Substance Abuse Among Older Adults: Facts And Resources

Although drug addiction impacts people of all ages, few people consider the impact of substance abuse on older adults.

However, many older people do experience addiction, which can create unique concerns and consequences for aging brains and bodies.

According to the National Institute on Drug Abuse (NIDA), 1 million adults ages 65 and older experience substance abuse in the United States.

Signs Of Drug Abuse In Older Adults

Detecting the signs of drug abuse can become difficult, as people with addictions often hide their substance use from loved ones.

In older adults, noticing addiction can become especially difficult, as some symptoms of drug abuse may mimic common signs of aging.

Some signs of addiction among older populations include:

• sleep disturbances
• mood changes
• cognitive difficulties
• unexplained injuries
• increased prescription medication tolerance
• blackouts
• financial difficulties
• social isolation
• aggression
• secrecy
• strained relationships with loved ones

Causes And Risk Factors Of Drug Addiction Among Older Adults

Generally, older adults are less likely than young people to misuse drugs and alcohol. As people age, factors such as risk-taking behavior decline, providing some protection against addiction.

However, older adults still experience certain risk factors that can increase their chances of substance misuse.

Co-Occurring Mood Disorders

Research shows different results on the prevalence of mood disorders among older adults.

According to NIDA, older adults are more likely than younger adults to experience mood disorders.

Other studies indicate that older adults are less likely to experience severe mood disorders such as bipolar disorder.

However, research on mental health among older people indicates that when these adults do experience mood disorders, they experience more negative health outcomes as a result.

Mood disorders, which are conditions that cause persistent negative feelings, are associated with substance abuse and addiction.

The exact link between these issues remains unclear, but many researchers believe that people with mood disorders often use substances as a form of self-medication.

Memory Issues

As the brain ages, people often experience memory loss. Older adults may struggle to form new memories, and they may lose some long-term memories as well.

The loss of short-term memory may increase a person’s risk of drug abuse.

For instance, an older adult may accidentally double their dose of a prescription after forgetting that they have already taken their medication.

Older adults may also forget about certain drug interactions, which may cause them to mix substances that should not be combined.

Social Difficulties

People in the older population experience more social difficulties than younger adults, often experiencing loneliness and isolation.

Social isolation is a risk factor for substance abuse, as people may use substances to compensate for feelings of disconnection.

Major Life Changes

According to NIDA, major life changes such as moving to a new home or losing a loved one are risk factors for substance use and addiction.

Older adults often experience several major life changes within a short timeframe.

Some of these changes include:

• grief and loss
• age-related bodily changes
• cognitive decline
• new health difficulties
• moving to new environments such as assisted living facilities

These changes create stress, and people may abuse drugs and alcohol to cope with that stress.

Types Of Drugs Used By Older Adults

People who experience addiction, including older adults, may abuse any number of substances. However, older adults abuse some substances at higher rates than others.

According to NIDA research, these substances include alcohol, marijuana, opioids, and other prescription medications.

Alcohol

Alcohol is the most commonly abused substance among virtually all demographics, including older adults.

As a legal substance, alcohol is widely available and easily accessible. NIDA states that 65% of people ages 65 and older report high-risk alcohol consumption.

Furthermore, more than 10% of older adults experience binge drinking.

Binge drinking equates to about five or more drinks in two hours for men, and four or more drinks in two hours for women, according to the National Institute on Alcohol Abuse and Alcoholism.

Marijuana

Marijuana use has also increased slightly among older adults, possibly due to increased legalization and the prevalence of medical marijuana.

Cannabis may provide relief for issues that older adults often face, including depression, appetite loss, and physical pain.

However, anyone who would like to use marijuana should consult their doctors first, especially if they have a history of addiction or other risk factors for substance abuse.

Though marijuana addiction is far more rare than other types of addiction, it is not impossible to develop a marijuana use disorder.

Opioid Medications

The opioid crisis in the U.S. has had a major impact on older adults, according to opioid addiction research.

