THE AGE OF EXCESS
IN HER 46th year, Isabella's life began to disintegrate piece by precious piece.
And so it was for the next two decades of Isabella's life. Until that catastrophic string of events, she had been a self-described social drinker. Then began a dark, double life of finding refuge in the booze, punctuated by episodes of getting on top of things.
"It's 20 years of like a revolving door," says the grandmother of four, whose experience illustrates an emerging crisis among older Australians, who are turning to substance abuse in growing numbers.
"I'm in AA [Alcoholics Anonymous], I'm not drinking, something goes wrong and I start drinking again," says Isabella, who lives on the Mornington Peninsula. "But I know from going to AA that you can't be cured as such. But you can definitely live your life free of alcohol."
For the past two months, this has been the experience of Isabella (whose name has been changed to protect her identity). But it was a close thing. She owes her life - literally - to an innovative service run out of Peninsula Health called Older Wiser Lifestyle (OWL), which is working with older people with substance abuse problems.
A psychologist from OWL was due to visit Isabella's home. "The night before, I'd taken all sorts of pills and things, because I thought that it was easier if I wasn't here," she says.
The psychologist took her to Frankston Hospital, where she was admitted to the psych ward. It proved a jolting experience. "To me, it was the most frightening thing I've ever been through," says Isabella.
Since then, things have looked up. Her daughter has become involved with sessions from counsellors, which has helped with understanding that Isabella's abuse problems are a disease, not a failure of will power. "The OWL program has also been a huge support," she says.
The program runs on a shoestring budget that allows for 2.5 staff. It's largely driven by Simon Ruth, who in 2007 travelled on a Victorian government fellowship to the United States and Canada, countries that are streets ahead in the recognition and treatment of substance abuse by older people.
"Since I've come back and I'm talking about it more, you'd be amazed at how many people who have an elderly relative, either a parent or an uncle or aunt, where they know they have a drug issue but they don't know how to talk to them about it," says Ruth, who is the director of complex service at Peninsula Health.
"We're not used to talking to our parents about their health issues and raising concerns with them. Parents are very used to talking to their kids and quite happy to push their kids into health care and argue with them about that.
"But we don't really know how to talk to our parents."
In the US, says Ruth, they talk a lot about "Granny's last vice: Grandad's dead, all the kids have left home, she's on her own, doesn't really have much in her life . . . so just let her have a couple of drinks, as long as it makes her happy.
"But the problem is that it's no longer making people happy and they're probably drinking too much, and it's causing other issues for them."
Ruth's program is the only one of its kind in Australia. Yet it is clear that the service it provides is barely scraping the surface of a problem that will only grow as Australia's population ages. The so-called Silver Tsunami is bringing in health problems that include substance abuse, mainly the abuse of alcohol, followed by prescription drugs. And as the Baby Boomers age, there is a belief that illicit drug abuse will become a greater problem.
Historically, the focus of Australia's drug policy has been on younger people: the dangers of binge drinking, of party drugs. But there is a largely unseen problem of abuse among older people.
Sam Biondo, executive officer of the Victorian Alcohol and Drug Association, says the ageing population is a hidden population. "They tend to be at home and out of view. They're not as obvious."
A paper by the association sets out the extent of the imminent crisis. The starting point is forecasts from the Australian Bureau of Statistics that the proportion of Australians aged over 65 will rise from about 13.5 per cent to about 25 per cent in the middle of the century.
"In the large part, substance misuse issues for the older population are pervasive yet silent, as many of the symptoms and harms are being subsumed and attributed to the normal ageing process," the paper says. It identifies an "urgent need" to bolster alcohol and other drug services to deal with the problem.
The November conference of the Australasian Professional Society on Alcohol and Other Drugs heard University of Melbourne's Dr Kim-Michelle Gilson report on her survey of 421 over-60s, which found one in five were drinking at hazardous levels, while 7 per cent of men were binge drinking weekly. Gilson argues the national guidelines of two drinks on any day should be halved for over-65s, following the US example.
At the conference, the University of NSW's School of Public Health also revealed preliminary data from a study into 65-year-olds presenting to aged care services. The data revealed one-fifth had alcohol or substance use problems.
Not only is it a case of dealing with the known - alcohol and prescription drugs including benzodiaszepines - there is the murky issue of illicit drugs.
In the case of people who inject or who are on methadone programs, we are seeing an increase in their median age in line with the broader ageing of the population.
This issue was identified in the December bulletin of the Illicit Drug Reporting System, from the University of NSW.
It cited a recent US study that estimated that substance abuse disorders among adults 50 or older would double as the Boomers age. This was likely to be mirrored in countries around the world. And Boomers have a much higher rate of illicit drug use compared to previous generations.
"Aged care and geriatric medicine may be about to confront treatment challenges not see on this scale before," the bulletin warns.
