There is a common misnomer that substance use disorder only affects younger individuals. However, according to Gaudenzia’s most recent FrontLine Report, there was a 3% increase in treatment admissions among adults aged 55 and older in the most recent fiscal year, contributing to an overall 8% increase over the past two years for this age group.
Identifying Substance Use Disorder in the elderly can be challenging as they may have higher rates of exposure to potentially addictive medications, such as opioids, for health-related issues. Currently, roughly 1 million adults aged 65 and older are living with opioid use disorder. This high prevalence reflects both the medical necessity of pain management in older populations and the inherent risks of long-term opioid use, making it crucial for healthcare providers to carefully balance pain treatment with addiction prevention.
According to the Senior Living Organization, treatment admissions for adults aged 55 and older increased significantly from 109,412 in 2009 to 167,200 in 2020 (a 53% rise). During this period, the proportion of older adults among all people seeking treatment more than doubled, growing from 5% to 12%. Among this age group, alcohol remains the primary substance requiring treatment, followed by heroin.
There are several key factors at play when understanding the reasons behind the increase and ways to differentiate substance use disorder from age-related health complications.
We sat down with Bill Wilson, Chief Program Officer at Gaudenzia, to gain some insight on the recent trends and to better understand treatment options for older adults. From Bill’s point of view, “Cognitive Behavioral Therapy (CBT) might be effective among the older population, but we may have to adapt our approach as this age group responds well to more direct language.” CBT combines cognitive therapy, a type of psychotherapy that deals with negative thoughts about oneself and the world, with behavioral therapy, which focuses on identifying and changing destructive behavioral patterns. “We need to closely examine how they became addicted to ensure our approach is customized for them, which may differ from traditional pathways.”
The rise in substance use among older adults is complex and multifaceted.
Easier Access to Drugs, Alcohol, and Tobacco at an Early Age
Recent research reveals a strong connection between early substance exposure and the severity of addiction in older adults. Studies show that individuals who began using substances before age 18 are significantly more likely to develop complex and persistent substance use disorders later in life. This early exposure often leads to more challenging treatment scenarios and a higher likelihood of prescription drug misuse in older adulthood.
The impact of early substance use can remain dormant for years, only to resurface during significant life changes or health challenges that commonly occur in older age. This delayed effect makes it particularly important for healthcare providers to understand a patient’s complete history with substances, as early exposure patterns can significantly influence treatment outcomes.
These findings emphasize why early intervention and prevention strategies are crucial for reducing substance use disorders among future older adults. Understanding this connection helps healthcare providers better anticipate and address potential substance use challenges before they develop into more severe problems.
Irregular Drug Use Due to Aging-Related Cognitive Issues
Research reveals that age-related cognitive changes significantly impact how older adults manage their medications and substances. As the brain ages, changes in memory, executive function, and information processing can lead to unintended medication misuse. Common challenges include difficulty remembering previous doses, confusion with complex medication schedules, and trouble comprehending detailed instructions.
The relationship between cognitive decline and substance use is bidirectional. While cognitive impairment can lead to medication mismanagement, substance use itself can accelerate cognitive decline. This creates a concerning cycle where declining cognitive function increases the risk of substance misuse, which in turn may further impair cognitive abilities.
Older adults experiencing both cognitive challenges and substance use disorders face particularly complex health risks. Their treatment needs often require specialized approaches that account for:
- Age-related changes in how the body processes medications
- Increased sensitivity to substance effects on brain function
- Greater vulnerability to adverse drug reactions
- Need for simplified medication management strategies that accommodate cognitive limitations
Potential Prescribed Drug Interactions
Health issues and chronic problems typically increase as individuals age, with studies showing that more than 40% of older adults use five or more prescription medications concurrently. This high rate of multiple medication use, known as polypharmacy, significantly increases the risk of dangerous drug interactions and potential misuse. These prescribed drugs can lead to an increased likelihood of addiction and/or dependence, potentially causing serious health issues, depression, anxiety, and cognitive impairment.
Therefore, it is vital that healthcare providers identify and differentiate substance use disorders from age-related health complications (i.e., physical, or mental health problems), and effectively refer these patients for treatment.
Abusing Prescription Medication
Prescription medication abuse among older adults has become increasingly complex, influenced by factors like rising healthcare costs and the challenges of managing multiple medications. While some may be tempted to share prescriptions or use leftover medications to manage health issues or reduce expenses, this practice carries significant risks.
