Drug abuse and addiction in elderly

Abstract

Misuse and abuse of legal and illegal drugs constitute a current and growing problem among older adults. This chapter reviews the prevalence, risks and protective factors, screening and diagnosis, and treatment of drug abuse in older adults. Despite a wealth of information on the epidemiology and treatment of alcohol abuse in older adults, few data are available on drug abuse in this population. Limited evidence suggests that although illegal drug use among older adults is relatively rare compared to younger adults and adolescents, there is a growing problem of prescription drug misuse and abuse, with nonmedical use of prescription drugs among all adults aged ≥50 years estimated to increase to 2.7 million by 2020. Factors associated with drug misuse and abuse in older adults include female sex, social isolation, history of a substance use or mental health disorder, and medical exposure to prescription drugs with abuse potential. The paucity of validated screening and assessment instruments impedes the identification and diagnoses of substance use disorders in the older population. Thus, special approaches may be necessary when treating substance use disorders in older adults with multiple comorbidities and/or functional impairment, with the least intensive approaches considered first. In conclusion, psychoactive medications with abuse potential are used by at least one in four older adults. The treatment of substance use disorders in older adults may involve family and caretakers, and should take into account the unique physical, emotional, and cognitive factors associated with aging. Further research should focus on epidemiologic, health services, and screening and treatment aspects of drug abuse in older adults.