Seniors and Drug Abuse: A Frighteningly Real Phenomenon

Older adults have not demonstrated high rates of drug or alcohol use over time as compared with younger adults. This has contributed to a misconception that seniors do not abuse alcohol or drugs. An ever-growing body of evidence suggests that drug and alcohol use and abuse among seniors has gone unnoticed for decades. The baby boom generation, which is currently in its 60s, faces some frighteningly real risks.

Seniors and Substance Use: The Facts

Drug and alcohol abuse is harmful at any age, but never more so than in seniors. The impact of alcohol-related injuries is much more severe, the general physical effects of drugs and alcohol are more serious, and dangerous medication interactions are a distinct and scary possibility. Below are some facts provided by the National Institute on Drug Abuse:

  • More than 2.5 million older adults suffer from a drug or alcohol problem.
  • The highest rate of alcoholism in the U.S. is observed in widowers over the age of 75.
  • Up to 11% of hospital admissions of older adults are due to alcohol or drug problems.
  • Older adults are hospitalized as often for heart attacks as for alcohol-related issues.
  • More than half of the people in nursing homes suffer from alcohol-related problems.
  • Seniors get almost 17 million prescriptions a year for tranquilizers, the most abused drugs.
Drug Abuse among seniors 2002-2011 chart

Why Do Seniors Abuse Drugs and Alcohol?

Elderly people turn to drugs or alcohol for many reasons. They retire and need to downsize to a smaller home. There’s the sheer boredom of retirement. Their children leave. Friends pass away. Physical and/or mental health suffers. A spouse of many years gets ill or dies. Apart from these, there are four main reasons the elderly abuse substances: by accident, because of tolerant attitudes, mental health issues, and because they are being abused.

Most seniors who abuse prescription drugs do so unwillingly. After all, they do take more medication than any other age group. According to data of the Substance Abuse and Mental Health Services Administration (SAMHSA), 33% of people between the ages of 57 and 85 use 5 prescriptions on average. This leads to a very real risk of mistakes. What is more, the number of people over 65 taking four or more prescription drugs at once rose from about 33% in 1988 to almost 50% in 2000.

The baby boomer generation has always been tolerant toward alcohol and drug use, and a large part of the population has a history of using illegal and illicit drugs. Americans born in the 1960 broke the record for frequency of illicit drug use, data of the national Monitoring the Future survey show – up to 80% of those surveyed admitted taking drugs.

An investigation by the Wall Street Journal revealed that many of them stopped doing drugs as they entered adulthood, but started again after experiencing some sort of trauma in their lives, such as job loss, divorce, or loss of a loved one. Other boomers never stopped using.

The coexistence of drug abuse and mental illness has been established in several studies, with prevalence estimated at 44% on average according to a study by Bartels published in the Journal of Dual Diagnoses. Every fourth elderly patient who is abusing drugs or alcohol suffers from comorbid depression. Anxiety disorders and cognitive disorders are common as well. They both occur in 10% to 15% of seniors who abuse drugs.

According to EADaily News Agency, almost 6 million seniors are abused every year. Most cases are not reported. Every year, an estimated 2.1 million older adults are victims of psychological, physical, or other forms of abuse. That’s one victim every few seconds. The connection with senior drug and alcohol addiction is undeniable. In 80% of the cases that are reported, the perpetrator is a close relative, a fact that makes the elderly even more vulnerable.

Early- and Late-Onset Addiction

According to the Office of Alcoholism and Substance Abuse Services, elderly persons with a substance use problem can be classified based on two general categories: early- and late-onset addiction. The former refers to people who have been abusing drugs or alcohol for many years and are over 65, while the latter develop addictions later in life.

Early-Onset Addiction

A study by Van Citters and Brockmann, published in the Journal of Dual Diagnoses, showed that early-onset abusers (where abuse started before they turned 65) tend to have many more mental and physical problems than their late-onset counterparts. Early-onset substance abusers make up 66% of alcoholic seniors. The reasons for this type of addiction involve tolerant attitudes toward drug and alcohol use, family conflict, and financial troubles. It is also more common among seniors without college degrees.

