Reducing Harm Related to Substance Use by Older Adults

While safety should be a lifetime concern, aging brings it into sharper focus when a slow decline in all human functions commences and accommodations must be made to continue life with health, quality, and competence in life tasks and relationships. These normal declines, magnified by chronic diseases and health conditions increase vulnerability in older adults to the effects of commonly used substances. Safety can then be compromised using alcohol, tobacco, psychoactive drugs, medications, and food supplements which people ingest to alter state of mind, emotional well-being, and alleviate disease conditions and infirmities. Compromised safety can be the untoward side effect of seeking more optimal states, and older adults make choices to experience pleasure and attain pain-free states and freedom of movement. The most commonly used substance worldwide, alcohol, is legal, socially sanctioned, widely promoted, and relatively inexpensive but also the most damaging to health and safety. Tobacco is the mostly deadly, resulting in the deaths of close to 500,000 people annually and a contributing factor to 200 diseases and health conditions. This chapter identifies the scope of health and safety consequences of substances commonly used by adults over 60, detailing the safety risks of each class of drug and its detrimental health effects. While a relatively small proportion of older adults (5–6%) are ever diagnosed with a substance use disorder, many more engage in binge drinking and unhealthy levels of alcohol consumption and combine alcohol with prescribed and over-the-counter medications resulting in unsafe and at times, lethal results. Excessive levels of opioid analgesic prescribing have resulted in loss of life and severe opioid use disorders which compromise safety and quality of life for many older adults. Models of care that integrate screening and drug and alcohol interventions into primary care, expand harm reduction, and use public health approaches to raise awareness about the health implications of substance use hold promise for deterring upward trends in substance use among older adults. Policy initiatives are described as frameworks for additional interventions.