Alcohol and Drug Abuse in Seniors

Warning signs of substance abuse & addiction in older adults

Unlike with teens and young adults, spotting the warning signs of addiction and substance abuse is more difficult in the elderly. This may be because interaction is less frequent, they are secretive about their problem, or they are misdiagnosed due to their age and related ailments. Also, doctors and other people often overlook signs of substance use and addiction in older adults because of stereotypes that these problems are more common in young people.^[1]

Here are some warning signs of alcohol and drug abuse in seniors:

• Solitary or secretive drinking.
• A ritual of drinking before, with, or after dinner.
• A loss of interest in hobbies or pleasurable activities.
• Drinking in spite of warning labels on prescription drugs.
• Immediate and frequent use of tranquilizers.
• Slurred speech, empty liquor and beer bottles, smell of alcohol on breath, change in personal appearance.
• Chronic and unsupported health complaints.
• Hostility or depression.
• Memory loss and confusion.

The health risks associated with drug and alcohol abuse are far more severe in elderly people. Falling down due to impaired coordination becomes more likely, the chance of mixing prescription medication with harmful substances increases, withdrawal symptoms become more dangerous (especially from opioid painkillers, alcohol, and benzodiazepines), the chance of fatal overdose is heightened, and the already dangerous results of abusing substances is far worse in seniors. 

Statistics of drug and alcohol abuse in seniors

While many assume that alcohol and drug abuse and addiction are rare in older adults, there are many statistics to suggest this isn’t the case, including:

• While illicit drug use typically declines after young adulthood, nearly 1 million adults aged 65 and older live with a substance use disorder (SUD) ^[2]
• While the total number of SUD admissions to treatment facilities between 2000 and 2012 differed slightly, the proportion of admissions of older adults increased from 3.4% to 7.0% during this time.^[3]
• Alcohol is the most used drug among older adults, with about 65% of people 65 and older reporting high-risk drinking, defined as exceeding daily guidelines at least weekly in the past year.^[4]
• more than a tenth of adults age 65 and older currently binge drink^[5]
• One study documented a 107% increase in alcohol use disorder among adults aged 65 years and older from 2001 to 2013.^[4]
• Nine percent of adults aged 50-64 reported past-year marijuana use in 2015-2016, compared to 7.1% in 2012-2013.^[6]
• The use of cannabis in the past year by adults 65 years and older increased sharply from 0.4% in 2006 and 2007 to 2.9% in 2015 and 2016.^[7]
• Between 4-9% of adults age 65 or older use prescription opioid medications for pain relief.^[8]
• The proportion of older adults using heroin—an illicit opioid—more than doubled between 2013-2015 ^[9]
• The proportion of people aged 55 and older seeking treatment for opioid use disorder increased nearly 54% between 2013 and 2015.^[9]

Prescription drugs and older adults

Chronic health conditions tend to develop more frequently in senior citizens as standard levels of health decline, leading to more prescriptions of potentially addictive painkillers and other drugs being administered by doctors. One study of 3,000 adults aged 57-85 showed common mixing of prescription medicines, nonprescription drugs, and dietary supplements. More than 80% of participants used at least one prescription medication daily, and nearly half used more than five medications or supplements, putting at least 1 in 25 people in this age group at risk of substance misuse and dependence.^[10] 

Other risks could include accidental misuse of prescription drugs and the possible worsening of existing mental health issues. For example, a 2019 study of patients over the age of 50 noted that more than 25% who misuse prescription opioids or benzodiazepines expressed suicidal ideation, compared to 2% who do not use them, underscoring the need for careful screening before prescribing these medications.^[11]

Why senior substance abuse is misdiagnosed

Providers may confuse SUD symptoms with those of other chronic health conditions or with natural, age-related changes. Many are also prescribed medications to manage these conditions, including some which may be addictive in nature. Because of this, doctors may overlook signs that would indicate prescription drug abuse in older adults, including frequent doctor visits, running out of medication early, doctor shopping, or having multiple controlled medications prescribed.

Also, doctors and mental health professionals often have stereotypes of people with addiction as being young people who are engaged in illicit drug use. This makes them less likely to consider addiction in older adults, and more likely to overlook signs and symptoms of addiction.

Research is needed to develop targeted SUD screening methods for older adults. Integrated models of care for those with coexisting medical and psychiatric conditions are also needed. It is important to note that once in treatment, people can respond well to care.^[3]

Treatment for elderly substance abuse

Little is known about the best models of care for treating substance abuse in older people, but research shows that older patients have better results with longer durations of care.^[12] Ideal models include diagnosis and management of other chronic conditions, re-building support networks, improving access to medical services, improved case management, and staff training in evidence-based strategies for this age group.^[12]

Once a problem with drugs or alcohol has been identified there are a number of treatment options available. Some patients may benefit from less invasive outpatient treatment programs, whereas some will require medically assisted treatment to detox and inpatient rehab to effectively begin recovery. Some may also require specialist treatment for ongoing medical conditions that can be exacerbated by recovery (from severe withdrawal symptoms, for example) and others may have co-occurring mental health conditions that also need treatment.

Final thoughts

Addiction is a common issue affecting Americans, including people who are over the age of 65. Substance use disorders and addictions often go unnoticed and undiagnosed in older adults, which reduces the likelihood that they will get the treatment they need. If someone you know is elderly or vulnerable and is suffering from alcohol or drug addiction or abuse, then contact a treatment provider today to see what avenues of help are available.