While the popular misconception that older adults do not abuse drugs continue to prevail, a lot of evidence explains that substance abuse among the elderly has been unidentified. The wave of baby boomers just turned 65 years and account for nearly 30% of the total American population. The increasing number of people in this age gap coupled with improved life expectancies prompts the census bureau to project that the number would further increase from 40.3 million to 72.1 million by 2030 ( Kuerbis, Saco, Blazer, Moore, 2014). Unfortunately, unlike the previous generation, current baby boomers have demonstrated high rates of alcohol intake and other drug abuse. The current baby boomers are different when compared to past generations during the 1960s and 1970s. The prevalence of substance abuse among this age group continues to soar higher as they continue to age. As a result, the adverse effects on their physical and mental health also rises ( Kuerbis, Saco, Blazer, Moore, 2014) . The ageing of the baby boomers creates a sense of urgency to control substance abuse among the elderly efficiently. This means that social workers should mobilize their indispensable nature of helping others and extend the same to older adults who are at risk of Substance Use Disorder.
Epidemiology
In the past, numerous research focused on substance abuse of alcohol, prescription drugs, cigarettes, and caffeine among young adults. However, baby boomers seem to defy these past trends through their increased abuse of drugs. Substance abuse problems result in serious health effects that affect social relationships and economic capabilities of people. In most instances, the problem is often unrecognized among the elderly instead of making it a priority issue. A 2013 survey revealed that the percentage of older adults between the ages of 50 and 64 who abused drugs increased from 2.7% in 2002 to 6.0% in 2013 ( Bhimani, Patel & Thomas, 2018). Illicit drug abuse also increased from 3.4% to 7.9% among those between 50 and 54 years, 1.9% to 5.7% among those between 55 to 59 years, and 2.5% to 3.9% among elderly people aged between 60 to 64 years ( Bhimani, Patel & Thomas, 2018) . Recent studies further exposed that among geriatric patients above the age of 65 years and admitted in trauma centers, 48.3% had positive drug screen results in their urine. By 2020, an estimated 5.7 million older adults would require treatment for substance abuse disorders ( Bhimani, Patel & Thomas, 2018) . The number is likely to double from 2.8 million older people who have Substance Use Disorders in 2006.
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Substance Abuse
Among the elderly, small amounts of alcohol can have serious health consequences. Despite it having a depressing effect, alcohol can create danger particularly when patients are taking prescription medications. Medical conditions could be further aggravated, falls increased, confusion and depression develop, and unintended deaths occurring. The rates of older adults binge drinking are 19.6% for men and 6.3% for women ( Bhimani, Patel & Thomas, 2018) . In a community-based survey, older adults reported having more than one drink in recent times. As one age, the proportion of lean body mass to total body water decreases as the ability to process alcohol reduces. Therefore, even small amounts of alcohol intake will be higher in the blood than younger adults ( Friedman & Williams, 2015). This means that they are also more likely to experience alcohol-related problems. Healthy alcohol levels that are established to be safe in younger adults and sustained as age progresses is a risk factor among older adults.
On the other hand, prescription medicine use is three times higher among the elderly as opposed to the general population. Lack of proper guidance in medication use could make patients take unnecessary doses, miss particular doses, incorrect timing of medicine consumption, taking medications for extended periods, as well as failing to fill in prescriptions also contribute to drug abuse among the elderly ( Friedman & Williams, 2015) . Contrary to the popular perception that drug abuse is intentional, unintentional misuse of mediations is also recognized as abuse since medication is not used as initially intended and prescribed.
Tobacco use is also prevalent among older adults where those above 65 years of reporting to have used tobacco in less than 12 months. Older adults also tend to be long-term heavy smokers with a higher dependence on nicotine. On the other hand, illegal drug use among the elderly is also on the rise ( Friedman & Williams, 2015) . Life-long recreational drug users particularly those who use marijuana may find it hard to discontinue its use due to the physical and sociological changes that take places such as isolation and retirement. Those who try to continue using hardcore drugs such as cocaine and heroin also find it very difficult to stop and withdraw from its use ( Friedman & Williams, 2015) . At the same time, chronic illnesses that may cause severe body pain may make the elderly purchase heroin and illegal opium products to relieve their suffering. Given the increased tolerance to narcotics, their body would normally demand higher dosages thereby contributing to drug abuse.
Risk Factors of Substance Abuse
Elderly people are exposed to health vulnerabilities such as bone thinning, arthritis, mental ailments, body aches, among other complications. As a result, they are predisposed to a lot of pain killers and other medicines that increase the risk of them abusing them particularly through overdosing. Among other physical risk factors such as inevitable poor health status of the elderly, physical disabilities, cognitive impairments, and polypharmacy further increases the burden of substance abuse among older adults ( Friedman & Williams, 2015) . As the body ages, normal body functions of the brain, liver, kidneys, and digestion slow down to affect how medications are absorbed and excreted from the body. Therefore, given that physicians may not be fully aware of the medications old people are consuming including OTC drugs, the is a greater risk of individuals having increased toxicity or dangerous drug interactions. For instance, taking depressants alongside alcohol could slow down the breathing process until a person completely stops breathing. The misuse of prescription medicine is far more common in the elderly. Unfortunately, the adjustments of making correct dosages for age-appropriate medications often misses when physicians communicate with the patients ( Pillemer, Burnes, Riffin & Lachs, 2016). Psychiatric risk factors include past histories of drug abuse, current psychiatric problems such as dementia, alcohol problems, and not applying the appropriate coping mechanism could likely contribute to the misuse of drugs. In most instances, people will abuse drugs to reduce the negative symptoms of mental health issues. Social risk factors may also contribute to the possibilities of substance abuse among adults. An elderly person living alone or isolation, bereaved, forced into early retirement, or has a lower socio-economic status are more likely to consume alcohol. Interactions between medications and alcohol cause increasing concerns regarding the health of elderly individuals.
