Author: James Anderson

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

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Many behavioral therapies and medications have been successful in treating substance use disorders in older adults. Older adults generally experience the effects of alcohol more quickly than when they were younger. This puts older adults at higher risks for falls, car crashes, and other unintentional injuries that may result from drinking. They offer a safe and comfortable space to talk freely and openly about one’s experiences. They can provide an opportunity for older adults to connect with peers who have gone through similar struggles, providing a forum to share advice and strategies that have proven successful in managing their addiction.

Older adults have higher rates of chronic pain, and opioid prescription fill rates were disproportionately higher among adults aged 65 years or older from 2008–2018 55. Han et al. found that, among adults 65 years and older, an estimated 1.2% reported past-year prescription opioid misuse in 2015–2016 56. According to Harvard University, older adults metabolize alcohol more slowly than younger people. This means that drugs can stay in their system longer and have a more significant effect. Additionally, their brains can be more sensitive to substances due to aging-related physical changes, such as decreased neurotransmitter levels or slowed metabolism.

Symptoms of Substance Abuse

In fact, a recent study demonstrated that baby boomers have an increased risk of death from prescription opioid and heroin overdose compared to younger cohorts, suggesting more dramatic consequences of opioid misuse in older adults 60. Adverse drug events included slowed colonic motility, delirium, nausea/vomiting, fall/fracture, urinary retention, and opioid-related adverse effects 61. The 2019 National Survey on Drug Use and Health reported an estimated 10.7% of adults aged 65 years and older engaged in past-month binge alcohol use (defined as over 5 drinks on an occasion) and 2.8% engaged in past-month heavy alcohol use (defined as binging in at least 5 of the past 30 days) 3. The overall number of older adults reporting binge and heavy drinking was likely grossly underestimated when considering that the binge threshold for older adults is typically considered to be 3 drinks per day for men and 2 drinks per day for women. A study utilizing data from the 2014–2019 National Health Interview Surveys reported that the estimated prevalence of past-month binge drinking among men 65 years or older significantly increased from 12.8% in 2015 to 15.7% 15.

Cannabis

However, it is important to note that the NIAAA also recommends that adults age 65 or older limit their alcohol consumption to 1 standard drink per day or 7 standard drinks per week with no more than 3 drinks per occasion 13. Alcohol, tobacco, and SUDs are a major public health issue contributing to a devastating increase in overdose mortality, health care costs, and suffering for individuals and their communities. It is important to recognize that the number of older adults who engage in unhealthy substance use is increasing dramatically, and present unique challenges for prevention and screening. There are unique physiologic and social changes with aging that need to be considered in screening older adults for unhealthy substance use behaviors, and providers need to be mindful the language used when talking about substance use and SUDs with their older patients.

As a result, a given amount of alcohol results in a higher blood alcohol level in older adults and ultimately puts older adults at risk for intoxication and harm at a lower intake of alcohol 16. There has been little research on the effects of vaping nicotine (e-cigarettes) among older adults; however, certain risks exist in all age groups. Some research suggests that e-cigarettes might be less harmful than cigarettes when people who regularly smoke switch to vaping as a complete replacement. However, research on this is mixed, and the FDA has not approved e-cigarettes as a smoking cessation aid. There is also evidence that many people continue to use both delivery systems to inhale nicotine, which is a highly addictive drug. Here are a few key factors contributing to the growing substance abuse problem among seniors.

As larger cohorts of adults continue to age, increasing concern regarding the unique healthcare needs of the geriatric population must be addressed. Substance use disorders (SUDs) among the geriatric population are one of the fastest growing public health concerns in the United States 1. 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. While only 18% of substance abuse treatment programs were specifically designed for the geriatric population, the general availability of SUD treatment facilities is limited for those of lower socioeconomic status, making it even more difficult for these patients to seek proper care for their SUDs.

1. It is advised that you conduct your own investigation as to the accuracy of any information contained herein as such information, including without limitation any medical advice, is provided “as is” for informational purposes only.
2. There is less known about the safety of buprenorphine in older adults compared to methadone although it may be preferable because it is less likely to cause withdrawal symptoms, erectile dysfunction, constipation, or respiratory depression 63.
3. This increase is primarily driven by the baby boomer generation, those born between 1946 and 1965, who have had higher rates of substance use at each stage of life compared to previous generations 1.

Prescription drug misuse

Additionally, the effects of some drugs—like impaired judgment, coordination, or reaction time—can result in accidents, such as falls and motor vehicle crashes. These sorts of injuries can pose a greater risk to health than in younger adults and coincide with a possible longer recovery time. 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. Substance use disorders are becoming increasingly prevalent in the geriatric population, necessitating an updated understanding of the existing literature. This review aims to describe the epidemiology, special considerations, and management of substance use disorders in older adults.

It’s especially dangerous because their bodies don’t process drugs as quickly as when they were younger. According to the CDC, alcohol was an underlying cause of death for 11,616 adults aged 65 and over in 2020. Although alcohol caused very few deaths in this age group, the rates have increased in recent years.

More Are Smoking Marijuana

Methadone has been shown to be safe and effective in the treatment of opioid use disorder in older adults 62. There is less known about the safety of buprenorphine in older adults compared to methadone although it may be preferable because it is less likely to cause withdrawal symptoms, erectile dysfunction, constipation, or respiratory depression 63. Buprenorphine can also be prescribed by primary care physicians whereas methadone must be administered at qualified opioid treatment centers. It is also important to note the difference between pharmacologic preparations of cannabis and medicinal cannabis. Pharmacologic preparations are approved by the Food and Drug Administration (FDA) for specific indications such as seizures or anorexia 34.

Dwindling Social Support

BZD use disorder, specifically, needs to be medically supervised with a slow taper spanning at least four weeks.3 See table 2 for more information about the pharmacologic treatment. The treatment of cannabis use disorder in older adults is similar to that of the general population. Cannabis use disorder treatment is primarily done through CBT, motivational enhancement therapy (MET), and contingency management (CM) with a combination of the three modalities producing the best outcomes 47. Make sure your primary doctor has a list of all the medications you take, even over-the-counter ones. The content, including without limitation any viewpoint or opinion in any profile, article or video, contained on this website is for informational purposes only.

Substance Use Disorder in Older Adults: Mini Review

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 that occurred during the pandemic. Additionally, many older adults deal with chronic physical or mental health issues that substance use disorders can exacerbate. Despite increasing rates of substance use in older adults, the number of referrals made by healthcare providers for substance use treatment has been declining 6. In addition to this, only 18% of substance abuse treatment programs are specifically designed for the geriatric population. Older adults face unique barriers to treatment such as social isolation, limited mobility, financial problems, transportation issues, and shame regarding substance use 5. Choi et al. found that lack of readiness and cost/limited insurance were the most frequently mentioned barriers to treatment among older adults 85.