Substance Abuse and Addictions in Older Adults

Substance Abuse in Older Adults

by Tarah Doyle, M.A./CAGS School Psychologist

The problem of substance abuse and misuse affects a surprisingly large number of older adults. It is estimated that 17% of those over the age of 65 have an alcohol-abuse problem (OASAS), and approximately 25% of nursing home admissions are due to medication misuse (Bush et. al., 2004).

Older adults who engage in substance abuse can be classified in one of two main categories. The first includes life-long substance abusers who are now older, while the second includes individuals who began abusing substances later in life. Quite often, abuse within the second category is triggered by some life circumstances and/or stress, i.e. the loss of a loved one, loneliness, medical conditions, etc.

Prescription drug misuse among older adults can have various causes. Older adults may misuse prescription drugs because they are unable to follow the directions or comply with complicated medication regimens. When any prescription is not taken according to directions, there are risks involved. According to Zerbe (2009), common symptoms of prescription drug misuse may include:

• Requesting prescription refills more rapidly than permitted.
• Having multiple prescribing physicians unaware of the others’ prescriptions
• Having a doctor who is unaware of certain symptoms that a specialist is treating

Aside from improper consumption (dosage or frequency) of prescription drugs, another related risk is the combined consumption of medications with alcohol. Research shows that alcohol has a negative reaction when mixed with any of over 150 medications. The combination of prescription drugs and alcohol can result in slowed blood flow to organs, increased risk of falls/fractures, and confusion which could lead to potentially overdosing (OASAS). In addition, substance abuse, especially involving alcohol, may accelerate the normal decline in physiological functioning that occurs with age (Katsoyannis and Gambert, 1995).

Despite its seriousness, substance abuse among older adults often goes unnoticed and therefore untreated. This oversight can result from family members or outsiders mistaking the signs of substance abuse for other conditions related to aging. Substance abuse by an older adult can also go unnoticed because the individual lives alone and can easily conceal an addiction from others.

Family members can be proactive about substance misuse in older adults by keeping in contact with a relative’s physician and/or pharmacist. It is also imperative to recognize the warning signs. The following list, published by The Center for Substance Abuse Treatment, may be indicators of an alcohol or medication-related problem in older adults:

• Memory difficulty following the consumption of a drink or medication
• Loss of coordination
• Changes in sleep and/or eating habits
• Unexplained injuries or bruises
• Feeling unsure of self
• Irritability, sadness, and/or depression
• Chronic pain that can not be explained
• Desire to be alone most of the time
• Poor hygiene
• Difficulty concentrating
• Trouble keeping in touch with family or friends
• Loss or lack of interest in usual activities

Once a substance abuse problem is identified in an older adult, appropriate treatment must follow. An appropriate program/treatment plan is customized; it addresses the particular abuse while acknowledging the individuality of the patient. Individuals should consult a primary care physician or licensed therapist to discuss treatment options, which may include individual counseling, group counseling, and/or brief interventions.

The information in the article above was drawn from the following sources:

• Bush, J., Tucker, S., and White, T. (2004). 2004 National Conference on Older Adult Substance Abuse (PPT). Retrieved June 17, 2009.
• New York State Office of Alcoholism and Substance Abuse Services – OASAS.(2008). Elderly Alcohol and Substance Abuse. Retrieved June 16, 2009.
• Gambert, S.R. and Katsoyannis, K.K. (1995). “Alcohol-related medical disorders of older  heavy drinkers.” In: Beresford, T.P., and Gomberg, E., eds. Alcohol and Aging. (pp. 70-81). New York: Oxford University Press.
• Substance Abuse & Mental Health Services Administration (SAMHSA). Information retrieved June 17, 2009 from web site: www.samhsa.gov.
• Zerbe, L. (2009). How to Tell if Grandad’s Popping Pills. Retrieved June 17, 2009.

General Resources on Aging and Wellness

• From Project INTERFACE: Caregiver Resources.
• Geriatric Mental Health Foundation.
• “Older Adults and Mental Health,” from Mental Health: A Report of the Surgeon General.
• PubMed, a collaboration of the U. S. National Library of Medicine and the National Institute of Health, provides a comprehensive list of journal articles regarding mental health and older adults.