Clients may misuse both prescribed and nonprescribed substances, such as alcohol, for such reasons. Thinking about the role of chronic physical conditions in older clients’ misuse of substances (e.g., use of substances to manage chronic pain). Such conditions can also affect symptoms of substance misuse and treatment response. No screeners have been statistically validated for assessing prescription or over-the-counter (OTC) medication misuse substance abuse in older adults that would identify accidental misuse or noncompliance issues. Nevertheless, healthcare and behavioral health service providers should assess how older adults use such medications, with an eye toward potential adverse reactions and interactions. The American Geriatrics Society’s 2019 Beers Criteria® address medications that are potentially inappropriately prescribed for older adults.319 See the Chapter 6 text box on the 2019 Beers Criteria®.

Alcohol can interact dangerously with medications taken by older adults, including over-the-counter drugs, herbal remedies, and prescriptions. Different years of NSDUH, TEDS, and DAWN data were used in this analysis because they are the latest years of data available. All NSDUH estimates in this report are annual averages based on combined 2007 to 2014 NSDUH data.

Screening for Co-Occurring Disorders and Conditions

Most calls involve someone who lives alone or with a family member or caregiver. It’s not clear whether better data collection also helped explain the increase, but evidence suggests that other similar jurisdictions — such as Michigan and Illinois — did not see such a steep increase. The opinions, analyses, reviews or recommendations expressed in this article are those of the Blueprint editorial staff alone. The information is accurate as of the publish date, but always check the provider’s website for the most current information. Prescription pain pill abuse is also high in Arkansas, Nevada, Louisiana and Alabama. The state with the lowest cocaine use is Texas, with just 1 in 100 Texans self-reporting cocaine use.

These groups and their availability vary greatly in various parts of the county. Some will not be available in many localities, but online and telephone meetings may be available. The most important parts of your full assessment are gathering information about the client’s substance use, mental health, physical health, and SUD treatment histories, as well as a listing of prescribed and OTC medications. Clients will feel safe sharing detailed information as their trust in you builds. Referrals to SUD treatment programs or mental health services for clients who need more indepth assessment or intervention. People with PTSD are at high risk for substance misuse.397 People with PTSD may use substances to help themselves cope and feel better.

Helping a Senior Recognize Risk​

This article presents an overview of epidemiology, service use, and clinical considerations on SUD in older adults and suggests future directions. SUD prevalence is lower in older versus younger adults, as are treatment rates among those with SUD. SUDs may be difficult to recognize and treat in older adults due to the presence of other psychiatric and general medical disorders. Better integration of SUD and general medical treatment, and increased attention to social determinants of health, are important future directions for research and treatment of SUD in elders. Naltrexone is the most well-studied medication used for SUD treatment among older adults,112 and it has demonstrated some effectiveness with this population. The standard dose of naltrexone is 50 mg, but some studies have investigated its effects at larger doses (eg, 100 mg).

As people age, many sooner or later have problems completing everyday tasks on their own, like bathing, cooking, shopping, and driving. Substance misuse can make everyday living even more difficult, including ADLs and instrumental activities of daily living (IADLs). ADLs are basic everyday tasks like dressing, using the toilet, using the phone, and feeding oneself. As part of assessing substance misuse, measure clients’ ability to complete ADLs and IADLs without help. Note that substance use greatly increases the risk of intimate partner violence. Screen all women who seek SUD treatment for intimate partner abuse, regardless of their age.512 Substance use increases the risk of abuse toward older adults,513 and experiencing elder abuse can contribute to substance misuse among older adults.

Opioid Pain Medicines

When considering referral for treatment, first consider the client’s thinking abilities. Problems with thinking could affect a client’s ability to participate in treatment. The client might need a treatment provider who has experience working with older clients with cognitive problems. Individual treatment rather than group treatment might also be a better choice.

In 1999, the annual death rate due to opioid overdose per 100,000 persons 55 years or older was 0.90 compared to 10.70 in 2019 [58]. The fatality rate was highest among non-Hispanic Black men 55 years or older, with a rate of 40.03 per 100,000 persons [58]. It is also important to note the difference between pharmacologic preparations of cannabis and medicinal cannabis. Pharmacologic preparations are approved by the Food and Drug Administration (FDA) for specific indications such as seizures or anorexia [34]. The FDA currently has approved one cannabis-derived and three cannabis-related drug products; these include cannabidiol, nabilone, and two brands of dronabinol [34]. Medicinal cannabis, however, is part of an unregulated industry with no medical or government oversight and thus largely operates under the Herbal and Dietary Supplements Industry.

What is the most popular drug in the U.S.?

Societal norms tend to reinforce the perception that older adults do not have SUD (Kuerbis and Sacco, 2013). This belief can be internalized by older adults, leading them to avoid treatment. On the positive side, because individuals ages 65 and older are eligible for Medicare, insurance is less often a barrier to care.

• An important future direction will be to expand the evidence-base for the treatment of older adults.
• Several screening tools have been adapted or validated for use in older adults, particularly for alcohol use disorder (AUD).
• There exist numerous screening and diagnostic tools for alcohol and substance use in the general population; however, these tools must be validated in the geriatric population due to the unique social characteristics of older adults.
• There is no “wrong door” through which older adults can arrive at the right diagnosis and care.
• These findings suggest an interplay between older age, race, and socioeconomic status that must be further explored to provide the most appropriate care for the geriatric population.