Late-Onset Addiction

Potential triggers for late-onset addiction (which developed after 65) include retirement, loss of income, death of a loved one, placement in a nursing home or relocation in general, trouble sleeping, and health decline. The most common health problems contributing to late-onset addiction are depression, major surgeries, and memory loss. Typically, late-onset abusers experience fewer physical and emotional health problems than early-onset ones. According to a study by Moos published in the Journal of Alcohol Health, they comprise 25% of all elderly patients with a substance abuse problem.

Most Commonly Abused Substances

Alcohol is the substance most commonly abused by seniors. Prescription drugs, more specifically opioids and benzodiazepines, come in a close second. Read on to find out about the reasons and signs of abuse.  

Seniors and Alcohol Abuse

Increasing rates of prescription and illicit drug misuse among seniors notwithstanding, alcohol remains the substance most commonly used and abused by adults over 65. 1.2% of individuals in this age group fulfill the criteria for alcohol use disorder according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), and 0.24% for alcohol addiction. The prevalence of alcohol dependence in adults over 50 years of age is estimated at 2.98%.

Rates of alcohol use disorder reach 22% within health care settings. It is believed these rates are actually higher because many cases of heavy drinking remain unreported, a large number of comorbid disorders are unidentified, and there are challenges to differential diagnoses of alcohol use disorders in seniors.

According to statistics from the 2005–2006 National Survey on Drug Use and Health, prevalence rates for risky alcohol consumption (more than 7 drinks per week or more than 3 drinks in one sitting) are approximately 10.9% for women and 16.0% for men. A lot of older adults have binge drinking issues as well (binge drinking being 5 or more standard drinks in one sitting). Almost 20% of men and just over 6% of women in this age group are binge drinkers.

Alcoholism in Seniors Chart

Why do Seniors Abuse Alcohol?

Social, individual, and familial factors that contribute to or are connected with unhealthy drinking later in life could apply to other substances as well. According to a study by Merrick and Horgan, the results of which were published in the Journal of the American Geriatric Society, physical risk factors include being male and Caucasian, suffering from chronic pain, reduced mobility or another physical disability, experiencing transitions in living or care situations, failing health, and incurable physical illness, as well as having received treatment for drug or alcohol abuse in the past.

Psychiatric risk factors include a previous and/or concurrent substance use disorder, previous or concurrent mental illness, and avoidance coping style. This coping style refers to the behavioral tendency to avoid problems and challenges rather than face and deal with them. This tendency is frequently connected to substance abuse.

Finally, social risk factors such as bereavement, social isolation, and unexpected or forced retirement can cause seniors to abuse alcohol.

Signs of Alcohol Abuse in Seniors

How can you tell a senior is abusing alcohol? There’s no 100% way to be sure, but there are signs your loved one may be abusing that you can look out for. These include secretive or solitary drinking, drinking rituals (before, after, or during dinner), loss of interest in things the person used to enjoy doing earlier, and consuming alcohol despite labels on prescription drugs warning about possible interaction.

Of course, slurred speech, smelling of alcohol, and change in physical appearance are all signs. Chronic, medically unfounded health complaints, confusion, hostility, memory loss, and depression are also common symptoms.

Prescription Drug Abuse

Seniors take more prescription medications than younger adults, increasing the risk of misuse and harmful interactions. A community-based cross-sectional study of 3005 persons between the ages of 57 and 85, published on the website of the US National Library of Medicine, found that 36% of women and 37.1% of men used at least 5 prescription drugs concurrently.  The study also showed that about 1 in 25 of those surveyed faced high risk of drug interaction.

Research by Blazer and Wu carried out for the National Institutes of Health found that 2.9 million adults over 50 years of age used opioids non-medically in 2012. Use of benzodiazepines, the most commonly prescribed class of psychiatric drugs, ranged from 15.2% to 32.0% in persons over 65 that year. Rates of benzodiazepine use are shown to be impacted by misdiagnosis, over-prescription, and misdosing.

