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Substance Abuse in the Elderly

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Medically Reviewed By: Diana Vo, LMFT

March 12, 2024

Table of Contents

Discovering how to detect the signs of substance abuse in the elderly means you’ll be better placed to help your parents, grandparents, or any other senior loved ones struggling with golden year addiction.

While research shows that teens and younger adults are at the highest risk of using addictive substances, substance abuse among the elderly is more prevalent than you might imagine. SAMHSA reports that 6.3 million over-65s in the United States have substance use disorder involving alcohol or illicit drugs.

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Regrettably, there is not much research being conducted in this area. The more you learn about how addiction impacts the elderly, the more easily you can help senior loved ones to pursue a health sober life. You can also more confidently determine whether they need professional treatment to kickstart their recovery.

How Addiction Affects Older Adults

Each year, SAMHSA (the Substance Abuse and Mental Health Services Administration) reports findings from NSDUH (the National Survey on Drug Use and Health).

The most recent data from NSDUH 2020 shows that:

  • 1.5% of substance use disorders (drug addictions) occur in those over-65s
  • 5% of alcohol use disorders (alcoholism) occur in those over-65s

Researchers are still exploring how drugs and alcohol affect aging brains. Some evidence suggests that older adults metabolize substances more slowly. Senior brains are also impacted more by the effects of addictive substances.

SAMHSA notes that older adults are more prone to the following conditions:

  • Mood disorders
  • Memory problems
  • Heart health complications
  • Lung problems

When seniors consume alcohol or drugs, this can inflame all the above conditions, leading to more severe negative health outcomes.

Many addictive substances from alcohol to opioids can impair coordination, slow reaction times, and trigger lapses in judgment. Many accidents like slips and falls or motor vehicle collisions tend to pose more serious risks for seniors than for younger adults. Most seniors also need much longer recovery times.

At any time, between 4% and 9% of the over-65s in the U.S. are prescribed opioid medications for the management of pain, according to NIDA (the National Institute on Drug Abuse). Research indicates that this represents a ninefold increase over the course of the opioid epidemic that has ravaged the United States since the last 1990s.

There is also some evidence linking cocaine use in early life to an increased vulnerability to adverse outcomes from the later use of cocaine.

Additionally, older adults developing alcohol use disorder or substance use disorder face all the negative consequences associated with addiction, withdrawal, and recovery.

Substance Abuse in the Elderly: Unique Issues and Concerns

The natural aging process brings with it many challenges to mental and physical health. When seniors abuse addictive substances, this typically exacerbates those issues.

This study exploring the potential health demands of elderly substance abuse highlights the following points:

Seniors metabolize alcohol and drugs more slowly and senior brains may be more sensitive to the effects of alcohol and drugs.

The WHO (World Health Organization) states that 20% of over-60s suffer from a neurological disorder or mental disorder. Mental health issues in later life can be precipitated by normal life stressors. Additionally, seniors face the following issues, all liable to negatively impact mental health:

  • Chronic pain
  • Loss of mobility
  • Reduced independence
  • Isolation
  • Bereavement
  • Drop in socioeconomic status

When seniors respond to those issues by self-medicating with substances, this initiates a vicious cycle. Misusing opioids or benzodiazepines is associated with a heightened risk of suicidal thoughts in the elderly.

Effects of Alcohol Addiction in the Elderly

As highlighted, seniors metabolize alcohol at a slower rate than younger adults. This leads to higher levels of BAC (blood alcohol concentration).

Not only do seniors become intoxicated more rapidly than younger adults, but seniors who report heavy drinking – more than 3 standard drinks per day – may also accelerate the development of cognitive decline and increase the risk of developing dementia.

Alcohol is a CNS depressant. Older adults who take medications like opioids or benzos when drinking alcohol will find the adverse outcomes triggered by both substances are enhanced.

Effects of Drug Use in the Elderly

Drug addiction is a chronic and relapsing brain disorder clinically classified as a substance use disorder.

Substance use disorder among seniors can increase the likelihood of mood disorders, memory problems, cognitive decline, falling, and car wrecks.

Substance Abuse and the Elderly Population Statistics

Substance abuse in the elderly population is summarized in the findings of SAMHSA’s NSDUH 2020:

  • 1.8 million seniors report heavy drinking
  • 5 million seniors report binge drinking
  • 1.5 million seniors meet the criteria for substance use disorder
  • 5.1 million seniors meet the criteria for alcohol use disorder

Unfortunately, only 27,000 connected with professional treatment for substance use disorder, and just 200,000 engaged with alcohol rehab, per the same data.