Opioid medications work by attaching to the brain’s opioid receptors and interrupting pain signals.

As a result, they are often prescribed for chronic and acute pain conditions, which older adults experience more often than younger adults.

However, these medications are addictive, as they can also create a euphoric high.

In the early years of the opioid crisis, pharmaceutical companies de-emphasized the addictive nature of prescription opioids, leading doctors to prescribe them in large amounts.

As a result, many people, who did not receive warnings about the addictiveness of these drugs, developed opioid use disorders.

Heroin

In recent years, the U.S. government and many state governments have tightened opioid restrictions, and many doctors prescribe opioids less frequently.

As a result, some people who can no longer access their pain medication, including some older adults, turn to heroin for relief.

Heroin is an opioid that works similarly to prescription pain medications. However, it is illegal, unregulated, and stronger than many of these drugs.

It is important to note, though, that some prescription opioid drugs, particularly prescription fentanyl, are stronger than heroin.

Fentanyl creates a high risk of overdose and death, as it is often mixed into batches of street heroin and other drugs without the buyer’s knowledge.

Prescription Drugs

Older adults are prescribed medication at a higher rate than younger people.

Apart from opioids, some of these drugs may include:

• antidepressants
• cholesterol-lowering medications
• ACE inhibitors

The most commonly used medications among older adults are not inherently addictive.

However, when combined with alcohol, illicit substances, or addictive prescription drugs, they may metabolize differently in the body and cause adverse effects.

What Are The Consequences Of Substance Abuse Among Older Adults?

Little research has been done on the impact of substance abuse on older adults. Far more studies have focused on drug use among teens and young adults.

However, the available research does point to some specific risks and consequences.

Drug Metabolism Differences

As we age, our brains and bodies experience changes, including changes in metabolism and brain chemistry.

As a result, older adults tend to metabolize substances more slowly than younger adults, and these substances generally take longer to exit their bodies.

Though more research is needed on drug metabolism and substance misuse, the longer half-life of substances may alter the impact of drugs on older bodies.

Increased Thoughts Of Suicide

NIDA states that older Americans are more likely to consider suicide than younger peers, with older adult men experiencing the greatest risk.

NIDA further explains that misusing opioids and benzodiazepine drugs increases suicidal thoughts among people aged 50 and older.

However, using these drugs as prescribed by a doctor does not seem to exacerbate this risk.

Physical And Mental Consequences Of Drug Abuse

Addiction creates physical and mental health consequences for people of all age groups.

The health consequences of drug abuse vary, depending on the type of drug used and the method of drug consumption.

Addiction-related mental health struggles may include depression, anxiety, paranoia, and similar concerns.

Physical consequences may include heart problems, kidney failure, and physical changes in the brain.

Older adults, who may be more sensitive to substances, may experience prolonged or intensified consequences than others.

Furthermore, drug use may worsen the effects of age-related health concerns. For instance, impaired judgment may increase the risk of accidents and falls in people who already struggle with stability and balance.

Addiction Treatment Options For Older Adults

Older adults have several options when seeking addiction treatment. These include various levels of care and different substance abuse services.

Levels Of Care

Drug rehab centers provide different levels of care. Some provide multiple levels, while others may only provide one or two.

The right type of care depends on the person, their needs, and the substances they have used.

Medical Detoxification

When a person stops using drugs or alcohol, their body will begin detoxing from those substances.

This process can cause uncomfortable and sometimes dangerous withdrawal symptoms, which is why many people begin their recovery with medical detoxification.

During medical detox, a person receives doctor supervision and care as their body adjusts to the absence of substances.

Doctors may prescribe medications to mitigate withdrawal symptoms or help the participant taper off of a drug gradually.

Inpatient Treatment

During inpatient addiction care, participants remain at the treatment center for a period of time, often lasting between 30 and 90 days.

This is an intensive form of treatment that includes a structured schedule, individual and group therapy, meals, and recreation.