The increased legal and social acceptance of marijuana from being a recreational drug to be used for medicinal purposes also increases its use among the older population. While marijuana is illegal under Federal law, some states have legalized its consumption. The euphoric effects associated with the depressant makes it appealing for older adults to relax their body and mind away from their sufferings ( Pillemer, Burnes, Riffin & Lachs, 2016) . The effects of marijuana on the body creates a temporal feeling of relaxation that makes its users forget about their suffering and body aches. However, the effect could weaken the immune systems of older adults while increasing the cardiac workload. In the end, they get exposed to higher risks of fatality.
Social Work Roles and Interventions
Depending on the severity of the problem and the setting of the individual, treatment options are many and readily available. Among the available treatment modalities, about 18% were specifically designed for older adults. However, mental health improvement was reported at lower rates in adults as opposed to other age groups. At the same time, older adults face a lot of stigmatization and shame when they are associated with substance abuse. They also undergo geographical isolation, face difficulties in payment, and find it difficult to move from place to place ( Reardon, 2012). After all, some of the treatment modules such as group therapy and peer support are expensive and capital intensive. Interventions that follow traditional methods such as office visits, emergency rooms, and senior centers have been implemented to reach vulnerable adults who are at risk of substance abuse.
Nonetheless, there is limited information and research on the effectiveness of treatment options of adults ( Reardon, 2012) . The amount of rigorous published evidence on how effective treatment interventions of SUD in elderly patients is very narrow. Therefore, there is no established guideline that clearly illustrates an effective approach to dealing with the growing menace.
As part of the expansive field of human services, social workers have an increasing role of serving and responding to drug problems among the elderly. However, they are required first to admit that the problem among this population exists in society. In most instances, care providers and social workers have not trained adequately in asking elderly people whether or not they abuse drugs or not ( Reardon, 2012) . Dealing with older patients requires a whole range of expertise and skills that would incorporate not only medical aspects but also socioeconomic factors as well. This means that social workers need to invest in training, retraining, and staff retention and development.
Nonetheless, since they are in the field of working with individuals from different backgrounds and with different problems, they are the most suitable people to help older patients who are struggling with SUD. At the same time, their widespread reach into the homes of individuals fills in the niche of capital limitations. The affected population would not have to incur transportation costs or forced to travel to treatment centers since social workers would avail themselves at their locations. Apart from convenience, social workers also work and collaborate with others such as community peer groups to ensure that treatment and coping mechanisms are adequately availed to the older population ( Reardon, 2012) . They are also in a better position to educate the affected individuals and their caregivers on how treatment and care should be provided.
Most importantly, their role of advocacy ensures that specialized services in the community, home-based, and clinical settings and provided to them. They are well-equipped with the capacity of training other professionals in identifying the drug abuse problem in old people, treating, and caring for them while considering other external factors such as socioeconomic elements ( Reardon, 2012) . However, despite their wide range of expertise and skills, they would have to work collaboratively with others to comprehensively address the problem.
While prevention is proactive and based on scientific evidence and processes, management is social based that includes non-scientific explanations and interventions. Therefore, social work plays a critical role in the management of substance abuse among the elderly ( Marsiglia, Becerra & Booth, 2014) . Social work not only targets reducing the effects of the prevalence of substance abuse among the given population but also helps to reduce the negative effects that are related to health and psychosocial outcomes and economic burden that individuals place on the society at large. Interventions often take the perspective of social work that act on different levels of the population ( Galvani, 2015) . Social workers’ role is not only limited to individual persons but also extended to families, neighbourhood, and the larger society.
Drug abuse prevention among older people share the same ethical issues and dilemmas that in other drug treatments. In this case, since social work targets the elderly who might have a lapse of judgment or associated mental illnesses, ethical dilemmas might easily arise. Social workers, therefore, have an ethical obligation to address the undesirable trait and condition while maintaining high levels of confidentiality while respecting patient autonomy ( Galvani, 2015). As part of their advocacy role, they are mandated to protect the affected individuals and their families in promoting their health and overall well-being. In the same regard, they are best suited to champion for better policies that meet the needs of the underserved population in relation to substance abuse.
References
Bhimani, J., Patel, M., & Thomas, M. N. (2018). Substance abuse among older adults: A growing problem. Current Psychiatry , 17 (3), 14-20.
Friedman, M. B., & Williams, K. A. (2015). Substance abuse and misuse in older adults. Substance Abuse .
Galvani, S. A. (2015). Alcohol and other drug use: The roles and capabilities of social workers.
Kuerbis, A., Saco, P., Blazer, D., Moore, A. (2014). Substance abuse among older adults. National Institutes of Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146436/
Marsiglia, F., Becerra, D., & Booth, J. (2014). Alcohol and drug problems: Prevention. Encyclopedia of Social Work. Retrieved from http://oxfordre.com/socialwork/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-517
Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder abuse: global situation, risk factors, and prevention strategies. The Gerontologist , 56 (Suppl_2), S194-S205.
Reardon, C. (2012). The changing face of older adult substance abuse. Social Work Today , 12 (1), 8.
