Abstract
Old and High: A Guide to Understanding the Neuroscience and Psychotherapeutic Treatment of Baby-Boom Adults’ Substance Use, Abuse, and Misuse outlines the pressing societal issue of psychotropic substance abuse among the baby-boom generation, types of substances used, as well as psychotherapeutic and harm reduction interventions.
In order to explain the increasing prevalence of psychotropic substance abuse among older adults, the first part of this book is dedicated to highlighting the population of interest, providing context, and introducing necessary anatomical and psychophysiological concepts. Historically, data have indicated that adult psychotropic substance abuse decreases over time, with most adults presenting for alcohol abuse (Duncan et al., 2010; Williams et al., 2005). However, the baby-boom cohort, which refers to Americans who were born between 1946 and 1964, displays higher rates of psychotropic substance use that is not limited to alcohol (Center for Behavioral Health Statistics and Quality [CBHQ], 2016; National Institutes of Health, 2014). In defining the baby-boom adults, the author highlights the potential etiology of increased psychotropic substance use in this cohort (e.g., different attitudes towards substances as a result of growing up in the rock’n’roll generation), as well as the importance of clinical interventions for this burgeoning population. The severity of psychotropic substance abuse within the baby-boom cohort is underscored by a recent study, which found the greatest percentage increase in overdose deaths among adults aged 55–64 (Centers for Disease Control and Prevention [CDC], 2017).
The development of psychotherapeutic interventions to address the growing problem of psychotropic substance abuse among baby boomers is inherently driven by the substances that are most commonly used, abused, and misused by this cohort of adults. The author provides a comprehensive explanation of the history and psychophysiological mechanisms of alcohol, benzodiazepines, sleeping medications, cannabis, opioids, psychostimulants, and nicotine. The addictive potential of these substances is illustrated through a series of vignettes, which adds a personal touch and allows readers to connect with the concepts outlined in this text. Additionally, the inclusion of electronic cigarettes when discussing tobacco abuse in baby-boom adults demonstrates the author’s awareness of trends that are just now beginning to make their way into the national spotlight.
These trends, in addition to more conventional forms of psychotropic substance use, are addressed in the final section of the book, which describes psychotherapeutic approaches to substance use in baby-boom adults. Among these, cognitive-behavioral therapy (CBT), rational-emotive behavioral therapy (REBT), mindfulness-based cognitive-behavioral therapy (MBCBT), and dialectical behavior therapy (DBT) are noted as effective for all three stages of the neurocircuitry of psychotropic substance abuse.
Throughout the book, the author argues against the conceptualization of psychotropic substance abuse as a disease. It is instead characterized as a biopsychosocial learning problem, which effectively distances substance users from the stigma of pathology and helplessness that accompany the “addiction disease” construct. In addition to stigma, the medicalization of substance abuse in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) may not be valid for older adults (American Psychiatric Association, 2013). Certain criteria that are used in diagnosing substance use disorders (SUD), such as tolerance thresholds, may be confounded by the age of the baby-boom cohort. For example, older individuals may have a lower tolerance for substances as a result of their age, which might prevent them from meeting that criteria for SUD. The author also argues the etiology of psychotropic substance misuse in some baby boomers may be linked to accidental behaviors (e.g., misunderstanding of prescription medication instructions due to cognitive deficits) rather than intentionally seeking to get high. This phenomenon is not assessed by the current DSM criteria, which furthers the author’s point that psychotropic substance abuse among older adults may be better classified as a biopsychosocial learning problem, rather than the addiction construct that is implied using DSM criteria.
Overall, the author does an excellent job of humanizing the issue of psychotropic substance use in aging baby boomers. The vignettes included illustrate the trials and tribulations of these individuals in a way that perfectly complements the factual information presented throughout the text. The book, however, does suffer from a several limitations. First, a majority of the points made by the author rely on the “3 stage neurocircuitry of psychotropic substance abuse model,” which was adapted from Koob and Volkow’s (2010) neurocircuitry of addiction model. Therefore, the origins of this adapted model are rooted in the “addiction disease” construct that the author opposes. Second, many of the risk factors that are conventionally linked with the etiology of substance abuse are not addressed in the context of the baby-boom adult population. Examples include a history of trauma, comorbid mental disorders, and certain personality traits such as impulsivity (Sloboda et al., 2012). It is unclear whether these risk factors simply do not apply to older adults, or whether they were omitted because of their close alignment with the construct of addiction throughout the substance use literature. Finally, evidence-based pharmacological treatments are not mentioned as potential treatment options, which may lead readers to think that the psychotherapeutic and harm reduction interventions described are the only options available for baby-boom adults struggling with psychotropic substance abuse.
In conclusion, this book contains a wealth of information detailing the issue of psychotropic substance abuse within the cohort of aging baby boomers, psychophysiological mechanisms of commonly abused substances, as well as psychotherapeutic interventions that have demonstrated efficacy in treating these individuals. This information is likely to most benefit healthcare providers who are on the frontlines treating psychotropic substance abuse in this population. Additionally, this book serves as a useful resource to researchers, who may find inspiration for new research questions. These questions may future research into the etiology of psychotropic substance abuse within the baby-boom cohort, and comparing obtained findings to those for different age groups. Moreover, future research could target the efficacy of additional psychotherapeutic and pharmacological interventions that are designed for this population. Overall, this text provides a useful discussion regarding psychotropic substance abuse among baby boomers as compared to previous cohorts, and has emphasized that a thorough understanding of this population is necessary in order to develop effective treatments.