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I Am An Addict

January 20, 2011

 

Millions of older Americans are making this confession. Families are being torn apart. The good news: There's help Clean and sober for more than five years, Ron Dash has rebuilt his marriage and his life. “When I saw what I was doing to my loved ones, it broke me”

In the predown darkness of December 5,2005, Patricia Dash woke her husband, Ron, and led him downstairs to the den of their house in New York. Ron was groggy—and confused, because standing by the fireplace was a stranger wearing a white turtleneck under a black sweater.

“What's a priest doing here?” he thought. “What the hell is going on?”

Maybe Ron was dreaming. Or maybe he'd drunk too much wine and vodka last night, or maybe it was the OxyContin and the Ambien he had popped along with the alcohol.

But the guy in the turtleneck wasn't alone. Perched nervously on the edge of the sofa were Ron's 8-year-old son, Sam; Ron's two older brothers; his 13-year-old niece; and his 86-year-old mother.

“Ron, say hello to Bob,” said Patricia. “He's going to have a chat with you.”

And that's when Ron got it: This was an intervention.

“She's gone way too far,” thought Ron. Not only had Patricia recruited other family members for the intervention, but she had involved young Sammy.

In the world of substance-abuse treatment, an intervention is a loving but direct call to arms, and often the last attempt by loved ones to end the destructive path of addiction. Patricia had hired Bob, an interventionist, to ensure that the family's initiative would succeed—and that no one would get hurt.

Ron scanned the faces in the room. He looked awful that morning— “like someone had hit him with a baseball bat,” recalls Patricia. “He had gained a lot of weight and was all swollen.” And he looked far older than his 52 years.

It hadn't always been this way. When Ron was enticed out of bachelorhood at 40 by his stunning Venezuelan bride, they had made an attractive and charismatic couple. They had also built a beautiful home: three stories with a bay view, an emblem of Ron's business success. Only a few years into their marriage, however, Ron began drinking at every possible occasion and started doing drugs more and more often. He became unpredictable, sullen, and sometimes violent.

So this morning his family had no idea how Ron would react to their collective action to end the chaos. They had all written him letters explaining how much they loved him and howmuch they wanted—needed— him to get sober. Haltingly, each family member read him their letter. Sam had written that he'd lost his father and wanted him back.

“I was enraged,” says Ron. He ran upstairs and grabbed the kitchen phone. “I was calling the cops to have everybody thrown out.” Patricia, a slight size 4, threw herself at her bear of a husband. Ron shoved back. “If you don't go to rehab,” Patricia screamed, “you'll never see me or Sammy again!”

And then Sam snapped.

“He marched to his bedroom and ripped up his letter,” Ron says. “He grabbed a pen and carved the words ‘I DON'T HAVE A DAD’ in the doors of his closet. Then he came to me holding a picture of the two of us and cut it in half.”

Seeing his little boy fall apart finally got through to Ron. “I saw—outside of myself—what I was doing to my loved ones. It broke me.”

Ron fell down on his knees and grabbed for Sammy.

“Okay, I'm going,” he said in tears. “I'm going.”

WITHIN HOURS, THE FAMILY and Bob boarded a plane to Florida, where Ron was scheduled to enter residential treatment— that day—for alcoholism and drug addiction. At the Hanley Center in West Palm Beach, Ron would spend the next 48 hours in a sweaty, hazy, queasy detox, coming down from booze, tranquilizers, the narcotic painkiller OxyContin, and the sleeping medication Ambien. Only after the drugs had left his bloodstream would he begin the intense individual and group therapy, with about 30 other men from their 20s through their 50s, that would launch his life as a sober person. At 57, Ron has been sober and straight for more than five years. The number of aging boomer addicts, however, continues to grow. The result: the first sizable population of over-50 adults to struggle not just with alcohol but also with drugs, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), a federal agency. And as the nation's 77 million baby boomers age, the agency predicts, the number of drug addicts who qualify for senior discounts will only grow. In a report published in December 2009, SAMHSA disclosed that 4.3 million adults age 50 and older had used an illicit drug in the preceding year. The number of boomers with substance-abuse problems will double from 2.5 million in 1999 to 5 million in 2020, the agency forecasts. Not surprisingly, SAMHSA projects that the need for treatment will also double, as longtime abusers gain greater access to prescription meds.

The explosion in midlife drug abuse is tearing families apart, ruining careers, destroying addicts’ health, and driving up health care costs. But not all the news is bad: The social stigma of addiction, though still present, is easing as it becomes clear that addicts are neighbors, friends, grandmothers, husbands. That awareness forces fewer addicts underground. Plus, it makes them more willing to seek help than yesterday's alcoholics were. Rehab is no magic solution, but when older addicts find the right treatment—be it a local 12-step meeting or an inpatient rehab program—recovery can transform a family's life.