Percentage of prescription drugs used in the past month 2007-2008 in seniors chart

Medication Misdosing

If an elderly person is taking multiple medications, they can misdose by accident. This can also happen due to cognitive decline, which is a normal part of aging, or disregard for warning labels.

It can be difficult for seniors to remember when and how much of each of their medications to take, especially when their mind is fuzzy and they are taking multiple drugs for relatively lengthy periods of time.

Why Do Seniors Abuse Prescription Drugs?

Opioids are used to minimize pain and are highly addictive. These include drugs such as hydrocodone with acetaminophen (Vicodin), oxycodone with acetaminophen (Percocet), and oxycodone (OxyContin). If one takes too much of an opioid or takes it for a long period of time, abuse and addiction become very likely.

Benzodiazepines are used to treat sleeplessness, anxiety, and panic attacks. Drugs such as alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), and clonazepam (Klonopin) are addictive if they are taken for extended periods of time.

Symptoms of Prescription Drug Abuse in Seniors

There are four types of symptoms of prescription drug misuse and abuse in seniors: cognitive, social, physical, and psychiatric.

  • Cognitive Symptoms - The main cognitive symptoms of drug abuse include disorientation and memory loss. These can go unnoticed because they are typical of old age. A clearer sign involves recent difficulties in decision making, which could be obvious to family members. Overall cognitive impairment may be present as well.
  • Social Symptoms - These can include sudden social isolation, family, legal, or financial troubles, or forms of behavior such as borrowing medication from others, getting a prescription for the same drug from two or more doctors, filling a prescription for the same drug at two or more pharmacies, and arbitrarily increasing the frequency and/or amount of their dose. The patient may then start running out of medication early.
  • Physical Symptoms - Among the most common physical symptoms of prescription drug abuse are poor hygiene, incontinence, impaired self-care, increased tolerance or unusual response to medicine, dizziness, poor nutrition, sensory deficits, idiopathic seizures, blackouts, and complaints of chronic pain.
  • Psychiatric Symptoms Finally, this group includes insomnia and other sleep disturbances, anxiety, rapid mood swings, and depression. They may become angrier or more withdrawn or appear forgetful and confused. They will talk about a drug very often and be afraid to go anywhere without it.
  • Other Symptoms - If a senior gets defensive when you ask them about a medicine, this could be a sign of abuse. In addition, they will make excuses for why they need the drug, store extra pills on their body or around their home, and hide or sneak medicine. If a loved one has been treated for prescription drug or alcohol abuse in the past, you need to be particularly vigilant.

Side Effects and Concerns For Seniors

The elderly are more vulnerable to the damaging effects of drugs and alcohol. Substance abuse is more dangerous in this age group than in any other. It can lead to rapid deterioration of health and/or prove fatal.

The Impact of Alcohol

As a person ages, the percentage of total body water and lean body mass decreases. The liver processes alcohol more slowly, and brain neuronal receptor sensitivity to alcohol and blood-brain barrier permeability increase. As a result, the elderly have higher blood alcohol concentrations than younger adults, suffer greater impairment, and are less aware of it. Older drinkers are more likely to experience drinking-related problems and functional impairment, compromising their ability to perform everyday tasks such as shopping, cleaning, and cooking.

According to a study by Moore and Endo, the results of which were published in the Journal of the American Geriatric Society, the higher rate of comorbid physical and psychiatric conditions and the prescription medicaments used to treat them render older adults extremely vulnerable to the impact of alcohol.

The Impact of Prescription Drugs

The same biologic changes that exacerbate the effect of alcohol among seniors also enhance the effects of prescription drugs. Seniors process benzodiazepines and opiates differently than younger people. Benzodiazepines such as tranquilizers with long half-lives can cause excessive sedation in older adults. These drugs act on their bodies longer because they have less lean muscle mass and more body fat. Other risks associated with prescription drug use in seniors can manifest because they may see many doctors, each of whom may prescribe them drugs that interact with alcohol or each other.

