The Silent Epidemic: Substance Use Disorders Among Older Adults

Substance Use Disorders In Seniors

Drug Dependence is a physical and mental condition that compromises an older adults’ mental health. Regrettably, this condition is not limited by any other factors, including race, religion, gender, age, or demographics. The frequency of substance use disorders among older adults is rising as the baby boomer generation ages. 

Alcohol, prescription medicines, and illegal drugs are the main contributors to substance abuse and use disorders among the many substances under consideration. The most prevalent drug use problem in older individuals is high-risk drinking and alcohol use disorder.

Continue reading to learn how substance use disorder can affect older adults’ daily lives.

What is Substance Use Disorder?

Substance Use Disorder (SUD) is a medical condition characterized by the recurrent use of a substance (such as drugs or alcohol) despite significant negative consequences. It is also known as addiction or drug dependence.

SUD involves a wide range of symptoms that can vary depending on the substance and the severity of the disorder. It is a complex condition that can affect individuals from all walks of life, and it can have severe consequences for both physical and mental health (mimic psychiatric conditions like depression, psychosis, or anxiety), relationships, and overall quality of life. 

SUD often requires professional treatment, which can include medication-assisted therapy, behavioral therapies, support groups, and other forms of support.

Substance Use Disorder Among Older Adults in the US

Statistics on drug use and substance use disorders in the US are available from the National Survey on Drug Use and Health (NSDUH). The latest NSDUH (2019) statistics demonstrate the prevalence of SUDs in the US among adults 12 and older during the previous year and particular categories of SUDs.

  • Four million individuals had a SUD.
  • Alcohol use disorders affected 5 million people.
  • There were 6 million marijuana users.
  • There were 1 million cocaine users.
  • Four hundred seventy-eight thousand people had a heroin use disorder.
  • One million had a methamphetamine use problem
  • prescription stimulant use disorder affected 558,000 people.
  • A prescription sedative or tranquilizer use disorder affected 681,000 people.
  • Overuse of prescription painkillers affected 4 million people.
  • There were 6 million opioid use disorders.

The NSDUH also gathers information on the use and need for drug abuse treatment.

  • In the previous year, 1 million patients with a SUD who are 12 or older got treatment.
  • The previous year, 9 million people aged 12 or older had a SUD but did not obtain treatment at a specialized hospital.
  • One million of them believed they did not require medical attention.
  • Two hundred thirty-six thousand people sought therapy because they believed they needed it.
  • 577,00 people believed they needed therapy but did not try to obtain it.

Common Types of Substance Use Disorder in Older Adults

Except for caffeine and cigarettes, the DSM offers diagnostic criteria for various kinds of SUD, which include:

Alcohol Use Disorder

Alcohol use disorder (AUD), also known as alcoholism, is a chronic medical condition characterized by a problematic pattern of alcohol consumption that leads to significant impairment or distress. AUD can range from mild to severe, and it can have a significant impact on an individual’s physical, mental, and social well-being.

Some of the symptoms of AUD include:

  • Craving or a strong desire to consume alcohol
  • Difficulty controlling the amount of alcohol consumed
  • Continuation of drinking despite negative consequences, such as interpersonal problems, legal or financial issues, or health problems
  • Developing a tolerance to alcohol, which requires increasing amounts to achieve the desired effect
  • Experiencing withdrawal symptoms when attempting to stop drinking or reducing alcohol consumption

Marijuana Use Disorder

Marijuana use disorder (MUD) is a medical condition characterized by a problematic pattern of marijuana use that leads to significant impairment or distress. MUD can range from mild to severe, and it can have a significant impact on an individual’s physical, mental, and social well-being.

Some of the symptoms of MUD include:

  • Craving or a strong desire to consume marijuana
  • Difficulty controlling the amount of marijuana consumed
  • Continuation of marijuana use despite negative consequences, such as interpersonal problems, legal or financial issues, or health problems
  • Developing a tolerance to marijuana, which requires increasing amounts to achieve the desired effect
  • Experiencing withdrawal symptoms when attempting to stop using marijuana or reducing marijuana consumption

Hallucinogens Use Disorder

Hallucinogen Use Disorder (HUD) is a medical condition characterized by a problematic pattern of hallucinogen use that leads to significant impairment or distress. Hallucinogens are a class of drugs that can cause profound alterations in perception, mood, and thought.

Some of the common hallucinogens include LSD, psilocybin (magic mushrooms), peyote, and DMT. The symptoms of HUD can vary depending on the specific drug used, the frequency and amount of use, and other factors. 

