Substance misuse among older adults represents a significant public health issue that is often overlooked or misdiagnosed. This demographic is increasingly vulnerable to issues related to drugs and alcohol, primarily due to the physiological changes that accompany aging and the high prevalence of chronic conditions requiring medication. Understanding the specific substances most often involved in misuse is an important first step toward addressing this under-recognized problem.
Prescription Drugs as Primary Concerns
Prescription medications, particularly psychotherapeutic agents, are the most frequently misused drugs in the older adult population. Approximately 85% of older adults take at least one prescription medication daily, increasing their exposure to potentially addictive substances. Misuse often begins not with the intent to get high, but as a consequence of taking medications initially prescribed for legitimate health issues, leading to dependence that is often missed.
Opioids are a primary concern, commonly prescribed to manage chronic pain stemming from conditions like arthritis or degenerative diseases. Misuse of these pain relievers, such as oxycodone or hydrocodone, has been steadily increasing in this age group. Misuse can lead to respiratory issues, cognitive impairment, and severe constipation, which is particularly dangerous for older adults.
Another category of concern is central nervous system (CNS) depressants, mainly benzodiazepines and sedative-hypnotics, prescribed for anxiety and insomnia. Benzodiazepines like alprazolam (Xanax) and lorazepam (Ativan) can cause severe sedation, impaired coordination, and an increased risk of falls and fractures. Because older adults have a slower metabolism and higher ratio of body fat, these drugs accumulate in the body and have a longer duration of action. This raises the risk of accidental overdose or dependence.
The problem is compounded by polypharmacy, defined as the regular use of five or more prescriptions. Nearly 40% of older adults take five or more medications daily, dramatically increasing the risk of adverse drug interactions and misuse. Misusing prescription drugs in this context can trigger a “prescription cascade,” where side effects are mistaken for a new illness, leading to another unnecessary prescription.
Alcohol Misuse and Age-Related Risks
Alcohol remains one of the most frequently misused substances among older adults, with around 10.7% engaging in binge drinking. Misuse falls into two categories: those with a lifelong pattern of heavy drinking and those who develop late-onset misuse. Late-onset misuse often starts as a way to cope with major life changes, such as bereavement, social isolation, or loss of purpose following retirement.
The aging body processes alcohol differently, leading to increased sensitivity to its effects. After age 65, the body’s lean muscle mass and total water content decrease, meaning the same amount of alcohol results in a higher blood alcohol concentration. Alcohol also stays in the system longer due to slower metabolism, increasing the likelihood of intoxication and impairment.
Alcohol consumption significantly increases the risk of falls, accidents, and fractures. It can also worsen existing chronic conditions, including diabetes, high blood pressure, and liver problems. Furthermore, alcohol has dangerous interactions with numerous prescription and over-the-counter medications that older adults commonly take, potentially leading to dangerous over-sedation and respiratory complications.
Other Commonly Misused Substances
Beyond prescriptions and alcohol, Over-the-Counter (OTC) medications pose a significant and often underestimated risk. Older adults are the largest consumers of OTC products. Misuse is frequently unintentional, resulting from a lack of awareness regarding drug interactions or dosing instructions.
Commonly misused OTC drugs include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, high-dose acetaminophen, and sleep aids containing diphenhydramine. Unintentional misuse involves drug-drug interactions, where an OTC medication interacts with a prescription drug, or drug-age interactions, where the drug is unsafe for an older person. For instance, combining high-dose acetaminophen with alcohol can cause liver damage, and many cold and allergy medications increase confusion or sedation.
Illicit drug use is generally lower than in younger age groups, but it is present. Cannabis use, in particular, is on the rise among older adults, often linked to changing legal access and the perception that it helps with pain or anxiety. The aging body’s increased sensitivity to psychoactive substances makes users more vulnerable to adverse effects like dizziness, anxiety, and impaired coordination.
Unique Factors Driving Vulnerability
Older adults are highly susceptible to substance misuse due to a combination of biological and social factors unique to aging. Age-related metabolic changes are a major biological driver, altering how the body absorbs, distributes, and eliminates drugs. Slower liver and kidney function means drugs are processed and cleared more slowly, leading to higher concentrations in the bloodstream and increased risk of toxicity and dependence.
Polypharmacy dramatically raises vulnerability, requiring the management of complex medication regimens. This can easily lead to unintentional misuse, such as incorrect dosing or dangerous drug combinations. The risk of drug-drug interaction is increased when multiple physicians are prescribing medications without full knowledge of the patient’s entire drug profile.
Social factors also play a substantial role, with isolation, grief, and loss of purpose acting as strong predictors of misuse. Retirement, the death of a spouse, and declining health can trigger feelings of loneliness, anxiety, or depression. Substance use may become a maladaptive coping mechanism to self-medicate these emotional pains.
The symptoms of substance misuse are often challenging to identify because they overlap with common age-related conditions. Symptoms like memory loss, confusion, poor coordination, and changes in mood are frequently misdiagnosed as normal aging, depression, or dementia. This diagnostic challenge means that substance use disorders often go unrecognized and untreated for long periods.