is now merged with Betty Ford). She found herself encountering older patients like Clare Mannion all the tim
“We’ve treated people who are older, but they are in with the 20-year-olds or the 40-year-olds, and it’s OK, but they have different needs—and different educational needs: What is an accidental addict? What do I do with a lack of structure, when all of a sudden I have lost all of my roles?”
Iliff two years ago started a new treatment program, BoomersPlus, tailored to adults ages 50 and older. Iliff is aware of only a handful of other such programs in the United States. Hers will serve as a pilot for the Hazelden Betty Ford network.
“It’s been a hole in our organization and in the treatment field,” says Iliff. She remembers a newcomer once introducing himself during a group counseling session. He’d run four major companies and was a prominent philanthropist. He ended his greeting by saying, “and I have no idea what a 61-year-old like me is doing in a place like this.”
Pair that gentleman with a college kid, and the two won’t have much in common; pair him with someone like another former patient, a retired businessman who referred to himself as “an FIP—a formerly important person,” and the conversation is far more likely to flow.
Today, as many of half of Hazelden’s patients are older adults. Their rehab includes a hefty dose of anatomy—explanations of age-related metabolic, chemical and neurological changes that exacerbate the effects of substances. A single drink for an older adult, Iliff explains, might be the equivalent of two or three drinks for a younger one. Patients explore the potential risks behind doctor-prescribed drugs and learn pain and medication management. They examine social, cultural and emotional matters like the role of older adults in a youth-obsessed society. They dig into the grief and loss that hits in later years—loss of loved ones, of health, of family roles, careers, structure, purpose. And they may address the nagging “Is this all there is?” question that had hit Mannion so hard.
Mannion is a petite and slender woman, wired with energy. “Intense,” she considers herself. Everything about her screams “hip”—spiky brunette hair, layered accessories, smart and stylish outfits. She married later in life, no children, and played the role of cool aunt to her family and chic hostess to her friends. Mannion started off in the hospitality industry, hit the proverbial glass ceiling and then went into real estate, where the possibilities were endless for a hard-charging young woman.
She spent her early adulthood in Manhattan and Chicago, where, in addition to her own career, she got deeply involved in volunteerism at a local children’s hospital and in the fledgling hospice movement.
She got restless in her 40s, watching friends settle down and raise families. “They were all wrapped up in their busy lives with children and jobs, which were all good, but I thought, ‘There’s got to be more than this for me. I don’t know what it is, or where it is.’”
That’s what drove her to Santa Fe—an entirely different kind of place filled with new people who celebrated spirituality and diversity and the outdoors. “There was lots of tremendous, unbelievable learning,” Mannion says. She re-established her sales career, made lots of friends, volunteered with a newly formed hospice, a children’s art therapy program and other organizations. She adopted a dog, Charlie, who became a constant companion and a symbol of her new life. She met her husband, Tom.
“I turned 50 in Santa Fe. It did not seem like a big turning point. I was happy and content to be where I was,” Mannion says.
There is a history of substance abuse in her family, and Mannion now knows that the seed of alcoholism was probably always within her. She loved to entertain and drank socially without incident for many years.
She weathered a slew of issues: a health matter requiring surgery; her sister’s health challenges; her husband’s job opportunities in California and then in Florida; her relocations to accompany him. On arrival, Florida felt unfamiliar. “If I were to draw a line through all the things I’ve done and all the places I’ve lived, it seemed I had always been attracted to cutting-edge situations,” she says.
As she worked to settle into her new life, a collision of events sent her reeling: the recession and the uncertainty it wrought; a change in life plans due to waning economics and job opportunities; her 60th birthday; and the death of her beloved dog, Charlie—a loss that few understood and too many disparagingly brushed off.
“I just wanted to be alone. I isolated,” she says. Mannion worried her adventures were over.
Her alcohol use escalated.
She got her first DUI on a Sunday afternoon. “You would think that would get my attention. But it didn’t.”
It wasn’t until three years later, with the second crash, that Mannion understood she absolutely needed help.
Millard Bowen completed Hazelden's program and is looking to channel his energy into helping others.
Millard Bowen, who goes by “Mil,” would recognize elements of Mannion’s story. He, too, landed at Hazelden after an alcohol-
Bowen is 68 with white hair, a youthful demeanor and a storyteller’s charm that must have made him good company all those afternoons at Clearwater-area bars with his hard-partying co-workers. There are no more bars now. On this morning, he’s sipping a latte at a Naples Starbucks and considering his winding journey through later-in-life alcohol abuse and rehabilitation.
Bowen is a jack-of-all-trades kind of guy who had started out as an educator, went into the military, ran special education programs, worked at Busch Gardens, drove a trash truck and a city bus, counseled drug addicts and culminated his working years at Tampa International Airport in airport security. In between, he got married and divorced “a couple of times,” and had a son, Austin, who graduated from Bowen’s alma mater, the University of South Florida. Bowen’s pride in his son is evident; his relationship with him, however, is sadly strained. Fixing that is Bowen’s next order of business.
