167 Substance Abuse and the Elderly

Alcohol and drug problems, particularly prescription drug abuse, have become a serious health concern among older adults. In 2016, nearly two-thirds (65.7 percent) of Canadian seniors were prescribed five or more different drug classes. The frequency of daily or almost daily alcohol use peaks in among 65- to 74-year-olds. This is almost three times as high as the frequency among 15- to 54-year-olds (Statistics Canada, 2016). The use of benzodiazepine receptor agonists is higher in older adults (14.6 percent). This is also higher in women (18.9 percent) than men (10 percent).

Although people sixty-five and older make up only 13 percent of the population, they account for almost 30 percent of all medications prescribed in the United States. According to the National Council on Alcoholism and Drug Dependence (2015), the following statistics illustrate the significance of substance abuse for those in late adulthood:

• there are 2.5 million older adults with an alcohol or drug problem;
• six to eleven percent of elderly hospital admissions, 14 percent of elderly emergency room admissions, and 20 percent of elderly psychiatric hospital admissions are a result of alcohol or drug problems;
• widowers over the age of seventy-five have the highest rate of alcoholism in the US;
• Nearly 50 percent of nursing-home residents have alcohol-related problems;
• Older adults are hospitalized as often for alcohol-related problems as for heart attacks;
• nearly 17 million prescriptions for tranquilizers are prescribed for older adults each year, with benzodiazepines, a type of tranquilizing drug, the most commonly misused and abused prescription medication.

Risk factors for psychoactive substance abuse in older adults include social isolation, which can lead to depression (Youdin, 2016). This can be caused by the death of a spouse/partner, family members and/or friends, retirement, moving, and reduced activity levels. Additionally, medical conditions, chronic pain, anxiety, and stress can all lead to the abuse of substances.

Diagnosis difficulties: Using criteria from the Diagnostic and Statistical Manual of Disorder, 5th Edition (American Psychiatric Association, 2013), diagnosing older adults with a substance use disorder can be difficult (Youdin, 2016). For example, compared to adolescents and younger adults, older adults are not looking to get high, but rather become dependent by accident. Additionally, stereotypes of older adults, which include memory deficits, confusion, depression, agitation, motor problems, and hostility, can result in a diagnosis of cognitive impairment instead of a substance-use disorder. Further, a diagnosis of a substance-use disorder involves impairment in work, school, or home obligations, and because older adults are not typically working, in school, or caring for children, these impairments would not be exhibited. Lastly, physicians may be biased against asking those in late adulthood if they have a problem with drugs or alcohol (National Council on Alcoholism and Drug Dependence, 2015).

Abused substances: Drugs of choice for older adults include alcohol, benzodiazepines, opioid prescription medications, and marijuana. The abuse of prescription medications is expected to increase significantly. Siriwardena, Qureshi, Gibson, Collier, and Lathamn (2006) found that family physicians prescribe benzodiazepines and opioids to older adults to deal with psychosocial and pain problems rather than prescribe alternatives to medication such as therapy. Those in late adulthood are also more sensitive to the effects of alcohol than those younger because of an age-related decrease in the ratio between lean body mass and fat (Erber and Szuchman, 2015).

Additionally, “liver enzymes that metabolize alcohol become less efficient with age and central nervous system sensitivity to drugs increase with age” (p. 134). Those in late adulthood are also more likely to be taking other medications, and this can result in unpredictable interactions with the psychoactive substances (Youdin, 2016).

Cannabis use: Lifetime prevalence of cannabis use disorder in Canada was 2.6 percent (Statistics Canada, 2012). The proportion was 4 percent for older adults in 2018, which rose to 4.4 percent in 2019 following legalization (Statistics Canada, 2019). The proportion of adults using cannabis between the ages of forty-five and sixty-four rose from 8.8 percent to 14 percent, indicating that as these populations age, the rate of cannabis use among the elderly will also increase. Blazer and Wu (2009) found that adults aged fifty to sixty-four in the United States were more likely to use cannabis than older adults. The Baby Boomers with the highest cannabis use included men, those unmarried/unpartnered, and those with depression. While there are negative effects of cannabis, which include panic reactions, anxiety, perceptual distortions and exacerbation of mood and psychotic disorders, cannabis can also provide benefit to older adults with medical conditions (Youdin, 2016). For example, cannabis can be used in the treatment for multiple sclerosis, Parkinson’s disease, chronic pain, and fatigue and nausea from the effects of chemotherapy (Williamson and Evans, 2000). 

Future substance abuse concerns: There will be an increase in the number of seniors abusing substances in the future because the Baby Boomer generation has a history of having been exposed to, and having experienced, psychoactive substance use over their adult life. This is a significant difference from the current and previous generations of older adults (National Institutes of Health, 2014c). Efforts will be needed to adequately address these future substance-abuse issues for the elderly due to both the health risks for them and the expected burden on the healthcare system.