By John Dyben and Juan Harris

A nearly 66-year-old CEO complaining of abdominal pain, vomiting, nausea and excessive sweating showed up at a trauma center, where doctors could find only slight dehydration. They sent him home with a diagnosis of viral syndrome.

His next admission was to the Hanley Center, a drug rehabilitation facility in West Palm Beach, Florida. Doctors there diagnosed a dependency on heroin, which he took through his nose. The ER doctors didn’t think to test for this, because they couldn’t imagine a 66-year-old executive doing illicit drugs.

Welcome to the latest adventure of the Baby Boom.

It’s been a long, strange trip for another Boomer, Gus, age 63, who got high for the first time when he was 18. After that, he was up for anything and everything, for years. Gus enjoyed the feeling of being on the forefront in college, from anti-war to civil rights demonstrations, and dope made it all larger than life. It was a “happening time.” When he joined the real world and took a job in retail, he fueled it with weed, cocaine and beer.

He was a “combination man:” beer with marijuana, LSD or cocaine, with cocaine becoming a favorite. Cocaine fueled his high-energy state. Quaaludes (methoqualone, a sedative hypnotic drug) were popular prescriptions in the late 70s, and Gus took those, too. He was successful in his job, and his life was a non-stop party scene. Then the scene became a party of one.

“Once in the early 80s I realized I was the only one left at a retail trade reception,” Gus said. Something had to give. He tried to stay clean but became tempted by a big expense account and cocaine. He finally gave up cocaine again, but still used weed and drank.

After he married and had a son in the mid 80s, Gus was never high around the child, until the boy turned 16, and Gus felt unneeded. Cocaine beckoned again, and this time Gus took up the invitation. Through a divorce and a regular polypharmacy routine, Gus thought he was fooling everyone. With an online supply of Oxycodone he was popping five or more pills a day.

“I finally felt I was losing my dignity. I could no longer trust myself to be me,” Gus says.   His recovery took him through two different residential treatment stays before he found stability. Today he volunteers and shares his story with those in treatment. He has rekindled a mutually satisfying relationship with his son.

A boomer drug boom
These aren’t isolated stories. Half of all Boomers have tried illicit drugs at some time in their lives. That could be experimentation, but 2009 statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA) show that 4.3 million adults age 50 and older had used an illicit drug in the prior year, and some 4 million of those nearing retirement age suffer from substance abuse. Drug use between ages 50 and 59 is nearly double that of previous generations, SAMHSA says. A study by Duke University found that a significant percentage of middle-aged adults are binge drinking.

The Boomers are at it again. Because of its sheer numbers – 77 million people born between 1946 and 1964 – the Baby Boom has played havoc with everything it touched – swelling the number of elementary schools, then high schools and colleges, pouring into the job market with multiple degrees, then getting married and creating its own baby boomlet.

Now the kids who declared, “Don’t trust anyone over 30” are starting to retire — every day more than 10,000 Baby Boomers will reach the age of 65, and that will continue every single day for the next 19 years. Another way to look at it: every seven seconds another Boomer turns 50.

And they’re bringing their “little helpers” along for the ride: SAMHSA predicts that at the number of Boomers with substance abuse problems will double from 2.5 million in 1999 to 5 million in 2020, and the need for treatment will also double.

The (Old) Age of Aquarius
Anyone who grew up in the 60s and 70s was touched by pervasive psychedelic cultural icons of the era, such as Timothy Leary’s mantra to “Turn on, Tune in, Drop out.” There was rebellion against all authority. These attitudes linger decades later, even among those who don’t consider themselves anti-authoritarian, and they make treatment for substance abuse difficult.

In one group session at Hanley a lady was talking about growing up in a generation that stuck it to the man, stuck it to the government. She said, “I didn’t grow up like that in the 60s. I was brought up in very conservative home. I was taught not to challenge authority, but rather to obey. In fact, my nickname in high school was ‘Establishment.’” As everyone in the group laughed, she said, “Oh my god. I’m realizing that I do have that mentality. It affected me. I always saw myself as apart, isolated, away from, because I was different from everyone else. Part of me will do what I’m told to do, but I resent it.”

The sex, drugs and rock and roll culture they grew up in affects them to this day. The national culture imprints you. The reality is that the Baby Boom is the only generation to grow up with a cultural question mark around drug use. People before had a very specific view: substance abuse is morally wrong and there was a lot of shame associated with it. Younger generations, Gen X, the 30 and 40 somethings, grew up with anti-drug campaigns from the time they were little kids. ‘Just say no.’ It doesn’t mean those things worked, but it means they grew up with a cultural concept of substance abuse being a problem.

