There is a relatively new group to be treated for addiction and alcoholism that is growing very quickly, and which is causing some in the field great concern: It is the retiring "baby-boomer" population.
There are several reasons that the "boomer" generation may potentially be home to many more addicts and alcoholics than the rest of the population. Some of these reasons are that the boomers were (1) the first generation to engage in wide-spread recreational use of a variety of addictive drugs (including cocaine, marijuana, and methamphetamines); (2) the first generation for which a wide variety of prescription medications and painkillers were readily available; and (3) the last generation for which treatment and recovery were not culturally acceptable. For these and other reasons, some are calling it, " America's hidden epidemic". [1]
According to some studies, it is expected that, by 2020, the number of seniors with alcohol and other drug problems will leap 150 percent to 4.4 million older people - up from only 1.7 million in 2001. [2]
Deborah Trunzo, research coordinator for the SAMHSA (Substance Abuse and Mental Health Services Administration), has said that, by 2020, the number of older people who will have drug problems, and be seeking treatment, will be "likely to swamp the system".
It is the baby-boomer generation, or the "young old" - those born between 1946 and 1964 - that are at the heart of this possible epidemic. Unlike their predecessors, those in the baby-boom generation are more comfortable taking medications for a wide range of problems, including pain, insomnia, depression, and anxiety.
In addition, the baby boomers are the first generation to widely experiment with recreational drug use. Yet along with all of these "firsts", they are also the last group born before it became somewhat permissible to admit to addiction or alcoholism, or to seek help or treatment.
One of the big concerns is that the boomers are much more vulnerable to late-life manifestation of alcoholism, addiction, and drug abuse.
In addition, in more recent years, this group has been prescribed with far more painkillers, as well as newer "designer drugs" including potentially addictive psychotropics.
A. Rush Limbaugh: The Poster-Child for Late-Onset Addiction
For example, in October 2003, at the age of 55, well-known political talk-show host, Rush Limbaugh, was charged with prescription drug fraud, and admitted to being addicted to painkillers - primarily oxycodone. With Mr. Limbaugh's admission to his addiction, he became the poster child (or poster "senior") of the new type of patient showing up in treatment centers, and emergency rooms. [3]
This "late onset" substance abuse is often linked to other medical problems, and the emotional traumas that can accompany old age, which arise from isolation, injuries and accidents, the death of friends and family, and the natural aging and dysfunction of the body.
As the boomers move into retirement, and leave the work force, they may find it more difficult to maintain their drug supply of choice: On the one hand, those who obtain drugs through legal means will have less medical coverage and less money to spend on prescription drugs. On the other hand, those who rely upon illegal drugs will no longer have as much money to pay for those drugs after retirement, and many will lose "access" to those drugs from their professional vocation (think of the dentist, nurse, or paramedic, for example, who has easy access during work). Retirement may simply mean a loss of supply, the attendant consequences of withdrawal, and the need for medical treatment.
A new legion of addicts is coming, and they require a far different approach to treatment, as well as a much higher level of medical intervention and support.
B. The Need for Greater and More Specialized Treatment
In general, older adults have different needs than younger adults; and, when it comes to the treatment of addiction and alcoholism in older adults, these differences are magnified.
Typically, younger adults are more resilient, and have abused themselves for a shorter period of time, and therefore, have a much better chance of living in recovery. On the other hand, senior citizens are much more likely to drop into a long decline toward death following any significant medical event (such as detoxification).
The aged are a very vulnerable group, and are noted to have the highest rate of suicide and other complications in relation to alcoholism. [4] Older adults are also showing an increase in seeking treatment for methamphetamine use. These are just some examples of the differences and trends which make the boomers such a widely diverse group, with different histories and backgrounds, giving the group the need for a wider variety of treatment plans and responses. [5]
Also, boomers are more likely to have dual diagnosis, with untreated long-standing co-morbid mental health problems, such as ADHD, anxiety disorder, and other personality disorders, that were simply not recognized by the medical community back in the day when the boomers were younger.
