Seniors are not the first demographic that comes to mind when envisioning drug and alcohol abuse. But individuals in this age group are more severely impacted by this issue than most people realize. With age, the elderly experience changes in their physical and mental well-being, social circles and family dynamics, and may require more assistance in their everyday lives. The challenges of growing older are only exacerbated by drug or alcohol use, an issue that is commonly overlooked among the older population.
With 2.5 million seniors struggling with a drug or alcohol problem in the U.S., elderly substance abuse grows more severe every day, and yet the understanding of and response to this health crisis is seriously lagging. To get seniors the help they need, it is imperative to know how and why the elderly use medications and other drugs, and which options for rehab care are the most successful for them. Senior substance use disorders can be treated, and recovery is possible for anyone, no matter their age.
Substance Abuse Among the Elderly
While substance abuse is harmful at any point in life, it is the most detrimental in old age. In tandem with an increasing number of life changes, seniors usually begin to supplement their health with more over-the-counter medications and prescription drugs, which can create harmful interactions in the body and spur addiction. And as a person grows older, the body’s ability to process each of these medications slows significantly. For this reason, seniors may become addicted to much smaller doses of prescription drugs than young people.
How Do Seniors Become Addicted to Drugs?
The elderly take pills for nearly every ailment, from high blood pressure to dementia, but drugs impact seniors differently than they impact adults and teenagers. Older people can easily become dependent on or addicted to drugs for various reasons, including:
- Being prescribed multiple drugs simultaneously
- Slower metabolism and increased medication sensitivity
- Co-occurring health conditions (e.g. diabetes, dementia, high blood pressure, etc.)
- Long-term use of psychoactive medications
- Increased rate of surgical procedures (requiring more prescriptions for pain)
- Higher levels of chronic pain
- Higher rate of sleep and anxiety disorders
- Tendency to self-medicate
- Cognitive decline (causing improper use of medications)
- Misdiagnosis from medical professionals
- Drinking alcohol while taking prescription drugs
Seniors use a variety of substances, but the most common types are alcohol and prescription medications, like opioids and benzodiazepines. But a growing number of elderly Americans also use illicit drugs. In 2010, according to emergency room reports, 60 percent of illicit substance users were ages 50 to 55. While some seniors reported taking drugs like cannabis for chronic pain, others also reported using cocaine, meth (or crystal meth) and heroin.
Seniors and Alcohol Abuse
As a regular vice or coping mechanism, alcohol is the most commonly abused drug among adults age 65 and over. According to the National Council on Alcoholism and Drug Dependence (NCADD), widowers aged 75 and older have the highest rate of alcoholism in America.
The American Geriatrics Society and the National Institute for Alcohol Abuse and Alcoholism recommend that those over the age of 65 drink no more than seven standard drinks (like a 12 oz. beer or 5 oz. glass of wine) per week. At-risk drinking (more than three drinks on one occasion or more than seven per week) is more common among the elderly than alcohol use disorders (AUD). While binge drinking is less widely noted in this age group, heavy drinking is often underreported, and alcoholism in elderly adults is frequently overlooked by medical staff and family members.
Signs of Alcohol Abuse in Older Adults
When it comes to the elderly and alcohol abuse, there are several signs that may indicate the presence of alcohol addiction, including:
- Poor self-care
- Shirking medical appointments
- Unstable hypertension
- Gastrointestinal issues
- Recurrent falls or other injuries
- Frequent visits to the emergency room
- Uncharacteristic changes in behavior
- Estrangement from friends and family
- Drinking before, during or after meals
- Outbursts of anger or increased irritability
As with any age group, if older adults drink alcohol while taking prescription drugs, harmful interactions can occur. With the elderly specifically, it takes their bodies a longer period of time to process alcohol, as their metabolism is much slower than a younger person’s. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) compiled a list of common medications seniors take and how each interacts dangerously with alcohol. There can also be dangerous interactions when an older adult mixes their prescription sleeping pills, benzodiazepines (including Xanax), and depressants with alcohol.
If you’ve noticed any signs of alcoholism in your older loved one, they might have an alcohol use disorder or may be experiencing withdrawal symptoms. If you’re concerned that a friend or family member’s drinking has gone too far, alcoholism treatment may be the best course of action.