But the Boomers had imprinted on them from their formative years the concept that maybe drugs are not so bad. They come into rehab having heard people tell them they have a problem, but they have a deeply ingrained denial system — the idea that what people say isn’t true, and they just can’t believe there’s a problem.

Don’t trust anyone
The Boomers’ reaction to authority means a recovery plan has to be very different.

A 75-year-old will come into one of our offices, look at the degrees on the wall, and say, “Aha, this person is an expert. I’m going to wait for this person to tell me what to do.” They expect to be given a lot of direction and instruction up front. And if they don’t get it they don’t think they’re getting their money’s worth.

With a Boomer, on the other hand, you greet them with a blank treatment plan. They might see diplomas, but they couldn’t care less. Boomers are not impressed with your credentials. They grew up in a self-help generation in which there’s a guru on every corner. There’s an expert on every channel and every webpage. If you try to take a position of authority — I’m an expert and therefore you should listen to me — the Boomer is going to say there are ten other experts better qualified than you. So you bring a Boomer in and say, “What do you want? How can I join with you?” You become a paraclete, one who walks alongside.

Boomers know how to use Google. They mistrust “what the man says.” For example, one of us was working with an alcoholic who could not stop smoking pot. He was convinced that pot was just fine. He would hear arguments like, “Pot destroys your brain cells.” This is not true, and it’s easy enough to do research and find out it’s not true. People would try to use these stories to tell him why he should stop smoking pot. But for every story of someone being destroyed by pot, he had 10 other stories of people smoking and doing fine. The trouble is, once he started smoking he’d start drinking, and he couldn’t stop.

We sat with him at length, going over the evidence about pot and brain cells and other scientific findings, admitting to the man that he was often right, acknowledging that not everything he’d been told was true. Boomers don’t trust “experts” and don’t give credence to old wives’ tales, but they will pay attention to facts.

Scanning the brain
One way we get their attention is with a SPECT scan of their brains. It shows blood flow, and it’s quite easy to see when the blood flow in areas of the brain having to do with addiction and depression isn’t normal. No need for half-true horror stories.

With older adults a very effective tool is using people’s stories of addiction and recovery from substance abuse to point them to a direction of health. With the Baby Boom it’s not as effective. It’s not completely ineffective, but rather than being moved by stories Boomers require a more solid, a very tech savvy, scientific base of information. Of course, hearing other people’s stories is a hallmark of 12-step programs.

Another Boomer problem: the peculiarities of their experience have to be talked about openly. Talking about how that culture impacts you, what it’s like coming into treatment, and having a sponsor and listening to those who have gone before you. When Boomers talk about that in treatment it’s easier for them to engage in Alcoholics Anonymous later. This is part of my mindset, they acknowledge: I’m going ahead with it. Those who don’t talk about it, who say I have a problem listening to other people, I’m a self made person, I’m going to do my own thing, they will go to one or two AA meetings, not say a word and then won’t go back.”

Aging bodies
Although they plan on remaining youthful forever, the realities of aging exacerbate the effects of substance abuse. Boomers will not be cheered by this list of physiological changes experienced by those who don’t suffer from addiction:
•    Changes in gastrointestinal tract function;
•    Total body water percentage for men declines from 60% to 54%;
•    Total body water percentage for women declines from 54% to 46%;
•    Muscle mass decreases by 30% for men and women;
•    Taste bud sensitivity decreases by 70% for men and women;
•    Cardiac reserve decreases from 4.6 to 4.4 times resting cardiac output;
•    Maximum heart rate decreases from 195 to 155 beats per minute;
•    Lung vital capacity decreases by 17%;
•    Renal perfusion (blood flow to the kidneys) reduces by 50%;
•    Cerebral blood flow reduces by 20%;
•    Bone mineral content reduces by 25 to 30% in women and 10 to 15% in men;
•    Brain weight reduces by 7%; and
•    Amount of light reaching the retina diminishes by 70%.

Now add these effects from alcohol and drug dependency:
•    Less volume distribution/decreased renal clearance;
•    Cognitive impairment;
•    Stroke;
•    Cancer;
•    Atrial fibrillation/flutter;
•    Insomnia and problems with restorative (REM) sleep;
•    Disease interactions; and
•    Psychiatric disorders.

Chronic pain plagues many Boomers. In one study people now aged 55-60 reported having more pain, chronic health problems, drinking and psychiatric problems than those surveyed earlier at the same age. In a comparison of cohorts born in the 20th century, substance dependence was highest for those born between 1953 and 1964.

