Substance Abuse Among Older Adults

Articles > Substance Abuse Among Older Adults

     The problem of Substance Abuse among our older adult population can be considered a “hidden epidemic.”  Researchers are only beginning to realize the extent of substance abuse among people 60 and older.  Until relatively recently, alcohol and prescription misuse, which affects as many as 17 percent of older adults, was not discussed in either the substance abuse or the gerontological literature. 

     One reason for the “hidden” nature of the problem is that health care providers tend to overlook substance abuse and misuse among older people, mistaking the symptoms for those of dementia, depression, or other problems common to older adults.  In addition, older adults are more likely to hide their substance abuse and are less likely to seek professional help.  Stigma often accounts for the tendency to be ashamed of the problem and the choice not to address it.  The result is thousands of older adults who are in need treatment do not receive it.

     With aging, there often comes an increase of daily medication, maintenance drugs for such things as blood pressure, cholesterol,  and depression.  The excess use of alcohol by the elderly can disrupt their medical management. Repeated alcohol intoxication may interfere with immune mechanisms and increase the risk of infection. 

     Many relatives of older adults with substance abuse disorders, particularly their adult children, are also ashamed of the problem and choose not to address it.  Younger adults often unconsciously reflect an  indifferent attitude in remarks like, “Let Grandpa have his cocktail hour, it makes him happy.  Besides, at his age, it’s too late to change.”  There seems to be an unspoken assumption that it’s not worth treating older adults for substance abuse disorders.  Behavior considered a problem in younger people does not result in the same urgency for care among older adults.

   These attitudes are not only callous, they rest on misconceptions. Most older adults can and do live independently.  Furthermore, Grandpa’s cocktails aren’t cheering him up.  Older adults who self-medicate with alcohol or prescription drugs are more likely to characterize themselves as lonely, and report lower life satisfaction.   The alcoholism rate is appreciably higher in elderly men than in elderly women, about 5 to 1, because women live longer and seek medical care more often.  Even so, women alcoholics are more likely to be undiagnosed due to bias and social isolation.

     The reality is that misuse and abuse of alcohol and other drugs take a greater toll on affected adults than on younger adults.  In addition to the psychological issues that are unique to older adults,  aging also compounds biomedical changes that influence the effects that alcohol and drugs have on the body.  Alcohol abuse, for example may accelerate the normal decline in physiological functioning that occurs with age.  In addition, alcohol may elevate older adults’ already high risk for injury, illness, and socioeconomic decline.

     Those clinicians providing services to older adults will mainly encounter abuse or misuse of alcohol or prescribed drugs.  Abuse of heroin and other opioids is rare, although some older adults misuse over-the-counter drugs that have a high alcohol content, such as cough suppressants.  Many of these over-the-counter drugs negatively interact with other medications and alcohol.

     Health care and social service providers who currently care for Americans age 60 and older may be slow to spot a substance abuse problem.  In addition, physicians also miss the problem.  The amount of time physicians spend with a patient decreases as the age of the patient increases.  Not only do physician encounters become shorter, but problems related to alcohol and drugs increasingly compete for discussion time against other health problems.  During a short office visit, there are many topics to cover such as renewal of prescriptions, etc, that substance abuse ends up at the bottom of the list or not discussed at all.

      With older adults being one of the most vulnerable and fastest growing sectors of the population,    

it is important for clinicians, family members, and social service providers to continue to stay aware of the risk of substance abuse problems.   Caregivers must continue to focus on the need to recognize the problems and develop early interventions to address this “hidden epidemic.”