Seniors - Treatment Guide

Last Updated March 25, 2024

Yoshiko is a retired bank clerk and is living alone in an assisted care facility. At 68 years of age, Yoshiko has developed several conditions, such as arthritis and old-age dementia. Having lost her husband nearly 10 years ago, Yoshiko is isolated, as she doesn’t have many family members living close by. After being relocated to assisted living, Yoshiko fell into a deep depression and is currently taking six different prescription medications to manage her conditions. Yoshiko also drinks alcohol in the evening to cope with her anxiety and feelings of loneliness.

While the above story is fictional, it is representative of what many seniors experience as they enter their twilight years. Factors such as retirement, loss of loved ones, physical isolation, and old-age illnesses can cause many seniors to turn to substances to cope. However, the good news is that while specific treatments for seniors can be limited, options and resources are available for people of this generation.

Prevalence and Causes of Addiction Among Seniors

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 1 million adults aged 65+ live with a substance use disorder (SUD).
However, according to statistics from Drug and Alcohol Dependence, the number of elderly people abusing substances in 2020 is said to be around 4 million.
The National Institute on Drug Abuse (NIDA) reports that between 2000 and 2012 the number of older adults admitted to treatment centers increased from 3.4% to 7.0%.
17% of people in the U.S. aged 65+ have abused prescription medications, according to the Office of Alcoholism and Substance Abuse Services.
According to the National Council on Alcoholism and Drug Dependence, approximately 30% of adults over 65 are given a prescription medicine.
The 2018 National Survey on Drug Use and Health reports that during the past year, 1.3% of seniors reported misuse of opioids; 0.5% reported misuse of tranquilizers; 0.4% reported misuse of benzodiazepines; and 0.2% reported misuse of sedatives.

Substances Commonly Abused by Seniors

Alcohol

Alcohol is the most used drug amongst all age groups, and seniors are no exception. According to NIDA, 65% of people aged 65 and older report drinking more than the prescribed daily guidelines. Even more concerning is the fact that one-tenth of adults 65 and older also report binge drinking (5+ drinks on one occasion for men, and 4+ for women). As of 2020, studies also show that increases in alcohol consumption are greater for people aged 50 and above, compared with younger age groups.

Prescription Drugs

Prescription drugs are also commonly consumed by seniors. Contributing factors include old-age and/or chronic illness, decreased mobility, and mental health conditions. According to NIDA, 50% of people aged 57 to 85 take more than 5 prescribed medications daily. Oftentimes, seniors who end up abusing these drugs do so by accident or because of misinformation.

Another factor is that as a person gets older, it slows down the body’s ability to absorb and filter substances. Therefore, an older person may become addicted or experience effects at lower doses than young people. Also, some prescriptions may lead to a worsening of mental health issues. This is evidenced by a 2019 study where 25% of patients over 50 years of age expressed suicidal ideation with benzodiazepine use, compared with 2% of people from this age group who don’t use these medications.

Opioids

With old age comes the potential for increased pain associated with conditions like arthritis and age-related diseases. Because of this, many patients in their senior years are prescribed opioids. Some reports indicate that between 4% and 9% of adults 65 and over-use prescription opioids for pain relief.

Opioids are notoriously addictive, which is why high rates of opioid use are concerning for people in this age group. Rates of heroin use, for example, have more than doubled between 2013 and 2015, partly because it is cheaper than prescription opioids.

Cannabis

Cannabis is becoming increasingly more common, especially now that it is legal in some states. For example, 9% of adults aged 50 to 64 have reported past-year marijuana use in 2015-2016, compared to 7.1% in 2012-2013. Also, the use of cannabis in the past year by individuals aged 65 and older increased dramatically from 0.4% in 2006-2007 to 2.9% in 2015-2016.

When it comes to medical cannabis, studies indicate that 25% of adults aged 65 and older have reported doctor recommendations for this substance in the past year. Medical cannabis may be beneficial for people in this age group, as it is known to help with pain relief, sleep, depression, and more.

Nicotine

According to the Centers for Disease Control and Prevention (CDC), roughly 8 out of every 100 adults 65 and older smoked nicotine in 2017. While rates for smoking are lower than among younger people, it is estimated that there are 300,000 smoking-related deaths each year among people in this age group. Seniors may be at increased risk of smoking due to factors such as loneliness, anxiety, and boredom.

Co-Occurring Disorders Among Seniors

Many seniors also struggle with underlying mental health conditions. Research suggests that the prevalence of co-occurring mental disorders is between 21% and 66%. Below are some of the common co-occurring conditions among seniors.

Depression

Depression is often marked by prolonged periods of sadness and hopelessness, making it difficult to cope with everyday life. When it comes to seniors, depression occurs in roughly 7% of the older population. Depression can sometimes be missed or underdiagnosed among seniors because they co-occur with other problems commonly seen in this age group.

Dementia

Dementia is a syndrome that is usually progressive, and it is characterized by a marked deterioration in memory, thinking, behavior, and the ability to perform everyday tasks. According to the World Health Organization (WHO), it is estimated that 50 million people worldwide are living with dementia. The total number of people with dementia is also expected to increase to 82 million by the year 2030.

Anxiety

Seniors can be more vulnerable to anxiety than adults at a younger age. Factors such as living with chronic health conditions, feeling depressed, and experiencing less mobility and activity can all contribute to increased anxiety among seniors. As people get older, they may also lose confidence in being able to do everyday things, which can exacerbate or cause anxiety.