The dangers of using another person’s prescription are particularly severe for older adults because:
- Medication dosages are carefully calculated based on individual factors like age, weight, kidney function, and other health conditions
- Drug interactions become more dangerous with age due to changes in how the body processes medications
- Existing health conditions can be severely complicated by inappropriate medication use
- The risk of adverse reactions increases with age
To prevent prescription medication abuse, healthcare providers recommend these essential safety practices:
- Maintain an up-to-date list of all current medications and supplements
- Use medication management tools like pill organizers or digital reminders
- Regularly review medications with healthcare providers to ensure they’re still necessary
- Properly dispose of expired or unused medications through authorized take-back programs
- Never share prescriptions, even with family members who have similar conditions. Throw out all expired medications
Stress
Stress remains a key risk factor in addiction and relapse, with recent studies highlighting how age-related changes in brain chemistry, particularly affecting mood-regulating neurotransmitters like serotonin and dopamine, can increase vulnerability to substance use disorders. Social isolation and reduced family support have emerged as significant contributors to substance use among older adults, often leading to loneliness, depression, and anxiety. Stressful life events, combined with poor coping skills impact the risk of addiction by increasing impulsive response and self-medication.
Facing substantial changes in life such as financial strain, retirement, grief, loneliness, and a loss of independence adds a great deal of stress and anxiety which may lead to substance use.
Some surprising factors that can lead to addiction are related to how we live. These include longer life expectancy, young adults staying with their parents after school, and grandparents becoming the main caregivers of their grandchildren.
Some may feel turning to drugs and alcohol will help alleviate these worries and help cope with their added stress and anxiety. Others may simply have different views on drugs and alcohol as the general perceptions and opinions on substance use began changing in their formative years.
While it may not be possible to eliminate stress, it is important to find ways to manage it. Consider meditation, journaling, breathing exercises, physical activity, etc. and find what works best for you.
Gaudenzia treats people 18 years and older with an evidence-based treatment model that integrates three of the industry’s most studied and validated therapeutic approaches; Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), and Relapse Prevention Therapy (RPT). Our treatment services for individuals with substance use disorder and co-occurring disorders include Comprehensive Assessment, including Psychiatric Evaluation:
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- Individualized Treatment Planning
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- Individual and Group Counseling
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- Integrated Medical and Psychiatric Care
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- Medication Management
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- Case Management and Care Coordination
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- Referral to Housing and Supportive Services
Too often the problems with substance use and co-occurring disorders among the older population go unnoticed. It is easy to mistake these symptoms for normal signs of aging. Research shows that older adults have better results with longer durations of care, including medication management, support networks, and access to services in evident-based strategies. The most effective way to help someone with substance use is to intervene early before the condition can progress.
If you or someone you love needs treatment for substance use and co-occurring disorders, please call Gaudenzia’s 24-hour Treatment and Referral HelpLine at 833.976.HELP (4357) or email HelpLine@gaudenzia.org
Key Questions About Substance Use in Older Adults
How can elderly patients safely manage chronic pain without developing dependency on prescription painkillers?
Managing chronic pain in older adults requires a balanced approach. Healthcare providers often recommend combining prescribed medications with non-pharmacological treatments such as physical therapy, meditation, or acupuncture. It’s crucial to work closely with your healthcare team to develop a personalized pain management plan that considers your overall health, existing medications, and risk factors for dependency. Regular monitoring and open communication about pain levels and medication effectiveness help prevent the development of tolerance and dependence.
What are the unique withdrawal symptoms that older adults may experience, and how do they differ from those of younger individuals?
Older adults often experience more severe and prolonged withdrawal symptoms due to age-related changes in how their bodies process substances. Common symptoms include increased confusion, balance problems, and heightened sensitivity to pain. These symptoms can be particularly dangerous because they may be mistaken for other age-related conditions. Additionally, underlying health conditions and multiple medications can complicate the withdrawal process, making medical supervision essential for safety.
How does marijuana use affect older adults differently, particularly those with existing mental health conditions or functional impairments?
Marijuana affects older adults more intensely due to changes in metabolism and brain chemistry. For those with existing mental health conditions, marijuana can exacerbate symptoms of anxiety or depression and may interact with psychiatric medications. Functional impairments may become more pronounced, particularly affecting balance, coordination, and cognitive function. The risk of falls and confusion increases, especially when combined with other medications. Regular use can also impact memory and decision-making abilities more severely than in younger adults.
Why do older adults develop drug tolerance more quickly, and what role does this play in substance use disorder?
Age-related changes in metabolism and body composition cause older adults to develop drug tolerance more rapidly. As the body becomes less efficient at processing medications, it may require higher doses to achieve the same effect, leading to a faster development of physical dependence. This accelerated tolerance development, combined with increased sensitivity to substances, creates a particularly dangerous cycle that can quickly progress to substance use disorder if not carefully monitored.
How can families distinguish between normal aging-related changes and potential signs of substance use disorder in elderly loved ones?
While some behaviors may appear similar, certain signs can help differentiate between normal aging and potential substance use disorder. Watch for sudden changes in sleep patterns, unexplained mood swings, increased isolation, or new financial difficulties. Other red flags include requesting early medication refills, visiting multiple doctors for the same symptoms, or changes in personal hygiene and home maintenance. If these signs appear alongside memory issues or confusion that seem to fluctuate throughout the day, it’s important to discuss these concerns with healthcare providers.