Addiction in older adults: an invisible problem

When we picture someone with an addiction problem, we rarely imagine our grandfather, our retired mother or the neighbour who is nearly eighty. The image society associates with addiction tends to be young, and that idea, as widespread as it is mistaken, leaves an ever-growing group in the shadows: older people. Addiction in later life is real, it is on the rise and yet it remains one of the most poorly detected and least treated health problems. It is what many professionals call a silent epidemic.

In this article we want to talk about it with respect and without drama. This is not about pointing a finger at anyone or reducing an older person's life to a label, but about giving visibility to a reality that affects many families and that can almost always be improved. Because there is a message worth stating from the outset: it is never too late to ask for help, and quality of life can be recovered at any age.

A real, growing and largely invisible problem

The ageing of the population is one of the great phenomena of our time. We live longer and longer, and with that comes a rising number of older people living with chronic pain, sleep difficulties, loneliness or accumulated grief. In that context, the prolonged use of alcohol or of certain medications finds fertile ground that often goes unnoticed.

Addiction at this stage of life is especially invisible for a simple reason: it develops behind closed doors. Many older people live alone or spend much of the day at home, without the social exposure that at younger ages usually makes the problem evident. There is no work performance that suffers, no visible conflicts out in public. Use settles into the domestic routine, discreet and constant, and it can continue for years without anyone around suspecting a thing.

Risk factors specific to this stage

Later life brings with it profound changes that, without being negative in themselves, can become sources of vulnerability when they accumulate or are faced alone. Understanding them helps us look at the problem with empathy rather than reproach.

• Retirement and the loss of role. Stopping work often means losing an important part of one's identity, of the structure of the day and of a sense of usefulness. That emptiness, when it is not filled with new activities and bonds, can push a person towards using substances as a way of filling time.
• Loneliness and isolation. A shrinking social circle, children who become independent and reduced mobility mean that many older people spend long periods without company. A drink or a pill can become a silent companion in the face of loneliness.
• Grief. The loss of a partner, of siblings or of lifelong friends is one of the most painful experiences of this stage. Grief that is not worked through sometimes seeks relief in alcohol or in anxiolytics.
• Chronic pain and health problems. Joint discomfort, degenerative illnesses or continuous physical malaise increase the use of painkillers and of other medications that can create dependence.
• Insomnia. Sleeping worse is common with age, and many people turn to sleeping pills to rest, with the risk that their use becomes prolonged and indispensable.

None of these factors condemns anyone to develop an addiction, but together they explain why this stage is especially delicate and deserves careful attention from family and professionals alike.

The most common substances among older people

Unlike what happens at younger ages, addiction in later life rarely involves illegal drugs. It is usually linked to legal substances that are socially accepted and, in many cases, prescribed by a professional. This makes the problem even harder to recognise.

• Alcohol. It is the most common substance. Sometimes it is use that comes from long ago and worsens with the years; other times it begins or intensifies precisely at this stage, as a response to loneliness or grief. The older body tolerates alcohol less well, so the same amount as always now produces far more intense effects.
• Benzodiazepines and hypnotics. Anxiolytics and sleeping medications are among the most prescribed drugs in older people. Taken over long periods they create dependence easily, and stopping them abruptly can be dangerous.
• Opioid painkillers. Treating chronic pain with opioids is sometimes necessary, but it carries a risk of dependence that must be monitored, especially when use continues over time without review.

The fact that these substances are legal or prescribed does not make them harmless. Dependence can develop all the same, and in an older person's body its consequences tend to be more serious.

Why it is so poorly detected

One of the most worrying aspects of addiction in later life is the enormous difficulty of detecting it in time. This is not due to a single cause, but to the combination of several factors that reinforce one another.

First, the symptoms are easily confused with what is considered typical of old age. Confusion, drowsiness, falls, memory loss or mood changes are attributed to the passing years or, at times, to possible cognitive decline or dementia, when in reality they may be caused or aggravated by the use of alcohol or of certain medications.

Second, there is far less screening. In clinical practice, older people are asked less often about their alcohol use or about how they use their sleeping pills, perhaps out of the false belief that at that age it no longer matters or that nothing can be done. That absence of questions keeps the problem hidden.

Finally, there is the weight of the family taboo. It is hard to imagine that an older loved one could have an addiction problem, and sometimes people prefer to look the other way out of respect, out of shame or because they do not know how to approach it. That silence, even when it is born of affection, delays help.

Specific risks at this age

The body changes over the years, and those changes mean that using alcohol or certain medications involves greater risks than at younger ages. It is worth knowing them, not to frighten anyone, but to grasp fully how important it is to intervene.

• Interactions with medication. Older people often take several medications at once. Mixing them with alcohol or with other drugs can cause dangerous effects and increase the toxicity of treatments.
• Falls and fractures. Drowsiness, slowed reflexes and instability increase the risk of falls, which at this age can have serious consequences, such as hip fractures and a significant loss of independence.
• Cognitive decline. Prolonged use can worsen memory and concentration, and aggravate states of confusion that are mistaken for dementia.
• Greater toxicity. The liver and kidneys process substances more slowly with age, so they remain longer in the body and their effects, both the desired and the harmful ones, are intensified.

Warning signs for the family

The family is usually the first able to notice that something is not right, as long as they know where to look. These are some signs that, without being definitive proof, invite us to pay attention with care.

• Changes in mood: greater irritability, persistent sadness or apathy.
• Neglect of personal hygiene, of the home or of eating.
• Repeated falls, clumsiness or unsteadiness when walking.
• Confusion, frequent forgetfulness or difficulty following a conversation.
• Growing isolation and the abandonment of hobbies or relationships once enjoyed.
• Bottles or medication packets appearing in striking quantities or running out ahead of time.
• Requesting prescriptions from several doctors or insisting on renewing certain medication.
• Use when alone, in secret or at unusual hours.

Noticing these signs does not mean accusing anyone. It means gently opening a conversation that may be the first step towards help.

It is never too late to ask for help

There is a very damaging belief that at a certain age it is no longer worth treating an addiction. Nothing could be further from the truth. Older people respond very well to treatment when they are offered suitable support, and the benefits of stopping are felt at any age: sleep, memory, mood, mobility and relationships with loved ones all improve. Recovering wellbeing at seventy or eighty is not only possible; it can completely transform the quality of the years still to be lived.

Recognising the problem and asking for help is not a sign of weakness or failure. It is an act of courage and care, both on the part of the older person and of the family accompanying them.

A respectful, tailored approach

Treating an addiction in later life requires a different approach from other ages. The pace should be slower, the manner especially warm and respectful, and the withdrawal of certain substances, such as benzodiazepines or opioids, always gradual and supervised, never abrupt. It is essential to take into account other health problems, the medication the person already takes and their personal and family situation. And, above all, it is vital to protect dignity: to listen without judging, to respect each person's timing and to acknowledge the life story behind every individual.

How we approach it at Reconectar

At Reconectar, in Las Palmas de Gran Canaria, we support older people and their families with an open method that requires no residential admission, allowing them to keep their daily life and familiar surroundings while working on the problem. Care is direct and provided by the therapists themselves, without intermediaries, in a close and personalised way. We adapt the treatment to each person's pace and can offer care either in person or by video call, whichever is more comfortable and accessible in each case. And all of it, always, with the utmost confidentiality.

If you recognise some of the signs we have described in a loved one, or in yourself, you do not have to face it alone. We will be glad to listen to you, answer your questions and accompany you calmly along this path. Getting in touch with us commits you to nothing: it is simply the first step towards recovering wellbeing. Because, truly, it is never too late to feel well again.