Elderly Prescription Drug Abuse
When it comes to drug abuse, elderly adults are more prone to addiction than other age groups. Seniors use prescription drugs for all sorts of ailments, from chronic pain to insomnia. According to the NCADD, those 65 years of age and older consume nearly 40 percent of all medications prescribed in the country. And in contrast to other age groups, the elderly are more likely to take an increasing number of prescription drugs at any given time. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that about 3 in 10 people between the ages of 57 and 85 use at least five prescription drugs. Additionally, about 25 percent of seniors take highly addictive psychoactive medications for longer periods of time than any other age group. All of these statistics add up to seniors being much more likely than any other age group to experience prescription drug addiction.
Signs of Prescription Drug Abuse in Older Adults
Any (or all) of these red flags could indicate your loved one is struggling with a dependence on prescription drugs. Signs include:
- Filling a prescription for the same medication at different pharmacies
- Getting a prescription for one medication from several doctors
- Taking a higher dose of a medicine than instructed
- Disregarding warning labels on pill bottles
- Taking pills at unusual times during the day
- Having a supply of “extra” pills in a pocket or purse
- Making excuses for needing extra medicine
- Hiding medication
- Exhibiting negative changes in mood or behavior
- Appearing confused or forgetful
- Becoming defensive when asked about their medication
While older adults take a variety of over-the-counter, prescription and illicit drugs, there are two classes of substances that most of their medication falls under: opioids and benzodiazepines.
Almost 17 million prescriptions for the elderly are for sedatives, the most commonly prescribed being benzodiazepines. This group of psychoactive medications includes drugs like Xanax, Valium and Klonopin. These are usually prescribed for anxiety disorders, cerebral palsy or insomnia. Regardless of the brand name, benzodiazepines have a high abuse potential, and their use should be monitored by a medical professional.
Opioids are among the most commonly used drugs in the country. In 2015, 1 in 3 Americans were prescribed an opioid painkiller. Often used to manage chronic pain, or ease post-surgical discomfort, these narcotic drugs are used by millions of people for a variety of reasons. However, the elderly have an increased chance of becoming addicted to opioids, as they commonly experience ailments that opioids are designed to treat. Older adults undergo surgery more often and have higher rates of arthritis and osteoporosis — all conditions for which a doctor could prescribe an elderly patient an opioid medication.
Why Is Substance Abuse in Older Adults So Common?
While there are many reasons adults struggle with drug abuse, elderly individuals face different struggles that make them more prone to substance use disorders. Substance use disorders in older adults can be spurred by an inability to cope with significant changes involved with aging. These can be related to marital issues, such as a difficult divorce or the death of a spouse, or a change of environment in moving to a senior living facility. Other major changes, like the loss of employment, can weigh heavily on seniors, prompting self-medicating with drugs or alcohol. Major physical changes can also spark drug addiction, such as increased physical disability and surgeries that require an increased dosage of opioid painkillers for recovery.
Mental health decline is another reason seniors struggle with substance abuse. With old age comes memory loss and confusion, and in some cases, dementia and Alzheimer’s disease. In addition, many seniors suffer from mental illnesses such as anxiety and depression, which tranquilizers like Xanax and Klonopin are often prescribed for. It can be all too easy for older adults to confuse two medications or take too many pills accidentally while they are dealing with mental illnesses or cognitive decline, which can lead to physical dependence on drugs.
Senior Living: Which Setting Is Best?
As an older adult or the caregiver of a senior, choosing where to live is paramount as you grow older. There are many different options, ranging from independent living at home to adult day care to retirement communities and assisted living facilities. You can also choose an in-home senior care service to live with more independence, or if you have unique medical needs, you may choose to live in a nursing home. The choice is yours, but each option involves different considerations.
Preferring the familiarity of a house or neighborhood, many seniors choose to stay in their homes well after retirement. As this living situation can be the least supportive when it comes to medical care, it’s important to assess the senior’s physical and mental health needs — both now and in the near future. Outside of staying in a home, independent living communities also allow seniors to “age in place” gracefully, with the convenience of less home maintenance and more social opportunities.
