Introduction
Substance use and particularly problematic use among older people is not adequately recognised in the UK.  Emphasis is on younger people and stemming the flow of young people using substances and developing problems with them.  At the same time, we hear messages about our ‘ageing population’ as people are living longer and benefiting from improved medical and social care.  What is becoming clear is that this ageing population is bringing with it some of the problems commonly associated with younger people.  Drug and alcohol use is one of those.  Use of substances among people aged 60 plus is an issue that has received limited attention in terms of research and practice.

The impact of substance use on older people will vary from individual to individual in the same way as it will with younger people.  However, the process of aging on the mind and body can make older people more vulnerable and more at risk of the negative impact stemming from substance use, particularly if combined with other prescribed medications.

Older age also tends to bring greater exposure to loss and bereavement and evidence shows that alcohol or drug use can be used as a coping mechanism or to aid sleep and relaxation.

Thus it is important that particular attention is given to older people’s substance use, particularly in terms of how practice should respond and support older people who may be experiencing problems with alcohol, illicit or prescribed drug use

Alcohol
Improvements in health and social care have resulted in people living longer.  While evidence suggests that alcohol and drug use tends to decrease with age, there is also evidence of higher rates of alcohol use among older people as the ‘baby boom’ generation enters the ‘older population’ bracket.

According to the Office for National Statistics, older men and women (>65 yrs) are more likely to drink every day than younger people (Lader and Goddard 2004).  They are also less likely to know about alcohol units.  In addition, older men drink more spirits as a percentage of their overall consumption than younger men (Lader and Goddard 2004). Older people may experience greater level of problems related to their alcohol use compared with other sections of the population as a result of their changing physiology as well as the higher rate of prescription drug use.

Some commentators have suggested that alcohol problems among older people may fall into two categories, that is, people who bring their drinking problems with them into older age, and those that have ‘late onset’ drinking problems often exacerbated by issues including loss, physical and mental ill health, bereavement and so on.  While this may be a helpful construct in terms of conducting a holistic assessment, its usefulness in determining appropriate treatment is limited. 

In spite of this data, national policy has tended to overlook older people with drink problems leading to gaps in service provision.  Nevertheless there are key considerations that practitioners need to address in the assessment and treatment of older drinkers (as discussed in the following sections).

There is much more information available about older people and alcohol than there is about older people and drug use. See ‘websites’ and ‘further reading’ sections for more information.

Drugs | Assessment issues | Treatment issues | Websites