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Substance Use Disorders in Older Adults

Topic Overview

Many people think alcohol and other drug use problems (called a substance use disorder) happen only to teens and younger adults. But anyone can have problems with alcohol and other drugs, including older adults.

Older adults may use illegal drugs or cannabis, use prescription or over-the-counter medicines in harmful ways, 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.

It can be harder to tell if an older adult has problems with substance use, because:

  • They’re more likely to drink alcohol or use other drugs at home rather than in public.
  • They may not go to school, work, or do other things that are affected by substance use.
  • Signs of substance use are similar to those found in other 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

Typically older adults do not drink as much alcohol as younger people. But for those that do choose to drink there are things to be aware of.

Older adults have different alcohol-related effects

The effects of alcohol are different in older adults. Older adults:

  • usually need less alcohol to become drunk (intoxicated) than someone younger
  • tend to stay drunk longer, because their bodies break down alcohol more slowly
  • may have seeing and hearing problems or may react more slowly which can lead to falls, a motor vehicle accident, and other accidents
  • may be more likely to mix alcohol with over-the-counter and prescription medicines which can be dangerous or even lead to death. This is because older adults tend to take more medicine than younger people.
  • may be more likely to develop certain health problems or make them worse when they use alcohol, including high blood pressure, ulcers, liver disease, anxiety, sleep problems, and depression

The risk factors above mean that older adults who choose to drink alcohol should not drink more than the daily and weekly limits outlined by Canada’s Low-Risk Drinking Guidelines.

  • Men should have no more than 15 standard drinks a week, with no more than three drinks a day most days
  • Women should have no more than 10 standard drinks a week, with no more than two drinks a day most days
  • Both men and women should plan non-drinking days every week to prevent developing a habit or dependency (addiction)

It’s important to remember this guideline is a low-risk but not a no-risk guideline. But remember that the risk for several chronic illnesses goes up with each drink a person has. And remember that this guideline sets a limit, not a target, for alcohol use. Some older adults should not drink any alcohol. Older adults who choose to drink should talk to their doctor about what amount of alcohol is safe for them.

Misuse of medicine

Older adults often take many medicines. This can sometimes lead to misuse of medicines, such as:

  • taking too much medicine
  • taking medicine when you don't need to
  • using expired medicines
  • using someone else's medicine
  • taking 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).
  • taking medicines while drinking alcohol
  • not taking medicines as prescribed, such as not taking enough or skipping doses

Drinking alcohol or misusing medicine or other drugs often starts after a big change in life. This can include retiring, the death of a spouse or good friend, leaving your home, or being diagnosed with a disease. If a life-changing event happens to you or a loved one, watch for signs of alcohol or other drug use problems.
Let your doctor know if you use alcohol, illegal drugs, and medicines, including over-the-counter medicines, herbs, and dietary supplements.

Warning signs of substance use disorder

Warning signs of alcohol or other drug use problems in older adults can include behaviour and mental changes.

If you notice any of these signs in yourself or someone you care about, talk to your doctor. Having these signs doesn’t mean you have a problem with alcohol or other drugs. Many of these signs are also related to other health problems that older adults may have. Changes in behavior can also be related to stress.

Behaviour changes

Signs of an alcohol or other drug use disorder include:

  • falling a lot
  • not being able to make it to the bathroom in time (incontinence)
  • having more headaches or feeling more dizzy than usual
  • not keeping yourself clean
  • changes to what and how you eat, such as not eating as much
  • spending less time with your family and friends
  • thinking about suicide
  • legal or money problems

Changes in mental abilities

Signs of an alcohol or other drug use disorder include:

  • feeling anxious a lot
  • memory problems that get worse
  • having a hard time focusing or making decisions
  • losing interest in your usual activities
  • having mood swings or feeling sad or depressed

Treatment

Treatment for substance use disorder in older adults is the same treatment as for younger people.

Alberta Health Services offers many addiction and mental health services, including the following free and confidential helplines that are available 24 hours a day:

  • Addiction Helpline – 1-866-332-2322
  • Mental Health Helpline – 1-877-303-2642

If medicine misuse is the problem, sometimes talking to a doctor, friend, or family member about the problem can help. Learning more about your medicines and organizing how you take them can help prevent misuse.

References

Citations

  1. Department of Health and Human Services (2008). Substance abuse among older adults. Treatment Improvement Protocol (TIP), Series 26 (DHHS Publication No. SMA 08-3918). Available online: http://store.samhsa.gov/product/TIP-26-Substance-Abuse-Among-Older-Adults/SMA08-3918.

Credits

Adaptation Date: 5/19/2020

Adapted By: Alberta Health Services

Adaptation Reviewed By: Alberta Health Services

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