Substance misuse can affect people at any age, including older adults. For families and caregivers, it can sometimes be difficult to recognize because the signs may look like other age-related changes, health conditions, medication side effects, grief, isolation, or stress.
Older adults may also face unique risks. They are more likely to manage chronic pain, take multiple medications, experience major life transitions, or cope with the loss of loved ones. Alcohol and medication use can also affect the body differently with age, increasing the risk of falls, confusion, sleep problems, and harmful interactions.
Understanding the warning signs and knowing how to respond can help families take action early and connect their loved one with the right support.
Why Substance Misuse Can Be Harder to Spot in Older Adults
Substance misuse in older adults is not always obvious. A person may not appear intoxicated or openly misuse medication. Instead, families may notice subtle changes in mood, memory, sleep, appetite, coordination, or daily routines.
In some cases, these changes may be mistaken for normal aging. In others, they may be connected to depression, anxiety, chronic pain, loneliness, grief, or another health concern. This is why it is important to look at the full picture rather than focusing on one symptom by itself.
Older adults may be at higher risk when they are dealing with:
- Chronic pain or long-term health conditions.
- Multiple prescription medications.
- Sleep problems.
- Grief or loss.
- Social isolation.
- Retirement or major life changes.
- Financial stress.
- A history of substance use or mental health concerns.
- Limited support from family, friends, or caregivers.
Substance misuse does not always begin earlier in life. Some older adults develop concerns later after a major change, such as losing a spouse, moving into a new living situation, retiring, or experiencing a decline in physical health.
Common Substances That May Affect Older Adults
Opioids and Pain Medications
Many older adults live with chronic pain or recover from surgeries, injuries, or health conditions that require pain management. When used as prescribed and carefully monitored, opioid medications may play a role in treatment. However, they can also carry risks, especially when taken in higher amounts, used longer than directed, combined with alcohol, or mixed with other medications. A 2024 study published in Addiction found that among people prescribed opioid painkillers for chronic non-cancer pain, about 1 in 10 were dependent on them, and about 1 in 8 were at risk of prescription opioid misuse.
Families should pay attention to possible warning signs such as:
- Taking more medication than prescribed.
- Running out of medication early.
- Appearing unusually sleepy, confused, or unsteady.
- Changes in mood, irritability, or sadness.
- Withdrawing from family or regular activities.
- Unexplained falls, bruises, or injuries.
- Memory problems or changes in daily functioning.
Concerns about pain medication should be handled carefully. It is usually best to start with a calm conversation and encourage the older adult to speak with a doctor, pharmacist, or other qualified healthcare professional. Stopping medication suddenly can be dangerous, so changes should be made with medical guidance.
Alcohol Use in Older Adults
Alcohol is one of the most commonly used substances among older adults. According to the National Institute on Alcohol Abuse and Alcoholism, 26.6 million people ages 65 and older, or 44.5% of that age group, reported drinking alcohol in the previous month in 2024. The same data found that 6.8 million people ages 65 and older, or 11.4%, reported binge drinking during that period.
Even if a person’s drinking habits have stayed the same for years, alcohol can affect the body differently with age. Changes in metabolism, balance, sleep, liver function, and medication use can increase the risk of harmful effects.
Alcohol may also interact with prescription medications, over-the-counter medicines, and supplements. These interactions can increase drowsiness, dizziness, confusion, falls, breathing problems, or other health risks.
Families may want to pay closer attention if an older adult:
- Drinks more often than usual.
- Uses alcohol to cope with loneliness, grief, pain, or sleep problems.
- Mixes alcohol with medication.
- Has more falls, confusion, or memory issues.
- Becomes defensive when alcohol use is mentioned.
- Misses appointments, meals, or responsibilities because of drinking.
- Shows changes in mood, sleep, or personal care.
A supportive approach is important. Rather than accusing the person of having a problem, families can express concern about specific changes they have noticed and encourage a conversation with a physician.
Nicotine and Tobacco Use
Nicotine dependence can continue into older adulthood, even when someone has tried to quit before. Tobacco use can affect overall health, worsen existing medical conditions, and make it harder for the body to heal.
Quitting can be difficult, especially for people who have smoked for many years. However, support can help. Counseling, quit plans, nicotine replacement options, and medical guidance may improve the chances of success.
