Press Releases: 1992-2000

Thursday, June 4,1998

Former First Lady Betty Ford joined former Secretary of Health, Education, and Welfare and CASA president, Joseph A. Califano, Jr., on Capitol Hill today, to release the first comprehensive report addressing the impact of substance abuse on women over 59, Under The Rug: Substance Abuse and The Mature Woman.

The 180-page report, developed over two years by The National Center on Addiction and Substance Abuse at Columbia University (CASA), finds that substance abuse and addiction to cigarettes, alcohol and psychoactive prescription drugs is at epidemic levels for American women 60 and over, robbing them of their health, independence and life. This hidden tragedy triggers $30 billion a year in hospital, nursing home, physician and home health care costs and such costs will top $100 billion annually in 20 years as baby boomers mature.

"Abuse and addiction to alcohol and psychoactive drugs and tobacco by women 60 and older is an inexcusable area of neglect," said Califano. "There are 25.6 million women in this age group. For a large percentage of them, we have written off the last quarter of their lives, years that should be rewarding and fulfilling. Instead we compromise the quality of those years or we condemn these women to early death or disability. We leave millions of grandchildren without grandmothers and children without mothers. We saddle others with the avoidable burden of caring for an ailing parent. What's inexcusable is that these tragedies are readily preventable."

As part of the study, CASA conducted a unique survey of primary care physicians with a significant number of patients who are women over 59. When presented with the classic symptoms of alcohol abuse in a mature woman, only 1% of primary care physicians considered a substance abuse diagnosis. Instead, more than 80% of physicians considered the diagnosis of depression, which might lead to prescriptions for sedating psychoactive drugs, a potentially deadly mix with alcohol.

The CASA report, the result of two years of intensive research and analysis, a unique survey of primary care physicians and analysis of prescriptions of psychoactive drugs for mature women, was funded by the Bristol-Myers Squibb Foundation. The study shows that women over 59 are susceptible to abuse and addiction of alcohol and psychactive prescription drugs because they get addicted faster and when using smaller amounts, than any other group. Other findings include:

• 1.8 older women abuse or are addicted to alcohol; 2.8 million abuse or are addicted to psychoactive prescription drugs and 4.4 million smoke cigarettes.
• Of 1.8 million mature women who need treatment for alcohol abuse and addiction, less than 1% (0.6% or 11,000) are getting it.
• Even when physicians refer mature adult patients to substance abuse counseling or treatment, one-fifth say their referrals were denied--a managed care organization or insurance company would not cover the costs.
• Women with incomes of at least $40,000 are almost three times likelier to drink heavily than are mature women with incomes below $40,000 (22.8% vs. 8.2%).

The cost of treating the health consequences of mature women with underlying substance abuse problems is staggering. CASA's analysis reveals that in 1998 substance abuse and addiction among mature women will trigger at least $10.1 billion in inpatient hospital bills, $12.2 billion in nursing home bills and $7.7 billion for physician services and home health care, a total of $30 billion.

The hidden nature of the epidemic of substance abuse among mature women is reflected in the imbalance between the money spent to treat substance abuse problems directly and the amount spent to treat the consequences of substance abuse.

Of hospital costs:

• Only 2% ($205 million) go to treat substance abuse.
• 98% ($9.8 billion) go to treat its consequences--lung cancer, cirrhosis, hip fractures, pancreatic cancer, stroke, heart disease and the like.

"The substance abuse and addiction of mature women is hidden in the shame, embarrassment and denial of those who struggle with it. It is swept under the rug of denial and desperation of families and friends who can't accept the reality of a mother or aunt or sister who may be abusing alcohol or addicted to it or who simply don't know what to do about it," said First Lady Betty Ford. "It is hidden in the diseases and injuries it spawns--cancer, heart attacks, diabetes, strokes, kidney failure, hip fractures--which we are great at identifying and treating while ignoring the underlying substance abuse and addiction that causes them."

CASA's analysis shows that treatment of substance abuse is far less costly than substance abuse treatment of its consequences. While the average cost of treatment is $1,800, the average hospital stay to treat the consequences of substance abuse is $15,700. If only 12% of substance abuse treatment works well enough to prevent a single hospital stay, then the treatment pays for itself.

