Substance Use Disorders In Seniors

Even though the United States has a continuing conversation about marijuana and substance abuse among teens and young adults, there are also substance abuse disorders impacting seniors. While this topic has less attention, the cause and effect of a senior's substance abuse can be just as significant as that of teens and young adults.

Derek Bast, DO, a board-certified family medicine physician with Franciscan Physician Network CityWay Family Medicine in Indianapolis, explains how substance abuse disorders impact seniors.

Key Takeaways: Seniors & Substance Use

• Self-medication, previous use and significant life transitions are among the reasons for substance use in seniors
• Seniors are at increased risk of negative health effects from alcohol, marijuana or other substances interacting with the medicines that they're already taking.
• Family members and friends of seniors need to be aware of changes in behaviors.

Do Seniors Really Struggle With Substance Abuse ?

While such a broadly impactful topic as substance abuse, it's easy for misconceptions about substance abuse among seniors to appear.

"I think the most common misconception is that seniors don't suffer from substance abuse," Dr. Bast said. "That misconception comes from people out in the community, whether they're thinking about their grandparents or parents. The thought of substance just doesn't really come to mind as something that you're concerned about."

Yet substance abuse among senior adults is happening.

• One in 11 adults ages 60 or older had a substance use disorder in 2022, according to the American Psychological Association.
• Twelve percent of adults ages 65 or older reported binge drinking in the previous month, according to the 2023 National Survey on Drug Use and Health.
• A 2024 study sponsored by National Institute on Drug Abuse National Institutes of Health found 13.7% of adults ages 55 to 65 reported using marijuana in the last 30 days,
• The same study found that 6.6 percent of adults ages 55 to 65 reported nonmedical use of any prescription drug (including narcotics, sedatives, tranquilizers, and stimulants) in the past 12 months.

"I don't think that substance use disorders are something that we think about for our senior population, and that's definitely a problem that we need to address," Dr. Bast said.

Why Do Adults Turn To Substances Like Alcohol Or Marijuana Later in Life?

"I think one of the more common reasons adults turn to certain substances is that they're self-medicating something," Dr. Bast said. "As people get older, they often have difficulty sleeping, joint pain and other concerns. With these issues, people tend to turn to alcohol and marijuana as a way to self-medicate."

Dr. Bast explained that some people may also turn to substance use because they've used them in the past.

"We're seeing a lot of people from the baby boomer population, which had the largest percentage of use of alcohol and marijuana, return to their substance use," he said.

One of the dangers of seniors returning to marijuana use lies in the fact that marijuana can be different from how it was when they were younger, Dr. Bast said. Some seniors may not recognize the specific marijuana that they're using.

"I work in a substance use disorder clinic," Dr. Bast said. "I'll often have patients who thought they were just smoking marijuana, but it really contains a lot of things they had no intention of using. And that's dangerous for a young, healthy population and even more dangerous for our aging seniors who have comorbid conditions that can be greatly affected by those substances."

Dr. Bast explained that if someone has chronic joint pain, a local pharmacy has a CBD product that may potentially make it better, but seniors still need to be careful to avoid medical interactions.

Are Seniors More Vulnerable To The Effects Of Marijuana?

Anyone who uses substances like marijuana can experience negative effects on their overall health. Still, the health of seniors can be severely impacted by substance use in comparison.

For example, recent studies have demonstrated that smoking marijuana has a negative effect on our cardiovascular health.

"We've been expecting that for years, but now there's some official evidence that proves that," Dr. Bast said. "Sure, that's a big deal for young people, but for seniors who are at higher risk of having a heart attack or heart disease, it's a much bigger issue."

Along with a higher risk of heart complications, Dr. bast also explained that seniors tend to be on more medications, which can result in things such as marijuana interacting with their other medications.

"As you age, there are physiologic shifts in your body that put you at higher risk for the negative effects of substances like confusion, falling and memory loss," Dr. Bast said

How Can I Talk With My Doctor About Substance Use?

Talking about using marijuana, alcohol or other substances with a health professional can be an awkward and even sensitive topic for many. Even so, having the conversation can avoid additional problems in the future.

"In my clinic, I'm very open with patients and ask them to bring questions regarding interactions with marijuana and medications during their visit," Dr. Bast said. "It's not common that they'll open up about the topic themselves."

Dr. Bast explained that he has some patients who are more direct with their concerns, such as drinking, but they are still a minority of the people he sees in the clinic.

"With most patients, if you crack the door for a conversation, they're happy to walk through it," Dr. Bast said. "As professionals, we at least have to be willing to open that conversation to them and show them it's okay to talk about it."

How Can Loved Ones Spot And Address The Signs Of Substance Abuse In Seniors?

It can be difficult to recognize signs of substance abuse in anyone, including seniors. Dr. Bast explained how with his own story.

"My grandmother had multiple doctor's visits for falls even though she was in good health," Dr. Bast said. "We had no idea why she was falling. Still, later on in her home, I remember seeing drinking glasses on her table and asking her about her drinking habits."

Dr. Bast shared that while her grandmother said that she only drinks so often at night, it turned out that she was falling at night because she was relatively dehydrated.

"She was having a couple of full glasses of bourbon at night, which resulted in her falling," Dr. Bast said. "At first, no one had any idea. Her daughter didn't recognize that this adorable 70-something-year-old lady had an alcohol use disorder."

He explained that it's essential to be aware of these symptoms in seniors. Even recognizing small statements such as "I'm not sleeping well at night" or "I'm more confused at night " can help identify whether what they're saying is related to substance use. If anything, it can start an important conversation.

What Role Do Mental And Physical Issues Play In A Senior's Substance Abuse?

People tend to turn to something that can assist them with their personal trauma. With seniors, their trauma can be more sudden, resulting in a quick turn to substance use.

"Mental and physical issues can be the primary driving factor of substance abuse and we see it pretty often," Dr. Bast said. "We need to be aware when there is a significant life transition with our seniors.

Dr. Bast explained that seniors can experience life transitions such as:

• Retirement
• Loss of a loved one
• Decrease in overall health
• A change in living situation

He explained that these sudden changes can result in personal responses, including:

• Bereavement
• Increased depression
• Anxiety
• Thoughts of using specific substances

"Those things are definitely a driving factor behind either restarting an alcohol use disorder or marijuana use," Dr. Bast said. "On top of that, seniors have less of a safety net for people to realize if there is a significant change with them personally."

He explained that if a younger person developed something that was affecting their ability to go to work, people would notice and someone would say something. If someone's not going to work on a regular basis, then they'll need that help from family and friends to recognize that change.