Alienation and Despondency in Old Age

People who have yet to enter their twilight years can’t understand the sense of alienation and despondency that many seniors face. While these feelings don’t affect everyone in this age group, there are factors that can lead to increased isolation and loneliness. These include:

Depression and/or anxiety
Feeling left out
Being physically isolated
Living alone
Losing spouses and family members
Decreased mobility
Age-related illnesses such as dementia and Alzheimer’s
A sense of losing one’s purpose
Neglect from family and friends

Causes of Substance Abuse Among Seniors

The feelings of alienation and despondency in old age described above are contributing factors to substance abuse. Below are some additional reasons why people in this age group turn to alcohol and drugs:

Death of a family member, spouse, pet, or close friend
Loss of income or financial strains
Retirement
Relocation or placement in a nursing home
Sleep issues, insomnia
Family conflict
Mental or physical health decline

Challenges of Identifying Substance Abuse in Seniors

One of the challenges of identifying substance abuse or addiction in seniors is that the signs can resemble other physical or mental health conditions such as diabetes, dementia, or depression. Therefore, doctors can misdiagnose a patient or dismiss their issues as being simply due to “old age.”

The danger is that doctors can recommend a mode of treatment that may worsen a person’s substance abuse problem and any underlying mental health issues. Also, some seniors may present with medical problems that are seemingly due to something else; however, it is later discovered that it is their alcohol or drug use that is making them ill.

Signs of Substance Abuse Among Seniors

While difficult to detect, substance misuse among seniors can come with an array of signs and symptoms. Below are some of the most common:

Memory problems
Changes in sleeping habits
Unexplained bruises
Irritability, sadness, depression
Unexplained chronic pain
Changes in eating habits
Wanting to be isolated
Lack of personal hygiene
Losing touch with loved ones
Lack of interest in usual activities
Hiding or lying about substance use
Frequently running out of prescriptions
Faking symptoms to obtain a prescription

Age-Specific Treatment Options

Unlike other groups such as teenagers, age-specific treatment options for seniors remains somewhat limited. Because people in this group are often under-identified for substance abuse, they end up missing the appropriate treatment.

While seniors are often screened for physical illnesses, they are rarely assessed for substance use disorders. However, medical staff should be aware of key signs such as social withdrawal, unexplained injuries, chronic sleep problems, and excessive preoccupation with obtaining a prescription or having enough pills.

When seniors can seek help for substance abuse problems, they may benefit from traditional rehab options, which range from inpatient to outpatient. These programs also include an array of treatment modalities that may be useful to people of this age group. These include:

Cognitive-behavioral therapy (CBT)
12-Step groups or therapies
Individual or group counseling
Holistic therapies like massage, meditation, and Tai Chi
Educational sessions on coping skills, dealing with isolation, grief/loss, etc.

While rehab centers and programs vary, they should cater to the specific needs of elderly people and consider the issues they face in terms of mobility issues, disabilities, and increased isolation and loneliness.

Medicare Coverage for Drug and Alcohol Rehabilitation

Medicare can be used to cover the cost of drug and alcohol rehabilitation. However, there are rules to consider since not all addiction treatments are covered by Medicare. It’s worth getting in touch with Medicare directly to find out more about how this coverage can work for your individual needs.

In general, you may be eligible for Medicare if:

You are 65 or older.
You are younger than 65 and have a disability.
You are younger than 65 and have end-stage renal disease (permanent kidney failure that requires dialysis or a transplant).

Low-income individuals may also be able to supplement their Medicare coverage with other insurance. For example, private insurance companies will usually cover medical detox under the Affordable Care Act (ACA) as they are required to provide substance abuse treatment coverage to their members. However, the level of coverage will depend on your state and health plan, such as PPO or HMO. Most rehab facilities will also indicate whether they accept private insurance or Medicaid.

Resources

If you or a loved one are struggling with substance abuse, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also find a list of treatment centers near you on our website to help get you on the path to recovery.

Key Sources

Grant B., Chou S., Saha T., et al. (2017). Prevalence of 12‐month alcohol use, high‐risk drinking, and DSM‐IV alcohol use disorder in the United States, 2001‐2002 to 2012‐2013: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. 74(9), 911‐923. https://10.1001/jamapsychiatry.2017.2161.

Han B., Moore A., Ferris R., Palamar J. (2019). Binge drinking among older adults in the United States, 2015-2017. Journal of the American Geriatrics Society. 31, 67(10). https://doi.org/10.1111/jgs.16071

International Psychogeriatric Association (IPA). (n.d.). Substance Abuse in the Elderly. ipa-online.org. https://www.ipa-online.org/news-and-issues/substance-abuse-elderly.

Lesser, B. (2021). Addiction in The Elderly. dualdiagnosis.org. https://dualdiagnosis.org/drug-addiction/elderly-addicts.

National Institute on Drug Abuse (NIDA). (2020). Substance Use in Older Adults DrugFacts. drugabuse.gov. https://www.drugabuse.gov/publications/substance-use-in-older-adults-drugfacts#ref.

Steinhagen, K., and Friedman, M. (2008). Substance Abuse and Misuse in Older Adults. Aging Well. 3, 20. https://www.todaysgeriatricmedicine.com/archive/071708p20.shtml

World Health Organization (WHO). (2017). Mental health of older adults. who.int. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults.

Medical Disclaimer

At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

We provide our readers with factual, evidence-based content concerning the causes and nature of addiction, as well as available treatment options. However, this informative content is intended for educational purposes only. It is by no means a substitute for professional medical advice, diagnosis, or treatment. With regard to any addiction-related health concerns, you should always seek the guidance of a qualified, registered physician who is licensed to practice medicine in your particular jurisdiction. You should never avoid or delay seeking professional health care advice or services based on information obtained from our website. Our authors, editors, medical reviewers, website developers, and parent company do not assume any liability, obligation, or responsibility for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a result of the material presented on RehabAid.com.