In the 2021 movie “The Good House,” Sigourney Weaver plays an alcoholic in her early 70s. While there are dozens of movies about young people battling substance abuse, it’s startling to see an older person struggle with addiction.
It’s easy to forget that older people can suffer from what doctors call “substance abuse disorder” just like everyone else. They’re hardly immune.
“We normally think the age of highest risk for substance abuse is the 20s and 30s,” said Kenneth Leonard, Ph.D., director of the Clinical and Research Institute on Addictions at University at Buffalo. “And overall, the problem tends to decline with age. But over the last 15 years, we’ve seen an increase in addiction in older people.”
Leonard, 68, speculates that some people of his generation face a risk of substance abuse after they retire. With more free time and fewer responsibilities, they can relive an earlier chapter in their life.
“Alcohol and substance use in the 1960s was on the increase,” he said. “Now they’re getting to an age where they retire and they’re returning to old habits.”
There’s a lack of research on seniors and substance abuse, so it’s hard to pinpoint what’s causing the uptick, Leonard says. But some experts worry it’s becoming a hidden epidemic.
Defining what constitutes an addict gets tricky. Older people who refill their wine glasses repeatedly in social settings may think they can control their intake. It may take a trigger event, like a car accident, for them—and their families—to confront the issue.
Alcohol isn’t the only substance that seniors tend to abuse. The proliferation of pain medications—and their addictiveness—poses another danger.
For Americans between 18 and 49, fentanyl—a synthetic opioid—is the leading cause of death (more than car accidents, suicides or gun violence). But older people are also caught up in this scourge; in 2021, there were 107,622 drug overdose deaths across the entire population, according to the Centers for Disease Control and Prevention.
Nearly 1 million Americans age 65+ live with a substance abuse disorder. Age can make seniors more vulnerable to drug misuse because they tend to metabolize substances more slowly and their brain can be more sensitive to drugs.
Alcohol and prescription opioids are the most common sources of substance abuse disorder among seniors, says Mohammad Alhabbal, M.D., medical director of AdCare Hospital in Worcester, Mass.
“It’s problematic,” he said. “We see it on a daily basis.”
He notes that as people age, they often take multiple medications for a range of ailments. Managing pain, whether due to longstanding ailments or a recent fall, can lead to addiction.
It’s easy for families to miss signs that a parent or grandparent is at risk. And front line medical providers may focus on an older patient’s anxiety or depression without exploring the possible role of substance misuse.
Moreover, primary-care physicians sometimes struggle to distinguish between common health problems that afflict aging adults (poor balance, loss of core muscle strength, mood disorders, memory decline, etc.) and symptoms of substance abuse.
“Education is essential,” Alhabbal said. “It’s important to spot a significant substance abuse disorder earlier, not later.”
He cites red flags such as:
– changes in baseline behavior, like a decline in personal hygiene;
– repeatedly missing appointments;
– requesting renewals on prescription pain meds earlier than needed and
– insisting on renewal of one pain medication instead of considering alternatives.
While an attentive primary-care doctor can identify signs of substance abuse, overcoming the problem requires a team effort. There’s no quick fix.
Prescribed drugs, such as naltrexone and methadone, can treat the addiction in the short term. But over the long haul, the patient faces a series of challenges to get clean.
“To overcome the addiction, a treatment plan needs to involve behavioral change in a supportive setting,” Alhabbal said. “There’s a recovery route. But the patient cannot do it alone. Everybody has to be on the same page,” including family members and medical providers.
He adds that even if an older person perseveres through the acute and chronic phase of substance abuse and advances to remission, there’s a possibility of relapse down the line. Harnessing a support system—of family, friends and medical personnel—can ensure prompt intervention.
Above all, seniors should not assume that because they have a history of managing their alcohol or drug intake, they are home free. All bets are off as you enter your golden years.
“As everybody ages, their body’s and brain’s ability to deal with substances like alcohol changes,” Leonard said. “What used to be fine won’t be fine. What you used to recover from easily, you won’t be able to recover from as easily anymore.”