Seniors & Addiction
Last Updated Dec 2, 2021
Prescription drug abuse and alcohol abuse are more common in older adults than is often recognized. In fact, the problem of addiction among seniors is quickly becoming a national health crisis.
People aged 65 and older, often referred to as senior citizens or elderly, make up nearly 17 percent of the United States population. It is projected that there will be more than 73 million older adults in the U.S. by 2030.
Close to 9 out of ten older adults, ages 65 and older, take at least one prescription medication. More than half take four or more prescription meds. Up to half of senior citizens do not take these drugs as directed by their doctor, meaning they misuse or abuse these prescription medications.
Drug and alcohol abuse and addiction are most commonly thought of as issues for younger adults and teenagers. The prevalence of these issues in older adults is regularly overlooked and underreported, although the risks and dangers for this demographic are often higher and more concerning.
Key Facts About Addiction in the Elderly
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that more than 1 million older adults, ages 65 and older, in the United States had a substance use disorder in 2014. More recent data on this demographic is difficult to come by, but it is believed that these numbers are likely higher today than they were then. Addiction in the elderly is likely underreported.
Senior citizens, ages 65 and older, also abuse drugs at relatively high rates — 2.1 percent misused illicit drugs other than marijuana. The National Survey on Drug Use and Health (NSDUH) for 2018 reports the following among seniors:
- 5.7 percent misused illicit drugs in the prior year.
- 4.1 percent used marijuana in the prior year.
- 1.3 percent misused pain relievers in the prior year.
- 0.6 percent misused tranquilizers or sedatives in the prior year.
- 0.7 percent misused benzodiazepines in the prior year.
- 1.3 percent misused opioids in the prior year.
- 10.7 percent engaged in binge drinking (five or more drinks in a sitting for a man and three or more for a woman) in the prior year.
- 2.5 percent drank heavily (five or more episodes of binge drinking a month) in the prior year.
- Close to 2 percent had a substance use disorder involving drugs or alcohol in the prior year, 1.6 percent had an alcohol use disorder, and 0.4 percent had an illicit drug use disorder.
Breaking Down Substance Abuse Among Senior Citizens
While drug and alcohol abuse and addiction are most common in younger adults between the ages of 18 and 25, senior citizens are a regularly overlooked population for substance abuse and addiction. This population of older adults is particularly vulnerable to addiction, but substance abuse is regularly underreported and often unrecognized in this age group.
Rates of substance abuse and addiction in the elderly are rising, however. It is a hidden epidemic that is quickly becoming a public health crisis in the United States.
Senior citizens are commonly more isolated than younger adults, and medical professionals are not as quick to screen for problematic substance abuse that can lead to addiction. This is especially concerning considering that older adults often struggle with more medical ailments that require prescriptions of medications that can be highly addictive and prone to misuse.
There is also the issue of ageism in the medical field and with loved ones. There is often the concept that grandma or grandpa is entitled to their pills or drinks because they have “earned it” or that addressing concerns about substance use will detract from their quality of life.
Substance abuse is taking any prescription drug outside of how it is prescribed and directed, using illicit drugs, or regular binge and heavy alcohol consumption patterns. Addiction is when substance abuse becomes compulsive. The individual no longer can control their drug or alcohol use, and they are unable to stop using these substances.
What Are the Most Common Substances Abused by Elderly Citizens?
Alcohol is the most commonly used substance by older adults. In adults ages 65 and older in the United States, data from 2007 to 2014 shows over 16 million older adults drinking alcohol in the prior month and close to 3.5 million engaging in binge drinking.
Prescription drug abuse is also common in the elderly. Senior citizens are more likely to already be taking prescription drugs, often many at a time. This increases the risk for misuse and abuse. Elderly citizens abuse opioids and sedatives at the highest rates.
Alcohol is the most widely used addictive substance by nearly all demographics. It is socially acceptable, legal, cheap, and easily accessible.
Alcohol use in the American population, ages 60 and older, has increased in the past few decades. Studies indicate 20 percent of people between the ages of 60 and 64 reported current binge drinking, and 11 percent of those ages 65 and older reported binge drinking. Binge drinking is a potentially harmful method of alcohol use that can lead to issues with alcohol, including addiction.
