Drug and Substance Use Disorders

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Care & Treatment

Usually, a team approach to treatment is best. Depending on the person’s needs, the team may include a nurse, social worker, psychotherapist, or counselor.

Older adults tend to do better than younger people in drug and alcohol treatment programs.

Support groups such as Alcoholics Anonymous, Rational Recovery, or Narcotics Anonymous have excellent track records. Finding a support group that works is more important than the type of substance the group focuses on. Ask your healthcare team for suggestions.

Non-Drug Therapies

The following are among the effective treatments that are part of a team approach:

  • Talk therapy (psychotherapy) with a trained supportive counselor
  • Group therapy with a trained therapist
  • Keeping a diary to record your patterns of misuse of substances
  • Residential care in a rehabilitation facility
  • 12-step programs and other long-term programs (such as Alcoholics Anonymous)

Drug Treatment

Treatment choices using medications include: 

  • Specialized drugs to reduce cravings and withdrawal symptoms
  • Slow tapering of the problem substance with drug substitutions as support
  • Hospitalization until the person’s health is stable and detoxification is complete. Detoxification means clearing the body of poisons when a person is acutely intoxicated or misusing substances.
  • Nutritional counseling, multivitamins, and supplemental B vitamins (in cases of severe problem drinking)

Medications to Reduce Cravings

Some drugs can help reduce cravings for the substance. For example,

  • Naltrexone, may help a person stay away from alcohol.
  • Buprenorphine and other drugs can help older adults who are trying to stay away from opioids like oxycodone. 

Other types of medications may help. A professional who is trained in treating substance use can help you.

Treatment Options for Opioid Use Disorder (OUD)

To prevent OUD in the first place, healthcare professionals will prescribe opioids only at the level a person needs. They will also monitor use of medications to avoid stockpiling and may request the return of unused prescriptions.

If a person has an opioid use disorder, treatment with buprenorphine can help reduce use of the drugs. Naltrexone can also do this. As a last resort, methadone is available for use in older adults, but they must be monitored closely for side effects.

People with active prescriptions for opioids need access to a naloxone reversal kit for opioid overdose. Many community-based organizations and pharmacies offer training in its use.

Nicotine Misuse

Quitting smoking improves quality of life by reducing coughing and shortness of breath in a few months and the risk of a heart attack in a year or two.  Even after age 65, quitting smoking can reduce mortality risk. Quitting smoking at any age slows the decline in lung function. Ask for help from your healthcare professional. Together, you can take the following steps:

  • Choose a date to quit that suits you
  • Get any needed medications
  • Arrange a follow-up visit
  • Educate yourself about smoking and the benefits of quitting
  • Get involved in a support group or buddy system to stay motivated to quit
Medications to Reduce Nicotine Use

Many people have had success in quitting smoking by:

  • Using medication along with programs that help change behavior.
  • Using nicotine replacement therapy (such as skin patches or chewing gum). This increases the success rate of quitting smoking by up to 70 percent. These therapies reduce withdrawal symptoms by delivering nicotine to the brain more slowly than smoking does. The use of both patches and gum is more effective than use of either alone.
  • Bupropion and varenicline are effective medications for reducing nicotine use. However, varenicline may be associated with a higher rate of injury from road accidents and falls.

The U.S. Food and Drug Administration (FDA) has not approved any e-cigarettes as aids for quitting smoking.

Monitoring 

Since recovery from substance misuse is considered an ongoing process, a healthcare professional needs to monitor a person’s progress and help ensure they continue to stay off the substance. Seeing a healthcare provider or social worker every three to six months helps.  

 

Last Updated May 2023

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