For families, the most helpful approach is usually encouragement rather than pressure. Older adults may be more open to quitting when the conversation focuses on quality of life, breathing, mobility, energy, family connection, and managing current health concerns.
Prescription Medication Misuse
Prescription medication misuse can happen when someone takes medication in a way other than prescribed. This may include taking higher doses, taking medication more often than directed, using someone else’s prescription, saving old medication for later use, or mixing medications without medical guidance.
Older adults are more likely than younger adults to take multiple medications, which can increase the risk of drug interactions and side effects. Alcohol, supplements, sleep aids, anxiety medications, pain medications, and over-the-counter products can all complicate medication safety. The National Institute on Aging recommends that older adults keep a complete list of all prescription medicines, over-the-counter products, vitamins, and supplements they take, and review that list with a doctor or pharmacist to help prevent side effects or harmful interactions.
Families should watch for signs such as:
- Confusion about medication schedules.
- Taking extra doses.
- Missing doses and then doubling up.
- Seeing multiple doctors for similar concerns.
- Using old prescriptions.
- Mixing medication with alcohol.
- New dizziness, sleepiness, agitation, or memory issues.
- A sudden change in mood, behavior, or daily functioning.
A medication review with a physician or pharmacist can be an important first step. This can help identify possible interactions, duplicate prescriptions, unnecessary medications, or safer alternatives.
Warning Signs Families and Caregivers Should Watch For
Substance misuse can look different from person to person. One warning sign by itself does not always mean there is a substance use concern, but several changes together may be a reason to check in.
Possible signs include:
- Changes in sleep, appetite, or energy.
- Increased isolation or loss of interest .n activities.
- Mood changes, irritability, sadness, or anxiety.
- Confusion, forgetfulness, or trouble concentrating.
- Unexplained falls, bruises, or injuries.
- Poor hygiene or changes in personal care.
- Missing appointments or responsibilities.
- Running out of medication early.
- Drinking more often or drinking alone.
- Mixing alcohol with medications.
- Becoming secretive about alcohol or prescription use.
- Worsening depression, grief, or loneliness.
Families should also trust their instincts. If something feels different, it is reasonable to start a conversation, ask questions, and look for support.
How to Talk to an Older Adult About Substance Misuse
A conversation about substance misuse can feel uncomfortable, especially when speaking with a parent, spouse, relative, neighbor, or longtime friend. The goal is not to blame or embarrass the person. The goal is to show concern and open the door to support.
It may help to:
- Choose a calm, private time to talk.
- Focus on specific changes you have noticed.
- Use supportive language, such as “I’m concerned” or “I’ve noticed.”
- Avoid labels, criticism, or accusations.
- Ask open-ended questions.
- Listen without interrupting.
- Encourage them to speak with a doctor or pharmacist.
- Offer to help schedule an appointment or review resources.
- Be patient if they are not ready to talk right away.
For example, instead of saying, “You have a drinking problem,” you might say, “I’ve noticed you’ve seemed more unsteady and tired lately, and I’m worried about how your medication and alcohol may be affecting you. Would you be willing to talk with your doctor about it?”
A calm and respectful approach can make it easier for the person to accept help.
When to Seek Support
Families do not have to figure everything out alone. If you are concerned about an older adult’s alcohol use, prescription medication use, tobacco use, or other substance use, it may be time to reach out for guidance.
Support may include:
- A primary care physician.
- A pharmacist.
- A mental health professional.
- A substance use counselor.
- A local prevention or referral organization.
- Family therapy or caregiver support.
- Treatment programs that understand the needs of older adults.
If there is immediate danger, such as severe confusion, trouble breathing, overdose symptoms, a fall with injury, or a medical emergency, call 911 right away.
Prevention, Connection, and Early Support Matter
Substance misuse in older adults is often connected to more than the substance itself. Pain, grief, isolation, stress, depression, sleep problems, and major life changes can all play a role. That is why prevention and support should focus on the whole person.
Families can help by staying connected, encouraging regular medical care, supporting safe medication use, reducing isolation, and having honest conversations before concerns become a crisis.
For information, referrals, and additional resources, contact Wellspring Center for Prevention at 732-254-3344. Wellspring provides prevention education, older adult programming, and referral support for individuals, families, and communities in Middlesex and Monmouth Counties.