Substance misuse among adults aged 65 and older is a growing public health concern that is frequently overlooked or misdiagnosed. The combination of demographic shifts and increased prescription medication use has created a vulnerable population where substance use disorders are on the rise. The issue is often hidden because the signs of misuse are frequently mistaken for normal aspects of aging or other health conditions. Understanding the specific substances and the unique factors driving misuse in later life is necessary for effective management and prevention.
Identifying the Most Abused Substances
Alcohol is the most commonly misused substance among older adults, with millions reporting past-month use. Rates of heavy drinking have increased in recent years, and nearly 1 in 20 adults aged 65 or older had an alcohol use disorder recently. A significant portion engages in binge drinking, defined as consuming four or more drinks for women or five or more drinks for men on a single occasion. Physiological changes accompanying aging mean that even moderate alcohol consumption can have a greater impact, increasing the risk of adverse health events.
Prescription medications represent the second major category of misuse, with opioids and benzodiazepines being the most problematic classes. Opioid analgesics, such as hydrocodone and oxycodone, are often prescribed for chronic pain, which affects a large percentage of older adults. Misuse can begin unintentionally, such as taking a higher dose than prescribed or running out of medication early, leading to dependency and addiction.
Similarly, benzodiazepines, including drugs like alprazolam (Xanax) and lorazepam (Ativan), are frequently prescribed to manage anxiety and sleep disorders. These central nervous system depressants increase the risk of falls, memory problems, and dangerous interactions with other medications or alcohol due to their sedative effects. Some older adults also misuse over-the-counter (OTC) medications, such as certain sleep aids or cold medicines containing psychoactive ingredients, often mixing them unknowingly with prescription drugs.
Unique Risk Factors in Later Life
Older adults are uniquely susceptible to substance misuse due to physical, medical, and psychosocial changes. Physiological changes significantly alter how the body processes substances, making them more potent and their effects longer-lasting. As people age, they experience a decline in liver and kidney function, which slows the metabolism and elimination of drugs and alcohol. Consequently, a standard dose for a younger person can lead to an unexpectedly high concentration and increased intoxication or overdose risk in an older adult.
Managing multiple chronic health conditions often results in polypharmacy, defined as the concurrent use of numerous medications. The number of prescriptions increases the likelihood of dangerous drug-drug interactions, even when substances are taken as directed. For example, the combined use of an opioid and a benzodiazepine is a common and dangerous combination that significantly elevates the risk of overdose.
Psychosocial factors also play a substantial role in driving misuse, often leading to self-medication for emotional pain. Major life transitions, such as retirement, loss of a spouse or friends, and social isolation, can create feelings of grief, loneliness, and a loss of purpose. Chronic pain and physical disability are more prevalent with age and further contribute to this vulnerability, as individuals may turn to substances to cope with physical discomfort and mental distress.
Recognizing Misuse: Symptoms and Challenges in Diagnosis
Detecting substance misuse in older adults is challenging because symptoms often overlap with common age-related conditions, leading to frequent misdiagnosis. Physical signs of misuse include frequent, unexplained bruises or falls, which are often attributed to frailty or balance issues rather than intoxication. Other physical indicators involve disrupted sleep patterns, general fatigue, and neglect of personal hygiene.
Behavioral and cognitive symptoms are also easily mistaken for normal aging, depression, or early-stage dementia. These manifest as increased confusion, memory lapses, mood swings, or heightened irritability and anxiety. A person may also withdraw from social activities, miss appointments, or show a loss of interest in hobbies and life events.
A major diagnostic hurdle is the tendency for healthcare providers not to routinely screen older patients for substance use disorders. This is often due to the belief that addiction is primarily a problem for younger populations. This ageism, combined with the fact that many older adults hide their substance use out of shame, means the problem frequently goes unnoticed. Routine screening and a high index of suspicion are necessary to differentiate a substance use issue from other medical or mental health concerns.
Prevention and Seeking Help
Effective prevention begins with careful medication management and open communication between patients and healthcare providers. Older adults should undergo regular prescription reviews where a provider checks all medications, including OTC drugs and supplements, for potential interactions and necessity. This “brown bag” audit helps identify medications that might be contributing to misuse or causing dangerous interactions.
Patients must be encouraged to discuss chronic pain, sleep difficulties, and mental health challenges openly. Providers should ensure these issues are addressed with non-addictive treatments first. Education on how alcohol affects the aging body and its interaction with common medications is a powerful preventative measure. Building and maintaining strong social networks can also reduce the feelings of isolation and loneliness that often lead to self-medication.
Recovery is possible for those needing intervention, with outcomes for older adults often being as good as or better than for younger people. Pathways for seeking help include specialized geriatric substance abuse programs that recognize the unique needs of this age group. Counseling, such as cognitive behavioral therapy, and participation in support groups provide the necessary tools and social support to maintain sobriety and improve overall quality of life.