The physician survey, conducted for CASA by Louis Harris & Associates, sought to probe physicians' understanding of substance abuse among mature women, whether physicians screen for the problem and if not, why not. The 400 physicians in the survey were a nationally representative sample of the 250,000 physicians nationwide who provide primary health care to some 19.7 million mature female patients, 78% of all mature women. The survey had a margin of error of +/- 3 - 5%. The CASA physician survey revealed:

• Physicians do not take into account the facts that tolerance for alcohol falls with age and that women have a lower tolerance for alcohol than do men.
• The average number of drinks per day physicians said would constitute problem drinking were virtually equal for all patients whether male or female, whether age 40, 60 or 60 plus-about 2.4 drinks. The National Institute on Alcohol Abuse and Addiction (NIAAA) recommends a limit of 1 drink per day for mature women.
• While nearly all physicians (96%) reported receiving some training in substance abuse, most physicians (67%) say their training took no more than one day.
• The greatest barriers to proper diagnosis cited by physicians were physician lack of time, patient denial, physician lack of knowledge and patient and physician discomfort discussing the problem.
• Only 62% of physicians believe that substance abuse treatment is effective for mature women.
• 37% of physicians agreed with the statement, "Many physicians fail to address problem drinking among mature patients because they believe drinking is one of the last few pleasures left for the elderly."
• Physicians agree overwhelmingly that problem drinking among older women is a significant health problem (91% female physicians; 79% male physicians).

The CASA report reveals the devastating impact of alcohol abuse and smoking on mature women:

• Women over 65 who commit suicide are 9 times likelier to consume at least three drinks a day than those dying of natural causes.
• Mature women who drink are more likely than men to develop liver cirrhosis, to develop it sooner and from drinking less alcohol.
• Between the ages of 65 and 74, women who smoke are more than twice as likely to die as women who don't smoke.
• More mature women die of lung cancer than breast cancer.
• Women who smoke cigarettes are likelier to get macular degeneration and osteoporosis than women who don't smoke.

Women age 60 and over are most susceptible to abuse and addiction of psychoactive prescription drugs because they are most likely to use such medications, use them for long periods of time, use them in combination with alcohol, which may facilitate dependence, and be physically vulnerable to their effects. Key findings regarding psycho-active prescription drugs and mature women include:

• Half (51.3%) of mature women who are taking benzodiazepines may have inappropriate prescriptions--22.4% are taking long-acting ones and 28.9% have taken short-acting benzodiazapines for more than four months.
• One in four mature women (6.4 million) are using at least one psychoactive prescription drug.
• Women who visit a physician are 37% likelier to receive a prescription for a tranquilizer, and 33% likelier to get a prescription for an anti-depressant than men who visit a physician.
• Use of anti-anxiety drugs, sedatives and sedating anti-depressants doubles the risk of falls and fractures among the elderly and use of sedating anti-depressants more than doubles a mature adult's chance of having a car crash; use of certain benzodiazepines increases the risk by 50%.

According to the physicians CASA surveyed:

• Women over 59 take an average of five prescriptions at the same time.
• Prescription medications that cause the greatest problems for mature women are psychoactive drugs taken for anxiety or depression (half of physicians specifically named the benzodiazepines) and analgesics, non-steroid anti-inflammatory medicines and narcotics.
• Medications that may cause trouble when combined with alcohol are prescription anti-anxiety or anti-depression medications, over the counter pain medications, prescription pain medications and over the counter sleep medications.

"What's most troubling is how preventable this situation is," said Califano. "Properly prescribed and used, psychoactive drugs are remarkably safe and effective in treating depression, anxiety and sleeping disorders and have improved women's lives immeasurably. Inappropriate prescribing and use undermine the great benefits these drugs can bring to mature women. It's essential to eliminate the inappropriate prescribing and misuse of these pharmaceuticals so women can get the maximum benefit from them," he said.

The CASA report offers recommendations to improve prevention, detection and treatment of substance abuse by mature women. Quitting smoking at or after age 60 can reduce the smoking-related risk of getting cancer and cut the risk of heart disease--a greater killer of women than men--in a year by 50%; within three years the risk disappears. Mature smokers can cut the risk of having a stroke by quitting and thus increase their years of independent living.

The report suggests that by counseling patients for as little as five minutes, a physician can help prevent the development of substance abuse by patients who appear at risk of the problem. Brief physician counseling also increases the odds that a woman will quit smoking and seek appropriate treatment for an alcohol or drug problem. Unfortunately most physicians miss these opportunities to intervene.

The report recommends that medical schools and continuing education provide physician training in knowledge, skills and attitudes about substance abuse. Insurance companies and managed care providers should pay physicians to talk to their patients and cover substance abuse treatment.

The National Center on Addiction and Substance Abuse at Columbia University is the only national organization that brings together under one roof all the professional disciplines needed to study and combat all types of substance abuse as they affect all aspects of society. CASA's missions are to: inform Americans of the economic and social costs of substance abuse and its impact on their lives; assess what works in prevention, treatment and law enforcement; encourage every individual and institution to take responsibility to combat substance abuse and addiction; provide those on the front lines with tools they need to succeed; and remove the stigma of substance abuse and replace shame and despair with hope.