Scott Webb (Host): When we think about substance use and abuse in America, seniors might not seem like they're at risk, but my guest today is here to share that many seniors turn to alcohol and marijuana later in life, and many may not fully understand the associated risks.

And here to share his expertise and perspectives today is Dr. Derek Bast. He's a board-certified family medicine physician with a special interest in treatment of substance use disorders.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about seniors and substance abuse. And this is definitely, as I was telling you, a new topic for me. So, what are some of the common misconceptions about substance abuse among seniors?

Dr. Derek Bast: I think the most common misconception is that seniors don't suffer from substance abuse. I think that misconception is both people out in the community, whether you're thinking about your grandparents or your parents, and that just doesn't really come to mind as something that you're concerned about.

But I think it's even deeper than that. I think it's the medical community as well. I don't think that substance use disorders are something that we think about for our senior population. And I think that's definitely a problem that we need to address.

Host: Yeah. And we're addressing it today as I told you when we were talking kind of off the air. I'm hoping to learn a lot from you today. I have a couple of seniors in my life, as others probably do as well. And I guess it makes me wonder like, why do adults turn to substances like alcohol or marijuana later in life?

Dr. Derek Bast: I think there's a couple different reasons. I think one of the more common ones is that they're self-medicating something. A lot of times as people get older, they have difficulty sleeping, they have joint pain, things like that. And, you know, people turn to alcohol and marijuana being the two common ones that we'll probably talk about a lot today. They turn to those things as a way to self-medicate.

I think another reason is because they've used those substances in the past. We're seeing a lot of people from the quote unquote baby boomer population, which had the largest percentage of use of alcohol and marijuana. And now, we're seeing as they age, we're seeing that senior population turn back to substance use as they get older.

Host: Interesting. Yeah. And it makes me wonder, you know, I know, again, a number of seniors, my folks and their friends, and some of my dad's friends, you know, have sort of turned back to marijuana later in life in their 70s. And my feeling about that, Doctor, is like, well, listen, if you live to be a certain age and you're dealing with a series perhaps of illnesses or ailments or sleep disorders or whatever it might be, my feeling is sort of like, as long as it's legal, I guess, then, you know, do what you have to do. Do you think that folks share that sentiment that it's like, "You know what? If you live to be 75 or 80 or something like that, that you should be able to do what you want to do?" Is that right?

Dr. Derek Bast: I think a lot of people share that sentiment. I mean, to be completely honest in a way, I share that sentiment for some patients. I think the danger lies in the fact that marijuana isn't today what it was then. And I think some seniors struggle with, you know, understanding what they're actually using.

I work in a substance use disorder clinic. And so many times I'll have patients who thought they were just smoking marijuana, and it contains a lot of things they had no intention of using. And that's dangerous for a young, healthy population. And that's, you know, potentially even more dangerous for our aging seniors who have comorbid conditions that can be greatly affected by those things.

So, I do share that sentiment. You know, at some point if you have chronic joint pain, local pharmacy has a CBD product that makes that better. Who am I to tell you not to use that? But you have to be careful.

Host: Yeah. You have to be careful for sure, right? As you say, the substances, marijuana, whatever it might be that folks may have imbibed in, let's say in the '60s when they were in college or something like that, is drastically different. And so, it makes me wonder, you know, are seniors just maybe more vulnerable to the effects of marijuana or other substances compared to younger adults, or is everybody equally sort of susceptible?

Dr. Derek Bast: Well, there has been recent evidence that's been published. American Journal of Medicine and the Cardiology Societies have been talking about how smoking marijuana has a very negative effect on our cardiovascular health. We've been expecting that I think for years, but now there's some official evidence that proves that. Obviously, that's a big deal for young people. But for seniors who are at higher risk of, you know, having a heart attack or having heart disease, that's a much bigger issue for them. So that's a concern as well.

But also, a lot of seniors tend to be on more medications. So when you start talking about alcohol or marijuana interacting with the medicines that they're already taking, they're certainly at a higher risk from that perspective as well. As you age, there are physiologic shifts in your body, and that puts you at higher risk for the negative effect of substances as well, like confusion, you know, fall risk, memory loss, things like that, that you can suffer because of alcohol and marijuana use.

Host: Yeah, I'm thinking about, you know, marijuana, alcohol, things like that. You pile those on top of blood pressure meds, cholesterol meds, maybe someone who's diabetic. You know, you start adding that to the mix and I wonder if that's just an interesting or difficult conversation maybe for seniors or family members to have with a primary of-- So, I'm thinking about this CBD or something like that. How might this interact with my other meds, right? Do folks readily have those conversations?