Lucy Burns, the bulletin's co-author, says that while we are attuned to the increase in the health needs of Boomers, there had not been enough thought given to what it means for sub-groups such as people who inject drugs.
For example, people who inject drugs age earlier. "The chronic diseases you might anticipate in the general population that might occur in the 50s will actually start to occur in the 40s in people who inject drugs," he says. "So I don't think we do have that in our scope just at the moment."
She agrees that the issue of substance abuse by older people has been hidden. "I think over the past decade, we've seen a big focus and emphasis on the need to prevent drug use in young people. And that's fantastic," she says.
"But at the same time we've neglected this particular area, so it's creeping up on us. Because sometimes, to be honest, we devalue older people in society. Their health needs aren't a major priority. So all of a sudden, our services may well be swamped with these people who we've unfortunately neglected."
An insight into the world of the ageing injecting drug user came in a 2010 discussion paper by the Australian Injecting and Illicit Drug Users League. Stressing that it was difficult to accurately estimate numbers, the paper said there may be as many 30,000 regular opioid users in Australian aged 40 and over, and up to 80,000 infrequent or non-dependent users.
Users interviewed for the survey reported a greater degree of discrimination than younger people who injected drugs. "It would seem that older injecting drug users are considered beyond help and redemption due to their advanced age," the paper said. "As a result, they are judged more harshly than their younger counterparts who, according to popular thinking, may yet 'see the light' and move away from illicit drug use."
One of the key issues emerging is the need for age-appropriate treatment, so that a 65-year-old doesn't find him- or herself next to an 18-year-old. In the US, the Hanley Centre in Florida was among the first to offer age-specific treatments. It has a Centre for Boomer Recovery and a Centre for Older Adult Recovery, as well as gender specific treatment.
Simon Ruth visited Hanley, which uses the 12-step AA approach, on his fellowship. He says the centre is "phenomenal", offering a combination of residential and day treatment.
The different centres for Boomers and older adults point to the fact that different approaches are needed. Boomers, says Ruth, are used to asking for help.
"But the pre-Baby Boomers aren't a group that tend to ask for help," he says. "Having drug and alcohol issues later in life is something that a lot of people are very embarrassed about.
"We also don't educate them well enough. We all know what a young person's alcohol issue looks like. We actually don't know what an older adults alcohol issue looks like. We don't run those public campaigns that raise awareness.
"For a retiree who has a drink with lunch and a drink in the afternoon and a couple of drinks with dinner and a night cap, their alcohol is probably double what they were drinking 15 years ago. That's actually going to have a huge impact on their life.
"Throw in three or four medications that they may be on, and suddenly you've got quite a mix there."
That reluctance to ask for help can be pervasive. Isabella recalls being brought up with a stoic approach.
"If you do have a problem, you think, oh well, 'I better get on with it. Nobody else is interested'." But as she knows now, "there are professional people so willing and able to help."
Identifying the problem in the first place can be its own challenge. Jess Frederiksen had hit 60 before he realised that his depression was linked to his drinking. "I've been living with depression most of my life, and I have been hiding in alcohol," he says.
Jess grew up in Denmark, where, he says, there is a drinking culture with "a drink for any event". His father worked in a liquor shop, and they were close to the owners. Alcohol was always available. At 12, he began drinking at home, with the occasional beer with the family in the evening. "Then it just escalated to a point where I just got myself blind again and again, never really realising why."
He came to Australia in 1983, and lived what on the surface what was a normal life. He married in 1985 and became a father of two children. (The marriage ended 15 years later.) He also had no problem holding down jobs and was at one point self-employed. "I was able to function, and never realised that I had a problem," he says.
Then came the program at Peninsula Health. He has his drinking under control, "not to the extent the doctors would like to see, but certainly to the extent that I'm happy with".
He has rekindled a love of music, and has formed a band covering classic rock called Vengeance. He's also co-facilitating a SMART Recovery group, where people with addictions try to help each other.
One of the main things he has learned is that there is always a reason why people drink or use drugs to excess. "If you don't deal with those problems, you are just likely to go on hiding in a bottle until the day you die. There's really a great need for the kind of help that I've had."
Directline 1800 888 236 is a 24-hour free alcohol and drug telephone counselling and referral service. Other services include Suicide Helpline Victoria on 1300 651 251 or Lifeline on 131 114, or visit beyondblue.org.au
GREYING AUSTRALIA AND SUBSTANCE ABUSE
University of Melbourne survey of 421 over 60s finds:
■ One-fifth drinking at hazardous levels.
■7 per cent of older men binge weekly.
■Those most at risk are drinking to cope with life stresses.
University of NSW study of 240 over 65s finds:
■One in five presenting to age-care services have alcohol or other substance-abuse problems.
■Strong link between harmful drinking and depression and loneliness.