Binge and heavy alcohol consumption are particularly harmful in the older population for a variety of reasons. First, metabolism changes with aging, and this can lower alcohol tolerance and increase its effects on the brain and body.
This means that an older adult will experience the effects of alcohol much more quickly than they did when they were younger. Drinking at rates they were once accustomed to can be more problematic, leading to a higher risk for injury, accident, and rates of dependence and addiction.
Additionally, alcohol commonly interacts with medications that elderly people take, which can compound the effects of each substance.
Surveys show that 9 out of 10 senior citizens take at least one prescription medication. More than a quarter of all prescription drugs sold in the United States are dispensed to adults ages 65 and older.
Older adults are highly likely to take medications for chronic conditions, such as pain, insomnia, anxiety, or muscle tension and joint issues. These medications used for these conditions all have elevated abuse and addiction potential.
These drugs also commonly interact with each other, which can raise the risk for an adverse reaction, overdose, and addiction. The most commonly abused prescription drugs by the elderly are opioids and sedatives, such as benzodiazepines, but opioid abuse is more prevalent.
Opioid drugs include both prescription pain relievers such as OxyContin (oxycodone), Vicodin (hydrocodone/acetaminophen), and morphine as well as illicit fentanyl and heroin.
One of the most common medical issues in older adults is chronic pain. Opioid medications are regularly prescribed to combat this issue.
Opioid drugs are highly addictive, and they have high abuse and diversion rates. A rise in opioid prescriptions leads to increases in opioid abuse and addiction. Problematic opioid use more than doubled in adults ages 50 and older from 2001 to 2014, for example.
Opioids are extremely habit-forming. Even when taken as directed, especially when combined with other medications, regular use can lead to dependence and addiction.
Opioids can create a pleasant and mellow “high” when active in the bloodstream. They can also trigger significant and difficult withdrawal symptoms and cravings when they wear off, which can lead to increased use, misuse, and addiction.
Sedatives, which commonly include benzodiazepines, are another type of common prescription medication taken and misused by senior citizens. These medications are prescribed for anxiety, as skeletal muscle relaxers, and for insomnia. They include Valium (diazepam), Xanax (alprazolam), and Ativan (lorazepam).
Like opioid medications, benzos are also extremely habit-forming. They have high rates of diversion, abuse, and addiction.
Benzodiazepines are central nervous system depressant drugs. Intoxication on a benzo can look very similar to being drunk on alcohol. When mixed with alcohol, the effects of both substances are heightened, which can increase the risk for falling down, injuries, overdose, and addiction.
Is it Hard to Tell if Senior Citizens Are Addicted?
Older adults take a lot of medications at a time. Many of these medications are highly addictive and can interact with each other, so it can be difficult to spot misuse.
Seeing senior citizens popping pills regularly is common, so it can be overlooked that these medications are not being taken as directed. Throw in ageism and the concept that senior citizens “deserve” their simple pleasures, and addiction can often be ignored or denied.
Older adults regularly suffer from mental health and medical conditions. These symptoms can often mask substance abuse and intoxication. For instance, memory issues like forgetfulness, cognitive decline, balance and coordination problems, mood swings, sleep difficulties, and eating and physical appearance changes can all be signs of aging as well as addiction.
Another factor to consider is social isolation. Senior citizens are often more isolated from family and peers, as spouses pass away, children move out and create their own lives, and friends start to drop off. It can be common for an older adult to spend more time at home and on their own instead of engaging in social activities or spending time with family as they once did. Because of this isolation, substance abuse problems and the development of addiction may not be caught in their early stages.
Most Common Symptoms of Substance Abuse in Senior Citizens
While it may be more difficult to spot signs of substance abuse in senior citizens, there are some specific physical, psychiatric, and social symptoms to watch out for. These can include the following:
- Increased tolerance for medications (needing to take more to get the same effects)
- Frequent accidents or injuries related to falls
- Mood swings that can be unpredictable
- Sleep issues and changes in sleep patterns
- Signs of cognitive impairment
- Hiding prescriptions or alcohol bottles
- Going to multiple doctors to get more prescriptions
- Slurred speech
- Changes in appetite
- Lack of motivation
- Increased secrecy and social withdrawal
- More mental health or medical problems
It is important to understand that many of these symptoms can also be the result of natural aging. If you suspect substance abuse in an older adult, it is helpful to address your concerns in a compassionate and empathetic manner.
