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Older person's hand holding medication

A substance use disorder (SUD) is an illness that results from the continuous use of drugs or alcohol. It causes physical, mental, or other problems that prohibit a person from functioning at work, school or home. The term substance use disorder combines both substance abuse and substance addiction together. However, each substance is addressed as a separate use disorder. For example, the addiction is classified as an opioid use disorder, an alcohol use disorder, etc. Treatment among these disorders are the same based on the level of severity.

Unfortunately, SUD affects an increasing number of older adults each year. SUD often goes undiagnosed in older adults because many people, including health professionals, assume that older adults do not misuse substances. This misconception is due, in part, to the relatively low drug use of previous generations. However, the increasing use and abuse of alcohol, prescription drugs, and illicit drugs among older adults have become emerging public health crises in the United States. According to the Substance Abuse and Mental Health Services Administration, in 2017 more than 1 million older adults (65 years or older) in the US had a SUD. However, it is estimated that more than 5.7 million adults aged 50 and older will have a SUD by the end of 2020.

Prescription Drug Misuse and Abuse

Illicit drug use among older adults is also on the rise, although older adults tend to abuse alcohol and prescription drugs more than illicit drugs. Prescription drugs most commonly abused by older adults are opioids (powerful painkillers) and benzodiazepines (medicines for sleeplessness and anxiety). The inappropriate use or abuse of prescription drugs by older adults may be intentional or unintentional. Some ways in which prescriptions drugs are abused or misused include:

  • taking a higher dosage than prescribed
  • taking dosage more often than prescribed
  • taking another person’s prescribed medication
  • taking prescribed medication with alcohol
  • taking for a longer duration than prescribed

Factors that Increase SUD

There are various factors that can put older adults at a greater risk of developing SUDs. Some of those factors include the following:

Age. As people age, a body’s ability to metabolize and eliminate drugs and alcohol decreases. This condition can lead to reduced tolerance of drugs and alcohol and increased risks for toxicity.

Gender. The higher likelihood of older females using prescription drugs that alter moods, perceptions, or consciousness, puts them at greater risk.

History of substance abuse. Having abused drugs before tends to increase the likelihood of an SUD when older. Drug use among baby boomers is higher compared to other generations.

Chronic pain. The prevalence of chronic pain in the United States has increased. Between 1995 and 2010, doctors prescribed more opioid drugs to better control pain among older patients, increasing usage nine-fold.

Multiple prescriptions. According to the National Council on Aging, older adults use more prescription and over-the counter medication. This makes it easier for them to make mistakes when it comes to dosage and timing.

Social isolation. Being alone increases drug usage.

Mental health disorders. Depression and/or anxiety leads to great drug use.

Incurable illnesses. Being diagnosed with an incurable disease can also increase use.

Physical immobility. Decreased ability to engage in activities or failing health can lead to greater use.

Grief. Loss of a significant other, child, and/or friend leaves an emotional void.

Lifestyle changes. Life events, such as retirement, leaving or sharing a home, raising grandchildren, and/or adjusting to a lower income, can all lead to increased substance usage.

SUD, Aging, and Increased Risks

Not only does the inappropriate use of alcohol and drugs increase an older adult’s risk of developing a SUD, it can also increase the risk of the following:

  • falls and accidents (bone fractures)
  • confusion or disorientation
  • forgetfulness or memory loss
  • suicide by self-poisoning
  • mental illness
  • death by overdose
  • impaired vision
  • impaired coordination


Because the symptoms of SUD tend to look like signs of aging, the recognition and/or detection of SUD among older adults is challenging for professionals, friends, and family members. For example, confusion and memory loss, which are typical of aging, can be signs of prescription drug abuse in older adults. An important first step in addressing this emerging health issue is to realize that older adults do misuse and abuse drugs like other generations. Increased awareness about this growing health problem can undoubtedly prepare us to better assist and care for older adults.

Visit www.aces.edu for more information about older adults.

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