Substance Use in Older Adults: Risk Factors, Warning Signs, and Where to Get Help

Substance use problems in people over 65 are common, underdiagnosed, and treatable. The most recent national survey figures from the National Institute on Alcohol Abuse and Alcoholism show that 26.6 million Americans age 65 and older (44.5 percent) drank alcohol in the past month, 6.8 million (11.4 percent) binge drank in the past month, and 2.9 million (4.8 percent) met criteria for an alcohol use disorder in the past year (NIAAA, Alcohol and Older Adults Ages 65+). Most of those people will never be asked about their drinking by a doctor, a spouse, or an adult child. This guide covers why aging changes the risks, what pushes drinking or pill use up later in life, why it so often gets missed, and what help actually looks like for someone in their 60s, 70s, or 80s.

How common it is

The numbers above cover alcohol, which is by far the most common substance problem in older adults. The consequences are not evenly spread across age groups, either. According to CDC figures reported by NIAAA, 40.9 percent of all alcohol-attributable deaths in 2022 and 2023 were among people 65 and older (NIAAA). Prescription medications, especially opioids for pain and benzodiazepines for sleep or anxiety, add a second layer of risk. In our experience it is rarely one substance on its own.

Why aging changes the math

The same two glasses of wine a person drank at 45 do not do the same thing at 75. NIAAA notes that older adults are "more sensitive to the sedative effects of alcohol, as well as its effects on balance, coordination, attention, and driving skills," and that reduced muscle mass and body water can mean higher blood alcohol concentrations from the same amount of alcohol (NIAAA, Older Adults). In plain terms, there is less water in the body to dilute the alcohol, and the brain reacts more strongly to what gets through.

Medications make this worse. Most people over 65 take at least one daily prescription, and many take several. NIAAA warns that mixing alcohol with medications "could cause the medications to not work properly or make them dangerous or even deadly," and that the combination raises the risk of falls, car crashes, and other injuries (NIAAA). A fall that would have meant a bruise at 40 can mean a broken hip at 78.

For healthy adults over 65 who choose to drink, the National Institute on Aging suggests no more than one drink a day for women and two for men (National Institute on Aging, Older Adults and Alcohol, PDF). Someone with liver disease, on certain medications, or with a history of alcohol problems may need to drink less than that or not at all, and that is a conversation for their doctor.

Risk factors that show up later in life

Chronic pain and the prescriptions that come with it

Arthritis, back problems, and post-surgical pain are common after 60, and so are the opioids and muscle relaxants prescribed for them. A person who has never had a substance problem can slide into one when a 30-day script turns into a two-year habit, and a drink on top of the pill takes the edge off in a way the pill alone no longer does. It usually starts with a legitimate prescription for a legitimate problem.

Loss and grief

The National Institute on Aging points to major changes "such as the death of a loved one, moving to a new home, or failing health" as things that can contribute to drinking in older adults, working through loneliness, boredom, anxiety, or depression (National Institute on Aging). A widower who never drank more than a beer at dinner can be putting away half a bottle of scotch a night within a year of his wife's death, and nobody around him will call it a drinking problem. They will call it grief.

Isolation

Friends move away or die. Driving gets harder. Kids live in other states. The people who used to put a natural brake on drinking are gone, and drinking alone in the evening becomes the routine.

Retirement

Work supplies structure, identity, and a reason not to have a drink at 2 p.m. When it ends, all three go with it. We wrote about this pattern specifically in our guide on addiction after retirement.

Depression and anxiety

Untreated depression and anxiety are common in older adults and often go unrecognized because low mood and poor sleep get chalked up to age. Alcohol and sedatives are effective short-term relief for both, which is exactly why they become a problem.

Why it goes unrecognized

Three things conspire to keep substance problems in older adults hidden.

First, the symptoms look like aging. NIAAA lists the clues to a possible alcohol problem in older adults as "memory loss, depression, anxiety, poor appetite, unexplained bruises, falls, sleeping problems, and inattention to cleanliness or appearance" (NIAAA). Every item on that list could also be dementia, a medication side effect, or "just getting older." Families reach for those explanations first because they are easier to accept.

Second, providers rarely ask. A 15-minute appointment focused on blood pressure and cholesterol leaves little room for "how much do you drink?", and many clinicians are uncomfortable asking a 76-year-old the question at all. When the question is asked, it is often phrased in a way that invites a quick "just a glass of wine with dinner."