IN 2005—THE SAME YEAR that Ron Dash checked into the Hanley Center—Fred Blow, Ph.D., noticed “a lot more boomers suddenly coming into treatment programs with cocaine problems.” Says Blow, a leading researcher on aging and addiction: “We'd never seen that before in this population.” This new crop of coke users, he says, are middle-aged, middle-class, and often retired. And now their free time is killing them: When retirement is bereft of fulfilling activities, Blow says, some people turn to drugs to fill the void.

Blow, professor of psychiatry at the University of Michigan Medical School, recalls a 58-year-old retiree who had taught school for 30 years. “He had smoked a little marijuana before,” says Blow, “but never had a problem. Now here he is entering treatment for a full-blown addiction to crack cocaine. He had too much time on his hands and turned to coke to cope.” One-third of boomers who enter treatment qualify as these “late-onset” addicts, Blow estimates. “This trend is going to continue,” he says. “We need to be prepared for it.”

Though alcohol remains the most commonly abused substance among the upper age brackets, drug use is rising. Among those age 50 and up, treatment-facility admissions for cocaine abuse quadrupled from 1992 to 2008; for heroin abuse they more than doubled. Prescription-medication and marijuana abuse also climbed significantly. “Whereas alcohol was the dominant, singular problem pushing people into treatment in the past,” Blow says, “now we're seeing more cases of a multiple-substance-abuse problem—people using alcohol plus marijuana, or alcohol plus cocaine.”

The easy availability of addictive prescription drugs magnifies this lethal mix. Over the past 20 years many doctors have become more aggressive in treating pain, making opium based (and synthetic opioid) painkillers some of the most widely prescribed drugs in the United States. In 2009 alone, doctors wrote 128 million prescriptions for hydrocodoneacetaminophen combination products such as Vicodin.

These powerful painkillers spare legitimate patients a lot of agony. But many of these drugs also cause euphoria. And that makes them highly addictive.

For people in recovery, pain medication can be a rose with thorns. Consider DougBergon,* a 50-year-old information-systems specialist in Roanoke, Virginia. He has weathered addiction, alcoholism, and depression since age 14, attempted suicide several times, and been in and out of rehab for much of his life. In 1999, as a new husband and father, Doug had been clean for nearly four years when he developed a cyst from a knee injury. He was referred to a surgeon for surgery, after which the doctor prescribed oxycodone.

“I can't take that,” Doug told the doctor. “I've had problems with substance abuse.”

The physician dismissed his concerns. “You're gonna be in a lot of pain,” he told Doug. “Just take it as I've prescribed.”

But that can be tough for recovering addicts. “Oxycodone is heroin in a pill,” Doug says. “It set off the craving, and I was back on heroin in, like, a minute.”

Doug managed to conceal his heroin use from his wife, Melissa,* until one night shortly before Christmas. “I was getting ready for bed when I heard this weird buzzing sound, like a motor,” she recalls. “I went outside and nearly tripped over the noise; it was Doug, lying by the pool, unconscious. I thought he'd had a heart attack.”

When paramedics arrived, they said Doug “had come within about four heartbeats of dying.” But not from a heart attack: “Your husband's had an overdose,” they told her.

“I could feel my life change in that instant,” says Melissa.

That it was heroin made it doubly horrifying: “I'd led such a straight-arrow life, I couldn't even say the word out loud.”

With Melissa's help, Doug entered a Florida clinic run by Hazelden, where he completed a three-month stint in rehab. Good months were followed by relapses. In 2007, shortly after he was dropped by his sponsor—someone who commits to mentor an alcoholic through a 12-step program—Melissa found Doug passed out on the couch in their study at 3 a.m. after a drug-and-alcohol binge. That's when she asked him to move out. “I couldn't let our kids see him drunk or high,” she reflects. “Thankfully, it never came to that.”

Doug and Melissa have been separated for three years. A former government employee, Doug is having a hard time getting a security clearance—or finding a job of any kind. As 2010 came to a close, he had been clean for six months.

DOUG WAS LUCKY that his wife found him-and saved his life—after his overdose. But many people who pop opioid painkillers at the same time they drink alcohol or take sedatives don't survive the toxic combinations, which can fatally depress breathing. And as the popularity of opioid painkillers has soared, so too have drug-overdose deaths. Overdoses are now the second leading cause of accidental death in the United States, topped only by car accidents. And look who's most likely to succumb: those ages 45 through 54, according to the Centers for Disease Control and Prevention.

