You may have recently found yourself asking if you, or someone you know, is drinking too much. Or maybe you were concerned about how your medications were impacting you. If you’ve asked yourself these questions or something similar, you’re not alone. It can be challenging to know where use “crossing the line” especially as our bodies ability to process substances changes as we age. Let’s start with some definitions to better understand the impact of substances on our bodies.

What’s the difference between substance misuse and substance use disorder (SUD)?

The first question to answer is what’s the difference between misusing a substance and having a diagnosable disorder. If we’re misusing a substance, say pain medication, we might need a higher dose to get the same relief or we may find ourselves drinking at inappropriate times, like first thing in the morning. One of the most misused substances is alcohol.⁵ It’s important to understand what alcohol misuse might look like. It could involve binge drinking, 5 or more drinks per occasion (males) or 4 of more drinks per occasion (females)⁵ or heavy drinking where a person binge drinks 5 or more days in the past 30 days.⁷

When misuse “crosses the line” to a diagnosable disorder the person’s use is now causing significant impairment or distress.¹ They may have trouble controlling their use, for example using more than they intended to, or experience social problems, like difficulties in their relationships. It could be they use the substance in risky situations, like driving under the influence or developing a tolerance for the substance meaning they need more of it to get the same feeling.¹

What is the prevalence of substance abuse?

Substance use is more common among older adults today compared to previous generations. According to the Substance Abuse and Mental Health Services Administration⁷ almost 13% of adults over the age of 60 engage in binge drinking, and approximately 3% engage in heavy drinking. Males were more likely to engage in these behaviors compared to females.⁷ Approximately 9.5 million (12.1%) of adults over 60 used an illicit drug in the past year, this included marijuana and opioid use.⁷ The most common mode of marijuana use was smoking, followed by eating/drinking. Almost 10% of respondents reported using marijuana in the past year.⁷

What are the most common substances of misuse?

You might be asking yourself what substances could be misused. Below you will find a list of some common substances that could be misused.⁵

1. Alcohol
2. Prescription drugs (examples: opioids, depressants (Xanax), stimulants (Ritalin)
3. Illicit drugs (heroin, cocaine, LSD, MDMAs)
4. Marijuana (recreational or medication)
5. Nicotine.

What are the risk factors associated with substance use disorders? 

Certain physical and social factors may put older adults at a higher risk for substance use disorders.⁴

Physical risk factors can include:⁴

• Chronic pain
• Physical disability or limited mobility
• Transitions in care or living situation
• Poor health/chronic
• Physical illnesses
• History of alcohol or substance use disorder

Social factors may include:⁴

• Grief and loss
• Social isolation
• Poor coping skills
• Unexpected or forced retirement.

Males are at a higher risk for alcohol use and females are at a higher risk for prescription medication use.⁴

If you’re concerned about your own use, or the use of a loved one help is available.

How can screening tools help with substance abuse?

Your doctor or mental health professional may begin with a validated screening tool to assess your substance use. These screenings will ask questions to assess your current usage of a substance. Some people find it more comfortable to complete a self-screening tool. With access to the internet, you can complete a mental health test through Mental Health America.⁶ As a reminder, screening is not a diagnosis. If your results indicate you maybe experience a substance use disorder, schedule an appointment with your doctor or a mental health professional for a full assessment and to discuss treatment options.

Are there treatment options available for substance abuse?

Treatment options may vary depending on the person, substance, and available resources. These may include in-patient rehabilitation, intensive outpatient treatment, therapy, self-help groups, including evidence-based programs like SBIRT (Screening, Brief Intervention and Referral to Treatment⁸), and/or medication management²³. 

Just because we turn 60 doesn’t mean our habits will automatically change. If you are concerned about yourself or a loved one’s substance use know that help is available. Visit FindTreatment.gov to find local resources.

Sources

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed., text rev.). March 2022. 

2. Centers for Disease Control and Prevention (CDC) Treatment of substance use disorders. April 25, 2024. Found on the internet at https://www.cdc.gov/overdose-prevention/treatment/index.html

3. Cleveland Clinic. Substance Use Disorder (SUD). November 19, 2024. Found on the internet at https://my.clevelandclinic.org/health/diseases/16652-drug-addiction-substance-use-disorder-sud

4. Alex Kuerbis et al., Substance abuse among older adults. Clinics in Geriatric Medicine. June 14, 2014. Found on the internet at https://pmc.ncbi.nlm.nih.gov/articles/PMC4146436/

5. A. Thomas McCellan. Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare? Transactions of the American Clinical and Climatological Association. January 2017. Found on the internet at https://pmc.ncbi.nlm.nih.gov/articles/PMC5525418/

6. Mental Health America. Take a Mental Health Test. Found on the internet at https://screening.mhanational.org/screening-tools/

7. Substance Abuse and Mental Health Services Administration (SAMHSA). Behavioral Health among Older Adults: Results from the 2021 and 2022 National Surveys on Drug Use and Health. May 2024. Found on the internet at https://www.samhsa.gov/data/sites/default/files/reports/rpt45341/2022-nsduh-older-adult-info.pdf

8. Substance Abuse and Mental Health Services Administration. Screening, brief intervention, and referral to Treatment (SBIRT). December 3, 2024. Found on the internet at https://www.samhsa.gov/sbirt