Understanding Substance Use and Mental Health Struggles in Older Adults

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Results from the 2021 and 2022 National Surveys on Drug Use and Health revealed that among adults aged 60 or older, 1 in 8 used illicit drugs in the past year, 1 in 11 had a substance use disorder (SUD) in the past year, and 1 in 8 had any mental illness in the past year. Unfortunately, substance misuse is often underestimated, overlooked, and undertreated in older adults.

According to the World Health Organization, by 2050, the number of people 60+ years old will double, and the number of people 80+ years old will reach 426 million! As the baby boomer generation ages, the number of older adults – those 65 and older –  in the United States is growing, now making up over 20 percent of our nation’s population. 

With the growing older adult population, the concern over their substance use and mental health struggles also grows. According to the National Institute on Drug Abuse (NIDA), substance use disorders in people aged 65 and older are expected to double by 2025. 

According to the National Institute on Drug Abuse (NIDA), substance use disorders in people aged 65 and older are expected to double by 2025. 

Risk Factors

Several factors contribute to the increased risk of substance use and mental health struggles in older adults:

  • Managing chronic health conditions and pain can impact both physical and mental health and lead to self-medicating and misuse of substances. As we age, our bodies metabolize drugs and alcohol more slowly, making older adults more susceptible to the effects of these substances.

  • Retirement, loss of loved ones, or a decline in physical health can lead to feelings of depression and anxiety, which may increase the likelihood of substance use.

  • Having few social relationships and inconsistent contact with friends and family can lead to feelings of isolation and loneliness, which impact overall health.

  • Physical, verbal, psychological, sexual, and financial abuse is not uncommon. 1 in 10 older adults experience some form of abuse, often by their caregivers.

Research shows that feeling social isolation and loneliness harms physical health, especially for older adults.

Mental Health

Research shows that feeling social isolation and loneliness harms physical health, especially for older adults. Loneliness can increase the risk of death by 50%. Social isolation and loneliness can increase the risk of:

  • Heart disease

  • Obesity

  • Anxiety

  • Depression

  • Congnitive decline

  • High blood pressure

Female older adults are more likely to encounter mental health struggles, with nearly 15% experiencing “any mental illness (AMI),” referring to any diagnosed mental, behavioral, or emotional disorder, and 2.6% experiencing a “serious mental illness (SMI),” which refers to a mental, behavioral, or emotional disorder that substantially interferes or limits one major life activities. Approximately 1 in 50 older adults had serious thoughts of suicide in the past year.

Chronic diseases among older adults are expected to increase significantly from 2020 to 2050.

Substance Use and Misuse

Chronic diseases among older adults are expected to increase significantly from 2020 to 2050. Managing these conditions often requires multiple medications, making it easy to become confused about dosage and timing. Polypharmacy, or taking several drugs concurrently, can be particularly dangerous, especially when over-the-counter drugs and herbal supplements interact with prescription medications, increasing the risk of falls, hospitalizations, and other complications.

Many older adults are struggling with major life changes and may turn to substances to find relief from feelings of loss – of self, friends, jobs – isolation, and loneliness. According to the 2021 and 2022 National Surveys on Drug Use and Health, over 7 million older adults had a substance disorder (SUD) in 2022, including 4.4 million with an alcohol use disorder (AUD) and 3.2 million with a drug use disorder (DUD), which includes opioids and marijuana. Males had a higher rate of SUD than females.

Effects of Substance Use

As the body ages, its ability to effectively metabolize substances changes, and the brain can be more susceptible to drugs and alcohol. Drugs can also worsen existing conditions, putting older adults at increased risk for ongoing physical and health issues and injuries. Some conditions impacted by substance use include:

  • Lung and heart problems

  • Hypertension

  • Diabetes

  • Motor coordination

  • Memory issues

Substance use can lead to social isolation, strained relationships, and decreased participation in community activities, further exacerbating feelings of loneliness and depression. The cost of substance use, including the purchase of alcohol or drugs, legal issues, and health care expenses, can strain finances, particularly for those on fixed incomes.

The stigma surrounding mental illness, substance use, and ageism can deter older adults from seeking the care they need, and studies show that older adults who would likely benefit from treatment often did not perceive that they needed it.

Treatment and Prevention

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About 8.5 million older adults were classified as needing substance use treatment in 2022 – about 1 in 9 – but fewer than 1 in 3 received treatment. The stigma surrounding mental illness, substance use, and ageism can deter older adults from seeking the care they need, and studies show that older adults who would likely benefit from treatment often did not perceive that they needed it.

Ways to improve outcomes for older adults struggling with substance use: 

  • Reduce stigma

  • Use targeted screenings for loneliness, isolation, and substance use

  • Tailor treatment for the older adult population and provide training for healthcare providers and caregivers

  • Reduce barriers to accessing treatment – cost, transportation, provide help navigating the healthcare system, especially online platforms

  • Rebuild family, peer, and community support networks

  • Offer culturally relevant counseling and therapy when appropriate

Prevention, treatment, and recovery services are available in Sacramento County. When you’re ready, we’re here for you!

Recovery is possible at any age. By taking the first step and seeking help, you can improve your quality of life and enjoy your golden years to the fullest. It’s never too late to seek help. Whether for yourself or a loved one, addressing substance use can lead to a healthier, happier life. We’re here to support you every step of the way.

Take the first step today—reach out to us, explore our resources, and know you are not alone. For help in Sacramento, https://www.safersacramento.com/county-resources or SAMHSA’s free National Helpline at 1-800-662-HELP (4357).

Recovery is possible at any age. By taking the first step and seeking help, you can improve your quality of life and enjoy your golden years to the fullest. It’s never too late to seek help.

Additional Resources

References

  • Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7). https://doi.org/10.1371/journal.pmed.1000316

  • National Institute on Drug Abuse. (2020, July 9). Substance use in older adults drug facts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/substance-use-in-older-adults-drugfacts

  • SAMHSA. (2020). Treating substance use disorder in older adults. https://store.samhsa.gov/sites/default/files/tip-26-pep20-02-01-011.pdf

  • Substance Abuse and Mental Health Services Administration. (2024). Behavioral health among older adults: Results from the 2021 and 2022 National Surveys on Drug Use and Health (SAMHSA Publication No. PEP24-07-018). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/older-adult-behavioral-health-report-2021-2022

  • World Health Organization. (2023, October 20). Mental health of older adults. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults