By Christine Hauser
Published in The New York Times, December 16, 2005

.After decades of drug addiction, Adriane Allen believes she has finally grown too old to smoke crack. At 57, she has chest pains, has lost most of her teeth and has trouble moving her arms. Lately, she worries about how her grandchildren will remember her when she is gone.

"I definitely do not want them mourning me as an addict, that I died as an addict," said Ms. Allen, shaking her head, covered with gray hair and fidgeting uncontrollably during an interview at a New York City needle-exchange center.

"You get tired of being tired," she continued. "They say that is a drug addict's saying, but it is true, you do get tired of being tired. I am tired of walking around in a daze. I am tired of walking around with sunglasses on. Blocking out real life. I am ready to face my demons and just say I don't want it anymore."

As the first of the baby boomers approach 60, addiction treatment centers are bracing for a growing population of older drug addicts. Many aging users, veterans of the counterculture 60's, started using drugs as teenagers and have progressed to harder substances and addiction, while others turned to illicit drugs, abuse of prescription medications or increased alcohol intake later in life, with the loss of jobs or spouses.

Since, traditionally, substance-abuse- treatment programs and research have focused on teenagers and young adults, doctors, social workers, therapists and researchers say that new approaches need to be developed for the ballooning number of boomer addicts.

"In treatment of people 55 and older, we are starting to see much more cocaine addiction, which we never saw before," said Frederic C. Blow, an associate professor in the University of Michigan's psychiatry department, who has developed policy recommendations for the federal Substance Abuse and Mental Health Services Administration. "In fact, in some treatment programs, we are starting to see more problems related to stimulant abuse: cocaine, crack and marijuana use."

The federal government's 2004 survey of substance abuse, released in September, estimated that more than three million adults 50 and older had used marijuana, hashish, cocaine or crack, heroin, hallucinogens or inhalants or had misused prescription drugs during the previous year. That number could more than double by 2020, said Joseph C. Gfroerer, director of the substance abuse agency's population surveys.

Willard L. Mays, a delegate to the White House Conference on Aging and a member of the executive committee of the National Coalition on Mental Health and Aging, said, "There are not enough geriatric specialists to handle this increased number of people who need services."

Their medical problems can be overwhelming. Long-term heroin use can hasten the decline in immunity that comes with age. Prolonged cocaine use can lead to erosion of the nasal passages, arrhythmia and other cardiovascular problems. The slower metabolism, lower body mass and decrease in an enzyme called alcohol dehydrogenase that accompany aging drive down the alcohol tolerance of older adults, contributing to liver disease and making them susceptible to falls. Older patients may already have diabetes, arthritis or hypertension, meaning that they need to be stabilized before they can start treatment for their addiction.

At the methadone maintenance treatment program at Beth Israel Medical Center, doses sometimes need to be adjusted for older patients who are more likely to be on several prescription drugs, said the medical director, Dr. Randy Seewald.

Older patients can also present practical treatment problems. Those with mobility problems might have trouble getting to treatment centers. They often need treatment literature printed in large type, or help in unscrewing the caps of methadone bottles, because of arthritis. Therapy must be tailored to address regret over wasted youth and lost spouses.

Substance abuse also often goes undetected - and therefore untreated - for long periods in older adults who are isolated. "When people are retired and do not have professional obligations and the children have left home, then our red flags are not raised quite as effectively," said Petros Levounis, director of the Addiction Institute of New York.

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