Other Risks

Older adults and seniors who abuse alcohol and/or prescription drugs face a higher risk of developing illnesses like osteoporosis, ulcers, diabetes II, irritable colon, varicose veins, conditions of the small or large intestine, and chronic bladder inflammation. These are not to be underestimated, as they can progress swiftly at this age. In particular, irritable colon and bladder inflammation have been linked to colon cancer in persons over 60. In addition, seniors abusing substances face an increasing risk of household-related accidents, like falls, bone fracture, and burns.

Misdiagnosis and Lack of Treatment

Drug or alcohol abuse may mimic symptoms of other physical or psychiatric disorders, such as diabetes, Alzheimer’s, or depression. Quite a few doctors have chalked symptoms of addiction up to “old age”.

A recent study of 400 primary care physicians shows how very unlikely it is for older adults to be screened for drug or alcohol abuse. The doctors were given a list of symptoms related to problematic drug use by a hypothetical senior. 

Just 1% of primary care physicians take the possibility of a substance use problem in seniors into account.

 Among the factors preventing screening and subsequent identification of risky substance use are social stigmas related to and the inconvenience of assessing for addiction, the fact that clinicians have too little time to screen for more than one potential issue or illnesses, and the similarities of the substance abuse symptoms to other illnesses common in late adulthood. Finally, seniors have trouble identifying risky behaviors surrounding alcohol and prescription drug use, making it even harder to establish that such behavior is occurring.

Irrelevance of DSM Criteria

Physicians rely on the criteria outlined by the DSM to diagnose substance abuse disorder in the general population. This is perhaps the main reason for misdiagnosis and lack of treatment of seniors – these criteria are less relevant to them.

Increased vs. Reduced Tolerance

One criterion in the DSM is increased tolerance toward the substance, and most seniors actually experience reduced tolerance due to age-related physiologic changes that augment the effects of alcohol and other drugs.

Interruption in Social Roles

Interruption in social and occupation roles or other repercussions of drug or alcohol use may be less noticeable or likely to occur at this stage of life. With age, one departs from these roles naturally in the vast majority of cases, such as through social isolation due to age-group peer mortality or retirement.

Continued Use

The DSM criterion related to continued use of the substance despite recurrent or persistent problems may not apply to many seniors who do not realize that these problems, such as depression, are related to alcohol use or misuse of prescription drugs.

Substance Use-Related Activities

Similarly, another DSM criterion – spending a lot of time on activities necessary to obtain and use a substance and/or recover from its effects – is irrelevant to older adults. Effects of substance use are evident after consuming relatively small amounts.

Loss of Interest

The DSM criterion related to giving up or reducing important social, recreational, or occupational activities in favor of substance use is similarly inapplicable. Seniors engage in fewer activities regardless of whether substance use is present or not, making it difficult to establish if this criterion is met.

Getting Help for Senior Substance Abuse

Treatment options for seniors vary depending on the level of care needed and may include educational and preventative services and support, medical detox, and outpatient or inpatient treatment. Admittedly, studies on the effects of treatment of senior substance abuse are few and far between, which is why it is crucial to find specific ways to engage the senior. Below are some recommended treatment options.

TherapyPsychopharmacology
Education about the risks of combining prescription drugs with alcohol and misuse of alcohol can make the difference for an older adult.

A study by Bartels and Coakley, published in the American Journal of Psychiatry, showed that 10% to 30% of seniors abusing alcohol were able to reduce their drinking after brief psycho-educational interventions, ranging from 1 to 3 sessions.

Psychotherapy is often recommended on an inpatient or outpatient basis depending on how severe the problem is. Experts have validated motivational interviewing as an effective method to establish an individual's willingness to change and to increase the motivation for change.

Another recommended option is cognitive-behavioral therapy. It finds wide application in substance abuse treatment at all ages.

In cases where substance addiction has been established, doctors recommend treatment with naltrexone, an opiate antagonist. This drug has been shown to reduce cravings for alcohol. It is prescribed as supplementary treatment to psychosocial support as a way of reducing the risk of alcohol addiction relapse.