Finally, the aging abused human body in retirement will require more medical attention, more care-giving, more nursing homes, more medications, and more money, on average, than one who has led a relatively healthy life.
Macroeconomics: Medicare and Social Security Programs
The greater monetary and social costs associated with older adult treatment, recovery, and medical support could be substantial. If we significantly under-estimate the number of baby-boomers that are or will be addicts and alcoholics in their retirement years, we may have greatly misjudged the overall costs to our healthcare systems.
The Social Security and Medicare Boards of Trustees just this week released the 2008 Annual Report on the Status of the Social Security and Medicare Programs. [6]
The Summary Report begins as follows:
"A MESSAGE TO THE PUBLIC:
Each year the Trustees of the Social Security and Medicare trust funds report on the current and projected financial status of the two programs. This message summarizes our 2008 Annual Reports.
"The financial condition of the Social Security and Medicare programs remains problematic. Projected long run program costs are not sustainable under current financing arrangements. Social Security's current annual surpluses of tax income over expenditures will begin to decline in 2011 and then turn into rapidly growing deficits as the baby boom generation retires. Medicare's financial status is even worse. This year Medicare's Hospital Insurance (HI) Trust Fund is expected to pay out more in hospital benefits and other expenditures than it receives in taxes and other dedicated revenues. The difference will be made up from general revenues which pay for interest credits to the Trust Fund. Growing annual deficits are projected to exhaust HI reserves in 2019 and Social Security reserves in 2041. In addition, the Medicare Supplementary Medical Insurance (SMI) Trust Fund that pays for physician services and the prescription drug benefit will continue to require general revenue financing and charges on beneficiaries that grow substantially faster than the economy and beneficiary incomes over time.
"The drawdown of Social Security and HI Trust Fund reserves and the general revenue transfers into SMI will result in mounting pressure on the Federal budget. In fact, pressure is already evident. For the second consecutive year, a "Medicare funding warning" is being triggered, signaling that non-dedicated sources of revenues-primarily general revenues-will soon account for more than 45 percent of Medicare's outlays. The President recently proposed remedial action pursuant to the warning in last year's report and, in accordance with Medicare statute, a Presidential proposal will be needed in response to the latest warning.
We are increasingly concerned about inaction on the financial challenges facing the Social Security and Medicare programs. The longer action is delayed, the greater will be the required adjustments, the larger the burden on future generations, and the more severe the detrimental economic impact on our nation."
The actuarial assumptions underlying the Annual Report are based upon the intermediate range of projected costs. As also stated in the Summary Report:
"How Are Estimates of the Trust Funds' Future Status Made? Short-range (10-year) and long-range (75-year) projections are reported for all funds. Estimates are based on current law and assumptions about factors that affect the income and outgo of each trust fund. Assumptions include economic growth, wage growth, inflation, unemployment, fertility, immigration, and mortality, as well as factors relating to disability incidence and the cost of hospital, medical, and prescription drug services. [Emphasis added.]
Because the future is inherently uncertain, three alternative sets of economic, demographic, and programmatic assumptions are used to show a range of possibilities. The intermediate assumptions (alternative II) reflect the Trustees' best estimate of future experience. The low-cost alternative I is more optimistic for trust fund financing, and the high-cost alternative III is more pessimistic; they show trust fund projections for more and less favorable conditions for trust fund financing than the best estimate. The assumptions are reexamined each year in light of recent experience and new information about future trends, and are revised as warranted. In general, greater confidence can be placed in the assumptions and estimates for earlier projection years than for later years. The statistics and analysis presented in this Summary are based on the intermediate assumptions." [Emphasis added.]
Therefore, it is possible that the current Reports significantly under-estimate the number of addicts and alcoholics in the boomer generation, the wide diversity of addiction types, and the overall health problems and medical needs of the boomers as they enter the Social Security and Medicare systems in the years ahead.
If so, the impact on the financial outlook of the systems could be catastrophic:
"What is the Long-Range (2008-2082) Outlook for Social Security and Medicare Costs? An instructive way to view the projected cost of Social Security and Medicare is to compare the financing required to pay all scheduled benefits for the two programs with the gross domestic product (GDP), the most frequently used measure of the total output of the U.S. economy. Costs for both programs rise steeply between 2010 and 2030 because the number of people receiving benefits will increase rapidly as the large baby-boom generation retires (Chart B). During those years, cost growth for Medicare is higher than for Social Security because of the rising cost of health services, increasing utilization rates, and anticipated increases in the complexity of services. [Emphasis added.]
The potential for amplified costs of treatment for a much larger population of addicts and alcoholics would rest upon the shoulders of an already absurdly large set of projected healthcare costs.
C. Conclusion
In conclusion, if the actual addiction and alcoholism rates of the retiring baby-boomers is significantly higher that our current estimate of those rates, then the overall medical and related costs to be borne by the Medicare and Social Security Programs could be substantially higher than our current predictions. This, in addition to the already high projected costs of healthcare for that group, could, in turn, impact all of us by way of the significant long-term financial impact on the United States Government.
As the Summary Report concludes:
"The combined difference grows each year, so that by 2017, net revenue flows from the general fund will total $449 billion (2.0 percent of GDP). The positive amounts that begin in 2017 for OASDI, and in 2008 for HI, initially represent payments the Treasury must make to the trust funds when assets are redeemed to help pay benefits in years prior to exhaustion of the funds. Note that neither the redemption of trust fund bonds, nor interest paid on those bonds, provides any new net income to the Treasury, which must finance redemptions and interest payments through some combination of increased taxation, reductions in other government spending, or additional borrowing from the public.
"Chart E shows that the difference between outgo and dedicated payroll tax and premium income will grow rapidly in the 2010-30 period as the baby-boom generation reaches retirement age. Beyond 2030, the difference continues to increase nearly as rapidly due primarily to health care costs that grow faster than GDP. After the trust fund exhaustion dates (2041 for OASDI, 2019 for HI), the increasing positive amounts for OASDI and HI depict the excess of scheduled benefits over projected program income. When the statutory SMI general fund revenue requirements are added in, the projected combined Social Security and Medicare deficits and statutory general fund revenues in 2082 equal 9.3 percent of GDP, indicating the magnitude of the potential effect on the Federal budget if general revenues were used to ensure payment of all scheduled program benefits. A similar burden today would require nearly 80 percent of all Federal income tax revenues, which amounted to 11.7 percent of GDP in 2007.
"To put these magnitudes into historical perspective, in 2007 the combined annual cost of HI, SMI, and OASDI amounted to 38 percent of total Federal revenues, or about 7 percent of GDP. That cost (as a percentage of GDP) is projected to double by 2060, and then to increase further to nearly 17 percent of GDP in 2082. It is noteworthy that over the past four decades, the average amount of total Federal revenue as a percentage of GDP has been 18 percent, and has not exceeded 21 percent in a given year. Assuming the continued need to fund a wide range of other government functions, the projected growth in Social Security and Medicare costs would require that the total Federal revenue share of GDP increase to wholly unprecedented levels."
While the financial outlook for the Programs is bleak, the failure to address a potentially larger problem of addiction and alcoholism in the next generation to retire could have amplified consequences for everyone.
References
(1) Jointogether.org; "Addiction Among Seniors Called 'Hidden Epidemic'; News Summary, July 21, 2003.
(2) The New York Times; "Addicts of A Certain Age: Baby Boomers Need Help." March 6, 2008.
(3) CNN.Com; "Limbaugh admits addiction to pain medication"; Oct. 10, 2003.
(4) National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert. Alcohol and Aging.
(5) Hughes, Mary Elizabeth; O'Rand, Angela; "The Lives and Times of the Baby Boomers", part of "The American People" series. http://www.aginghipsters.com/blog/archives/1/000346.php; 12/16/04.
(6) Actuarial Publications; "Status of the Social Security and Medicare Programs/Summary of the 2008 Annual Reports"; Social Security and Medicare Boards of Trustees; http://www.ssa.gov/OACT/TRSUM/trsummary.html
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