Steve Bartels, M.D., director of the Dartmouth Centers for Health and Aging in Lebanon, New Hampshire, warns his patients about the body's declining ability to metabolize drugs as they age. “Older adults who may be abusing marijuana, cocaine, or other drugs are sensitive to smaller amounts than when they were younger,” he says. “The problem is, they don't know that. So they get into trouble—motor vehicle accidents, domestic incidents—at much lower levels of use.”

Substance abuse in an older adult mimics many of the signs of aging: It causes memory loss, cognitive problems, tremors, and falls. The upshot is that even family members may not be able to recognize that a loved one is an addict. Late-stage abuse—especially in women only 55 or 60 years old—induces weight loss, muscle wasting, and, among alcoholics, elevated rates of breast cancer. “Addiction will move you into ‘old old’ very quickly,” says interventionist Debra Jay, coauthor of Aging and Addiction. “You maybe healthy, a runner, a vegan—but if you're doing cocaine or any other drug or alcohol, your body will break down much faster at 55 than it will at 35.”

THE RISE IN BOOMER DRUG USE is perhaps unsurprising. This is the generation, after all, that made drug experimentation mainstream, so today's 55-year-old addict is often yesterday's high school stoner. At least two-thirds of boomers who wind up in treatment have been drinking, taking drugs, or doing both for the bulk of their adult lives—and during some of their teen years, as well. “The earlier your onset, the worse your problem,” says John Dyben, the Hanley Center's clinical director.

Ron Dash first smoked pot at 13 and “loved it from the start,” he says. “I grew up reading about Allen Ginsberg and Timothy Leary. For a kid like me, who wanted to be different, to get attention, pot was cool.” And for him it led to hash, cocaine, mushrooms, and LSD, often amplified by alcohol.

Dyben also points to the boomer proclivity to medicate both physical and emotional pain. “So here I am as a baby boomer, hitting 50,” Dyben says, role-playing the midlife everyman. “My knees hurt a little more when I play tennis, and from the culture I grew up in I have the mind-set that says, ‘If I'm hurting, something's wrong. And if something's wrong, a pill will fix it.’ But the idea of ‘better living through chemistry’—that you can feel better by taking a pill, or by smoking or drinking something— that mind-set is killing boomers.”

Many doctors unwittingly collude with addicts to keep them armed with pills. Russ C., a 61-year-old retired tree-worker supervisor and a grandfather, began taking narcotic pain relievers after a work-related neck injury at 37. Over the years he took more and more narcotics and tranquilizers to tamp down the pain. By 2003 he was in such agony he had to leave his job. He went on disability and experienced a severe depression—a not-uncommon consequence of job loss or retirement. “All I had to do was sit around and take pills,” he says. By 2005 “it got to where my wife was afraid to come home from work. Would she find me dead on the floor?”

At age 56, desperate to kick his habit, Russ turned to a psychiatrist—who gave him a bit of misguided advice that outrages him to this day. “You're much too old, and you've been on pain meds far too long, to detox,” the doctor told him. Instead he prescribed methadone, piling it atop the other medications he knew Russ was taking. “He told me to make myself as comfortable as possible for however long my life would be,” says Russ.

On methadone, he says, “I had no feelings. I thought God had taken my soul and my heart. I couldn't drive. My memory was gone.” He was so unstable that his grown children refused to leave him alone with his grandchildren. Says Russ: “I had no purpose to my life.”

It was just as bad, if not worse, for his wife, Kathy, now 59. She met Russ while she was still in high school; they married the day after she graduated from junior college. Almost 40 years on, she is still devoted to him. But his illness was eating her life whole. “On methadone he constantly wanted coffee so he wouldn't become comatose,” she says. “But as fast as you could snap your fingers, he would nod off and spill scalding coffee all over himself. Things like that would happen five or six times a day.”

Kathy paid dearly for her husband's addiction: “I couldn't devote my attention to the grandchildren because I had to take care of Russ,” she says. “It wasn't just one person who had this disease. We were all disabled by it.”

By 2007 Russ had dropped from 170 to 118 pounds. Terrified by her husband's deterioration, Kathy and their kids began looking for a rehab facility. But they said nothing to Russ. “We felt seeking treatment had to be his choice,” Kathy recalls.

Finally Russ felt he could no longer function. He had to quit the painkillers. But he dreaded repeating an experience from two years earlier, when he spent seven rough days at an inner-city detox center. “People drove through the parkinglot at night, shouting through the windows at patients,” says Kathy. “They had lockdowns; they had body searches. We didn't know every rehab's not like that.”

Loath to endure another such experience, Russ resolved to quit methadone on his own. “I had violent shakes,” he recalls. “I was vomiting. I could feel my organs trembling in my body.” Kathy, conceding she couldn't help him by herself, reached her limit on November 12,2007. “We've found a place that would be good for you,” she told Russ. “Will you go?”

