Misuse of drugs and related products can lead to a person having a substance use disorder. This means that a person uses chemical substances in ways that cause problems. They also usually cannot control their use of the substance. Substances is a general word that includes legal and illegal drugs, alcohol, and nicotine.

Misuse of drugs is the second most common cause of substance use problems among older adults. Many older adults who misuse drugs also have another serious medical condition, such as chronic pain or mental health problems.

Age-related Changes

Physical changes to a person’s aging body can make substance misuse problems worse. Older adults often have stronger reactions to these substances than younger people. These reactions can add to changes that already are happening with age, such as:

• Increased mental problems
• Increased fall risk
• Organ system damage, like kidney and liver disease
• Poor self esteem
• Problems managing their life and relationships

Misuse can occur even in older adults who have never had a problem before. Examples of these problems include:

• Small doses of some substances may be enough to create a need for more.
• Use of some drugs causes “drug tolerance.” This means the person needs higher doses to get the same effect as before. Or the person may feel withdrawal symptoms when stopping the drug.
• A drug that is helpful at first may become harmful. This can happen when a person takes other drugs or their health changes. 

The Most Common Types of Substance Use Disorders

Prescription and Over-the-Counter Medications 

Older adults often misuse prescription drugs, over-the-counter medications, alcohol, and nicotine. Other commonly misused drugs include medicines for anxiety, sleeping problems, and pain.

Some older adults also use illegal drugs, including cocaine, hallucinogens, and injected narcotics. Some people use more than one substance.

Benzodiazepine Use

An older adult with a prescription for a benzodiazepine may not be misusing it. Benzodiazepines are depressants used to treat anxiety, muscle spasms, and seizures. However, they can have bad side effects and aren’t generally intended for long-term use.

The use of benzodiazepines can complicate assessment and treatment of mental health problems. For example, some side effects of this drug can mimic cognitive (memory and thinking), emotional and behavior problems.

Opioid Use

Older adults are more likely to get prescriptions for opioids because they are more likely than younger people to have chronic pain. Opioid misuse is widespread, and older adults are at high risk of misuse or overdose.

Older adults who misuse opioids tend to fall into two types:

• Those who experimented with recreational opioids when younger.
• Those who started using opioids because of a health problem later in life.

Both types need monitoring for risky behavior.

Alcohol Use

Older adults should not drink more than seven standard alcoholic drinks per weeks, or more than three on one day. The upper limit is no more than an average of one standard drink per day and no more than two episodes of binge drinking in three months. Binge drinking is more than two drinks for women and more than three drinks for men at any one time.

A standard drink is 12 ounces of beer OR 5 ounces of wine OR 1.5 ounces of hard liquor.

Frequent drinking can cause serious illness and make health problems worse. They can:

• Increase risk of stroke
• Interfere with needed medications, including warfarin (a blood thinner)
• Decrease quality of life
• Increase falls and injuries
• Harm sleep and memory

The risk of bad interactions between alcohol and many medications is high. This includes  medications that affect the brain, such as those for sleep, anxiety, or depression. Some older adults may not be able to drink alcohol at all or only in small amounts.

Nicotine Use

Nicotine use includes tobacco in cigarette, pipe or cigar smoking, as well as snuff (smokeless tobacco).  Nicotine is also available in electronic cigarettes (e-cigarettes or vapes). Nicotine use in any form may contribute to serious heart diseases and cancer.  Smoking is linked to coronary heart disease, stroke, and 90% of lung cancers.  It is linked to many other cancers including throat, mouth, kidneys, bladder, cervix, and pancreas. 

Last Updated May 2023