Substance Use in Older Adults

Contrary to belief, substance use disorder (SUD) is a reality for many older adults. By 2050, the number of individuals aged 65 and older is expected to rise to 82 million, representing 23% of the United States population. With baby boomers and members of Gen X aging, there’s an urgency to learn about, identify and treat addiction among this population. It’s also critical to overcome the societal barriers and stigmas preventing many older adults from getting the care they need.

Comprehensive addiction treatment can help older adults heal from the adverse effects of addiction and lead healthier, more fulfilling lives. In this article, we will provide an overview of substance use in older adults, including risk factors, health implications, types of treatment and how to get help for addiction.

Substance Use Trends and Statistics Among Older Adults

Drug overdose deaths among older adults increased between 2000 and 2020 — from 2.4 to 8.8 deaths per 100,000 standard population. Another study found that more than 79,000 adults aged 55 and over died due to an opioid overdose from 1999-2019. 

Overall, boomers use substances at higher rates than previous generations. With this population getting older, learning about addictions in this demographic is important for prevention. Common substance use disorders in older adults include the following.

Benzodiazepine Misuse

Benzodiazepine helps relieve anxiety and reduce muscle spasms, but overuse can be harmful and cause serious problems, especially among the older population. Despite the risk, prescriptions for this medication have risen significantly in recent years. Benzodiazepine misuse and addiction can increase the risk of confusion, falls and fractures. It can also contribute to the impairment of driving skills and lethargy in older adults. 

Opioid Misuse

Many older adults experience chronic pain, and some may be prescribed opioids. Due to the slow metabolism of opioids, there is an increased risk of older adults experiencing adverse events from misusing them. Some older adults may also turn to illicit opioids to manage pain. Opioids can lead to effects like increased risk of falls, impaired motor coordination, dizziness, respiratory depression, impaired cognitive function and overdose. 

Marijuana Misuse

Older adults who misuse marijuana for social recreation or relaxation may experience short-term memory impairment, issues with motor skills, altered judgment, paranoia and even psychosis. 

Prescription Medication Misuse

Older adults typically use more prescriptions and over-the-counter (OTC) medications than any other group. They are likelier to unintentionally misuse medicines by taking them too often or forgetting to take them at all. 

Alcohol Misuse

Alcohol is the most misused substance among older adults, and studies have found that 20% of adults aged 60 to 64 reported binge drinking. Around 11% of adults over 65 have also reported binge drinking.

There are two categories of drinking. Early-onset, including those who have been drinking for many years, and late-onset, or those who began drinking due to a recent stressful life event. 

Whether an older adult is affected by early-onset or late-onset drinking, alcohol addiction in older adults can lead to gait and balance issues, muscle weakness, suppression of the immune system and nutritional deficiencies. 

Additionally, older adults have higher rates of sleep disturbance than younger adults, and alcohol use can exacerbate these issues, causing problems like insomnia and worsened sleep apnea.

Effects of Substance Use Disorder on Older Adults

Aging can potentially lead to physical and social changes that increase one’s susceptibility to substance misuse. While there’s still more to learn about the effects of drugs and alcohol on the aging brain, older adults metabolize substances slowly, which means their brains may be more sensitive to substances. Substances can worsen conditions older adults are prone to, such as: 

• Heart and lung conditions.
• Memory issues.
• Mood disorders.

The effects of certain drugs can also lead to accidents among older adults, such as falls and vehicle accidents. Older adults with SUD can also experience worsened medical outcomes, which may create more challenges for an already burdened health care system. 

Risk Factors for Substance Use in Older Adults

The following factors can increase an older adult’s risk of substance use:

• Social isolation and loneliness
• Marital loss
• Retirement
• A medical diagnosis that causes impairment
• The death of a loved one
• Needing to care for a loved one
• Co-occurring mental health disorders like depression and anxiety

Identifying Substance Use 

The general signs of drug use in older adults include excessive time spent obtaining or taking substances, cravings, continued use despite consequences and repeated use occurring despite dangerous situations. Many screening tools can help identify substance use among older adults, including:

• Screening, Brief Intervention and Referral to Treatment (SBRITE)
• Alcohol Use Disorder Identification Test (AUDIT 10)
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• Short Michigan Alcohol Screening Test (SMAST-G)
• Drug Abuse Screen Test (DAST)

Barriers to Treatment for Older Adults

It’s important to overcome the barriers individuals often experience when attempting to get the care they need. These include:

• General low awareness of SUD among older adults.
• Low suspicion among health care professionals, as they may view complaints as age-related changes.
• Stigma and shame among this population.
• Underreported or inability to provide an accurate history.

As a preventive action, screening for SUD should be done at every visit older adults have with their primary care provider, as early detection and treatment can increase successful outcomes. Additionally, overcoming isolation, establishing social support, and promoting new hobbies or interests may also lower an older adult’s risk of substance use disorder. 

Treatment Approaches for Substance Use 

Addiction is a complex condition that requires comprehensive treatment. The right treatment approach involves integrated care, addressing addiction and mental illness simultaneously, and evidence-based therapies tailored to older adults. Depending on the severity of the addiction, individuals can seek inpatient care, where they live within a residential setting, or outpatient care, where they receive care during the day and return home at night.

Substance use treatment for older adults might include the following.

Detoxification and Withdrawal

People experience uncomfortable withdrawal symptoms when attempting to stop substance use, like disturbed sleep, tremors, anxiety, nausea, confusion, disorientation and increased vitals. Detoxification can help older adults rid of substances from their bodies and reduce withdrawal symptoms that make it difficult to focus on recovery. 

Support Groups

Older adults may be less willing or able to participate in support groups like AA due to a lack of transportation or disabilities. However, support groups can increase a person’s chances of a successful recovery from substances, particularly when separated by age.

Therapy

Evidence-based therapies like cognitive-behavioral therapy (CBT) have been shown to help people identify addiction behaviors and beliefs and start changing them. When tailored to older adults, therapy can be effective in overcoming substance use disorder. 

Medication Management

Medication management is another approach to addiction treatment, involving the use of prescription medication to reduce drug cravings, block the effects of certain substances and help older adults through the recovery process. Examples of medication prescribed in treatment programs include:

• Disulfiram (Antabuse) 
• Naltrexone
• Acamprosate (Campral) 
• Methadone
• Buprenorphine

Promoting Recovery and Well-Being in Older Adults

Identifying common signs of addiction and overcoming treatment barriers can ensure older adults get the care and support they need. Diamond House Detox opened in 2017. We provide detox services, residential programs, partial hospitalization programs (PHPs), intensive outpatient programs and outpatient detox. 

If you or someone you know is experiencing addiction, we encourage you to reach out to us. We can help older adults begin the journey of addiction recovery and healing.

Vicky is a board certified Family Psychiatric Mental Health Nurse Practitioner, certified by the American Nurses Credentialing Center. She began her nursing career in healthcare by working in the intensive care unit, and then an inpatient psychiatric hospital. After realizing the mental health needs of both the patients and the families she served, she became a Psychiatric Nurse Practitioner. Throughout her experience working with clients, she has developed a passion for those with dual diagnoses and specializes in helping individuals recognize the issues driving their substance use. This recognition has been crucial to the individual’s success in treatment. Vicky opened Diamond House Detox so that she can address these issues early on in a therapeutic environment to allow clients to transition to the next level in their recovery.

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