The number of senior citizens in the United States is expected to grow substantially over the next several decades, with a 2014 report from the U.S. Census Bureau estimating that the number of aging American adults will nearly double between 2012 and 2050.1 Given these numbers, it is important to examine under-acknowledged issues, such as addiction, to help address the specific needs of senior citizens. Although substance abuse in older adults has not been extensively studied, professionals in the field agree that addiction in the aging population is a serious problem.2
The prevalence of substance use disorders (the clinical term for addiction) among people older than 50 is projected to increase “from about 2.8 million in 2006 to 5.7 million in 2020.”3
One study reported that the number of admissions to treatment programs among men and women over the age of 55 for illicit drug abuse increased from 1994 to 1999, by “25% and 43%, respectively.”2 Another article reported that, “in 2001, only 11.9% of an estimated 1.7 million older adults with substance abuse treatment needs had received treatment within the previous year.”4 According to the most recent numbers from the National Institute on Drug Abuse, people aged 65 and older accounted for just 0.6% of the admissions to publicly funded substance abuse treatment programs.5
Reasons They Become Addicted
There are many reasons why senior citizens become addicted to drugs or alcohol, including:3,4,6
- Unaddressed addictions that developed earlier in life. In some cases, an older adult may have had a drug or alcohol abuse problem that began when they were younger but went undiagnosed by healthcare professionals or was unidentified or ignored by family members or loved ones.
- Stressful life events. Losses associated with aging—such as the death of loved ones; personal illness or illness in friends or family; being faced with one’s own mortality; retirement; and social isolation—may contribute to the development of substance abuse and addiction in senior citizens.
- Becoming addicted to medications that were prescribed for a legitimate reason. One-quarter of prescription medications in the U.S. are used by senior citizens.6 Some aging adults may become addicted to certain drugs if they take a more frequent dose or a higher amount than recommended by their doctors. Often, prescription drug misuse in the aging population is unintentional. For example, they may receive multiple prescriptions from different doctors or might misunderstand their doctor’s instructions on safe medication use or dosage.
- Coping with illness-related side effects. Older adults may abuse certain substances in an attempt to stave off specific symptoms of medical or psychological conditions. For example, one clinical review suggests that older adults may abuse cannabis more frequently to deal with otherwise unmanaged medical symptoms. Additionally, the relatively recent changes to medical and recreational marijuana laws in several parts of the country could be influencing the upward trend seen in cannabis use prevalence. The same review also reports that seniors may drink alcohol as a way to reduce pain or deal with sleep disorders, such as insomnia.
- Comorbid mental health problems. Anxiety, depression, and personality disorders are common in younger adults and often continue into later life. One clinical review points out that though research on psychiatric problems and substance abuse in older adults is far from exhaustive, there have been studies that support the link between specific mental illnesses, such as depression, and substance abuse (especially alcohol), in the aging population.
- Coping style. People who tend to have avoidant styles of coping with stress or life problems demonstrate a higher likelihood of developing problems with alcohol later in life.
How Addiction Affects Them
Addiction in seniors can be more difficult to identify because many of the associated signs and symptoms resemble those of common medical problems.3 Also, addiction can impact senior citizens differently than it affects younger people, especially when it comes to effects on physical and mental health. One report suggests that severe substance abuse can have other negative consequences, such as lower socioeconomic status and antisocial behavior, in aging adults.6
When compared to younger people, addicted seniors may suffer more from issues such as:2
- Decreased physical health. Physical health may already be compromised in many seniors, and substance abuse can cause or worsen medical problems. One clinical review explains that “excessive use of substances, and even minimal use of alcohol in combination with prescription and over-the-counter drugs, seriously affects the physical health of adults age 65 and older.”
- Impaired mental health. The same clinical review reports that substance abuse often goes hand-in-hand with mental health problems in aging adults. For example, a study that examined veterans with alcohol problems reported that older veterans were more likely than younger veterans to have “major depression, anxiety disorders, and organic brain syndrome or dementia.”
Substances commonly abused by senior citizens may cause symptoms that differ from the effects these substances have on younger people. Senior citizens are most likely to abuse alcohol, marijuana, and prescription medications like benzodiazepines.
Alcohol has been reported as the substance most frequently abused by people older than 50. Regardless of age, alcohol addiction can cause several harmful side effects, such as:3,4,6-10
- A weakened immune system.
- An increased risk of liver disease.
- An increased risk of pancreatitis.
- A higher chance of developing certain cancers.
Senior citizens addicted to alcohol may be more prone to experience:
- Higher levels of impairment in carrying out daily living activities, such as shopping, cooking, and taking prescribed medications.
- A higher risk of alcohol-related dementia.
- An increased chance of developing liver damage.
- Immune system impairment.
- Cardiovascular, GI, and endocrinological problems.
Regardless of age, abuse and addiction to marijuana is associated with a number of negative effects, including:
- Impaired short-term memory.
- Increased heart rate.
- Breathing difficulties and elevated respiratory rate.
- High blood pressure.
Also, a “4-time increase in the risk for heart attack in the first hour after [use]” is associated with marijuana abuse in people of any age. In seniors, these effects may be more pronounced, especially in those who already suffer from cognitive or cardiovascular problems.
Older adults abuse benzodiazepines—medications generally used to treat anxiety and, less frequently, to manage some seizure conditions, muscle spasms, and insomnia—more than any other age group. People who use benzodiazepines may experience negative symptoms such as:
- Memory impairment.
- Poor concentration.
- Increased excitement or hostility.
- Suicidal ideation (in some cases).
