The aging generations of baby boomers will raise the percentage of older people using both alcohol and drugs to a new level, even as this group grows to nearly 1 of 5 North Carolinians by 2030.
The effect of drinking and using drugs - from cocaine to prescription pain pills - is still under study, but science and experience show it can be deadly. The state Alcoholic Beverage Control Commission is launching an early-warning campaign to alert people, not just about drinking, but also about the larger issues of substance abuse among the elderly.
"I certainly think that it's going to be a rapidly growing problem, and we in health care need to be aware of it and aware of how to deal with these concerns," said Jena Burkhart, geriatric clinical pharmacist at UNC-Chapel Hill's Eshelman School of Pharmacy.
Research into the effects of substance abuse on older people, yielding a number of grim statistics, have sparked efforts by the ABC and the medical community to give people more and better information on the subject. Baby boomers are the generation after World War II, generally those born between 1946 and 1964.
As a boomer and a recovering alcohol and drug user himself, Keith Kimbro, 60, sees plenty of evidence of the trends in his job at the Alcohol/Drug Council in Durham.
"Typically, these people have had some issues that have happened, a car accident, a spouse's dying, they're becoming disabled," Kimbro said. "That's the people who up to this point have not had an issue with addiction. Then they hit 55 or 60.
"Our tolerance drops. What you were drinking five years ago is making you falling-down drunk."
In April, Duke researchers Dr. Dan Blazer and Li-Tzy Wu called illicit substance abuse among people older than 50 a "looming public health concern." The number of Americans 50 and older with the disorder will rise from 2.8 million in the mid-2000s, to 5.7 million in 2020, just eight years from now, the Duke researchers project.
The troubling number of older people with alcohol and drug habits recently got the attention of the state ABC Commission, which previously devoted most of its education efforts to training permitted businesses about the laws and rules they must follow. Now the politically powerful agency, which has fought off moves to turn over its functions to private vendors, wants to broaden its public education efforts.
"Right now our plan is to reach out to various caregivers in the aging community - doctors, social workers, retirement communities, adult children," said Kristin Milam, director of education and training for the ABC Commission.
"We want to educate them about the special risks, prevalence and prevention/action items that they can do to make sure their patients and loved ones avoid alcohol and other substance abuse and misuse."
'Crosses all boundaries'
Kimbro, who grew up in Caswell County, says he drank without running into trouble for years as he married, had children and built a career as a commercial illustrator.
"The amount I drank could be considered social drinking," he said. "As the years went on I drank more and I drank more.
"I found this wonderful drug called cocaine. It was pretty accessible. With the cocaine, I was able to drink more and drink longer."
Kimbro says he lost his home, business and family before turning to Alcoholics Anonymous for help. He has fought the disease of addiction for more than 20 years, staying sober most of the time, but having relapses as recently as 2008. The alcohol-drug combo that crept up on him can hook the unlikeliest people, he said.
"It crosses all boundaries - age, religion, income, race," Kimbro said. "I got a call from an individual; he was 68 years old, he was ex-Marine, he had never drunk, never used any drugs.
"He said, 'I had hip surgery two years ago, they gave me pain pills for it and I find that I'm an addict.' "
Metabolism changes
Changes in body metabolism can heighten the effects of alcohol on older people, who tend to add body fat and lose water as years pass. Because alcohol metabolizes more slowly in fat, the effects of a few drinks can hang on longer.
"We are going to be facing this in North Carolina more than in other states because we have so many retirees," Milam said.
Older adults are in general likely to take more medication, according to national statistics compiled by safe driver groups. Representing about 1 in 8 residents, they take more than 30 percent of all prescribed medications and more than half of all over-the-counter preparations.Burkhart, the UNC clinical pharmacist, said the baby boom generation is at particular risk given its history of drug use at younger ages.
"I do think that as baby boomers age, there are going to be a lot of challenges for providers and for families," Burkhart said. "(Baby boomers) need to take a step back and say, 'Something that I used in my earlier years, is it going to be safe?' They need to make an educated decision."
Burkhart said she wouldn't advise against the commonly heard wisdom that it's all right for an older person to have a glass of red wine a day.
"But they should definitely weigh the risks and the benefits," she said.
"I would emphasize keeping open lines of communication with your doctor and your pharmacist. There's no reason to hide those things from your provider, it's just going to make it worse."