Understanding Substance Use Disorders in Older Adults: A Focus on Opioid and Alcohol Use
By: Mardoche Sidor, MD; Annelle Primm, MD, MPH; Jacob Appel, MD

Meet James: At 68, James had worked hard throughout his life, but recent years have been challenging. After losing his job due to economic shifts, he began using opioids prescribed for chronic pain. Over time, his opioid use escalated, leading to health complications and social isolation. James’s story is emblematic of a growing issue among older Black adults, who face significant challenges due to both systemic neglect and economic disparities.

Meet Joan: At 74, Joan was a vibrant part of her community, always volunteering and attending social gatherings. However, after losing her husband, she began drinking more frequently, finding solace in alcohol. Over time, her drinking led to health problems, and she became increasingly isolated. Joan’s story is not unique; many older adults face similar challenges with alcohol use.

Introduction:
Substance use disorders, particularly opioid and alcohol use, are pressing yet often overlooked issues among older adults. In particular, older Black men like James are disproportionately affected by opioid use disorder due to systemic neglect and economic disparities. Similarly, alcohol use disorder is prevalent among older adults like Joan, exacerbated by grief, loneliness, and social isolation. This guide explores the factors contributing to both opioid and alcohol use disorders in older adults and offers practical tips for addressing these issues.

Why It Matters:
The opioid and alcohol crises have profoundly impacted older adults, particularly those marginalized by economic and social shifts. Opioids, while effective for pain management, can lead to dependence and overdose, especially in older populations who may be more vulnerable due to age-related changes in metabolism and health. Likewise, alcohol use disorder can silently progress, leading to severe health complications and increased mortality. The economic downturn and loss of social support exacerbate these issues, as older adults face limited access to healthcare and support services. According to a recent New York Times exposé, older Black men in Baltimore are experiencing high rates of opioid overdose, a stark reminder of the urgent need for targeted intervention. Similarly, alcohol use disorder among older adults is a growing concern, with many suffering in silence.

Additional Consideration:
While this discussion primarily addresses cases where substance use disorders develop later in life, it is important to recognize another significant population: older individuals who have struggled with substance use for years. For this group, substance use may become more apparent to friends and relatives or become harder to manage as they age. Both new onset use and chronic use into old age present unique challenges and may manifest differently.

Signs of Substance Use Disorders:
Recognizing substance use disorders in older adults can be difficult. Look for signs such as:

- Increased Isolation: Withdrawal from social activities and family.
- Changes in Behavior: Unexplained mood swings, confusion, or drowsiness.
- Physical Symptoms: Unexplained weight loss, frequent falls, or changes in sleep patterns.

How to Address It:
1. Open Communication: Initiate a conversation with the individual about their substance use. Express concern and offer support without judgment. Engage in active listening to understand their struggles.

2. Consult Healthcare Professionals: Discuss concerns with a doctor who can provide a comprehensive evaluation and recommend treatment options. For more information, visit the National Institute on Drug Abuse (NIDA) or National Institute on Alcohol Abuse and Alcoholism (NIAAA).

3. Seek Support Services: Access specialized programs for opioid and alcohol use disorders. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers resources and treatment options tailored for older adults.

4. Promote Healthy Activities: Encourage participation in activities that support recovery, such as community programs, exercise, or hobbies. Addressing economic and social isolation through local engagement can provide additional support.

5. Address Economic and Social Factors: Advocate for policy changes that address economic disparities and improve access to healthcare for older Black adults. Support community initiatives aimed at reducing economic hardship and providing comprehensive care.

Prevention and Support:
Preventing substance use disorders involves early intervention and ongoing support. Regular health check-ups and screenings can help identify issues early. Community support groups and advocacy can play a crucial role in reducing isolation and improving access to resources.

Take Action:
If you or someone you know is struggling with opioid or alcohol use disorder, take proactive steps today. Reach out to healthcare providers, explore support services, and advocate for policy changes that address economic and healthcare disparities. For more information and resources, visit NIH’s National Institute on Aging, NIDA, or NIAAA.

By staying informed and engaged, we can address the crisis of substance use among older adults and work towards a healthier and more equitable future.

References:
1. National Institute on Drug Abuse (NIDA). (2021). Opioid Use Disorder in Older Adults. Retrieved from https://www.drugabuse.gov

2. National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2022). Alcohol and Older Adults. Retrieved from https://www.niaaa.nih.gov

3. Substance Abuse and Mental Health Services Administration (SAMHSA). (2022). Resources for Older Adults. Retrieved from https://www.samhsa.gov

4. Thieme, N., Zhu, A., & Gallagher, J. (2024). In Baltimore's Senior Homes, Overdoses Plague a Forgotten Generation. The New York Times.

The Central East ATTC has collaborated with the Mid-Atlantic Aids Education Training Center (MAAETC) and the STD/HIV Prevention Training Center at John's Hopkins to sponsor the trainers listed below for various topics throughout the EMS series hosted from July 2024 through April 2025.

Please click on the flyer to be redirected to the series landing page for more details and registrations.

Laura Hinds, MSW, LCSW
Principal Partner, Hindsight Consulting Group
Consultant, Health Federation of Philadelphia

Mark LePore, EdD, LPC, LCSW
Mental Health Trainer, American Red Cross (ARC)  
Volunteer Partner Director, Red Cross Service to the Armed Forces (SAF) Branch, Washington, D.C

Nick Szubiak, MSW, LCSW
Integrated Care Consultant and Principal, NSI Strategies
Advanced Implementation Specialist, Opioid Response Network
Substance Abuse and Mental Health Service Administration (SAMHSA)

For immediate questions, please email [email protected]