PSYCHOACTIVE SUBSTANCES AND AGING: TRENDS, CONSEQUENCES, AND INTERVENTIONS IN INDIVIDUALS OVER 65 YEARS
DOI:
https://doi.org/10.18623/rvd.v23.4893Keywords:
Older Adults, Substance Use disorders, Alcohol Misuse, Prescription Drug Misuse, Aging Population, Psychosocial Interventions, Social Work, Integrated Care, Prevention and TreatmentAbstract
Older adults are increasingly vulnerable to the physiological and psychological effects of psychoactive substances, often abusing alcohol, medications, or combinations of substances as coping mechanisms in response to loss, retirement, chronic illness, and social transitions. Alcohol remains the most widely used psychoactive substance, with a significant increase in alcohol-related disorders among those over 65 years of age. Treating substance abuse in later life requires a multidisciplinary and integrated approach that combines pharmacological care with psychosocial interventions, including cognitive behavioral therapy, motivational interviewing, brief interventions, case management, and family support. Despite this need, specialized services and prevention programs for older adults remain limited. This article offers an original interdisciplinary contribution by integrating international empirical evidence and theoretical models from social work and public health perspectives. It systematizes age-specific risk factors such as polypharmacy, chronic diseases, social isolation and stigma and identifies personalized psychosocial interventions for people over 65 years of age. The article proposes a model for integrated psychosocial interventions, age-appropriate and applicable to professional practice, developed by the author. The model can serve as a conceptual basis for the development of policies in the prevention and treatment of substance abuse among the older population.
References
Barry, K. L., Blow, F. C., & Oslin, D. W. (2002). Substance abuse in older adults: Review and recommendations for education and practice in medical settings. Substance Abuse, 23(Suppl. 3), 105–131. https://doi.org/10.1080/08897070209511510
Bartzokis, G., Beckson, M., Hance, D. B., Lu, P. H., Foster, J. A., Mintz, J., Ling, W., & Bridge, P. (1999). Magnetic resonance imaging evidence of "silent" cerebrovascular toxicity in cocaine dependence. Biological Psychiatry, 45(9), 1203–1211. https://doi.org/10.1016/s0006-3223(98)00228-5
Breslow, R. A., Castle, I. P., Chen, C. M., & Graubard, B. I. (2017). Trends in alcohol consumption among older Americans: National Health Interview Surveys, 1997 to 2014. Alcoholism: Clinical and Experimental Research, 41(5), 976–986. https://doi.org/10.1111/acer.13365
Calvo, E., Allel, K., Staudinger, U. M., Castillo-Carniglia, A., Medina, J. T., & Keyes, K. M. (2021). Cross-country differences in age trends in alcohol consumption among older adults: A cross-sectional study of individuals aged 50 years and older in 22 countries. Addiction, 116(6), 1399–1412. https://doi.org/10.1111/add.15292
CDC. (2024). Tobacco product use among adults — United States, 2022: 2022 National Health Interview Survey (NHIS) highlights. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/media/pdfs/2024/09/cdc-osh-ncis-data-report-508.pdf
Center for Behavioral Health Statistics and Quality. (2025a). 2024 National Survey on Drug Use and Health (NSDUH): Methodological summary and definitions. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/methodology
Center for Behavioral Health Statistics and Quality. (2025b). Key substance use and mental health indicators in the United States: Results from the 2024 National Survey on Drug Use and Health (HHS Publication No. PEP25-07-007, NSDUH Series H-60). https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases
Chhatre, S., Cook, R., Mallik, E., et al. (2017). Trends in substance use admissions among older adults. BMC Health Services Research, 17, 584. https://doi.org/10.1186/s12913-017-2538-z
Galicia-Castillo, M. (2016). Opioids for persistent pain in older adults. Cleveland Clinic Journal of Medicine, 83(6). https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/issues/articles/Galicia-Castillo_OpiodsForOlderAdults.pdf
Han, B., & Palamar, J. J. (2020). Trends in cannabis use among older adults in the United States, 2015–2018. JAMA Internal Medicine, 180(4), 609–611. https://doi.org/10.1001/jamainternmed.2019.7517
Han, B., Moore, A., & Levander, X. (2022). To care for older adults with substance use disorder, create age-friendly health systems. Health Affairs Forefront. https://doi.org/10.1377/forefront.20220505.917481