Russ agreed, and Kathy promptly called their kids. Together they drove Russ from his home in southern California to Community Bridges in Mesa, Arizona. Russ doubted he would survive the nine-hour trip. “I didn't want to die in front of my family,” he says.

He spent 10 days in detox, then transferred to Journey Healing Centers in Scottsdale for 45 days of rehab. This time, the treatment worked. (Patients are far less likely to relapse if—as Russ was—they're surrounded by a supportive, sober family.)

Russ has been clean for three years. Though he doesn't talk about it, Kathy says he's in pain every day but simply tolerates it. What he does talk about is the thrill of rejoining his family. He plays often with his eight grandkids and even babysits them. “Not a night goes by,” he says, “that I don't thank God for this second chance.”

For midlife families—many of whom must care for children and older parents at the same time—the stress of addiction can be almost unbearable. Crises can brew for years before they erupt. Such was the case for Blake H., 45, a writer and married father of two in California. He describes his 63-year-old father, Sam, as a lifelong drug addict. “Marijuana was part of the household,” he says. “After I went to bed at night, my dad would sit in the living room and smoke. I would stuff towels under my door.” Now, Blake says, his father is addicted to methamphetamines, a dependence that makes him volatile, dishonest, and unable to handle money.

Over the past 15 or 20 years, Sam has asked Blake to help him pay his mortgage, to buy him a car, and even to purchase a motor home for him. Ever hopeful that Sam could get clean, Blake always sent the money. “I thought he'd make an effort to find out where he wanted to be in life instead of acting like a 15-year-old kid.”

But Sam continued using meth and coke. Last year he wound up penniless once again.

Blake no longer trusts Sam's promises. He has stopped writing checks. He rarely speaks to his father—or conceals his anger. “I thought, ‘What happened to this generation that needs their kids to support them—not because they're elderly but because they won't take responsibility?'”

In prior generations the shame associated with addiction often kept people from seeking treatment. But midlife addicts—and, crucially, their spouses—are far more open to confronting thorny issues. “Younger spouses aren't willing to take secrets to their graves,” says interventionist Debra Jay.

That makes boomers likelier than their parents to seek therapy. Yet even patients who can afford it must hunt hard for rehab of any kind. Treatment programs across the country have dwindled in the past two decades, says Fred Blow: “That's something we're going to have to face as a nation; we must have more treatment programs. Older people can advocate for that.”

Five years after the intervention that changed his life, Ron Dash remains clean and sober. Patricia, Ron, and Sam now live in Florida, where Ron bikes, swims, and attends 12-step meetings in between driving Sam to football practice and cooking dinner. “After being pretty much absent all those years, Ron has learned to be Sam's father,” says Patricia. “And he has learned to be his friend.”

Despite the odds against them, she and Ron have rebuilt their marriage. It didn't happen the day he walked out of rehab, nor in the weeks and months afterward. “I spent four years waiting for the other shoe to drop,” Patricia admits. “Not until this year have I finally started trusting him again.”

“That was huge,” says Ron, pondering how his life might be otherwise. “What happens to Sammy if we go through all this trouble and the addict, the alcoholic, doesn't stay sober?”

He plans never to find out.

Elaine Appleton Grant is the health reporter at New Hampshire Public Radio, where in 2010 she produced the series Prescription Drug Abuse in New Hampshire.

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Media Coverage

November 16, 2012
Physicians take lead role in confronting opioid misuse, but still face hurdles: This is the second in a series exploring the intersections between effectively caring for people living with chronic pain and the rise in unintentional poisoning deaths due to prescription painkillers. (The first post is here.) The series will explore the science and policy of balancing the need for treatment as well as the need to prevent abuse and diversion. This week’s story looks at clinical efforts to reduce the risk of opioid abuse and overdose while still caring for patients; the next story will explore the role of public health officials in curbing opioid abuse. Read More

November 14, 2012
AMA webinar spells out 8 ways physicians can curb opioid misuse: The Association holds the first in a series of webinars to teach doctors more about appropriate pain management. Read More

September 17, 2012
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July 3, 2012
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April 9, 2012
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April 5, 2012
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April 1, 2012
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April 1, 2012
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March 8, 2012
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March 2, 2012
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November 2, 2011
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November 1, 2011
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September 14, 2011
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August 26, 2011
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June 30, 2011
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June 23, 2011
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June 15, 2011
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April 27, 2011
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April 20, 2011
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April 19, 2011
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April 11, 2011
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March 22, 2011
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March 10, 2011
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February 12, 2011
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February 5, 2011
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January 24, 2011
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January 20, 2011
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January 10, 2011
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December 15, 2010
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December 9, 2010
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November 9, 2010
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October 25, 2010
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October 18, 2006
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September 27, 2006
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September 20, 2006
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June 8, 2006
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