Substance Use Disorders

The physiology of aging and systemic medical comorbidities exposes geriatric patients to increased risks from psychoactive substances, alcohol, stimulants, opioids, benzodiazepines, or hypnotics. Often the potential for adverse effects of these agents, even when appropriately prescribed, and the risk of abuse and/or misuse, are not explored sufficiently in aging adults. Abuse of illegal substances or prescribed medications can exacerbate age-related physical, cognitive decline, and impaired social and relationship changes. Impaired level of arousal, delayed reaction times, sedation, and imbalance all can contribute to falls, car accidents, burns, and head injuries, which accelerate loss of independence (Kuerbis et al. Clin Geriatr Med 30(3): 629–654, 2014; Markota et al. Mayo Clin Proc 91(11): 1632–1639, 2016; SAMHSA, Substance abuse among older adults. Treatment Improvement Protocol (TIP) Series, no 26. HHS Publication No. (SMA) 12–3918. Rockville, MD, Substance Abuse and Mental Health Services Administration, 2012). This chapter reviews substance use disorders in the aging individual to encourage early recognition and appropriate interventions, which can avoid later, more severe psychiatric and systemic medical complications. We distinguish early-onset substance abuse which continues into older age, from late-onset, substance abuse, which is often associated with stressors of aging such as retirement, loss of a partner, financial strain, relocation, family conflict, social isolation, chronic pain, or health problems.