CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Other Substances

The substances most commonly abused by older adults besides alcohol are nicotine and psychoactive prescription drugs. Both nicotine and prescription drug abuse are far more prevalent among older adults who abuse alcohol than among the older general population.^4-7 A major concern regarding drug misuse and abuse is the large number of older adults using prescription drugs without proper physician supervision.

Drugs of particular concern include benzodiazepines, sedatives, and hypnotics.⁸ Older patients are prescribed benzodiazepines more than any other age group. About 20 percent of drugs prescribed to older adults are benzodiazepines.⁹ One study showed that nearly 20 percent of older adults used benzodiazepines on a long-term basis.¹⁰

Older adults are apparently more likely to continue using psychoactive drugs for longer periods than younger people.^11,12 About one-quarter of older adults reported using a psychoactive drug within the last year. One-fifth used a tranquilizer daily.^11,13 In addition, older adults frequently use antidepressants, and a recent study found that they may be getting the wrong medications.¹⁴

Narcotic abuse is rare among older adults, except for those who abused opiates in their younger years.¹⁵ Prescribed opioids are an infrequent problem as well. Only 2 to 3 percent of noninstitutionalized older adults receive prescriptions for opioid analgesics.¹⁶ The vast majority do not develop dependence. One study, for example, found that only 4 of nearly 12,000 patients who were prescribed morphine for self-administration became addicted.¹⁷

In the past, the use of illicit drugs has been limited to a tiny group of aging criminals and long-term heroin addicts.¹⁸ Research is limited on older adults’ use of illicit substances (e.g., heroin, cocaine, marijuana), but health care personnel are seeing more older adults with symptoms of illicit drug use. Many of these older illicit drug users receive drugs from a younger relative or partner who uses or sells drugs.