Drug and Substance Use

Basic Facts

Most drugs and other chemical substances are helpful when used properly. Unfortunately, the misuse of medications and drugs—both legal and illegal, as well as alcohol and tobacco—is a growing problem in the older population. The terms “drug use disorder” or “substance use disorder” is defined as the use of chemical substances that lead to an increased risk of problems and an inability to control the use of the substance. 

Dependence on a drug or alcohol is particularly dangerous in older people because older adults tend to have more harmful effects from these substances than younger people. These effects include increased mental problems, kidney and liver disease, and increased vulnerability to falls. Dependence can occur even in older people who have never had an addiction problem before. 

With some drugs, your body needs increasingly higher doses to get the original effect, or you may feel withdrawal symptoms when the drug is stopped. This is referred to as drug "tolerance," meaning that the drug makes your body change in these ways. Even small doses of certain substances may be enough to create a dangerous need for more. Also, a drug that is beneficial when first prescribed may become harmful when other drugs are added, or when there is a change in your health. 
Many different organ systems can be damaged by substance use disorder.. Substance use disorder has negative effects on how you feel about yourself, how you manage problems or changes in your life, and your relationships.  This can add to other challenges that are common in later life. 

The Most Common Types of Drug and Substance Use Disorders

Prescription and Over-the-Counter Medications 

Among older adults, prescriptions, over-the-counter medications, and alcohol are commonly misused. Addiction to nicotine (cigarette, pipe, or cigar smoking) is also a common problem. Other commonly misused drugs include anxiety pills, sleeping medications, and pain medications.

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

Many older adults who become addicted to drugs also have another serious medical condition, such as chronic pain or a mental illness. 

Alcohol Use Disorder

Women and men over the age of 65 years should not drink either more than 7 standard alcoholic drinks per week on average, or more than 3 drinks on any day. A standard drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor. Drinking more than these amounts puts people at risk of serious alcohol use problems. Frequent drinking can:

  • cause serious illness, especially stomach and liver problems
  • increase risk of stroke
  • worsen other medical conditions
  • interfere with needed medications, including warfarin
  • greatly decrease overall quality of life
  • increase falls and injuries
  • impair sleep
  • impair memory

Particularly troublesome is the potential for harmful interactions between alcohol and medications (prescribed or over-the-counter), especially medications that affect the brain, such as medications for anxiety and depression. Older adults with health problems or who take certain medications may need to drink less or not at all.

Tobacco Abuse

Tobacco abuse includes cigarette, pipe or cigar smoking.  Smoking is the cause of many serious heart and lung diseases, as well as cancer. It also makes many diseases, such as diabetes, more complicated and disabling. 

How Common are Drug and Substance Use Problems?

Misuse of alcohol or other drugs is a common cause of physical and mental health problems in older Americans, especially older men. Rates of illegal drug use and dependence are lower in the older population than in younger people. But other types of substance abuse, such as inappropriate use of prescription and over-the-counter (non-prescription) medicines, is increasing. 

About three out of five older adults take painkillers regularly. More than one in five take a medication that affects their central nervous system and about 11% take benzodiazepines (a type of sedative). Older women are much more likely to use benzodiazepines than men. 

Nearly 50 percent of adults over age 65 years consume alcohol. Among these, 14.5 percent drink more than the recommended weekly allowance ( more than 7 drinks per week) or drink in binges. When accounting for older adults' other medical problems, a survey classified 53 percent of older drinkers as having harmful or hazardous drinking patterns.


Last Updated July 2020

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