Recently, a study in the Journal of the American Geriatrics Society reported that 9 percent of community-dwelling Medicare recipients consumed excessive amounts of alcohol, which has the potential to adversely affect their health.

By all accounts, the number of older adults battling substance abuse will rise dramatically in the next 20 years. The Substance Abuse and Mental Health Services Administration indicates that the number of older people requiring help for addiction will increase from 1.1 million today to 4.4 million in 2020, which would totally overwhelm current resources available to deal with addictions.

Alcohol is not the only source of substance abuse in older people. A recent article in The New York Times quoted evidence indicating that 11 percent of those over the age of 55 are addicted to opiates, 5 percent to cocaine and 8 percent to other drugs. Even at age 75, 9 percent are addicted to opiates, 4 percent to cocaine and 11 percent to other drugs.

In general, alcohol abuse is more common in men than women and is more likely to occur in whites, in individuals with a higher income and in people who are divorced, separated or single. Alcoholics are more likely to smoke and are frequently depressed.

After age 60, the ability to tolerate alcohol and other drugs decreases significantly and can greatly affect overall health and quality of life. Two or more drinks can lead to significant personality changes, abusive behavior and amnesia.

In addition, alcohol and every other addictive drug interfere with gait and balance, which can lead to life-threatening falls and fractures. Alcohol is particularly damaging to the brain, and in susceptible individuals, small amounts of alcohol can lead to severe memory loss.

The health problems and complications of excessive alcohol intake are not an indictment on alcohol altogether. Remember, it is generally accepted that one or two glasses of wine and even a cocktail may actually be associated with quantifiable health benefits. However, once an adult crosses the line and takes one drink too many, the tide quickly shifts.

In the geriatric clinic, we see patients who consume substantial amounts of alcohol each day.

For those who experience personality changes, significant amnesia after drinking or who have obvious memory loss, we strongly urge them to become complete teetotalers — ending alcohol intake altogether.

These patients often ask, "Can't I have just one or two drinks?" Here, the answer is an absolute and emphatic no. If you have a problem that may be aggravated by alcohol, even the smallest amount must be avoided. Furthermore, for this type of patient, sticking to just one or two drinks daily is almost always impossible.

Beyond alcohol addiction, dependence on painkillers and tranquilizers is a particularly difficult problem for many adults. When dealing with anxiety or severe depression, overprescribed tranquilizers such as Xanax and Ativan are highly addictive and lead to depression, confusion and memory loss. On occasion, discontinuing these drugs could require therapy in an inpatient center.

Many older adults have illnesses that cause significant pain and find narcotic therapy very beneficial. When treating pain, the use of narcotics such as morphine or OxyContin rarely is associated with addiction. However, it can be difficult for a physician to distinguish between drug-seeking behavior and the need for more pain therapy. If there is any concern regarding pain management and narcotics, a pain specialist should be consulted.

Fortunately, for patients over the age of 65, Medicare covers certain psychiatric units to treat addictions that affect patients' personality and behavior. This has significant disadvantages, as mingling older addicts with younger patients does not work well. Older addicts are more prone to outbursts of anger, are more stubborn and require different therapeutic approaches compared to younger people.

As the baby boomers grow older, substance abuse will become more and more prevalent. For the current generation of older adults, the tide of substance abuse tends to center around alcohol; however, the baby boomers are likely to have more problems with illegal drugs such as crack cocaine and heroin.

As with any other medical problem, you must deal with addictions early. No matter your age, if you have a problem with substance abuse, seek help now before it is too late.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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