October 19, 2023


There is growing concern among prevention specialists and public health officials regarding older adults and substance use, misuse, and increasing substance use disorders. Substance use in older adults is complicated and often gets missed, especially when individuals are experiencing other health-related aging conditions. While the number of older adults needing treatment has more than doubled in the last 20 years,1 prevention and treatment services may not be currently tailored to the needs of older adults.

Many prevention organizations don’t know how to focus prevention efforts on this age group, so we see a lag in the growing amount of concern and the numbers of communities taking action.

Patterns of Use Are Shifting

Following are some statistics on the patterns being seen today:

  • Alcohol use and misuse in older adults has been increasing, particularly among women. Alcohol-induced deaths have gone up as well. In 2020, alcohol-induced causes were recorded as the underlying cause of death for 11,616 adults aged 65 and over.1
  • Although these deaths comprise less than 1% of all deaths in this age group, age-adjusted death rates for alcohol-induced causes have been increasing since 2011 and rose by 18.2% from 2019 (17.0 deaths per 100,000 standard population) to 2020 (20.1).2
  • Cannabis use among older adults has also increased significantly in recent years. This is due in part to a growing interest in the use of cannabis to treat terminal health conditions and symptoms, common among older adults.3
  • The number of adults over 65 hospitalized for opioid abuse has more than tripled in the last 20 years.4
  • Overdose rates for older adults are increasing,5 in part due to misuse of prescription drugs, especially benzodiazepines and opioids.6

Why This Matters

Older adults have unique vulnerabilities. Use or misuse of substances can create problems more quickly and make existing health conditions worse. Increased sensitivity to alcohol can increase risks for falls, car crashes, or unintentional injuries.

Many medications interact badly with alcohol or cannabis, and cognitive decline can contribute to misuse, producing dangerous situations when substances such as benzodiazepines and opioids are mixed.7

Life transitions such as loss of a spouse, moving, or failing health in this population can lead to anxiety or boredom and align with misuse and depression. Loneliness in this population has consequences for well-being as well as for physical and mental health—and even for mortality.8

How Prevention Specialists Can Take Action

So how do we as prevention specialists shift gears and respond to this emerging public health issue? First, we need to understand what is happening in our communities and consider developing new partnerships that can work across sectors that engage traditionally older adults.

Community engagement is important and can influence the equitable scale-up of evidence-based practices with this vulnerable population. The World Health Organization defines community engagement as “a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes.”9

Promoting the health and well-being of seniors will require us to work at the community systems level. Through community partnerships, we can strengthen support for older adults, identify and implement programs and policy, and even re-orient health systems.

Final Thoughts

I encourage prevention specialists working at all levels to prioritize older adults as a population and build community capacity to implement prevention across the lifespan. Check out evidence-based practices designed for older adults, such as WISE on the National Council on Aging website. Or download Community Engagement: An Essential Component of an Effective and Equitable Substance Use Prevention System from SAMHSA’s Evidence-Based Resource Center.

Learn more about what we’re doing at EDC regarding substance misuse prevention and stay connected for updates by joining our EDC Solutions for the Prevention Workforce email list.

Chuck Klevgaard is a project director at EDC, overseeing training and technical assistance projects that provide the prevention workforce with the information and skills they need to sustain effective, data-driven approaches for individuals and communities.

1NIH National Institute on Aging. (n.d.). Facts about aging and alcohol. https://www.nia.nih.gov/health/facts-about-aging-and-alcohol

2Kramarow, E. A., & Tejada-Vera, B. (2022). Alcohol-induced deaths in adults aged 65 and over: United States, 2019 and 2020. CDC Stacks. DOI: https://dx.doi.org/10.15620/cdc:122045

3Han, B. H., & Palamar, J. J. (2020). Trends in cannabis use among older adults in the United States, 2015–2018. JAMA Internal Medicine, 180(4), 609–611.

4Rosengren, J. (2017). America’s addiction to pain pills. AARP. https://www.aarp.org/health/drugs-supplements/info-2017/opioid-drug-addiction-pain-pills.html

5Mason, M., Pandya, K., & Lundberg, A. (2023). Older adult drug overdose: An application of latent class analysis to identify prevention opportunities. Research Square. https://doi.org/10.21203/rs.3.rs-3210814/v1

6Schepis, T. S., McCabe, S. E., & Ford, J. A. (2022). Recent trends in prescription drug misuse in the United States by age, race/ethnicity, and sex. The American Journal on Addictions, 31(5), 396.

7Schepis, T. S., McCabe, S. E., & Ford, J. A. (2022). Recent trends in prescription drug misuse in the United States by age, race/ethnicity, and sex. The American Journal on Addictions, 31(5), 396.

8Dahlberg, L., McKee, K. J., Frank, A., & Naseer, M. (2022). A systematic review of longitudinal risk factors for loneliness in older adults. Aging & Mental Health, 26(2), 225–249.

9World Health Organization. (2020). Community engagement: A health promotion guide for universal health coverage in the hands of the people. https://www.who.int/publications/i/item/9789240010529

older adults
Substance Misuse Prevention

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