Prescription and Over-the-Counter Medications
Other prescription and over-the-counter (OTC) medications that senior citizens may abuse include opioid painkillers, sleeping pills (e.g., Ambien), and cold medicines (e.g., antihistamines, decongestants). Any of these medications may have adverse effects on their own, especially when misused, but may present more pronounced dangers when combined with other drugs or alcohol.
Overdose and harmful interactions are potential consequences of combining prescription and OTC medications because older adults’ bodies are more sensitive to their effects. Metabolic processes slow to some degree in an aging population, which can affect the pharmacologic activity of certain medications. This may magnify some of the potential effects of medication as people age, which consequently may increase the risk developing an addiction to prescription drugs more quickly than younger adults.
Seniors who abuse prescription or OTC medications are also more likely to experience:
- Interactions between different drugs, especially if they are taking multiple prescriptions.
- An increased risk of falls due to sedation.
- Cognitive impairment.
- Attention problems.
- Ataxia, or a loss of control of body movement.
As with treatment geared toward younger people, senior citizens with substance abuse problems may benefit from a wide range of treatment approaches, including detoxification, outpatient or inpatient treatment, and aftercare. However, specialized detox and treatment services designed for older adults can help address some of the differences between older and younger substance abusers. For example, older adults tend to have longer-lasting withdrawal symptoms and may require longer detox treatment.2
For many seniors struggling with addiction, detox is the first step in the treatment process. Depending on withdrawal risks and other considerations, detox may take place in either an inpatient setting or on an outpatient basis; the average length of the detoxification process is also influenced by the specific substance(s) involved and other individual factors, such as mental health status, that will naturally vary from person to person.
In general, detox programs consist of 3 steps:11
- Evaluation. The first step of detox is an evaluation, during which patients undergo a comprehensive evaluation to determine an appropriate level of care based on the extent of the substance abuse problem. Patients should also receive an assessment for issues such as depression, grief, and loss-related issues.
- Stabilization. The second step in the detox process is stabilization, in which the actual detoxification takes place. In this stage, patients receive assistance and, in some cases, medication, to help minimize withdrawal symptoms as the substance is cleared from the body.
- Fostering entry into treatment. In the third step of the detox process, patients receive guidance and assistance to transition into an appropriate addiction treatment program.
Unfortunately, certain barriers may prevent senior citizens from receiving the addiction treatment they need, including:3
- Stigma and shame about alcohol and substance abuse.
- Geographic isolation.
- An inability to pay.
- Transportation difficulties.
The establishment of more accessible and affordable programs in places like primary care offices, emergency rooms, senior centers, and retirement communities, may help make treatment more convenient and available to vulnerable seniors.3
Detox programs that are specifically designed for senior citizens are based on the same protocols for detox in other populations, but they should be sensitive to the unique needs of seniors. These programs should have a positive, non-ageist philosophy and provide services in a supportive and non-confrontational manner.11 They should also be aware of a number of considerations that are specific to older adults, in part because detox can be a more medically risky undertaking. Programs should pay particular attention to whether a person is best served in an inpatient or outpatient detox setting, especially if any medical or psychiatric issues are present.
Some factors that are important in determining whether a senior will require inpatient or outpatient detox include:12
- The presence of suicidality.
- The potential for the development of withdrawal symptoms like seizures or delirium.
- A high potential for relapse.
- Multiple addictions.
- The presence of serious psychiatric problems, such as clinical depression or bipolar disorder.
- Unstable or uncontrolled medical issues that require constant monitoring or intravenous drug administration, such as diabetes.
- Little or no social support at home.
- A failure to respond to outpatient treatment.
- Previous encounters with detox or withdrawal complications.
Detox programs should also keep in mind that older adults usually tend to “require lower doses of many medications” used for treating withdrawal symptoms.12
In addition, detox programs geared toward senior citizens should ensure that they:2,12
- Have staff with expertise in treating older adults.
- Use a non-confrontational approach.
- Conduct programs at a slower pace.
- Can provide referrals to other necessary services for seniors, such as health care or transportation.
- Respect the dignity of the client at all times.
Since detoxification is only the first step of a comprehensive addiction treatment program, detox staff should be able to provide referrals to the appropriate treatment program required to help a person stay abstinent once they have successfully detoxed.12
- Ortman, J., Velkoff, V., & Hogan, H. (2014). An Aging Nation: The Older Population in the United States. Current Population Reports, P25-1140. U.S. Census Bureau.
- Feidler, K., Leary, S., Pertica, S., & Strohl, J. (2002). Substance Abuse Among Aging Adults: A Literature Review.
- Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance Abuse Among Older Adults. Clinics in Geriatric Medicine, 30(3), 629–654.
- Steinhagen, K. & Friedman, M. (2008). Substance Abuse and Misuse in Older Adults. Aging Well, Summer 2008 (3), 20.
- National Institute on Drug Abuse. (2011). Treatment Statistics.
- Bogunovic, O. (2012). Substance Abuse in Aging and Elderly Adults.
- Center for Substance Abuse Treatment. (1998). Substance Abuse Among Older Adults: Treatment Improvement Protocol (TIP) Series, No. 26. Chapter 1—Substance Abuse Among Older Adults: An Invisible Epidemic. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- National Institute on Alcohol Abuse and Alcoholism. Alcohol’s Effects on the Body.
- American Academy of Family Physicians. (2015). Prescription Drug Abuse in the Elderly.
- Longo, L. & Johnson, B. (2000). Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. American Family Physician, 61(7), 2121–2128.
- Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- Center for Substance Abuse Treatment. (1998). Substance Abuse Among Older Adults: Treatment Improvement Protocol (TIP) Series, No. 26. Chapter 5—Referral and Treatment Approaches. Rockville, MD: Substance Abuse and Mental Health Services Administration.