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Elderly Substance Abuse

Dangers of Substance and prescription drug abuse in elderly

An analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions suggests that one in five people over 65 have had a substance or alcohol abuse problem at some point in their lives. Alcohol and tobacco topped the list of nonmedical substances abused by survey participants. Substance and alcohol abuse are a concern for senior health because of possible interactions with prescription medication, their impact on overall health, and the increased senior health risks, such as falls, associated with intoxication.

According to the Office of Alcoholism and Substance Abuse Services, substance abuse among senior citizens can be classified into two general forms: the “hardy survivor,” or those who have been abusing substances for many years and have reached 65, and the “late onset” group, which is those who form addictions later in life. Regardless of how old you are or when your addiction started, there are treatment options available to help you get back on a healthy path.

Causes Of Addiction In The Elderly

  • Family conflict
  • Mental or physical health decline (depression, memory loss, major surgeries, etc.)
  • Retirement
  • Death of a family member, spouse, pet or close friend
  • Loss of income or financial strains
  • Relocation
  • Trouble sleeping

Substance Abuse Dangers In The Elderly

Drug or alcohol abuse among the elderly is particularly dangerous because senior citizens are more susceptible to the deteriorating effects of these substances. Individuals over 65 have a decreased ability to metabolize drugs or alcohol along with an increased brain sensitivity to them. This makes it dangerous for seniors to use drugs or alcohol at all, even if the person isn’t addicted.

Benzodiazepines, which are used to treat anxiety, pain or insomnia, are some of the most dangerous prescription drugs for seniors. These are generously prescribed and highly addictive. The rate of senior citizens addicted to benzos has increased every year.

indentifying causes of drug addition in elderly


Identifying Addiction In The Elderly

Alcohol or drug abuse may actually mimic symptoms of other medical or mental health disorders, such as diabetes, dementia or depression. This makes it easy for doctors who encounter an older patient to chalk up declining mental or physical health simply to “old age.”


"Not long ago, a medical colleague referred a 67-year-old woman with mild depression, weakness and complaints of short-term memory loss. Her physician told her there was no clear medical explanation for her symptoms, given that her physical exam, exhaustive lab tests and brain M.R.I. were all normal. The problem, soon discovered, was that her alcohol consumption had tripled since the death of her husband a year earlier. She did disclose to her internist that she drank but minimized the amount. She had turned to alcohol, self-medicating her grief, but it only worsened her mood and impaired her memory, typical of alcohol’s effects on the brain."

- Richard A. Friedman, M.D., NYTimes.com

Mental Dependence vs. Physical Dependence

Mental dependence is when use of a substance is a conditioned response to an event or feeling. These are known as “triggers.” Triggers can be emotional responses to events, certain people, places or anything a person associates with using a substance. Something as simple as driving can trigger a desire to use. These triggers set off biochemical changes in a person’s brain that strongly influence addictive behavior.

Something as simple as driving can trigger a desire to use. These triggers set off biochemical changes in a person’s brain that strongly influence addictive behavior.

When the symptoms of mental and physical dependence are apparent, an addiction is usually present. However, the main characteristic that distinguishes addiction from dependence is the combination of mental and physical dependence with uncontrollable behavior in obtaining and using a substance.

So, why do some organizations scrap the word “addiction” from their vocabulary? The DSM believes the term carries too much negative connotation and is ambiguous. The World Health Organization also wanted to replace the medical designation of “addiction” with the word “dependence” back in 1964 (which probably contributed to the confusion).

Substance Abuse vs. Substance Dependence

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the leading source for diagnosing and understanding addiction. The DSM-IV defined abuse and dependence as two separate disorders. However, the most recent edition of the DSM no longer creates this distinction.

Abuse and dependence are defined on a scale that measures the time and degree of substance use. Essentially, abuse is like the early stage of dependence. As substance abuse becomes more frequent, the likelihood of developing a dependence disorder becomes greater.

Identifying Prescription Drug Abuse

Prescription drug abuse is when people misuse prescribed medicines. They may abuse their own medicine in a way that is not instructed by the doctor. This includes taking more medicine than they need or taking it when they don’t need it. Or they may abuse a prescription that is meant for someone else. Prescription drug abuse also can occur when people mix medicine with alcohol or other drugs.

Prescription drug abuse is a term that refers to the improper use of medicines that are categorized as “controlled substances” by the Drug Enforcement Administration. Examples include medicines that doctors prescribe to treat pain, anxiety, or sleep. This can lead to serious problems, such as drug interactions, addiction, or even overdose. A drug interaction occurs when two or more drugs react with each other. It could make drugs less effective or cause harmful side effects.

Symptoms of prescription drug abuse can be hard to recognize in older adults. This is because they are similar to symptoms of aging. For instance, confusion and memory loss are symptoms of both. The following are warning signs that someone may be abusing prescription drugs. If they:

  • Get a prescription for the same medicine from two different doctors.
  • Fill a prescription for the same medicine at two different pharmacies.
  • Take more of a medicine than they used to or take more than is instructed on the label.
  • Take the medicine at different times or more often than is instructed on the label.
  • Become more withdrawn or angry.
  • Appear confused or forgetful
  • Often talk about a medicine.
  • Are afraid to go somewhere without taking a medicine.
  • Are defensive when you ask about a medicine.
  • Make excuses for why they need a medicine.
  • Store “extra” pills in their purse or in their pocket.
  • Sneak or hide medicine.
  • Have been treated for alcohol, drug, or prescription drug abuse in the past.

Communicating With The Doctor

If you suspect that an older adult is abusing a prescription drug, contact their doctor right away. Tell them about your concerns. The doctor will likely make an appointment to evaluate the person. They can diagnose if the problem is prescription drug abuse. The doctor also will help determine treatment. Treatment options for prescription drug abuse vary by person. It depends on what drug is abused, the degree of addiction, and the risk of having a withdrawal of the drug. Treatment may include counseling, medicine, or both.

Questions To Ask The Doctor

  • Are there any medicines I take that could cause a drug interaction?
  • What should I do if I feel like I’ve become dependent on a medicine?
  • What is the best way to organize medicines so I don’t make a mistake?
  • What are the symptoms for prescription drug abuse?
  • How do I know if I need help?

Why Are Older Adults At Risk For Prescription Drug Abuse?

Most older adults who suffer from prescription drug abuse do so by accident. They take more medicine than other age groups. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 3 in 10 people between ages 57 to 85 use at least 5 prescriptions. This increases the risk for mistakes and drug abuse.

Growing older also slows down your body’s ability to absorb and filter medicines. This means that an older adult might become addicted to or have side effects from a prescription drug at a lower dose than a younger adult.


For help managing prescription medications in an elderly spouse or parent, call Heritage Senior Care (800) 562-2734




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