Other Substance Abuse and Dependence

Use of illegal drugs is uncommon among elderly people, although this may change as the baby boom generation ages. Adverse effects of prescription and over-the-counter drugs, on the other hand, occur quite often. Alcoholics are particularly at risk of misuse of other psychoactive drugs. Benzodiazepines and opiates are the categories of drugs most likely to cause trouble in the elderly.

Up to 20% of older people use benzodiazepines. Whereas alcohol use and abuse are more common among men, benzodiazepine use is more common among women. Surveys suggest that most people for whom these drugs are prescribed usually take them either as directed or less than as directed. Even when benzodiazepines are taken as directed, tolerance, dependence, adverse effects, and toxicity may develop. Long-acting benzodiazepines have been shown to markedly increase the risk of falls and hip fracture. Because the half-lives of some benzodiazepines are extremely long in the elderly, the drug gradually accumulates in the body, producing a toxic state. High blood levels of benzodiazepines commonly cause such symptoms as slurred speech, ataxia, and delirium.

There are very few studies of opiate abuse and dependence among the elderly. Intentional misuse of opiates is probably uncommon, but adverse effects of prescribed doses, such as constipation, urinary retention, delirium, and falling, are often problematic.

Tobacco dependence is the only substance-related disorder more common among the elderly than alcoholism. Tobacco-related illnesses cause tremendous suffering, and the benefits of smoking cessation have been documented. Physician counseling is very effective in helping people quit smoking and should be done at every opportunity.