Topic Overview

Many people think substance use disorder happen only to teens and younger adults. But all ages can have problems with drugs and alcohol, including older adults.

Older adults may use illegal drugs, misuse prescription or over-the-counter medicines, drink too much alcohol, or mix alcohol and medicines. Doing any of these can cause serious health problems and problems with money and the law. It also can harm relationships with family and friends.

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

• Older adults are more likely to drink or use drugs 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.
• Signs of substance use disorder are similar to those found in health problems that many older adults have, such as depression and dementia.
• Caregivers of older adults may be aware of the problem but may not want to talk about it.

Alcohol

Alcohol use disorder is dangerous for all people, and it can be very dangerous for older adults. Older adults:^{footnote 1}

• 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, which means alcohol-related falls, car crashes, and other kinds of accidents are more likely.
• May be more likely to mix alcohol and medicine because they are taking so many medicines. Mixing alcohol with many over-the-counter and prescription medicines can be dangerous or even fatal.

In older adults, alcohol can trigger some health problems or make them worse. These health problems include high blood pressure, ulcers, liver disease, anxiety, sleep problems, and depression.^{footnote 1}

Experts suggest that adults 65 and older have:^{footnote 1}

• No more than 1 standard drink a day.
• No more than 2 drinks on any drinking occasion, such as New Year’s Eve or weddings.

Some older adults should not drink alcohol. Women who are small may want to ask their doctors what amount of alcohol is safe for them.

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 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 get a prescription renewed.
• You don’t take medicine as your doctor directs, such as not taking enough medicine or skipping doses.

Warning signs of substance use disorder

Below are some of the warning signs of substance use disorder in older adults. Signs can include changes in your behavior as well as changes in your mental abilities.

If you notice any of these signs in yourself or someone you care about, talk to your doctor. Tell your doctor about the drinking or medicine use, including over-the-counter medicines, herbs, and dietary supplements. Tell your doctor about any alcohol or drug use in the past.

Changes in behavior

You may have substance use disorder if:

• You fall a lot.
• You are not able to make it to the bathroom in time (incontinence).
• You are having more headaches and dizziness than usual.
• You are not keeping yourself clean.
• You have changed what and how you eat. You may not eat as much, for example.
• You begin to ignore and lose touch with your family and friends.
• You begin to think about suicide.
• You begin to have legal or money problems.

Changes in mental abilities

Here are some mental signs of substance use disorder:

• You begin to feel anxious a lot of the time.
• Your memory becomes worse.
• It’s hard for you to focus or make decisions.
• You lose interest in your usual activities.
• You have mood swings or feel sad or depressed.

If you have any of these signs, it may not mean you have substance use disorder. Many of the signs listed here also can be signs of health problems many older adults have. Changes in behavior also could be signs of stress.

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

Treatment

Treatment for substance use disorder in older adults is the same treatment as for younger people. Detoxification, medicine, counseling, therapy, and 12-step programs all may be used.

If medicine misuse is the problem, sometimes talking to a doctor, friend, or family member about the problem can help. Treatment could be as simple as 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.

Your success in treatment is strongly linked to admitting that you have a problem and to your desire to stop drinking too much or using drugs.