Elderly individuals (people over the age of 65) are vulnerable to substance abuse like any other group of people.
If you are older and need help for a substance use disorder, you will respond to treatment the same as anyone else, but there may be some special modifications you require.
Reasons Elderly People Abuse Drugs or Alcohol
Research studies have suggested that people who are 65 or older have lower rates of substance use disorders than younger age groups. However, particular challenges which occur with age that may predispose some people to drink or use drugs.
According to the book The American Psychiatric Publishing Textbook of Geriatric Psychiatry, older people face specific life challenges that can lead to them engaging in alcohol or drug use. These include:
- Declines in physical health, strength, and mobility
- Loneliness or feelings of isolation due to the loss of a life partner, friends, or relatives
- Boredom
- A loss of a sense of purpose
- Lack of strategies or coping skills to deal with life changes
- The onset of psychological problems like depression
- A previous history of substance use or abuse
Most Salient Risks
Of the above-listed factors, the two most salient are a history of a prior substance abuse problem (or some other mental health diagnosis) and significant feelings of loss due to losing a partner, close friends, or family members.
It is rare that a person will suddenly develop some form of mental illness like depression, an anxiety disorder, bipolar disorder, an eating disorder, or some disorder for the first time after they are 65 years old, but there are certain age-related disorders that can increase the risk for substance abuse, such as problems with memory, reasoning, and other cognitive issues.
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Indicators of Substance Abuse in an Older Person
The diagnostic criteria used to identify official substance use disorders that have been developed by the American Psychiatric Association (APA) are valid over all age groups. Thus, the formal diagnosis of a substance use disorder in someone over the age of 65 would require that they meet the same criteria that someone younger would have to meet.
If you suspect that an older person may be abusing alcohol or drugs, there are some other indicators that can serve as red flags.
- Secretive or solitary use of alcohol
- Adhering to a schedule of drinking alcohol before, during, and after meals
- Displaying decreased attention to grooming, hygiene, or self-care.
- Becoming more isolated from others
- Mood swings that can range from irritability to depression
- Decreased interest in social activities or hobbies that were once important
- Health complaints
- Frequent falls, slurred speech, or cognitive problems, such as memory loss
Substances Abused by the Elderly
Based on reports from the National Institute on Drug Abuse (NIDA), APA, and the yearly data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), the most common substances of abuse in people who are over the age of 65 are:
- Alcohol, with alcohol use disorders being the most common substance use disorder in individuals over the age of 65
- Tobacco products
- Benzodiazepines, which are frequently prescribed for older adults to help with sleep, control anxiety, and manage seizures
- Prescription pain medications, such as opioids to address chronic pain
Different Effects
People over the age of 65 do not respond to prescription drugs and alcohol the same
way they did when they were younger. Their metabolisms are typically slower, and
they have less tolerance for the substances. When they combine different types of
medications, such as benzodiazepines and alcohol, there is a significant risk for
overdose or other problems, such as severe lethargy or sedation that can lead to
accidents.
One of the highest rates of alcohol use disorders occurs in elderly individuals —
those over the age of 75 who have lost a life partner.
High rates of substance use disorders may be prevalent among nursing home
residents. It is believed that a significant portion of hospital admissions of elderly
individuals may be related to drug or alcohol abuse.
Abuse May Be Overlooked in Elderly People
Substance abuse issues are often overlooked and underreported in elderly individuals. Some of the symptoms listed above may be attributed to other factors like cognitive decline, physical deterioration, or the result of using multiple medications to address numerous physical issues.
Sometimes, elderly people forget if or when they took their medications and may wind up taking too many of them. This can be problematic if they are using alcohol and/or if they are prescribed benzodiazepines or some other prescription central nervous system depressant.
Elderly individuals often believe that prescription medications are not harmful because a doctor prescribed them. They may need to be instructed on the potential dangers of some of the medications they use.
Treatment for Older People
NIDA and APA consider the standard treatment protocols for substance use disorders just as appropriate for older individuals as they are for other individuals. If you know someone who is age 65 or older and needs treatment for substance abuse, there are some considerations to keep in mind.
- Any treatment protocol to address substance abuse should be appropriate for the person’s physical condition, cultural background, and age.
- No single treatment that works for everyone.
- Some elderly individuals may have conditions that restrict them from benefitting from certain treatment interventions.
- For treatment to be effective, it must be delivered for an adequate amount of time.
The essential components of an effective treatment program for elderly clients involve:
- Respect for the client
- Treatment providers build a strong, personal and therapeutic relationship with the client
- Specialized and targeted assessment and treatment protocols
- Communicating all aspects of treatment to the client effectively
- Emphasizing social support in recovery
How to Structure Treatment for Older Individuals
Although the overall approach used to treat older individuals for substance use
disorders is the same as it is for other groups, many older adults need to be
educated regarding the particulars of treatment interventions.
Treating substance abuse is not like treating many other disorders that the older
generations encounter. In this context, they are told to take some medication and
come back later. Treatment for substance abuse requires that the person is heavily
involved in treatment, changes their ways of thinking, and alters their habits.
- The treatment program should have a substantial psychoeducational component.
- Treatment providers should be specially trained to deal with geriatric issues.
- Some elderly individuals might not understand the need to attend substance use disorder therapy.
- Elderly individuals will most likely do better in groups that contain many members who are within their age bracket
- The use of peer support groups like Alcoholics Anonymous that contain many other over 65 members can be beneficial.
- It is important to incorporate substance use disorder treatment into the client's care routine.
- Older individuals might benefit from integrated treatment protocols where numerous specialists work with them on different issues.
Things to Look for in Recovery
- Look for addiction medicine physicians and therapists who specialize in treating older and elderly individuals.
- Find peer support groups or community groups that have people of the same age bracket in the group.
- Discuss the issue of substance abuse with the person’s primary health care physician.
- If possible, get other family members or close friends involved to support the person in their recovery program.
There are addiction treatment options for people over the age of 65. All it takes is a little research and asking questions of health care providers to find the most suitable treatment plans for the elderly.
(2015) The American Psychiatric Publishing Textbook of Geriatric Psychiatry. American Psychiatric Publishing. from
(2013) The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. American Psychiatric Association. from
(January 2918). Are there specific drug addiction treatments for older adults? National Institute on Drug Abuse. (Retrieved April 2019 from from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/are-there-specific-drug-addiction-treatments
(October 2018). National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. Retrieved April 2019 from from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf
(June 2015). Substance abuse among the elderly: What works in treatment. California State University, San Bernardino CSUSB Scholar Works. Retrieved April 2019 from from https://scholarworks.lib.csusb.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=1192&context=etd