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Senior Citizens and Substance Use

The number of senior citizens in the United States is expected to grow substantially over the next several decades, with a 2020 report from the U.S. Census Bureau estimating that the number of American adults aged 65 and older will nearly double by 2060.1 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 elderly population is often overlooked and undertreated.2,7

For example, between 2013 and 2105, the number of people aged 55 and older seeking help for opioid use disorder (OUD) increased by almost 54%.13 Similarly, between 2001 and 2013, alcohol use disorder (AUD) in people aged 65 and older increased 107%.13

Reasons Seniors Become Addicted

There are many reasons why senior citizens become addicted to drugs or alcohol, including:3,4,6,7

  • Unaddressed addictions that developed earlier in life. In some cases, an older adult may have had a drug or alcohol use 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. Prescription drug misuse in the aging population may also be 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 side effects of medical or mental health conditions. Older adults may misuse certain substances to stave off specific symptoms of medical or psychological conditions such as pain or problems with sleep and appetite.
  • Depression, anxiety and other co-occurring mental health problems. An estimated 1.7 million older adults aged 50 and older had a co-occurring mental health disorder and substance use disorder in 2019, with only an estimated 10% receiving treatment for both. Substance misuse and co-occurring disorders are often related, and major depressive disorder and generalized anxiety disorder are two common mental health disorders that co-occur with substance use disorder in older adults.
  • 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 Senior Citizens

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:2,7

  • 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 aged 65 and older.”
  • Impaired mental health. The same clinical review reports that substance misuse 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 misused by senior citizens affect them differently than younger people, and smaller amounts can have a greater impact.7 Senior citizens are most likely to misuse alcohol and prescription medicines like opioid pain relievers and benzodiazepines.7 They also use marijuana, cocaine, and heroin.7


Alcohol has been reported as the substance most frequently misused by people older than 50. As the body ages, older people do not metabolize alcohol as efficiently as younger people, increasing their risk of cognitive and physical problems, like confusion and falls.7 Most older people who drink (approximately 78%) also often take medicines that interact with alcohol.7 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 cardiovascular and liver damage.
  • Immune system impairment.


Older adults also often misuse benzodiazepines—medications often frequently prescribed to for anxiety and insomnia.7 People who use benzodiazepines may experience negative symptoms such as:

  • Memory impairment.
  • Drowsiness.
  • Poor concentration.
  • Vertigo.
  • Increased excitement or hostility.
  • Depression.
  • Suicidal ideation (in some cases).

Older adults who use benzodiazepines are especially at risk for potentially harmful alcohol-drug interactions.7

Opioids and Other Prescription and Over-the-Counter Medicines

Other medicines that senior citizens may misuse include opioid painkillers, sleeping pills (for example, Ambien), and over-the-counter pain relievers and cold medicines (for example, antihistamines, decongestants). Seniors who misuse these medicines are also more likely to experience:7

  • Harmful interactions between different drugs, especially if they are taking multiple prescriptions.
  • An increased risk of injury and falls.
  • Cognitive impairment (problems with thinking).
  • Sleep problems.
  • Heart and liver disease.
  • Overdose, which can be fatal.
  • Suicide.

Specialized Rehab for Seniors

As with treatment geared toward younger people, senior citizens with substance use disorders may benefit from a wide range of individualized treatment approaches, including detoxification, outpatient or inpatient treatment, and aftercare. However, specialized detox and treatment services designed for the needs and circumstances of older adults can help address some of the differences between older and younger substance abusers. Older adults may be dealing with depression, loneliness, and loss of career or a loved one, and they are also more likely to have comorbid medical conditions.11 Older adults may also have a slower metabolism which may require adjustments to medication dosages and result in longer-lasting withdrawal symptoms that may require longer detox treatment.2,11

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

Medical detox and other drug treatment programs that can specifically accommodate senior citizens are based on the same protocols for detox in other populations, but they should be sensitive to the unique needs of seniors. 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 an appropriate 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.

Detox programs should also keep in mind that older adults may require adjustments to doses of many medications used for treating withdrawal symptoms and substance use disorders.12