THE FORGOTTEN WOMAN

Washington is a Babel of talk of tobacco legislation, patients' rights,
taming aggressive managed care companies and reforming Medicare and
Medicaid. In this cacophony of political concern about health care, let's
hope the administration and Congress don't drown out what former first lady
Betty Ford calls "America's hidden epidemic": substance abuse among older
women.

Prevention and treatment of substance abuse and addiction have long been
relegated to the back of America's health care bus. What's so disturbing
about the recent report of the National Center on Addiction and Substance
Abuse at Columbia University ("Under the Rug: Substance Abuse and the
Mature Woman") is its revelation that women age 60 and over are seated in
the last row.

Of 1.8 million women 60 and over who need treatment for alcohol abuse and
alcoholism, only 11,000 -- less than one percent -- receive it. A convicted
felon has a far better chance of getting such treatment than an older woman.

Presented with a classic description of a mature woman in the early stages
of alcohol abuse, only one percent of surveyed primary care physicians with
a significant proportion of mature female patients even considered alcohol
abuse as a diagnosis. More than 80 percent suggested depression, a
diagnosis likely to lead many doctors to prescribe sedating psychoactive
drugs that can exacerbate the condition of an alcoholic woman and even kill
her.

Half of the prescriptions for benzodiazepines -- tranquilizers and sleeping
pills -- given to mature women are inappropriate. Contrary to standards set
by expert panels, they either should not be prescribed for these women or
should be prescribed for shorter periods of time. No wonder 2.8 million
women in this age group abuse psycho active prescription drugs.

There are 25.6 million women 60 and over in the United States. With a life
expectancy of 83 and climbing, a 60-year old woman has more than a quarter
of her life ahead of her. Yet our medical system, perhaps reflecting
attitudes of society at large, sees these women as though they are within
walking distance of the grave. How many of us have said, "What's the point
of trying to get mother to quit smoking? She's old and set in her ways."
Or, "Let grandma get tipsy at night. She's lonely and has so few
pleasures." Or, "At that age what difference does it make if she's taking
too many tranquilizers and drinking while she uses sleeping pills. It makes
her feel better and she's easier to get along with."

It makes a big difference. In good health these women have many years ahead
as productive workers and loving parents and grandparents.

Within three years of quitting, former female smokers are no more likely to
have heart attacks than women who have never smoked, and they are less
likely to die from smoking-related cancers than current female smokers.
Congress has given plenty of attention to discouraging smoking among young
girls. But most members are oblivious to the needs of the 4.4 million
mature women whose smoking threatens them with premature death and loss of
years of independent living. As Congress frets about the financial future
of Medicare, it ignores the hefty costs that substance abuse by older women
imposes on the trust fund, costs certain to increase as the number of women
over 59 explodes with the baby boomers moving into senior status.

Though medical science has demonstrated that one drink generally has the
impact on a woman that two drinks have on a man, most physicians treat a
woman more like a man. When asked what they considered excessive drinking
for mature women, primary care physicians set the standard at 2 1/2 drinks
a day. The National Institute on Alcohol Abuse and Alcoholism sets that
mark at more than one drink daily. A woman faces signific ant risk of liver
cirrhosis if she consumes two drinks a day; that risk doesn't become
significant for a man until he belts down more than six drinks a day.

Doctors blame their failure to identify substance abuse in women age 60 and
older on their lack of knowledge and time, patient denial and physician and
patient discomfort in discussing the problem. Medical schools and
continuing education (and some female-focused research) can fix the
knowledge gap. States should require individuals seeking licenses to
practice medicine or certification as specialists to demonstrate their
understanding of how to spot and treat substance abuse and addiction.

The gaping hole in the medical system's handling of mature women with
substance abuse problems is its failure to provide appropriate
reimbursement. Three of the top health problems that women age 60 and over
face are smoking, psychoactive prescription drug abuse, and alcoholism and
alcohol abuse. Many of the others, such as cancer, heart disease and
osteoporosis, are caused or exacerbated by substance abuse.

Medicare- and Medicaid-eligible mature women are three to five times
likelier to be hospitalized for substance abuse-related ailments than for
non-substance-abuse related heart attacks. Yet 98 percent of hospital
charges for mature women go to treat the consequences of substance abuse;
only two percent go to treat the abuse itself. Of physicians who have
referred mature women for substance abuse treatment, 20 percent say that a
private or public health plan denied coverage.

Medicare and managed care and insurance companies should pay doctors to
talk to these women, not just to cut, stick, image and slip pills to them.
And, as a bill introduced by Sen. Paul Wellstone would require, these
programs should accord to treatment for substance abuse the same status
they give treatment of other diseases.

Copyright 1998 The Washington Post Company

Checked-by: Richard Lake