Here is a snapshot of three of the most commonly abused substances among the elderly demographic:

  • Opioids: Johns Hopkins University reports that up to 9% of the over-65s use prescription opioids for pain management. This study highlights the period from 2013 to 2015. In this period, the number of over-55s in the United States increased by 6%. During the same period, the number of over-55s connecting with treatment for opioid use disorder increased by more than 50%. Also, the number of seniors using heroin more than doubled in the same period. Some seniors no longer able to afford prescription opioids or unable to refill their prescriptions resort to using street heroin to dull the pain.
  • Alcohol: This analysis of studies shows that 65% of seniors reported drinking more than the CDC guidelines for moderate drinking. This is known as high-risk drinking. Research also indicates that 10% of seniors report binge drinking. Overall, a greater increase in alcohol consumption in 2020 was reported by those aged 50+ than among young adults.
  • Marijuana: In 2006, less than 0.5% of seniors reported using marijuana. By 2015, with laws concerning medical marijuana relaxing, almost 3% of seniors reported using marijuana. According to this study, 9% of adults aged from 50 to 64 reported previous year’s marijuana use.

What Can Older Adults Do to Fight Addiction?

If you are concerned about a senior loved one addicted to drink or drugs, it can be useful to consult a professional with experience in this field before confronting your family member. This could involve any of the following:

  • Doctor
  • Psychologist
  • Counselor
  • Social worker

Assemble the following information so the addiction professional can examine the situation as accurately and objectively as possible:

  • Brief life history of the senior
  • List of all prescribed and OTC medications the senior is taking
  • List of doctors the senior is seeing
  • The current condition of senior
  • Level of independence – can the seniors life alone and take care of themselves?
  • Health effects of substance use
  • List of concerned family members

Equipped with more knowledge, you can now raise the subject of substance abuse with your senior loved one, outlining the most effective forms of treatment for their needs.

For many elderly people with substance abuse issues, inpatient treatment offers the safest and most comfortable environment for detox, withdrawal, and early recovery. You can also find plenty of outpatient programs for seniors who don’t want or need to head to an inpatient facility. Remote therapy ensures that seniors with mobility or transportation issues can still connect with the care they need.

You may find that peer-support groups like AA and NA offer age-specific meetings in your area, allowing your elderly loved ones to surround themselves with other seniors undergoing similar experiences.

If your elderly family member is concerned about financing addiction treatment, all over-65s are automatically enrolled in the federal Medicaid program for health insurance. This may not cover the costs of residential rehab, but should provide for at least the outpatient treatment of addiction to drink or drugs.

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Elderly Substance Abuse Treatment

If you are concerned about a senior loved one who you feel could be abusing alcohol, prescription medications, or illicit drugs, the signs of addiction will vary depending on the substance of abuse.

The most common markers for elderly substance abuse include:

  • Anxiety
  • Depression
  • Social isolation
  • Loss of interest in favored activities
  • Aggression
  • Hostility
  • Drop in personal hygiene standards
  • Secretive behaviors
  • Memory loss
  • Confusion
  • Forgetfulness
  • Changes to physical appearance
  • Doctor or pharmacy shopping
  • Chronic health conditions
  • Extreme lethargy
  • Drowsiness

For seniors concerned about the need to head to residential rehab, there are many other options for recovery, including:

  • OPs (regular outpatient programs)
  • IOPs (intensive outpatient programs)
  • PHPs (partial hospitalization programs)
  • Virtual IOPs (remote outpatient programs)

Regardless of the intensity of treatment, seniors looking to engage with addiction treatment can access the following evidence-based therapies in rehab:

  • MAT (medication-assisted treatment): FDA-approved medications can help streamline the detox, withdrawal, and recovery process for both alcohol use disorder and opioid use disorder. MAT is most effective when utilized in combination with psychotherapy.
  • Psychotherapy: Informally known as talk therapy, approaches like CBT (cognitive behavioral therapy) and DBT (dialectical behavior therapy) can help seniors unravel the psychological aspect of addiction.
  • Counseling: Individual and group counseling sessions help seniors to learn more about addiction in general and their addiction specifically.
  • Holistic therapies: To supplement research-backed treatment, many treatment facilities offer a variety of holistic rehabs like meditation, mindfulness, and yoga.

It’s never too late to start making healthier lifestyle choices, so reach out if you need help for a senior loved one with substance abuse issues.



At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible. Give us a call today to verify your insurance coverage or to learn more about paying for addiction treatment.

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Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. Connect with Joe on LinkedIn.

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