Residential Treatment

Residential treatment is similar to inpatient treatment, but it is less intensive and takes place in a home-like environment rather than a clinical setting.

Residential treatment often lasts longer than inpatient treatment, with many participants remaining in treatment for several months or longer.

Outpatient Treatment

Outpatient treatment occurs in three levels.

These levels are:

• partial hospitalization programs (PHP) — the most intensive available form of outpatient care
• intensive outpatient programs (IOP) — a slightly less intensive but still highly structured type of outpatient addiction treatment
• general outpatient care — the least intensive type of outpatient treatment

Often, outpatient rehab centers offer a “step down” approach, in which participants begin with PHP and gradually decrease the intensiveness of their treatment.

Best Approaches And Modalities For Older Adults With Addiction

Little research has been done on the best type of addiction treatment for older adults. However, the following types of substance abuse care may meet the unique needs of this demographic.

Group And Family Therapy

Older adults may benefit from group and family therapy, as well as support groups that include other older adults.

These types of therapy may mitigate the loneliness that older adults often experience. As loneliness is a common addiction trigger, group-based therapy modalities may serve as an effective form of relapse prevention.

Individualized Therapy Modalities

Older adults, like younger adults, benefit from individual therapy sessions while in recovery for substance abuse, and therapy can be personalized to the client’s individual needs.

Many types of evidence-based therapy are available to meet a wide range of needs. For example, a person dealing with trauma may benefit most from eye movement desensitization and reprocessing (EMDR).

People who struggle with internalized motivation, such as people with attention-deficit/ hyperactivity disorder (ADHD), may benefit from the external motivation of contingency management.

Because so little research has been done on addiction therapy in older adults, a personalized approach proves especially important with this population.

An older adult may respond to therapy differently than research may suggest, as the existing research may not account for their experiences.

Therefore, a treatment center that uses multiple modalities may be the most beneficial choice because it can tailor and adjust its approach.

Faith-Based Addiction Treatment

For many people in addiction recovery, faith and spirituality play a crucial role in their path to sobriety.

Faith may prove especially important for older adults in addiction treatment, as the majority of older U.S. adults are religious.

Faith-based rehab programs, such as Christian rehab programs, may benefit older adults who wish to incorporate their spirituality into their addiction care.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) involves the use of medication paired with therapy to facilitate addiction recovery.

One of the most common forms of MAT is opioid replacement therapy, in which a doctor prescribes a long-acting opioid medication to replace the drug that the person currently uses.

When used appropriately, these replacement opioids do not cause euphoria, but they do reduce or eliminate withdrawal symptoms.

MAT is often safer and more comfortable than quitting certain drugs “cold turkey.”

As a result, this type of treatment may work well for older adults, especially those who experience opioid dependency.

Treatment Challenges For Older Adults With Substance Use Disorders

In addition to the limited research available on older adults with addiction, this population faces several other challenges when dealing with substance use disorders (SUDs).

Overlap Between Substance Use Disorders And Signs Of Aging

As mentioned above, loved ones may miss the signs of addiction in older adults because many of these signs overlap with typical signs of aging.

For instance, a person who misuses alcohol may experience issues with balance and coordination, but these issues may also increase as we age.

As a result, loved ones may miss the signs of substance use in their older adult loved ones, which may delay or prevent these older adults from receiving care.

Limited Availability Of Specialized Programs

Addiction is an isolating disorder, and feelings of isolation can trigger alcohol and drug use.

Group therapy can mitigate these feelings of loneliness, but older adults may have fewer opportunities to participate in addiction groups.

When rehab centers provide specialized care for older adults, they may offer support groups for this demographic. However, few programs have this type of care.

As a result, when older adults participate in group therapy, other group members may be much younger than themselves.

Therefore, some older adults may struggle to relate to the rest of the group, which may increase feelings of isolation rather than alleviate them.