Dr. Derek Bast: I think, in my clinic, I'm very open with patients about asking for them to bring that to the table. It's not common that they'll do it themselves. I do have some patients who will come in and straight up tell me, you know, "You know what? I think I'm drinking too much." But, you know, I would say that's the minority of patients. I think most patients, if you crack the door, they're happy to walk through it. But I think we at least have to be willing to open that conversation to them and kind of invite that, invite that conversation.

Host: Yeah. As you say, like crack the door open and invite them into the conversation, of course, right? So, how can family members or caregivers identify the signs of substance abuse in seniors and how do we talk to our parents about their usage?

Dr. Derek Bast: I think it's incredibly difficult. I'll tell a personal story here. My grandmother, who has unfortunately since passed away, she had multiple doctor's visits for falls. She's a very healthy lady in every other regard. We had no idea why she was falling. And I remember being at her condo one day and seeing multiple low ball glasses, kind of sitting on her table. And I just asked her, like, "Grandma, how much alcohol do you drink?" And she's like, "Oh, not that much. I just have a couple bourbons with water every night." And I mean, it literally turned out that she was falling at night because she was relatively dehydrated. She was having a couple glasses of bourbon that she probably had a little bit of a heavy hand pouring. And that was it. That was why she was falling. And no one had any idea. Her daughter didn't consider the fact that this adorable 70-something-year-old lady had an alcohol use disorder, but that was what it was.

 And so, I think that when we're trying to help take care of our parents, our grandparents, that we just need to be very aware of the fact that maybe these symptoms of, you know, "I'm not sleeping well at night," "I'm more confused at night," maybe falling, being quick to think is that related to the substance use? Or being willing to at least bring up the conversation of " How much are you drinking?"

Host: Yeah. "How many Manhattans are you drinking per night, Grandma?" Yeah.

Dr. Derek Bast: Is this the second or third or the, you know, the fourth? You know, do we need to talk about this? Because maybe family does have that ability to be the first line of defense to help seniors not suffer so much from this, and to at least open that door so that that conversation can be had with somebody.

Host: Right. Yeah. One quick story about my great aunt. She was in her 80s. and I went to pick her up to take her out to dinner from the place she was living at, you know, assisted living place. And I knocked on the door and I opened the door, and the first thing she said, not "Hello, how are you? Thanks for coming." She basically yelled at me, "I'm out of booze," right? And I quickly texted my mom. I said, you know, "We might need to investigate this a little bit." If this is so top of mind for her, this is the first thing she can think of when she sees me is that she's out of booze, maybe something's going on there, right?

Dr. Derek Bast: That deserves further investigation.

Host: Yeah. As you say, the signs and symptoms perhaps. Good stuff today. I feel like we could stay on longer. And as I said, you know, I have a lot of seniors in my life, so I'm a captive audience, of course. But I just want to drill down a little bit more about whether it's chronic pain, mental health issues, whether it's anxiety, depression, what role do these things these conditions, if you will, play in the substance abuse of older adults?

Dr. Derek Bast: I definitely think that those are probably the primary driving factor of this that we see a lot of times. And this can be a way, you know, to your previous question of how do we realize this is happening. I think we need to be aware, especially with the seniors in our life, that when there is a significant life transition. Because seniors experience significant life transitions quite frequently, whether it's retirement, you know, the loss of a spouse, something like that, and that brings about bereavement, increased depression, anxiety. Those things are definitely a driving factor behind either restarting and alcohol use disorder or just restarting marijuana use or something like that. I think those conditions that you brought up, anxiety, depression, insomnia, joint pain, I think all of those are very strong driving factors for our seniors to use substances.

Host: For sure. Yeah. So, it feels like, you know, we as the children or caregivers, we should be on the lookout, not only for physical signs and symptoms, falling perhaps, you know, maybe too many drinks at night, but also the mental or psychological effects of these transitions, of these things that happen, you know, in their lives, death of spouses, whatever it might be. We need to kind of be on the lookout for everything, right?

Dr. Derek Bast: Yes, yes. And seniors, they have less of a safety net as far for people to realize if there is a significant change. I mean, if you or I was to develop something that was affecting our ability to go to work, people would notice and someone would say something. But you know, if someone's not going to work on a regular basis, then you know they need that help from their family and friends of people around them to recognize that change because there might not be as many opportunities for other people to recognize that.

Host: Absolutely. Well, doctor, I really appreciate your time, expertise, compassion today. Thanks so much.

Dr. Derek Bast: Okay. Thank you, scott.

Host: And for more information, go to franciscanhealth.org and search substance abuse. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.