Author: James Anderson

Substance Use in Older Adults DrugFacts National Institute on Drug Abuse NIDA

Older adults have not demonstrated high rates of drug or alcohol use over time compared with younger adults. It has contributed to a misconception that seniors do not abuse alcohol or drugs, and there is no such problem as alcoholism in the elderly. An ever-growing body of evidence suggests that substance abuse in older adults has gone unnoticed for decades. The baby boom generation, which is currently in its 60s, faces some frighteningly real risks. On the other hand, having strong social connections can improve mental health and reduce the risk of substance use disorders. Studies have found that increased social interaction among seniors has been linked with positive outcomes such as improved cognitive functioning and lower rates of depression and anxiety.

1. This type of disorder is particularly concerning when it affects seniors, as they can be especially vulnerable to the consequences of drug addiction.
2. Finally, a third important direction will be to ensure increased attention to social determinants of health (Blanco et al., 2020).
3. The baby boom generation, which is currently in its 60s, faces some frighteningly real risks.
4. If they are taking several prescription drugs for different health conditions at once, it would be very helpful to write down the doses and administration times in big letters on a sheet and put it up where they will see it, like on the fridge.
5. That is perhaps the main reason for misdiagnosis and lack of treatment of seniors – these criteria are less relevant to them.

Gender and racial inequities and stigma increase the risk of SUD at all ages and can act as a powerful barrier to treatment. Lack of social support, which often increases with age, can increase the risk for and worsen the course of, SUD. Housing, the built environment and other neighborhood characteristics also can be powerful determinants of substance use and access to treatment. Developing and implementing evidence-based approaches to social determinants of health will be key to improving the health of older adults and decreasing the risk of SUDs. One of the primary reasons older people struggle with substance use disorders is a decrease in family support and social interaction as they age. Unfortunately, social isolation is common among older adults as family members and friends move away or pass away.

Symptoms of Substance Abuse

In this article, we will review the signs and symptoms, risk factors, screening tools, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria, and challenges of treating substance abuse in the older adults. Because comorbid psychiatric disorders, such as anxiety, depression, and personality disorders, are common and recognized among younger adults, it is assumed that these comorbidities also continue into late life. For example, older adults may be more likely to disclose depressive symptoms and present to primary care settings rather than mental health or substance abuse treatment settings. This alarming trend is due to a combination of factors, including an increase in access to prescription drugs and alcohol and a decrease in family support and social interaction, especially during the Covid-19 pandemic. Additionally, many older adults are dealing with chronic physical or mental health issues that substance use disorders can exacerbate.

It is possible to have a mild substance use disorder where you might still be able to control it on your own with family support or counseling. Other times it can be more severe and require professional help such as inpatient treatment or medication to recover. Early recognition and treatment are some of the best ways to help anyone struggling with substance abuse issues. Addiction Resource is an educational platform for sharing and disseminating information about addiction and substance abuse recovery centers.

These findings are consistent with the results of the National Epidemiological Survey and Related Conditions-III (NESARC-III), which estimated the prevalence of AUD and DUD at 2.3 percent and .8 percent, respectively (Grant et al., 2015; Grant et al., 2016). Sex can be a risk factor for substance abuse, especially alcohol abuse, in older adults. Studies have shown that older women are more prone to the harmful effects of alcohol than older men due to their lower body mass and certain biological factors. Additionally, women may drink less often than men, but the same amount of alcohol will, on average, affect a woman more severely than a man.

Elderly Drug Abuse: The Facts​

One can help an elderly parent or grandparent do so by asking if they are taking any medicines that could cause drug interaction and communicating the symptoms of prescription drug misuse or abuse to them. If they are taking several prescription drugs for different health conditions at once, it would be very helpful to write down the doses and administration times in big letters on a sheet and put it up where they will see it, like on the fridge. Let them know they should always turn to their loved ones and a doctor if they feel like they’ve become dependent on a particular medicine or other substance.

At present, SUD treatment for older adults is based on clinical experience and on studies conducted in younger populations, as most clinical trials for SUD tend to exclude older adults (Blanco et al., 2008; Blanco et al., 2015; Okuda et al., 2010). An important future direction will be to expand the evidence-base for the treatment of older adults. This could include new clinical trials with less restrictive inclusion criteria, use of electronic medical records and observational studies, and simulations, as well as a combination of all these approaches (Blanco et al., 2017). Some predisposing factors, such as age and knowledge, may be less favorable for older than younger adults. For example, due to feelings of isolation and shame (Kuerbis and Sacco, 2013), older adults often prefer treatment settings geared toward individuals of their same age, rather than settings with broader age ranges.

Getting Help for Senior Substance Abuse​

SUDs may be difficult to recognize and treat in older adults due to the presence of other psychiatric and general medical disorders. Better integration of SUD and general medical treatment, and increased attention to social determinants of health, are important future directions for research and treatment of SUD in elders. Mental health conditions such as depression or anxiety can affect how a person perceives and responds to stimuli, making them more vulnerable to risky behaviors like substance misuse. Seniors with co-occurring psychiatric disorders may be more likely to try drugs or alcohol as a means of self-medicating to cope with their symptoms. It’s essential for family members and healthcare providers alike to be aware of this risk factor so they can take steps to prevent it in their loved ones.

The standard dose of naltrexone is 50 mg, but some studies have investigated its effects at larger doses (eg, 100 mg). The major limitation of naltrexone in an older-adult population, many of whom have chronic pain, is that it blocks the effect of opiate-based pain medications. Problem substance use is characterized by those individuals who are already experiencing problems in the aforementioned areas as a result of their use. Identification of problem use among older adults does not depend on the quantity and frequency of use but on the context in which substances are used.

Older adults have lower prevalence of substance use than younger adults, which may lead clinicians to think that older adults do not use psychoactive substances or develop SUD. Furthermore, recent cohorts of individuals ages 65 and older tend to show a higher prevalence of lifetime substance use than that seen in prior generations (Chhatre et al., 2017). A family history of substance abuse or addiction can also be a risk factor for seniors developing addiction issues. Studies have shown that people are more likely to engage in risky behaviors like binge drinking or drug use if someone close to them has had similar problems. Naltrexone is the most well-studied medication used for SUD treatment among older adults,112 and it has demonstrated some effectiveness with this population. Naltrexone is an opioid receptor antagonist thought to reduce craving and the pleasurable or stimulating effects of alcohol by blocking alcohol-induced dopamine release in the brain.123 It can be taken daily or as needed, although only daily treatment of naltrexone has been tested with older adults.

Interruption in social and occupation roles or other repercussions of elderly drug abuse may be less noticeable or likely to occur at this stage of life. With age, one departs from these roles naturally in the vast majority of cases, such as through social isolation due to age-group peer mortality or retirement. Of course, slurred speech, smelling of alcohol, and change in physical appearance are all signs that a person needs help and treatment. Common symptoms include chronic, medically unfounded health complaints, confusion, hostility, memory loss, and depression.