For those who want the freedom of living in their own home, but need extra daily support, in-home services can be a viable option. Caregivers are normally paid per hour and can provide a range of services. In-home care personnel can aid the elderly with chores like cleaning or laundry, and can even provide around-the-clock medical assistance. This type of living situation is ideal for those who want to stay a familiar setting or with their family, but require more care than family members can give. There are plenty of guides on how to select the appropriate in-home senior care service for your loved one.
Today’s retirement villages give seniors more options than ever for living in a communal setting. They can be a good first step for those who are looking to downsize from a larger home to a small apartment and usually offer onsite care seniors need at each stage as they “age in place.” Retirement communities are ideal for people who are still physically active and in relatively good health but would like to save time and money on living expenses. Don’t know which community is right for your elderly loved one? Check out U.S. News’ helpful guide.
Usually located in senior centers, nursing homes, hospitals or as a standalone business, adult day care facilities help meet seniors’ health and social needs throughout the day in a safe, supportive environment. These programs are ideal for those seniors who live with family members who work during the day. Adult day care can provide your loved one with meals, recreation opportunities, companionship and even physical therapy and counseling.
With opportunities for community activities, housekeeping, and 24-hour support and supervision, assisted living facilities help seniors stay mobile, healthy and safe. In contrast to retirement communities, this type of living situation comes with less privacy and independence, which may not be ideal for those who are still in pristine health. Assisted living facilities aid seniors in their everyday living, from nutritional support to fitness programs to housekeeping and on-call medical care. Depending on your loved one’s needs, assisted living can be a great option.
Depending on the range of services provided, long-term care can be included in assisted living facilities and continuing care retirement communities, or in-home care. Most commonly, 24-hour, long-term care is found in nursing homes. Ideal for those who require constant medical supervision or need a greater level of assistance in daily living, nursing homes generally cater to those who are age 80 and over. Comparing nursing homescan be a difficult task, but with the right resources, it can be done.
Each of these settings has its own pros and cons, and each will cater to your physical, medical and mental needs in a different way. The best way to decide on a senior living style is to talk your options over with your family members and your doctor, both of whom will take into account your specific needs and wants.
Misdiagnosis of Senior Substance Use Disorders
Misdiagnosis of substance use disorders in seniors happens for many reasons. Insufficient knowledge, limited data and rushed office visits all contribute to this problem. The red flags of substance abuse in older individuals may be difficult to pinpoint, as they are similar to the signs of aging. They can also mimic the signs of other common disorders seniors experience, like diabetes, dementia and depression.
Making matters worse, the signs of addiction can appear differently in seniors, which can lead to misdiagnosing of medication and the overlooking (or dismissal) of drug dependence altogether. In addition, most doctors will not automatically suspect that a senior has a drug use problem, even though the elderly are often prescribed several drugs simultaneously.
Senior Medication Misdosing
When seniors take multiple medications, misdosing can be accidental. But in other cases, this can occur due to cognitive decline (and in some cases, Alzheimer’s disease), disregard for warning labels, chemical dependence and misdiagnosis by a doctor. It can be difficult for older adults to remember when and how to take each of their medications, especially when their memory isn’t as clear as it used to be and they are taking multiple prescriptions for a longer period of time.
Incorrect dosing of medication can lead to chemical dependence and addiction, so it’s important to always take each prescription as directed. If you’re worried about your medication use or that of a loved one, talk to your doctor or medical professional. You can ask questions like, “Do I take any pills that shouldn’t be taken together?” or “What should I do if I feel like I can’t stop taking a medicine?”
Treatment for Elderly Substance Abuse
Being the family member of a senior with a drug or alcohol problem can be a hard struggle to cope with. Your loved one may be unaware that they have an addiction, without realizing that the risks increase with the amount of pills they take. If your elderly parent, friend or family member is visibly impaired, defensive about their medications, or displays other uncharacteristic behavior, it may be time to seek professional rehab care.
With a team of caring medical staff, The Recovery Village helps adults of all ages overcome substance use disorders in a safe environment. Depending on the severity of the addiction, treatment may start with medical detox before moving on to inpatient or outpatient programming. Each treatment plan at The Recovery Village also includes mental health counseling, holistic therapies like yoga, and beautiful amenities at each location nationwide.
At The Recovery Village, you can find the strength you need to leave substance abuse behind for good at any age. Call today to speak with a representative who understands what you’re going through and can guide you toward the right program of care.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.