Bowen had always been a social drinker. He started drinking more in his early 50s, driven by “domestic issues and working conditions.”
“I noticed I wanted to [drink] more, but I was still able to stop it,” he says. His co-workers frequently would cap off their 4 a.m. to 1 p.m. shifts with trips to the bar. Drinking, Bowen says, felt like an escape—until he sobered up and realized nothing had changed.
He was on a couple of prescriptions for unrelated medical conditions and now understands that the mixture of medications, drinks and normal physiological changes of aging exacerbated the alcohol’s effects. “I found a way to just push through. ... I always had that extra energy or ability to overcome whatever I felt like and get to work anyway, but then it started to really affect me and I couldn’t do it.”
He went to Hazelden for the first time in 2014. He completed rehab, but he admits his heart hadn’t been fully in it. That same year, in addition to acknowledging his addiction, he retired and went through a divorce. “All three of those major events within a year and a half—any one of which would have been hard for someone. I had them: boom, boom, boom. I just went out and picked up again. I started drinking beer again. I thought I could handle it.”
On his way home one afternoon, he pulled into a bar. “I don’t know what possessed me to do that. ... I sat at the bar, putting them down, having a grand time.”
Seven hours later, he was driving home—yes, intoxicated—when he nudged the car in front of him. The other driver called police.
“If there was a hell on earth for me to experience, that was it. Just the memory of that—having been booked into the jail with my scrub suit and my plastic ID badge and my tray with my toothbrush and flip-flops and all that stuff. ... What a nightmare. I remember all that so vividly. Just that would make me never pick up a drink again.”
He went back to Hazelden. This time, he was ready. And this time, the Boomers program was fully in place.
“Even though it’s the same center, the same basic program, it was a completely different setting for me. This time, my heart was in what I needed to do,” he says.
Hazelden may be taking the lead on treating seniors, but other rehabilitation centers are taking note of the trends and trying to adapt their counseling to fit older clients’ needs.
“Yes, (our numbers) are going up,” says Rosemary Boisvert, the assistant vice president for residential treatment at SalusCare, a substance abuse and mental health treatment organization in Lee County. She attributes the increase to the aging boomer population. “A lot of them were brought up in that generation where it’s OK to use, and maybe even abuse, to a certain extent.”
Treating older adults can be more complex, Boisvert says, if they arrive with other health conditions such as diabetes and hypertension—or with a lifelong use history that may have resulted in complications like liver damage.
Late-onset addicts—the ones who started abusing substances in response to a crisis or slipped into painkiller addiction or who didn’t adhere to warnings against mixing alcohol with prescriptions—generally rebound with brief interventions, Boisvert says.
“Usually you identify the situation, you address it ... you help them see these things and you work with them to offer solutions and alternatives,” she says.
At the David Lawrence Center in Collier County, the majority of clients seeking residential treatment and detoxification are in the 30- to 50-year-old age range, followed by the 18- to 25-year-olds. But the 50-plus population has held at a steady 15 to 20 percent, says Nancy Dauphinais, the clinical director of the Crossroads Substance Abuse Services program.
She worries about the rates of older adults taking anti-anxiety and sleep medication—and drinking along with them. And she sees several issues in the health care system that can exacerbate the risk of substance misuse and abuse: multiple specialists prescribing multiple drugs and doctors failing to consider substance use as the underlying cause of memory lapses, falls or confusion.
“They may think it’s dementia, or, what everybody fears, Alzheimer’s. Sometimes, there is a more simple explanation: They are taking a lot of medication and mixing it with alcohol—or maybe it’s too much Ambien (a sleep aid),” Dauphinais says.
Rehab, of course, means detoxifying the body, but at its core, it is really about cleansing the soul.
Mannion likens it to the peeling of an onion, an examination of the self one layer at a time until you understand what had triggered the abuse, resolve to make changes and practice new ways of thinking before re-entering the world.
“It’s what I do with my thinking that has made all the difference,” she says. “It’s a thinking disease equally as much as a drinking disease.”
She continues: “For me, it was about altering my perspective. I used to strive for perfection. I thought that was a good thing and the right thing to do.”
She has learned to let go—and to identify the things she can control and the things that she cannot.
“I continue to be a seeker in life. I want to be a productive member of society. I want to make a contribution wherever I am and in whatever I do,” she says. “My road to perceived hopelessness happened fast—the disease kept me hopeless. Treatment, education and recovery have given me abundant hopefulness.”
Bowen continues the hard work of healing through a 12-step program. He is remarried, and his wife struggles with addiction, too. He is hopeful that the two can support each other through their recoveries. He is looking also for opportunities to help others like himself through work or volunteerism.
“For me, to not drink has become easy,” he says. “It’s all the other things I have to learn in my new life: patience, acceptance, not to have resentment or drag baggage from the closet with you at all times, and to adjust to the ways people are.”
“How many more chances do we have?” he adds, pondering the narrowing window of time older addicts have to straighten out their lives. “It’s divisive and sneaky and deadly, and we can’t play with it, especially the older we get. You hear the saying, ‘I’m too old for this’—literally we are.”