What all this means is that having a drink does different things to a Boomer’s body than to a younger person.

“It’s more complicated when you’re in your 50s or your 60s because your metabolism isn’t as fast, not like when you were 20,” Peter Delany, director with the Office of Applied Studies at the Substance Abuse and Mental Health Services Administration, said in an interview on NPR. “At the same time, people who are in their 50s and 60s tend to have other things going on with their bodies, hypertension, they may have another chronic illness. And with the drug use happening at the same time, the drug use can exacerbate any other conditions. If that condition comes on, it tends to sometimes mask it.”

Drugs make the bad things of aging even worse, Delaney says. “Any drug may take a little bit longer to metabolize out of your system. So if there’s significant cognitive impairment, it may take longer for that to improve. So you’re at higher risk for other complications. You might fall. You might have bad judgment. A number of things happen. So it’s a risk factor for other things happening to you.”

Not to mention driving a car.

Muscle has more water content than fat, and as a person ages, the body has more fat, so it has less water content to dilute, say, alcohol. A person could be honest in saying they were having just one drink a night, but that one drink is really knocking them on their butt. We call this “reverse tolerance. A little goes a lot further as they age, which increases the potential for addiction. This applies to medicine, as well. A dosage can be therapeutic in a younger person but almost toxic for a leading edge boomer.

But something more than physical is happening to this generation. They feel their power fading, their control over their lives diminishing, their sense of purpose withering. Dr. Barbara Krantz, Hanley’s CEO, reports a significant increase in dual diagnoses (drug abuse plus a mental problem) in the 50 to 65 year old group — anxiety, depression, and bipolar conditions. Perhaps as many as 80 percent of Boomers have a dual diagnosis.

“Are bipolar disorders on the rise in this age group as a result of better diagnosis or because of poly-drug and illicit drug use?” she writes. “We can’t be sure, but with better diagnosis we can more effectively treat the individual holistically.”

Better living through chemistry
When Boomers knock on Hanley’s door they are quite experienced with meds. Alcohol is still the drug of choice, often in combination with drugs. The most popular psychotropic, addictive prescription drugs for Boomers are benzodiazepines, commonly prescribed for anxiety and sleep disorders. Opioids such as OxyContin are often prescribed for pain relief. Boomers in treatment have taken an average of 4.5 prescription meds and 3.5 over-the-counter medications.

Entrenched patterns of substance abuse seem to be a more prevalent trend than that of late onset addiction. Boomer patients often started drinking and and/or using illegal drugs when they were in college or in the service. They really never stopped. The drugs have often changed from illegal substances to prescription pain pills and other prescribed psychotropic drugs.

Very often what happens is people abusing alcohol start experiencing falls or start forgetting things. Alcohol keeps them from getting a good night’s sleep. So they ask their doctors for drugs like Ambien, Valium and Xanax to help them sleep better. When you mix these meds with alcohol, one plus one can equal five. That’s when you get the falls and the forgetfulness.

To the physical and mental challenges, we must add what we might call the spiritual. Boomers are suddenly realizing for the first time that they’ve lived more years than they’ve got left. They’ve got two minutes left in the third quarter and the fourth is looking kind of short. They’re facing mortality. What’s my legacy? At this point they get pretty serious about this recovery business.

There is hope
Consider the story of Ellen, whose cocktail driven life as a high level Wall Street executive was fraught with denial, even when she checked into a treatment center that she understood offered a “cure.” After an almost immediate relapse, several more different treatment stays and a descent into secretive drinking, Ellen is now in successful recovery and knows there is no quick fix.

What made the difference this time for Ellen? She describes a personal, spiritual rekindling in treatment.

“They tapped into my heart and soul,” she said. “I found a spiritual path and began to pray consciously.” She connected with peers who she could communicate with, found a trusted sponsor and a Twelve Step support group. Her 38-year marriage has survived.

In recovery, Ellen has learned how to separate her emotions from alcohol use. “I realized I was using alcohol initially to take the edge off the adrenaline rush and later on to blunt my anxiety,” she said. “I drank and drank alone to relieve the unease of my emotions and a terrible sense of loneliness and isolation. Now I can place my anxieties outside of myself and give my worst fears to God. The Third Step really helped me. I feel I’ve awakened from a long nightmare. The curtain has lifted.”

John Dyben, a mental health and addiction counselor, program supervisor and chaplain, is Clinical Director of Hanley Center. He is responsible for supervising all residential and outpatient treatment as well as Spiritual Care and Wellness programs. Juan Harris, a certified addictions counselor, is Program Director of the Center for Older Adult Recovery.