Substance use among older adults can result in significant risks to various aspects of well-being. Substance use treatment and rehab for older adults, therefore, should consist of comprehensive treatment programs and holistic care to address all aspects of the individual’s health.
- Older adults are less likely to experience substance use disorders than other age groups, but they can result in more serious consequences.
- Treatment for older adults often involves a comprehensive assessment to recognize and address various aspects of the individual’s physical and mental well-being, alongside substance use recovery interventions.
- Holistic approaches are appropriate for older adults in substance use recovery, as they tend to have a wider range of treatment needs, including physical functioning and nutritional needs.
Late-onset triggers and why addiction occurs in older adults
Older adults might experience unique risk factors for substance misuse and addiction, such as health, social relationships, economic status, neurological, and psychological factors, particularly depression, anxiety, grief, and isolation. These issues could increase the risk of substance use as a coping strategy. [1]
Additionally, as of 2024, older adults (aged 65 and over) make up 18% of the US population, a figure that has grown in recent decades due to increased life expectancy and the “Baby Boom generation”. Research suggests that alcohol and substance use among this group, who grew up in the 1960s and 70s, has remained high since these decades. [2]
The changing legal status of cannabis in the US has likely impacted the prevalence of use among all age groups, including older adults. Cannabis use among older adults is more prevalent than any other drug (aside from alcohol) and is likely often used for its medicinal properties, as it can help with various illness side effects that can occur in old age. [2]
Similarly, prescription and over-the-counter medications are also used far more prevalently among older adults than other age groups, increasing the risk of addiction and harmful effects. [1][2]
Unique risks of substance use in seniors
Unique risks among older adults include: [1][2][3]
- High levels of alcohol consumption and physiological differences in alcohol absorption and metabolism, as well as risk for drug and medication interactions.
- Increased risks of serious health problems, including cardiovascular and pulmonary issues, impaired mobility and physical functioning, confusion, impaired immunity, poor appetite and self-care, cognitive impairments, and mood-related issues.
- High percentage using prescription medications, increasing the risk of addiction, drug interactions, and prescription drug abuse.
- Increased risk of unintentional medication misuse due to confusion or multiple prescriptions.
- Increased likelihood of negative side effects, including dizziness, oversedation, and neurological impairments.
Warning signs of drug misuse in seniors
Potential warning signs of drug misuse in older adults can include: [2]
- Increased falls and accidents.
- Impairments in self-care, hygiene, and nutrition.
- Incontinence.
- Headaches.
- Dizziness.
- Chronic pain.
- Unusual response or increased tolerance to medications.
- Cognitive impairments, including memory loss and confusion.
- Sleep difficulties.
- Anxiety.
- Depression.
- Issues within interpersonal relationships and increased isolation.
- Financial, social, or legal problems.
- Running out of medication or borrowing from others.
How rehab for seniors is different
Substance use treatment for older adults requires tailored interventions that account for the individual’s specific health needs. This might include: [1][2][4]
- Integrated care models to address underlying or co-occurring medical and psychiatric conditions.
- Education and management of medication prescriptions to heighten awareness.
- Supported or supervised medication administration to reduce the risks of intentional or unintentional misuse.
- More regular or consistent monitoring of medication side effects, withdrawal symptoms, or psychological changes during treatment.
- Increased need for family or caregiver involvement.
Substance use treatment options for older adults
Currently, access to older adult-specific substance use treatment is limited, and more research is required to ensure that specialized interventions are developed and utilized. However, there are available treatments that recognize the unique needs of this age group and provide appropriate interventions to prevent and treat serious substance use issues. [4]
Brief interventions
Brief interventions, ranging from 15 minutes to five 1-hour sessions, can provide necessary education around the harms of substance use, increase motivation to change using techniques such as motivational interviewing (MI), and connect individuals to additional treatment providers if required. [2][4]
Medications
Medication options for older adults are limited due to a lack of evidence around their safety and effectiveness in this age group. Medications such as disulfiram and acamprosate can be used to treat alcohol use disorder, although disulfiram may increase cardiovascular risks in older adults. [2][4]
Naltrexone has shown effectiveness among this age group for alcohol use issues, and is generally deemed to be safe and effective, although it can impair the effects of opioid pain medications and may worsen depression symptoms. [2]
Medically-supervised detoxification
As with other age groups, detox services can be provided to older adults with substance use issues. This will require particularly careful monitoring, due to the increased risks associated, and should incorporate individualized care. [2]
Inpatient and outpatient programs
Rehabilitation programs can be beneficial for some older adults, although they may experience challenges when receiving treatment in the community or group settings due to limited age-specific interventions. [2]
Therapies
Therapeutic interventions can be particularly helpful for this age group, particularly cognitive behavioral therapy (CBT) and supportive therapy models (STM). Both have been researched and adapted for older adults with positive outcomes. [2][4]
CBT helps to recognize and alter harmful thoughts and behaviors associated with substance use and create positive coping strategies. STM provides support and coping strategies, focuses on developing social support and self-esteem, and addresses the individual’s needs with a holistic approach. [2][5]
Holistic recovery for older adults
Holistic recovery approaches include lifestyle changes that involve improved exercise, nutrition, and stress management routines. This can be particularly important for older adults in recovery, as these aspects of lifestyle and well-being are often affected. Interventions regarding these areas can help improve mental and physical health, thereby improving recovery outcomes. [2][6]
These interventions can be reinforced through specialist services, primary care, or older adults' community services, and can be incorporated into a comprehensive treatment program. [2][6]
Barriers to treatment in older adults
Older adults might experience the following barriers to treatment: [2][4]
- Issues with transport and mobility, preventing appointment attendance.
- Financial difficulties and reduced insurance coverage.
- Confusion or cognitive issues preventing engagement or understanding of treatment.
- Societal stigma.
- Limited service providers offering age-appropriate programs.
Seeking help and support
Older adults requiring support should consult their primary care physician, who can conduct initial assessments and make appropriate referrals to specialist service providers.
Because of the unique and extensive health needs of older adults, it is necessary for a full and comprehensive assessment to take place in order to implement an appropriate and effective care plan.