Third, families minimize. The thinking goes: he's 79, he's earned it, what's the harm at this point? The harm is falls, medication failure, memory decline that gets misread as dementia, and a shortened, lonelier life. Adult children also fear disrespecting a parent, and that keeps the conversation from happening. Our guide on signs your parent has a drinking problem walks through what to look for, and how to help a parent with alcoholism covers what to do next.

Signs worth paying attention to

Beyond the NIAAA clues above, we'd add a few things we watch for. Empty bottles that don't match the "one glass with dinner" story. A parent who is noticeably different on the phone after 6 p.m. than at noon. Refilling a pain or sleep prescription early, or seeing more than one prescriber for the same problem. Defensiveness when the subject comes up. A pattern of small accidents: a scraped car, a burned pan, a fall in the bathroom. Any one of these can have an innocent explanation. Several together, over months, usually do not.

What help looks like in your 60s, 70s, and 80s

Start with a clinician

The first call should be to a physician, and this matters more for older adults than for anyone else. NIAAA is direct that a person who stops abruptly after prolonged heavy drinking "can go into a painful or even potentially life-threatening process of withdrawal" (NIAAA, Treatment for Alcohol Problems). Withdrawal is harder on an older body, and the medication list needs reviewing by someone who can see the whole picture. Nobody in their 70s should quit heavy daily drinking or a long-term benzodiazepine on their own.

Treatment options

NIAAA describes three FDA-approved medications for alcohol use disorder (naltrexone, acamprosate, and disulfiram) and behavioral treatments that build coping skills, social support, and reachable goals, with the reminder that "No single treatment will benefit everyone" (NIAAA). For an older adult, outpatient care is often the right level, since it keeps them at home, near their doctors, and on their routine. The NIAAA Alcohol Treatment Navigator is a good place to find quality programs, and the SAMHSA National Helpline at 1-800-662-4357 can make referrals.

Ongoing support from home

Treatment ends, and that is where older adults tend to fall through the cracks. Driving to a meeting three nights a week is not realistic for many people over 70. NIAAA describes recovery as "more a marathon than a sprint" and recommends a continuing care plan alongside the initial one (NIAAA). For this age group, that plan usually needs to come to the person rather than the other way around. Virtual peer coaching, phone or video check-ins, an at-home breathalyzer, and a daily group meeting on a screen can all be done from a kitchen table. That is the model Accountable was built for, and we work with a lot of members in this age range. You can read more on our page for older adults and Medicare-age members, and our relapse prevention plan for older adults gets into the specifics.

A note for families

If you are reading this about a parent, two things. The first is that you are probably right to be concerned; most families wait far too long, not the other way around. The second is that how you raise it matters more than what you say. Confrontation tends to backfire with older adults, who often experience it as a loss of dignity. Curiosity works better: "I've noticed you seem tired a lot lately, and I wondered if the wine at night is part of it." Al-Anon and SMART Recovery Family & Friends both offer support for families, and Accountable runs a weekly family Zoom group for the families of enrolled members. If you'd like to talk through a specific situation, you can check coverage or call the care team at (646) 450-7641. If your parent is in crisis, call or text 988.

Common questions

Is it too late to get help at 75 or 80?

No. Older adults who get treatment often do well, partly because their lives are more stable in other ways and partly because the health consequences give them a concrete reason to stop. We have members in their 80s.

Can my parent just cut back instead of quitting?

Sometimes, and that is a decision for their physician, who can weigh their medications, liver function, and history. For someone who has met criteria for alcohol use disorder, cutting back tends to be harder to hold than stopping.

How do I tell the difference between drinking and early dementia?

You often can't from the outside, and the two can coexist. That is a reason to get a medical evaluation rather than a reason to wait. Memory problems that improve after a period without alcohol tell you something important.

Does Medicare cover this kind of support?

Coverage for peer recovery coaching varies by plan. Accountable is covered by a growing list of commercial health plans, with more added each month, and offers private-pay options starting at $375 per month. The quickest way to find out what applies is to check coverage online or call us.

Sources

• National Institute on Alcohol Abuse and Alcoholism. Alcohol and Older Adults Ages 65+.

• National Institute on Alcohol Abuse and Alcoholism. Older Adults.

• National Institute on Aging. Older Adults and Alcohol (April 2023).

• National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help.

• National Institute on Alcohol Abuse and Alcoholism. Alcohol Treatment Navigator.

• National Institute on Alcohol Abuse and Alcoholism. Support Recovery: It's a Marathon, Not a Sprint.

• Substance Abuse and Mental Health Services Administration. National Helpline, 1-800-662-4357.

• 988 Suicide & Crisis Lifeline. 988lifeline.org.