Overview

People who have substance use disorder keep using alcohol or other substances even though it causes harm to themselves or others. Many people think that substance use disorder happens only to teens and younger adults. But people of all ages can have this disorder, including older adults.

Older adults may use illegal drugs, misuse prescription or over-the-counter medicines, drink too much alcohol, or mix alcohol and medicines. Doing any of these can cause serious health problems and problems with money and the law. It also can harm relationships with family and friends.

Substance use disorder in older adults may be overlooked, because:

• Older adults are more likely to drink or use substances at home rather than in public.
• Older adults may not have duties that are affected by substance use, such as going to school or work.
• Signs of this disorder are similar to symptoms of health problems that many older adults have, such as depression and dementia.
• Caregivers of older adults may be aware of the problem but may not want to talk about it.

Alcohol

Alcohol use disorder can be dangerous for older adults. They:^{footnote 1}

• Usually need less alcohol to become drunk (intoxicated) than someone younger.
• Stay drunk longer, because their bodies process alcohol more slowly.
• May have vision and hearing problems and slower reaction times. Alcohol can make these problems worse. This means alcohol-related falls, car crashes, and other kinds of mishaps are more likely.
• May be more likely to mix alcohol and medicine because they are taking so many medicines. Mixing alcohol with many over-the-counter and prescription medicines can be dangerous or even fatal.

In older adults, alcohol can trigger some health problems or make them worse. These health problems include high blood pressure, ulcers, liver disease, anxiety, sleep problems, and depression.^{footnote 1}

Misuse of medicine

Older adults often have to take many medicines. This can easily lead to misuse of medicines. You misuse medicine when:

• You take too much medicine or take medicine when you don't need to.
• You use older medicines or another person's medicine.
• You take medicine to feel good or "high." This happens most often with medicines used to treat conditions such as depression, anxiety, or pain you have had for a long time (chronic pain).
• You take medicines while drinking alcohol.
• You don't get a prescription renewed.
• You don't take medicine as your doctor directs, such as not taking enough medicine or skipping doses.

Warning signs of substance use disorder

Below are some warning signs that an older adult may have substance use disorder. Signs can include changes in behaviour as well as changes in mental abilities.

Drinking, misusing medicines, or using illegal drugs often starts after a big change in a person's life. Retiring, the death of a spouse or good friend, leaving your home, or being diagnosed with a disease can trigger substance use. If a life-changing event happens to a loved one, watch for signs of substance use disorder.

If you notice any of these signs in someone you care about, talk to the person's doctor. Tell the doctor about the person's substance use, including misuse of prescription and over-the-counter medicines. Tell the doctor about any substance use in the person's past.

These signs may not mean that a person has substance use disorder. Many of the signs listed here also can be signs of health problems many older adults have. Changes in behaviour also could be signs of stress.

Changes in behaviour

Signs that older adults may have substance use disorder include:

• Falling a lot.
• Not being able to make it to the toilet in time (incontinence).
• Having more headaches and dizziness than usual.
• Not keeping themselves clean.
• Having changes in what and how they eat. For example, they may not eat as much as they used to.
• Ignoring and losing touch with their family and friends.
• Having legal or money problems.

Changes in mental abilities

Other signs that older adults may have substance use disorder include:

• Feeling anxious a lot of the time.
• Having memory problems.
• Finding it hard to focus or make decisions.
• Losing interest in their usual activities.
• Having mood swings or feeling sad or depressed.

Treatment

Treatment for substance use disorder in older adults is the same as for younger people. Detoxification, medicine, counselling, therapy, and 12-step programs all may be used.

If prescription medicine misuse is the problem, sometimes it can help to talk to a doctor, friend, or family member. Treatment could be as simple as learning more about your medicines and organizing how you take them. You may be able to work with your doctor to cut back on how many medicines you take or make it easier to take them.

Your success in treatment is strongly linked to admitting that you have a problem and to your desire to stop using substances.