Some of the general symptoms of HUD include:

  • Craving or a strong desire to use hallucinogens
  • Difficulty controlling the amount of hallucinogens consumed
  • Continuation of hallucinogen use despite negative consequences, such as interpersonal problems, legal or financial issues, or health problems
  • Developing a tolerance to hallucinogens, which requires increasing amounts to achieve the desired effect
  • Experiencing withdrawal symptoms when attempting to stop using hallucinogens or reducing consumption

Addiction To Opioids

Addiction to opioids is a medical condition characterized by a problematic pattern of opioid use that leads to significant impairment or distress. Opioids are a class of drugs that include prescription painkillers like oxycodone and hydrocodone, as well as illegal drugs like heroin.

Some of the symptoms of opioid addiction include:

  • Craving or a strong desire to use opioids
  • Difficulty controlling the amount of opioids consumed
  • Continuation of opioid use despite negative consequences, such as interpersonal problems, legal or financial issues, or health problems
  • Developing a tolerance to opioids, which requires increasing amounts to achieve the desired effect
  • Experiencing withdrawal symptoms when attempting to stop using opioids or reducing consumption

Sedative, Hypnotic, Or Anxiolytic Use Disorder

Sedative, Hypnotic, or Anxiolytic Use Disorder (SHAUD) is a medical condition characterized by a problematic pattern of using sedatives, hypnotics, or anxiolytics, which are a class of drugs commonly prescribed for sleep or anxiety disorders, leading to significant impairment or distress.

Some of the common sedatives, hypnotics, or anxiolytics include benzodiazepines, barbiturates, and non-benzodiazepine sleep medications like zolpidem and eszopiclone.

The symptoms of SHAUD can vary depending on the specific drug used, the frequency and amount of use, and other factors. 

Some of the general symptoms of SHAUD include:

  • Craving or a strong desire to use sedatives, hypnotics, or anxiolytics
  • Difficulty controlling the amount of sedatives, hypnotics, or anxiolytics consumed
  • Continuation of use despite negative consequences, such as interpersonal problems, legal or financial issues, or health problems
  • Developing a tolerance to sedatives, hypnotics, or anxiolytics, which requires increasing amounts to achieve the desired effect
  • Experiencing withdrawal symptoms when attempting to stop using sedatives, hypnotics, or anxiolytics or reducing consumption

Stimulant Use Disorder

Stimulant Use Disorder, is a medical condition characterized by a problematic pattern of using stimulants, which are a class of drugs that increase alertness, attention, and energy. Some common stimulants include amphetamines, methamphetamine, cocaine, and prescription drugs like Ritalin and Adderall.

The symptoms of Stimulant Use Disorder can vary depending on the specific drug used, the frequency and amount of use, and other factors. 

Some of the general symptoms of stimulant use disorder include:

  • Craving or a strong desire to use stimulants
  • Difficulty controlling the amount of stimulants consumed
  • Continuation of use despite negative consequences, such as interpersonal problems, legal or financial issues, or health problems
  • Developing a tolerance to stimulants, which requires increasing amounts to achieve the desired effect
  • Experiencing withdrawal symptoms when attempting to stop using stimulants or reducing consumption
[QUICK FACT: It's important to note that substance use disorders can involve both legal and illegal substances and can affect individuals of any age, gender, and socioeconomic background.]

Causes Of Substance Use Disorder In Older Adults

The causes of Substance Use Disorder in older adults can be complex and multifactorial, involving a combination of genetic, environmental, and social factors. Some of the common factors that may contribute to Substance Use Disorder in older adults include:

  1. Chronic pain: Many older adults experience chronic pain due to age-related conditions, and they may be prescribed opioids or other pain medications to manage their symptoms. However, prolonged use of these medications can lead to Substance Use Disorder.
  2. Social isolation: Older adults who live alone or have limited social connections may turn to drugs or alcohol as a way to cope with feelings of loneliness and isolation.
  3. Retirement: Older adults who retire may struggle with a loss of identity and purpose, which can lead to depression and anxiety. They may turn to drugs or alcohol as a way to cope with these feelings.
  4. Medical conditions: Older adults with medical conditions such as depression, anxiety, or sleep disorders may be prescribed sedatives or other medications that can lead to Substance Use Disorder.
  5. Trauma: Older adults may have experienced traumatic events earlier in life, and they may turn to drugs or alcohol as a way to cope with the lingering effects of trauma.
[QUICK FACT: Substance Use Disorder is a treatable condition, and recovery is possible with the right support and treatment. ]

Why Are Substance Use Disorders Difficult To Detect In Older Adults?

It is important for healthcare providers and caregivers to be aware of the challenges and to actively screen for Substance Use Disorder in older adults. A comprehensive assessment that includes a thorough medical history, medication review, and screening for substance use can help to identify Substance Use Disorder in older adults and facilitate appropriate treatment and support.

Substance Use Disorders can be difficult to detect in older adults for several reasons:

  • Stigma: There is often a stigma attached to substance use, and this can be especially true for older adults. They may be reluctant to admit to substance use or seek help for fear of being judged or stigmatized.
  • Misinterpretation of symptoms: The symptoms of Substance Use Disorder in older adults can be misinterpreted as signs of aging, such as memory loss, confusion, or depression. As a result, healthcare providers may overlook substance use as a possible cause of these symptoms.
  • Polypharmacy: Older adults are more likely to be taking multiple medications, and drug interactions can be difficult to detect. Symptoms of Substance Use Disorder may be attributed to medication side effects or interactions.
  • Atypical presentation: Substance use can present differently in older adults than in younger individuals. For example, older adults may be more likely to experience falls or cognitive impairment as a result of substance use.
  • Underreporting: Older adults may underreport their substance use due to fear of consequences, shame, or denial.

Warning Signs

The warning signs of Substance Use Disorder can vary depending on the specific substance like what we have provided above, but some general and common signs to watch for include:

  1. Changes in behavior: This may include social withdrawal, mood swings, irritability, agitation, or sudden changes in energy level.
  2. Physical changes: This may include bloodshot eyes, changes in appetite or sleep patterns, tremors, unsteady gait, or sudden weight loss or gain.
  3. Neglecting responsibilities: This may include missing work, school or social events, neglecting personal hygiene, or failing to meet important obligations.
  4. Financial problems: This may include borrowing money frequently, selling possessions, or unexplained financial difficulties.
  5. Legal issues: This may include driving under the influence, public intoxication, or other legal problems related to substance use.
  6. Health problems: This may include recurrent infections, chronic pain, or other health problems related to substance use.
  7. Tolerance and withdrawal symptoms: This may include needing more of a substance to achieve the desired effect, or experiencing physical or psychological symptoms when the substance is stopped or reduced.
[NOTE: These warning signs do not necessarily indicate Substance Use Disorder, but they may be indicative of a problem and should be addressed by a healthcare professional.]

How Can Substance Use Disorders Affect The Lives Of Older Adults?

Drugs undergo a complicated trip from the moment we take our prescriptions until they leave our bodies.

How a medicine is absorbed, utilized by the body, and excreted can all be impacted by age. Some drugs may linger in your body longer if changes make it harder for your body to break them down or eliminate them from your system.

Dizziness and falls, weight loss or gain, changes in memory, or our capacity to understand and absorb information are all common side effects of substance use disorder in older adults. They, in turn, have the potential to damage older people and eventually reduce their capacity to carry out daily tasks.

Older adults who misuse alcohol and other drugs risk developing various illnesses, such as liver and pancreatic diseases, immune system disorders, osteoporosis, diabetes, high blood pressure, stroke, and seizures. 

Treatment Options for Older Adults

The same treatment options are available for younger and older persons with substance use disorders. One may employ any of the following:

  • Detoxification: This involves a medically supervised withdrawal from the substance of abuse to manage withdrawal symptoms.
  • Medications: Certain medications can be used to manage withdrawal symptoms or to reduce cravings for the substance of abuse.
  • Counseling: This can include individual or group counseling to address underlying issues that may have contributed to substance use, as well as to develop coping skills and relapse prevention strategies.
  • Support groups: Participation in support groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) can be helpful in providing ongoing support and accountability.
  • Behavioral therapies: This can include cognitive-behavioral therapy (CBT) or contingency management, which use a combination of education, coping skills, and positive reinforcement to help individuals overcome substance use disorders.
  • Rehabilitation programs: Inpatient or outpatient rehabilitation programs can provide comprehensive treatment, including medical, psychological, and social support, to help individuals overcome substance use disorders.
  • Complementary therapies: This can include meditation, yoga, or acupuncture, which may help to reduce stress and improve overall well-being.

It is important for healthcare providers to work closely with older adults and their families to develop an individualized treatment plan that addresses their unique needs and circumstances. 

With the help of doctors and families, you can reduce the number of medications you take or find a more convenient way to take them. Admitting that you have a problem and wanting to quit taking drugs is critical to your success in treatment.

Must Read: Maintaining Wellness for Older Adults

Wrap Up

Older adults are less likely to use substances or have SUD than the general population, but they are also more likely to seek treatment extremely infrequently, necessitating special therapeutic concerns.

A greater understanding of substance abuse in older adults, including how to approach screening, evaluation, and treatment, can benefit providers and professionals. Similarly, family members and caregivers may get knowledge and tools to assist them in identifying, preventing, and treating drug abuse in their elderly loved ones.