A recent review in Current Opinion in Psychiatry addressed the unique problems posed by substance abuse among older adults. In addition to describing the prevalence of substance abuse, this review covered challenges in diagnosing and treating substance abuse in older adults, the consequences of substance abuse for older populations, and changing trends in substance abuse as the baby boomer generation retires.
The most commonly abused substance among older adults is alcohol. Among adults 50 to 64, alcohol dependence, abuse, or dependence symptoms were reported by 11 percent. For adults over 65, that percentage was 6.7 percent. However, when only looking at adults who had consumed alcohol in the past year, of these drinkers 20 percent of those 50 to 64 years old and 15 percent of those over 65 showed alcohol dependence, abuse, or dependence symptoms. However, for older adults there may be factors that lead standard diagnoses of drinking problems to under-represent drinking problems among older adults. One factor would be questions that are more relevant to individuals in the workforce (such as whether alcohol leads to problems at work) than to retired individuals. Other questions may be less likely to be endorsed by older individuals than younger adults, due to generational differences in attitudes. This study also notes that for older adults, there may be additional effects of alcohol and risks associated with alcohol consumption due to factors like changing metabolism, body composition, and general health. Due to these factors, the American Gerontological Society considers at-risk drinking for adults over 65 to be two or more drinks during a usual drinking day within the past 30 days to be “at-risk drinking.”
Research suggests that older men who drink heavily may be using alcohol to cope with depressive moods, and the authors of this review suggested that individuals using higher amounts of alcohol should be screened for depression. They also note that financial strain puts older adults at increased risk for heavy drinking. Since older women are at greater risk of social isolation and economic deprivation, they may also be more vulnerable to a faster progression to alcohol dependence. As a result, this group should not be overlooked.
The second most commonly abused substance among older adults was addictive prescription medications, although less was said about these. Researchers did note that for adults over 55, the two most common medications cited in emergency room visits were opioids (33 percent) and benzodiazopenes (21 percent). The authors also noted that women without social support were most likely to show improper use of prescription drugs.
This review also points out that with baby boomers entering retirement age, the use of illegal non-prescription drugs such as marijuana may become a larger issue due to that generation’s attitudes toward those types of drugs.
Lastly, this review suggested that adults 50 to 59 were far more likely to use substance abuse treatment. Among all adults over 50 years old, 50 to 59 year olds accounted for 83 percent of all admissions for substance abuse treatment. On the bright side, researchers also reported that older adults were as likely to benefit from treatment as younger people.
Wang, Y-P and Andrade, LH. Epidemiology of alcohol and drug use in the elderly. Current Opinion in Psychiatry (2013); 26(4): 343–348.