Research shows that approximately 17% of American adults age 60 and over misuse alcohol and prescription drugs, but substance use disorders in this population are often undiagnosed and untreated. Symptoms of substance abuse may go unrecognized because they mimic the symptoms of other medical and behavioral disorders, such as diabetes, depression, and dementia. In addition, older adults who are no longer employed, are perhaps socially isolated, and drive less (or not at all), can more easily conceal the signs and symptoms of alcohol or drug dependence, such as cravings, blackouts, physical signs of withdrawal, and neglecting responsibilities. Risk factors for substance use disorders among older adults include social isolation, loss of spouse and other significant losses, family history of addiction, substance abuse in earlier years, co-morbid psychiatric disorders, among other factors.

Older adults are more apt to abuse alcohol and prescription drugs as opposed to illegal street drugs such as heroin. However, health problems associated with heavy drinking or prescription drug misuse can be severe and include:

• Liver diseases, such as fatty liver, cirrhosis, alcoholic hepatitis, and fibrosis
• Pancreatitis
• Cancers of many kinds, including liver, mouth, throat, larynx, breast, colon, and esophagus
• Heart problems, including cardiomyopathy, irregular heartbeat, and high blood pressure
• Stroke
• Weakened immune system
• Malnutrition
• Psychiatric disorders, including depression and anxiety
• Falls, accidents, and injuries as a result of being intoxicated

There are a number of barriers to the diagnosis and treatment of substance use disorders among older adults. Lack of awareness, shame, denial, and fear of social stigma (especially for women) prevent many individuals and their families from acknowledging a problem in the first place. Healthcare providers may lack expertise in this area and avoid asking about substance use histories. Co-morbid health conditions may complicate diagnoses.

In general, older adults are less likely to be identified as having a substance use disorder during routine medical care, or to be recommended for treatment. Other barriers for older adults with a substance use disorder may include lack of transportation, financial and insurance constraints, lack of mobility or cognitive impairments, and lack of suitable treatment programs.
Given the prevalence of substance use disorders among older adults, health care providers, clinicians, family members, and others in contact with older adults should become educated about substance use disorders and be on the lookout for signs of problems.

Resources:
SAMHSA
Texas Department of State Health Services
Screening assessments:
SMAST-G and CAGE.

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