Asking older adults about drug and alcohol use can feel uncomfortable, especially if you're working in a health or community context where you don't typically asking about substance use. Read on for a few tips on how to start this conversation and to learn about what to do if you think someone needs additional follow-up or resources.

Why ask older adults about problems with substance use?

Older adults experience physiological changes that make them more sensitive to substances compared to other age groups. This means an older adult may not be able to drink the same amount of alcohol they did when they were younger without experiencing more side effects or consequences. Increased sensitivity also applies to other drugs, including cannabis, and prescription medications where even small amounts may have large effects.

Another concern: older adults may have life transitions that increase their risk of problematic drug and alcohol use. These transitions may include:

• coping with chronic medical problems
• a lack of enjoyable activities following retirement
• loneliness, grief, or social pressure associated with living in retirement communities in which drinking offers a means of interacting with others

Considering their lower tolerance for drugs and alcohol, as well as the impact of life transitions, older adults should be screened yearly for drug and alcohol problems. Although the majority of older adults do not report a problem with drug and alcohol use, the consequences of problematic drug and alcohol use can include worsening of current health problems, onset of new health problems, and changes to cognitive status.

How can you ask older adults about their alcohol and drug use?

One of the difficulties with asking about drug and alcohol use is that many people who are engaging in a hazardous level of substance use do not think recognize the danger. This may be due to lack of knowledge or awareness about their drug and alcohol use patterns and the possible consequences. Because older adults may be unaware they have a problem, the easiest way to ask older adults about drug and alcohol use is to start with open-ended questions to get the conversation going.

For example, you could ask:

• How much alcohol do you typically drink (in a typical day or week)?
• How often do you use cannabis or other drugs?

Asking questions in this open-ended style assumes that older adults are using some drugs or alcohol and that it is okay to talk about it. Asking closed-ended questions (“Do you drink alcohol or use cannabis?”) may lead older adults to feel uncomfortable replying “yes.”

If someone is drinking regularly, providers can follow the NIAAA low risk drinking guidelines to ask further questions. Specifically, providers can ask if the older adult has recently consumed more than three drinks on any given day or more than seven drinks in a week. Some guidelines recommend no more than one drink per day for older adults. Older adults with complex medical conditions may need to abstain from drug and alcohol use.

Start from a place of concern, not judgment

If an older adult seems to be drinking more alcohol than the NIAAA guidelines or is engaging in hazardous drug use, it can be helpful to start from a place of concern. You might say, “I’m concerned about your cannabis use; can we talk about it further?” From here, you can try to better understand their patterns of use by asking what times of day or situations they are most likely to drink or use other drugs.

You could ask them to describe the last time they engaged in a hazardous level of drug or alcohol use. It can also be helpful to ask if this is a new pattern of drug and alcohol use, or if this is a longstanding pattern going back to young adulthood. Some older adults have had problems with drugs and alcohol for most of their adult lives, while others do not have problems until life transitions or other factors affect them in older adulthood.

Possible questions to ask about this include:

1. At what age did you start drinking/using on a regular basis?
2. When did you notice changes or problems with alcohol/other drugs?
3. Were there periods of time in adulthood when you were not drinking/using drugs? 
4. Have changes in your drinking/drug use coincided with specific events (e.g., loss, retirement, changes in medical conditions)?

Avoiding judgment and using screening tools

Although it may seem like an unusual question, it can also be helpful to ask someone, "What do you like about drug and alcohol use?" The answer will give you an idea about what motivates them to continue using drugs and alcohol. These types of open-ended questions can help to start the conversation about substance use in a way that is collaborative and not judgmental.

If you are looking for more formal ways of assessing drug and alcohol use, the AUDIT-C is a brief screening measure that can be used in multiple settings to gauge problematic alcohol use. There is a similar short screening measure for cannabis use called the CUDIT short form which includes items 3, 5, and 6 from the longer eight-item version of the scale (CUDIT-R) with a cut-off score of 2. 

What helpful follow-up recommendations can I give someone with substance use conerns?

If you are concerned about someone's level of drug and/or alcohol use, you can encourage them to talk to their physician about their substance use. Suggest the older adult write down what amount of drug and/or alcohol they use in a typical week and share that information with their physician.

You can also provide some general information through reputable handouts or websites that address substance use among older adults, such as: 

• Older Adults and Alcohol: You Can Get Help
• Suggested strategies to cut back or stop, which can be applied to any type of substance use

NCOA hosts the annual Older Adult Mental Health Awareness Day to highlight critical issues in addressing mental health needs as we age. 

This article is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $5 million with 100% funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.