Substance use disorders can affect anyone, but they often go undetected or untreated in older adults. SUD is a treatable, chronic medical condition that makes it hard to control the use of legal or illegal substances, including alcohol, tobacco, prescription opioids, heroin, methamphetamine, or cocaine. Substance use can affect both health and daily life. While stigma can keep people of all ages from seeking help, older adults face added barriers to care.
“By 2031, one in five Americans will be over 65, and for the first time in U.S. history there will be more older adults than children. Yet this segment of society almost becomes invisible,” explained Cindy Wanamaker, a 71-year-old Pennsylvania mental health advocate and certified family recovery specialist. “I definitely don’t think, as a community, we are prepared.”
How can health workers who serve older adults and their families spot the signs sooner?
Public Good News spoke with Wanamaker about what she’s seeing in her community. If you work with older adults, read on for her insights.
[Editor’s note: The contents of this interview have been edited for length and clarity.]
Public Good News: What are we missing when it comes to substance use and older adults?
Cindy Wanamaker: We’re doing more screening for younger adults but not older adults. They’re a unique population, with stressors younger adults don’t face. They’re dealing with grief. They’ve either lost a spouse, a partner…friends either have serious illnesses or they’ve passed away. They’re lonely.
They’ve also lost, in many cases, their sense of purpose after retirement. The first time we spoke at an assisted living, this guy said to me, “You know, I used to get up and go to work every day, and now I get up, and then I go to bed.”
No matter what their age, mattering matters—having a sense of purpose.
People often think that age can’t contribute. And yet, an older adult, especially someone who has had substance use challenges earlier in life, could be the perfect peer to help somebody else that’s struggling. Most older adults don’t want to go to support groups with 20- to-40 year olds, because they can’t relate.
PGN: What should health workers screen for specifically?
C.W.: Health workers first need education on substance use and mental health in older adults. Signs can be subtle—for example, stumbling, might be assumed to be a balance issue—but it could be alcohol use. Depression or anxiety may lead to self-medicating. Cannabis use is increasing among older adults.
And then there’s [medical] interactions; because most older adults are on prescribed medication, yet they don’t realize the possible harm of blending an illegal substance with legal substances. And their body metabolizes substances differently.
Family members don’t want to discuss that grandma has a drinking problem, or grandma’s, you know, taking more painkillers than they should be. And that’s the other thing. Oftentimes, they’re taking medication that can get them into trouble if they don’t follow the correct dosages. So it’s complicated.
They hand you a survey and ask, ‘Are you depressed?’ Well, most people are going to say no. You have to have a conversation. You have to look for signals—and that means spending more than 10 minutes in the exam room.
PGN: What are some system gaps health workers can help to close?
C.W.: It’s very difficult to even find a place that will take you if you’re an older adult with substance use or mental health challenges or both. Very few places in Pennsylvania will accept people on methadone, suboxone, vivitrol; [places] that also take Medicare.
Suicide in the older adult community is increasing, especially for men. Mutual aid groups don’t always feel welcoming because older adults don’t see their peers there.
As a society, you know, we don’t know enough. There are not a lot of research dollars going into this. So it’s understudied, under diagnosed, for sure, and it’s not properly managed.
PGN: What is working? What do you recommend health workers do today?
C.W.: One of the most effective strategies is education. Local NAMI chapters offer free support and educational programs that help health workers understand older adults’ needs.
Speaking at community groups or senior centers builds awareness and connections.
So you know, that’s how we’ve gotten in the door here. And one thing leads to another. So you know, you speak to one group, and then, you know, they hear about it, and then somebody else contacts you. That’s really what’s kind of happened in our area.
I think there could be a lot done with more peer support for that age group.
Find older adults who’ve had challenges and see if they might be willing to become peer support.
This article was supported by Life Unites Us, a health campaign that receives funding from the Pennsylvania Department of Drug and Alcohol Programs. Public Good News retains full editorial control over its reporting.