Addiction Treatment for Older Adults

Key takeaway

Older adults can be more affected by smaller amounts of alcohol or other drugs, because the body processes them more slowly. SAMHSA says this pattern is often missed and can worsen other illnesses. Alcohol is the drug this age group uses most. Treatment still exists, and a longer course of care has had better results in this group.

Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)

A parent is confused, falling, or pulling away from friends, and "just getting older" is the explanation everyone reaches for. Sometimes that explanation is right. Sometimes alcohol, a prescription, or both are in the picture, and the two stories look alike. NIDA says providers may confuse symptoms of a substance use disorder with other chronic conditions or with changes that come with age.

If a seizure, collapse, trouble breathing, or severe confusion is happening now, call 911.

Smaller amounts can hit harder

NIDA's DrugFacts on older adults, released July 9, 2020, says older adults typically metabolize substances more slowly, and that their brains can be more sensitive to drugs. Effects such as impaired judgment, coordination, or reaction time can lead to falls and motor vehicle crashes. Those injuries can pose a greater health risk than in younger adults, and recovery can take longer.

SAMHSA's TIP 26, updated in 2020, puts the same idea in plainer words. Substance misuse can be very dangerous for older adults. They are affected differently than younger adults, and smaller amounts can have more of an impact. Misuse can worsen chronic medical conditions. Taking more than one medication raises the chance of a harmful drug interaction. The TIP also says misuse in this age group is underrecognized and undertreated.

Using 2018 survey data, NIDA reports that nearly 1 million adults aged 65 and older lived with a substance use disorder. Between 2000 and 2012, the share of substance use treatment admissions that were older adults rose from 3.4 percent to 7.0 percent. Those figures describe a trend in published data. They do not describe one household.

Alcohol is the drug used most

NIDA says alcohol is the most used drug among older adults. Sleep, medicine interactions, and how sensitivity changes with age are on the alcohol and older adults guide. The figures here are the ones NIDA publishes. In the research it cites, about 65 percent of people 65 and older reported high-risk drinking, defined there as exceeding daily guidelines at least weekly in the past year. More than a tenth of adults 65 and older were binge drinking, defined as five or more drinks on the same occasion for men and four or more for women. Most admissions to treatment in this age group are for alcohol. One study NIDA cites found a 107 percent increase in alcohol use disorder among adults 65 and older from 2001 to 2013.

NIDA lists health problems that alcohol use disorder can raise the risk of in older people, including diabetes, high blood pressure, congestive heart failure, liver and bone problems, memory issues, and mood disorders. That list is a reason to ask a clinician. It is not a score you add up at the kitchen table.

Situations NIDA lists as raising risk include chronic pain, disability or less mobility, a move into a new living situation, the death of someone close, a forced retirement or a change in income, poor health, chronic illness, and taking many medicines and supplements. Psychiatric factors on the same list include an avoidance style of coping, a past substance use disorder, a current or past mental illness, and feeling socially isolated. A risk factor is not a diagnosis.

Quitting a long run of heavy drinking all at once can be dangerous. NIAAA says that kind of stop can be life-threatening. Red flags are on the alcohol withdrawal guide. That guide is not a home schedule.

Prescriptions taken together

Chronic illness becomes more common with age, and NIDA says older adults are often prescribed more medicines than other age groups. That raises exposure to medicines that can be misused. A study of about 3,000 adults ages 57 to 85 found common mixing of prescriptions, nonprescription drugs, and dietary supplements. More than 80 percent used at least one prescription daily. Nearly half used more than five medicines or supplements. The same study put at least 1 in 25 people in that age group at risk for a major drug-drug interaction.

TIP 26 tells clinicians, families, and caregivers to watch for nonmedical use of prescriptions, including opioids and benzodiazepines. The FDA says physical dependence on a benzodiazepine can occur even when the medicine is taken as prescribed, and that stopping it abruptly or cutting the dose too quickly can cause withdrawal, including seizures, which can be life-threatening. More detail is in the benzodiazepine detox guide. Do not stop a prescribed medicine to "clear the system" before an appointment.

NIDA also notes that drugs can worsen mood, lung, heart, or memory problems that are already more common in later life. A 2019 study it cites found that more than 25 percent of patients over 50 who misused prescription opioids or benzodiazepines expressed suicidal ideation, compared with 2 percent who did not use them. If those thoughts are present, call or text 988. Do not wait for a treatment bed.

What care can look like

NIDA says many behavioral therapies and medications have been successful in treating substance use disorders in older adults, and that medications are underused. It also says little is known about the single best model of care, and that older patients have had better results with longer durations of care. Ideas it lists for a fuller model include treating other chronic conditions, rebuilding support, improving access to medical services, stronger case management, and staff trained in approaches that fit this age group. You cannot order that package by a brand name.

TIP 26 says it is never too late to stop, no matter a person's age, and that providers need to know which interventions work so they can offer treatment or a referral quickly. The same chapter says feelings of shame and stigma linked to addiction-treatment settings lead many older adults to seek care from primary care or an emergency department, rather than from a program that specializes in addiction. Starting with a trusted clinician is a reasonable path. Ask that clinician to screen.

Virtual visits are one option, and they fail when the person cannot get online in private. SAMHSA's telehealth guide says Americans 65 and older are the group most likely to have a chronic disease, and that almost half (40 to 45 percent) do not own a smartphone or have broadband internet. When a video visit may fit is on the telehealth guide. A video option is not a reason to skip in-person care for withdrawal.

If opioids are part of the history, ask about medicines used for opioid use disorder and keep naloxone where people can find it. What CDC and NIDA publish on those medicines, without doses, is on the prescription opioid guide and the overdose guide.

How to start

FindTreatment.gov lets you search by location. What a specific plan pays is a question for that plan. Call (800) 653-9376 if you want help asking which programs see older adults and whether they can coordinate with the doctors already involved.

If the next step is stopping alcohol or a benzodiazepine, talk with a clinician before anyone tries that at home.

Additional Resources

Sources cited on this page:

Common Questions

Is forgetfulness or a fall a sign of a substance use disorder?

Not by itself. NIDA says providers may confuse substance use symptoms with other chronic conditions or with ordinary changes that come with age. A fall, a memory slip, or a low mood can have many causes. Only a clinician who can examine the person can sort that out.

Why can the same drink affect an older adult more?

NIDA says older adults typically metabolize substances more slowly, and their brains can be more sensitive to drugs. Impaired judgment, coordination, or reaction time can lead to falls and crashes, and those injuries can take longer to heal than they would in a younger adult.

Are prescription medicines part of this problem?

They can be. NIDA describes a study of about 3,000 adults ages 57 to 85 in which more than 80 percent used at least one prescription medicine daily, and nearly half used more than five medicines or supplements. That study put at least 1 in 25 people in the age group at risk for a major drug-drug interaction. Mixing those medicines with alcohol adds another risk. Do not stop a prescribed medicine on your own.

Is it too late to get treatment after 65?

No. SAMHSA's TIP 26 says it is never too late to stop misusing substances, and that treatment for older adults is available. NIDA says many behavioral therapies and medications have been successful in this age group, and that older patients have had better results with longer durations of care. A longer stay is not a promise of a particular outcome.

Can an older adult detox at home to avoid a facility?

Do not plan that. NIAAA says quitting all at once after chronic heavy drinking can be life-threatening. The FDA says stopping benzodiazepines abruptly, or cutting the dose too quickly, can cause withdrawal that includes seizures and can be life-threatening. Call 911 for a seizure, collapse, trouble breathing, or severe confusion. Call or text 988 in a mental health crisis.