Substance Use Disorders in Older Adults

Overview

People who have substance use disorder keep using alcohol or other substances even though it causes harm to themselves or others. People of all ages can have this disorder. They may misuse prescription or over-the-counter medicines, use marijuana or other drugs, drink too much alcohol, or mix alcohol and medicines. This can cause serious health problems and problems with money or the law. It also can harm their relationships.

Substance use disorder in older adults may be overlooked, because:

• Older adults are more likely to drink or use substances at home rather than in public.
• Older adults may not have duties that are affected by substance use, such as going to school or work.
• Symptoms of this disorder are similar to symptoms of health conditions that many older adults have, such as depression and dementia.
• Caregivers of older adults may be aware of the substance use but may not want to talk about it.

Alcohol

Alcohol use disorder can be dangerous for older adults. They:

• Usually need less alcohol to become drunk (intoxicated) than someone younger.
• Stay drunk longer, because their bodies process alcohol more slowly.
• May have vision and hearing problems and slower reaction times. Alcohol can make these problems worse. This means alcohol-related falls, car crashes, and other kinds of accidents are more likely.
• May be more likely to mix alcohol and medicine if they are taking a lot of medicines. Mixing alcohol with many over-the-counter or prescription medicines can be dangerous or even fatal.

In older adults, alcohol can trigger some health problems or make them worse. These include high blood pressure, ulcers, liver disease, anxiety, sleep problems, and depression.

Misuse of medicine

Older adults often have to take many medicines. This can easily lead to misuse of medicines. You misuse medicine when:

• You take too much medicine or take medicine when you don't need to.
• You use older medicines or another person's medicine.
• You take medicine in a way that's not prescribed, just to feel good or "high." This happens most often with medicines used to treat conditions such as depression, anxiety, or pain you have had for a long time (chronic pain).
• You take medicines while drinking alcohol.
• You don't take medicine as directed by your doctor. For example, you don't take enough medicine, you skip doses, or you don't get a prescription renewed.

Warning signs of substance use disorder

Below are some warning signs that an older adult may have substance use disorder, including changes in behavior and mental abilities. But it's important to note that these signs may not be related to substance use disorder. Many of them also can be signs of health problems that some older adults have. These include mental health problems, such as depression and anxiety.

Drinking alcohol, misusing medicines, or using marijuana or other drugs often starts after a big change in a person's life. Retiring, the death of a spouse or good friend, leaving your home, or being diagnosed with a disease can trigger substance use. If a life-changing event happens to a loved one, watch for signs of substance use disorder.

If you notice any of these signs in someone you care about, talk to the person's doctor. Tell the doctor about the person's substance use, including misuse of prescription and over-the-counter medicines. Tell the doctor about any substance use in the person's past.

Changes in behavior

Signs that may point to substance use disorder include:

• Falling a lot.
• Not being able to make it to the bathroom in time (incontinence).
• Having more headaches and dizziness than usual.
• Not keeping themself clean.
• Having changes in what and how they eat. For example, they may not eat as much as they used to.
• Ignoring and losing touch with their family and friends.
• Having legal or money problems.

Changes in mental abilities

Other signs that may point to substance use disorder include:

• Feeling anxious a lot of the time.
• Having memory problems.
• Finding it hard to focus or make decisions.
• Losing interest in their usual activities.
• Having mood swings or feeling sad or depressed.

Treatment

Treatment for substance use disorder in older adults is the same as for younger people. It may include detox, counseling, therapy, and substance use education. Medicines are often used to help control cravings, ease withdrawal symptoms, and prevent relapse.

If you have a problem with prescription medicine, it may help to talk to a doctor. Treatment may include learning more about your medicines and organizing how you take them. You may be able to work with your doctor to cut back on how many medicines you take or make it easier to take them.

Treatment works best when you accept that you have a substance use disorder and you want to get better.