Hu, J., Kulkarni, N., Maliha, P., & Grossberg, G. (2024). Prevalence and treatment of substance misuse in older adults: Beyond early adulthood. Substance Abuse and Rehabilitation, 15, 87–98. https://doi.org/10.2147/SAR.S375653
Humphries, K., & Shover, C. (2023). Twenty-year trends in drug overdose fatalities among older adults in the U.S. JAMA Psychiatry, 80(5), 518–520. https://doi.org/10.1001/jamapsychiatry.2022.5159
Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance abuse among older adults. Clinical Geriatric Medicine, 30(3), 629–654. https://doi.org/10.1016/j.cger.2014.04.008
Lewer, D., Croxford, S., Desai, M., Emanuel, E., Hope, V. D., McAuley, A., et al. (2022). The characteristics of people who inject drugs in the United Kingdom: Changes in age, duration, and incidence of injecting, 1980–2019, using evidence from repeated cross-sectional surveys. Addiction, 117(9), 2471–2480. https://doi.org/10.1111/add.15911
Li, Y., Zhang, X., Yang, L., Yang, Y., Qiao, G., Lu, C., et al. (2022). Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 100, 104630. https://doi.org/10.1016/j.archger.2022.104630
Lin, J., Arnovitz, M., Kotbi, N., & Francois, D. (2023). Substance use disorders in the geriatric population: A review and synthesis of the literature of a growing problem in a growing population. Current Treatment Options in Psychiatry, 10(3). https://doi.org/10.1007/s40501-023-00291-9
Lin, J., et al. (2011). Alcohol, tobacco, and nonmedical drug use disorders in U.S. adults aged 65 years and older: Data from the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions. American Journal of Geriatric Psychiatry, 19(3), 292–299. https://doi.org/10.1097/JGP.0b013e3181f22a73
Merrick, E. L., Horgan, C. M., Hodgkin, D., et al. (2008). Unhealthy drinking patterns in older adults: Prevalence and associated characteristics. Journal of the American Geriatrics Society, 56, 214–223. https://doi.org/10.1111/j.1532-5415.2007.01539.x
National Institute on Alcohol Abuse and Alcoholism. (2024). Alcohol's effects on health. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics-z/alcohol-facts-and-statistics/alcohol-and-older-adults-ages-65
National Institute on Drug Abuse. (2024). Substance use in older adults: DrugFacts. https://nida.nih.gov/publications/drugfacts/substance-use-in-older-adults-drugfacts
NCPHA. (2021). Health and social measures related to drug use. In European Guide: Older Adults with Problematic Opioid Use (pp. 99–105).
Ndukwe, H. C., Tordoff, J. M., Wang, T., & Nishtala, P. S. (2014). Psychotropic medicine utilization in older people in New Zealand from 2005 to 2013. Drugs & Aging, 31(10), 755–768. https://doi.org/10.1007/s40266-014-0205-1
Oslin, D. W., Grantham, S., Coakley, E., et al. (2006). PRISM-E: Comparison of integrated care and enhanced specialty referral in managing at-risk alcohol use. Psychiatric Services, 57(7), 954–958. https://doi.org/10.1176/appi.ps.57.7.954
Qato, D. M., Alexander, G. C., Conti, R. M., Johnson, M., Schumm, P., & Lindau, S. T. (2008). Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA, 300(24), 2867–2878. https://doi.org/10.1001/jama.2008.892
Sacco, P., & Kuerbis, A. (2013). Older adults. In M. G. Vaughn & B. E. Perron (Eds.), Social work practice in the addictions (pp. 213–229). Springer.
SAMHSA. (2025). Companion infographic report: Results from the 2021 to 2024 National Surveys on Drug Use and Health. https://www.med.unc.edu/fammed/nctac/wp-content/uploads/sites/1256/2025/09/2024-nsduh-companion-report.pdf
Schepis, T. S., Simoni-Wastila, L., & McCabe, S. E. (2019). Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults. International Journal of Geriatric Psychiatry, 34(1), 122–129. https://doi.org/10.1002/gps.4999
Shuman, T. (2025). A guide to substance abuse in older adults: Risks, warning signs, and treatments. SeniorLiving.org. https://www.seniorliving.org/research/substance-abuse-seniors/
Sutherland, R., Chrzanowska, A., Prael, G., & Peacock, A. (2024). Substance use and related harms among Australians aged 50 years and older 2001–2021. National Drug and Alcohol Research Centre, UNSW Sydney.
White, A., Castle, I., Hingson, R., & Powell, P. (2020). Using death certificates to explore changes in alcohol-related mortality in the United States, 1999 to 2017. Alcoholism: Clinical and Experimental Research, 44(1), 178–187. https://doi.org/10.1111/acer.14239
Wojt, I. R., Cairns, R., Clough, A. J., & Tan, E. C. K. (2021). The prevalence and characteristics of psychotropic-related hospitalizations in older people: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 22(6), 1206–1214.e5. https://doi.org/10.1016/j.jamda.2020.12.035
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