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Schoenbaum: Shedding light on a new wave of drug addiction among the elderly

Pharmaceutical recreation was a trendy avocation during my formative years in the early ’70s, and I was enough of a conformist back then to indulge in various mind-altering substances. The effects were not always sublime. I recall sharing a joint with a friend of mine while riding a ski lift to the top of a very steep mountain in California, paying no attention to the fact that (1) I hadn’t been on a pair of skis for at least 10 years and (2) I had never been on a pair of skis on a real mountain. The subsequent descent was remarkable only for the fact that I did not collide with any stationary objects.

I could list several other ill-conceived, drug-induced adventures during that mercifully brief chapter of my life, but you get the point. It was, for me, the “adolescent” indulgence of a mostly oblivious twentysomething — an excursion common to most of my peers at the time. That most of us managed to survive those days I can only chalk up to dumb luck.

That’s why I’m so dumbstruck when I run into old pals from back in the day who are still imbibing on a semi-regular basis. I want to say, “Hello?? You are pushing 70 and still acting like a 20-year-old hippie???” But I don’t, of course, because I believe everyone, including myself, has the right to occasionally act like an idiot, as long as they don’t hurt anybody.

Besides, the allure of pharmaceuticals is not peculiar to the young (or to geezers who still think they’re young). We’re immersed in a (legal) drug culture that makes our silly foray into hallucinogens in the ’70s seem trivial by comparison. Seven out of 10 Americans take at least one prescription drug each day, and some of those drugs can be as hard to kick — and as harmful — as some of the stuff I was smart enough to avoid back in the day.

The Rise in Benzodiazepine Prescriptions

The New York Times ran a piece last week describing the rising concern over benzodiazepine use among older folks. Prescribed for anxiety and insomnia, this category of drugs (sold under the brand names Valium, Xanax, Ativan, and Klonopin) has become extremely popular among the 65-to-85 set; about 10 percent of geezers in this age group use them regularly — “an extraordinarily high rate of use for any class of medications,” Michael Schoenbaum, a senior advisor at the National Institutes of Mental Health told the Times.

This despite years of studies showing that benzodiazepine users are more likely to suffer from reduced cognition, falls and the resulting fractures. As D.P. Devanand, MD, director of geriatric psychiatry at Columbia University Medical Center, puts it, “Even after one or two doses, you have impaired cognitive performance on memory and other neuropsychological tests, compared to a placebo.”

But a large number of geezers don’t seem to care about the risks. Schoenbaum and his colleagues found that benzodiazepine use actually rises as folks get older. And it’s often pretty tough to get them to lay off the pills.

Just one example from the Times piece:

Consider a pilot study that Dr. Gregory Simon, a psychiatrist and senior investigator at the Group Health Cooperative in Seattle, and his colleagues decided to undertake nearly 20 years ago.

They planned a program to help people discontinue chronic benzodiazepine use and sent letters announcing it to 50 older patients. “Half the people called and said, ‘Don’t contact me. I don’t want to talk about stopping,’” Dr. Simon recalled. Only five people agreed to discuss the pilot; two actually showed up. The study never took place.

Years ago, long after I’d taken my last toke from a crumpled joint, I edited a profile of a guy who studied the history and culture of ecstatic experiences around the world. It was a fascinating glimpse into what he believed was an innate psychological drive common to all humans — as innocent as a 5-year-old spinning around for the joy of feeling dizzy and as serious as a ragged junkie shooting up in an abandoned warehouse. It’s probably what compels my old hippie pals to fire one up every so often.

But it seems to me that this benzodiazepine trip is a little more complicated. Maybe you get to a certain age and all you want from your doctor is a pill that will make you feel better or different or . . . something. Even if it doesn’t actually work the wonders you expect it to, it’s easier than talking with a shrink about what’s really keeping you awake at night or anxious all day.

The real addiction problem, it seems to me, isn’t the pull toward some feel-good pharmaceutical; it’s our habit — especially as we get up there in years — of always looking to our doctor to make everything better. I know life can feel like a slippery slope sometimes, but most of us have the ability to steer clear of obstacles and even apply the brakes when we need to.

Thoughts to share?

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