A study on 44 older veterans addicted to alcohol showed a dosage of 50 mg/d was safe in a three-month, randomized, placebo-controlled trial. Careful assessment of the need for detoxification and the likelihood of grave withdrawal symptoms occurring is required regardless of the treatment modality chosen.

Educational interventions and psychotherapy need to be tailored for each elderly patient. Ideally, therapy should be offered to patients of similar ages in groups because these sessions make them feel more comfortable. They will then be more likely to adhere to recommendations.

Recovery Support and Relapse Prevention

Taking part in 12-step program meetings such as Alcoholic Anonymous is an important approach to relapse prevention and an important part of treatment in general. Meetings with same-age cohorts enable peer bonding, provide mutual support, and help establish peer sobriety networks. Families also play a crucial role in supporting the recovery of their seniors and preventing relapse. Family members should focus on communicating with the elderly in a respectful, empathic way.

Family Communication

Communication should be as clear and simple as possible, taking into account age-related brain changes, both normal and abnormal. It is easy to get frustrated with an older person who is abusing substances, sometimes more so than with one in another age group, because they’re very defensive and set in their ways. One must recognize this is normal and not give up.

Seniors are frequently unaware of the risks they are taking by misusing or abusing psychotropic substances. They may be taking these substances in the same doses or amounts they always did without realizing that they now face a higher risk. This is why objective information about the dangers of alcohol or prescription drug use can be helpful.

Helping a Senior Recognize Risk

A senior may not recognize risks even after undergoing some sort of therapy. You can help your elderly parent or grandparent do so by asking if they are taking any medicines that could cause a drug interaction and communicating the symptoms of prescription drug misuse or abuse to them. If they are taking several prescription drugs for different health conditions at once, it would be very helpful to write down the doses and administration times in big letters on a sheet and put it up where they will see it, like on the fridge. This is a good way to avoid mistakes. Let them know they should always turn to you and a doctor if they feel like they’ve become dependent on a certain medicine or other substance.

The Best Settings for Seniors

The type of residence is very important to the senior’s prospects in terms of long-term recovery from substance abuse. It would be a good idea to perform a detailed physical and psychiatric health assessment and drug tests to help determine the best level of care. There are many options, ranging from adult day care and assisted living to retirement communities. Of course, independent living at home is also possible.

This option is ideal for a senior who doesn’t want to leave their home, but needs additional daily support. Caregivers normally charge per hour and offer a variety of services. These include not only everyday chores like cooking and cleaning, but also medical assistance.

SAMHSA recommends that a senior who has undergone substance abuse or addiction treatment have a caregiver and a case manager check in regularly to watch for signs of relapse.

Adult day care centers can be located in nursing homes, senior citizen centers, hospitals, or independently. A good day care facility will help meet your senior’s social and health needs throughout the day in a supportive and safe environment.

This is the best choice if the elderly person lives with a family member who works daytime. Adult day care can also offer therapy and counseling.

Retirement communities give seniors very good options to live in a communal setting. These settings can offer onsite care the elderly need, including for elderly persons recovering from substance abuse.

They are the best choice for seniors who don’t want to be alone and are looking to downsize from a bigger place, but still in relatively good health.

Long-term care can be part of in-home care or retirement communities. Nursing homes offer 24-hour, long-term care as well. This setting is best for a senior recovering from substance abuse and a comorbid disorder, who needs a great deal of assistance in daily living or constant medical supervision.

Typically, nursing homes cater to seniors over 80 years of age.

Assisted living facilities offer seniors housekeeping services, 24-hour supervision and support, and opportunities to take part in community activities. These facilities are a good choice if a senior is struggling with failing health and substance abuse. In the absence of a comorbid condition, this type of setting is not recommended, as it comes with less privacy and freedom.

Assisted living facilities are a suitable option for elderly patients who need help in their everyday lives, from chores and nutritional support to therapy and on-call medical care.

Anyone can find strength to leave the addiction behind at any age. Depending on the severity of abuse or addiction, the road to recovery could begin with medical detox and move on to outpatient or inpatient treatment.   

Seniors and Drug Abuse: A Frighteningly Real Phenomenon
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