Disability And Chronic Health Conditions

Some disabilities commonly overlap with SUDs. Factors such as physical pain, discrimination, and inaccessibility can trigger alcohol and drug use.

As people age, they often experience increased chances of disability and chronic health conditions.

If rehab programs lack appropriate accommodations, they may prevent older adults with disabilities from receiving treatment.

Mental Illness And Addiction Stigma

Older adults may resist addiction treatment and other mental health services due to internalized stigma regarding mental illness.

SUD experts generally agree that addiction is a mental health disorder, much like depression, anxiety disorders, and similar conditions.

Although some stigma still surrounds mental health disorders, public attitudes are shifting considerably, and younger adults often have favorable views of mental health treatment.

Older adults, however, spent their formative years during a time when mental health treatment carried a much heavier stigma than it does today.

Addiction may carry an especially powerful stigma among older adults, whose religious communities may view substance abuse as a lack of self-control rather than an illness.

Tips For Preventing And Treating Substance Abuse Among The Older Population

Older adults, family members, and treatment providers have several factors to consider regarding substance abuse.

Because older adults have unique needs, these specific considerations can allow them to receive the most effective care.

Preventing Accidental Drug Misuse

Older adults, as well as family members and caregivers, can take steps to prevent accidental drug misuse.

For example, prescription timer caps, which display the length of time that has passed since the bottle was last opened, can prevent people from accidentally taking a prescription twice.

Specialized Treatment Programs

Rehab centers often offer specialized programs, such as addiction treatment for LGBTQ people, veterans, and young adults.

These programs recognize that various demographics face specific challenges and stressors, and they provide treatment that addresses those issues.

Rehab centers may implement specific programs for older adults as well, which can foster a sense of belonging.

Accounting For Age-Related Physical Differences

During addiction treatment for older adults, providers will want to remain aware of how age-related physical differences may impact the recovery process.

For instance, because older adults metabolize drugs more slowly than young people, those who undergo medical detox may need to remain in this treatment phase longer than other participants.

How To Choose Addiction Treatment For Older Adults

Choosing an addiction program can become daunting, especially for older adults and their family members.

Some specific considerations may help older adults and their loved ones find the right care.

For example, some addiction programs accept Medicare for SUD treatment. Older adults and their loved ones might start by looking for Medicare-accepting services.

Other ways to find addiction care for older adults include the following:

• Look for programs that offer specialized services, such as support groups made up of older adults.
• Look for MAT programs, especially for older adults who experience opioid abuse.
• Consider your or your loved one’s transportation needs.
• Choose a program that aligns with your or your loved one’s beliefs and values.
• Ask your or your loved one’s doctor for treatment recommendations.

Resources For Older Adults With Substance Abuse And Their Loved Ones

Addiction creates many difficulties, especially when it occurs in underrepresented communities. The following resources can help older adults, their loved ones, and care providers with SUD management.

These resources can help older adults and their loved ones find addiction care and mental health services:

• A.A. for the Older Alcoholic: In this large-print publication, older adults detail their experiences with alcohol use disorder and Alcoholics Anonymous.
• Behavioral Health Treatment Services Locator: This tool provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) helps people find local addiction and mental health treatment.
• National Council on Aging: The NCOA is a nonprofit organization that seeks to improve the lives of older adults. Its resources include behavioral health and substance abuse information.
• National Coalition on Mental Health and Aging: The NCMHA offers education, research, and other resources to improve the mental health of older adults.

The following resources can help caregivers, assisted living directors, and treatment providers support older adults with SUDs:

• E4 Center: This organization seeks to reduce mental healthcare disparities by providing training for people who serve older adults.
• Promoting Emotional Health and Preventing Suicide — A Toolkit For Senior Centers: This SAMHSA publication describes the warning signs of suicide in older adults and offers prevention-based activities.
• Treating Substance Use Disorder in Older Adults: This SAMHSA publication offers evidence-based treatment protocols for older adults with SUDs.

Written by the Addiction Resource Editorial Staff