Symptoms of Aging versus Addiction: How to Tell the Difference

When I worked as a family practitioner years ago in Vermont, I treated several five-generation families: the great-great-grandmother, the great-grandmother, the grandmother, the parents, and the children. From these and other families, I heard many of the same questions about their older loved ones. And as a former physician director at the Betty Ford Center, where I treated people for substance use disorders, I addressed many of the same questions and concerns: Is Mom drinking too much or is she forgetful because she’s getting dementia? One doctor doesn’t seem to talk to the next. How can I possibly figure out all of these medications? She keeps all of her pills in one bottle, and I have no idea what they are. What she says just doesn’t make any sense. I don’t know what to do. No one seems to be able to help. What is the distinction between aging versus addiction?

Before anyone can help, we need to know the true cause of the symptoms, and the signs and symptoms of aging and addiction often overlap: forgetfulness, loss of balance, and impaired speech are just a few. Sometimes these symptoms are the consequence of taking a bad drug combination. Mom might have sipped on a scotch, taken her anxiety medication, and started slurring her words. A similar and growing problem is polypharmacy, or when a person is taking multiple medications, usually prescribed by different doctors, that when combined have unwelcomed side-effects. When you take Mom to the doctor for help with her balance issue, the doctor prescribes XXXXX to help restore her equilibrium. This is what’s known as a prescribing cascade.

Your best weapon here is knowledge, and you might have to play detective to get the information you need. Ask Mom questions about her drinking and drug use. Note how she reacts. Is she nervous or matter of fact? Ask her to show you her medication bottles. Read the labels. How many different doctors are prescribing pills? Then, put every medication in the house—prescription, over the counter, as well as herbals—into a brown paper bag and take it to your family doctor or the local pharmacist and ask for what’s known as a medication audit. They will look up each drug and note any dangerous interactions. Older adults can be on 15 to 20 different medications, and polypharmacy can lead to symptoms such as dementia. It’s worth your time to determine whether medicine is the culprit.

If Mom’s medications check out, and you’re confident alcohol is not the issue, then the signs you’re seeing are likely related to aging or an underlying condition that should be checked out by her doctor. During the visit, you can practice some prevention by being sure the physician has a list of all of her current medications.