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Older Adults and Substance Use Disorder

Substance abuse, particularly of alcohol and prescription drugs, among adults 60 and older is one of the fastest growing health problems facing the country. Yet, even as the number of older adults suffering from these disorders climbs, the situation remains underestimated, underidentified, underdiagnosed, and undertreated.

There is a lack of attention to substance abuse in older adults.  One reason is older adults disapproval of and shame about use and misuse of substances and a reluctance to seek professional help for what many in this age group consider a private matter. Many relatives of older individuals with substance use disorders, particularly their adult children, are also ashamed of the problem and choose not to address it. There is an unspoken but pervasive assumption that it's not worth treating older adults for substance use disorders. There is an impression that alcohol or substance abuse problems cannot be successfully treated in older adults, there is the assumption that treatment for this population is a waste of health care resources.

There are three reasons why aging Baby Boomers are more likely to use illicit drugs. One is cultural: Baby boomers grew up in an era when illicit drugs were widely available, and their use had a certain allure. Another reason is economic: Boomers are increasing their use of illicit drugs because the recession and its aftermath have heightened their anxiety about job security and retirement savings. A third reason is emotional: Aging boomers may turn to illicit drugs to cope with grief and loss issues such as the death of a spouse or the end of a career. (4)

National data indicates:

Of the 2.2 million adults age 50 and older:

  •  54 % used marijuana.
  •  28 % misused prescription drugs.
  •  17 % used other illicit drug. (5)

Here is a list of characteristics of older adults with substance use issues:

  • Older adults are grossly underserved.
  • Older adults do not seek services in traditional service settings.
  • Lack of awareness by professionals, society, family, and older adults prevent detection and treatment.
  • “Baby Boomers” have less hesitation about using substances recreationally and for coping with the aging process.
  • Alcohol is the drug of choice for older adults. One of the most damaging drugs to the human body, alcohols effects on physical health and cognitive functioning can be devastating to a body already facing changes in mobility and cognition as a part of the aging process.
  • People age 50 and older have lower tolerance for alcohol and a heightened response to over the counter and prescription medication.
  • More patients 65+ are admitted to hospitals for alcohol problems than for heart attacks.
  • About 1/4 of nursing home admissions occur because the patient is unable to manage their medications.
  • This misuse of prescription drug use indirectly causes up to 14% of hip fractures in seniors 60+.
  • 85% are currently taking at least one prescription drug.
  •  20% use tranquilizers daily.
  • Largest consumers of psychoactive drugs.
  • 70% use OTC medications daily.
  • Adults 65+ use 3 times as many medications as those under 65.
  • Older patients average 2 - 3 serious medication errors per month.
  • Even patients who understand and agree with treatment are only 75% compliant.
  • At least 40% don't follow prescription directions. (6)

Certain health problems are common in older adults. Heavy drinking can make these problems worse, including:

  • Diabetes
  • High blood pressure
  • Congestive heart failure
  • Liver problems
  • Osteoporosis
  • Memory problems
  • Mood disorders

Many prescription and over-the-counter medications, as well as herbal remedies can be dangerous or even deadly when mixed with alcohol.  Medications that can interact badly with alcohol include:

  • Aspirin
  • Acetaminophen
  • Cold and allergy medicine
  • Cough syrup
  • Sleeping pills
  • Pain medication
  • Anxiety or depression medicine (7)