What Are the Causes of Addiction for the Elderly?
Addiction is characterized by compulsive and chronic drug or alcohol use, and it is due to the regular and repeated abuse of these substances. Elderly individuals are a particularly vulnerable population for addiction due to some specific risk factors.
- Major life changes: Senior citizens often have to face the death of a spouse or loved one, divorce, children moving away, retirement, loss of mobility, and moving out of their homes. These can all be extremely stressful and triggers for substance abuse and addiction.
- Medical conditions: Elderly people commonly face physical health issues, illness, disease, or chronic pain, which can require the use of powerful and habit-forming medications. Drugs and alcohol may be used as a form of self-medication for untreated or undiagnosed issues. This raises the odds for addiction.
- Mental health problems: Aging can exacerbate anxiety, depression, and mental health conditions that can cause increased frustration and a desire to self-medicate with alcohol or drugs.
- Social isolation, abuse, and neglect: Increased time spent alone can influence moods and raise the odds of a substance abuse issue going unnoticed, which heightens the risk for addiction. Elder abuse and neglect can also result in substance abuse as a coping mechanism.
What Are the Risks & Dangers of Substance Abuse for Seniors?
Substance abuse is particularly hazardous for senior citizens, as the impact is going to be greater later in life. As we age, our metabolism slows down, and this means that drugs and alcohol will have a greater effect on the brain and body.
Even amounts that used to be easily tolerated before can now potentially have a much bigger impact. This increases the risk for a potentially life-threatening overdose.
Additional dangers of substance abuse for seniors include the following:
- Risk of falls, fractures, and injury: Bones are often frailer, so the impact of an accident can be much more damaging.
- Dangerous medication interactions: Senior citizens often take a variety of prescription medications already. Abusing substances can cause an adverse reaction with one or more of these medications.
- Higher incidence of mental health and/or medical complications: Substance abuse can compound mental health and medical conditions that already exist, making them worse or interfering with their treatment.
- Heightened risk for addiction: Lowered metabolism and greater impact of substances on the elderly brain and body can lead to drug dependence and addiction much more quickly than in younger adults.
Treatment Options for Senior Citizens Struggling With Substance Abuse
Compassion and sensitivity are imperative for substance abuse treatment in senior citizens. Programs that are age-specific and cater to this demographic can be optimal, as they will address specific issues related to elderly substance abuse and life circumstances.
Medical and mental health care are equally important. It is vital that all medical professionals are on the same page with identified health goals to ensure that all medications are safe and effective when used together.
Co-occurring mental health and medical conditions are common. All conditions will need to be managed together through a dual diagnosis treatment program for safety and overall health.
Treatment programs may include the following components:
- Medical detox
- Medical care and support
- Group and individual counseling and therapy
- Educational programming
- Nutritional support
- Sober recreational activities
- Family involvement
- Relapse prevention programming
- Support groups
Older adults often do not seek treatment in traditional settings. It is imperative to consider any specialty needs and offer alternative forms of treatment for elderly individuals. Some seniors may have physical limitations that will need to be considered when choosing a treatment program.
There is also an incorrect assumption that substance abuse issues do not need to be addressed in the elderly, and that many senior citizens consider their substance use to be private and will not seek help. Many seniors seek help for addiction every day.
Treatment improves overall quality of life and can extend life expectancy. There are many different options available specifically for older adults. Reach out for help today.
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Date Note: Prescription Drugs and Older Adults. (August 2019). Kaiser Family Foundation.
Aging and Drugs. (September 2022). Merck Manual.
A Day in the Life of Older Adults: Substance Use Facts. (May 2017). Substance Abuse and Mental Health Services Administration.
Substance Abuse Among Older Adults. (August 2014). Clinical Geriatric Medicine.
Older Adults. National Institute on Alcohol Abuse and Alcoholism.
Substance Abuse in Aging and Elderly Adults. (July 2012). Psychiatric Times.
Problematic Opioid Use Among Older Adults: Epidemiology, Adverse Outcomes, and Treatment Considerations. (September 2021). Nature Public Health Emergency Collection.
Older Adults and Substance Use Disorder. NC Department of Human Health and Services.
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