What do you do if your aging mother seems to be spending much more time home alone than at her book group or golfing with friends as usual? Her house has slid into a dusty, clustered state and there’s more wine than food around. Could she be addicted to booze or painkillers? How do you bring up this thorny subject without her shutting you out? It’s not an easy prospect, but an important one, says a British doctor who specializes in treating older people and looking for hints of substance use disorder. Tony Rao, MD, makes house calls solely to patients over 65 years old. He makes good use of his visits, checking far more than just vital signs. He trains his senses to listen, smell and look for substance abuse, a growing problem with the onset of the aging of baby boomers. But his suggestions work for talking with a loved one of any age whom you may worry has a drinking or drug problem.
What to Say and How
“The approach from a loved one requires a non-judgmental approach,” says Dr. Rao, one of the editors and writers of a recent book called Substance Abuse and Older People. Rao is also a consultant psychiatrist at South London and Maudsley National Health Services Trust in the U.K. He says approaching loved ones about potential substance abuse could be framed with caring questions such as:
- “Mom, I noticed that you don’t get out so much these days and don’t wear makeup anymore. Is everything OK?”
- “Dad, you don’t seem to have as much money to spend on food as you used to. Is there anything wrong?”
“These questions can be followed up by asking about specific risks such as bereavement, loneliness, pain or feeling blue,” Rao says. “By getting older people to link changes in their substance misuse with changes in their everyday lives, this could address substance misuse.” And Rao says interventions for older people are trickier. Why? “Because there is often resistance through denial and also rationalization that comes from loved ones in the form of attitudes such as, ‘It’s all I have left in life,’” he says. “There may also be the usual smokescreen of other problems, such as depression or physical illness, that masks substance misuse in older people.”