Substance Abuse in Older Adults

It’s much more than a casual drink or a pain pill now and again. More middle-aged and older adults are misusing alcohol, opioids, heroin, and marijuana. The National Institute on Drug Abuse reported in 2019 that rates of substance use had climbed in adults between 50 and 64 years old and in those 65 years and older in the previous decade. It's been called the "invisible epidemic."  But knowing what to look out for can help you protect yourself or a loved one.

People face big changes later in life. They may feel stress and anxiety due to:

• Retirement
• Loss of loved ones
• Loneliness
• Sleep problems
• Family conflicts
• Financial concerns

Some turn to alcohol or drugs to soothe worries and fill the time. Also, baby boomers (those born between 1946 and 1964) came of age when opinions about alcohol, marijuana, and other drugs were changing. Some kept those views as they aged.  

Among people 50 and up with substance abuse problems, men are more likely to abuse alcohol. Women are more likely to abuse prescription drugs. You're at a higher risk of abusing drugs or alcohol in your later years if you:

• Are white
• Are a baby boomer (born between 1946 and 1964)
• Have a higher income
• Live alone
• Lost your spouse
• Retired unexpectedly or were laid off
• Have long-lasting (chronic) pain
• Are disabled
• Have a history of substance abuse or mental illness

Family, friends, and doctors often don't know when older people have a problem with alcohol and drugs. It's easy to mistake some symptoms for normal signs of aging. Once you retire, problem drinking or drug use doesn't interfere with your job. And more time alone makes it easier to hide substance use. Sometimes, people notice but ignore it, thinking it’s best for older people to keep doing what makes them happy.

When you age, your body reacts differently to alcohol. You may get drunk on less, and it takes longer to wear off. Alcohol interacts with many drugs that older people take. And it can make many medical conditions worse, such as:

• Diabetes
• High blood pressure
• Dementia
• Depression

Experts recommend that older people have no more than seven alcoholic drinks per week. More than that could signal problem drinking.

There are several reasons older people may have problems with prescription drugs:

• People over 65 take more prescription (and nonprescription) drugs than others.
• They might see several doctors, and take many medications that don't mix well.
• As you get older, drugs can have stronger side effects and stay in your body longer.  

Make sure your primary doctor has a list of all the medications you take, even over-the-counter ones.

About 4.2% of those 65 and older reported using marijuana in 2018, up from 2.4% in 2015. Cannabis has medical uses, such as pain relief. But it can also cause problems, especially in older people and those with heart disease. It may:

• Boost the effects of other drugs
• Hurt short-term memory
• Raise blood pressure, heart rate, and breathing rate
• Increase your heart attack risk just after you smoke it

Talk to your doctor before you try it.

Use of illegal drugs like cocaine and heroin (and marijuana, in some states) is much lower in people 50 and up than in younger people. But it's more common among this age group in the U.S. than almost anywhere else. It's especially dangerous because their bodies don't process drugs as quickly as when they were younger. This can lead to falls, accidents, and overdoses.

If you think you might have an alcohol or drug problem, first talk to your doctor. They can assess you, and help you find treatment if needed. Depending on your situation, it could include:

• A session with your doctor
• Medication
• Individual or group therapy
• A detox program
• Support groups

Treatment usually works even better for older people than for younger ones.

If you're worried about an older loved one's use of alcohol or drugs, talk to them about it. Be direct, but be kind and don’t judge. They might not realize they need help. They may say they are fine. But encourage them to talk to their doctor. If that doesn't work, consider asking their doctor, minister, or a longtime friend to approach them instead.