A silent epidemic is sweeping through America’s older population, as addiction treatment admissions and substance-related deaths among seniors climb to unprecedented levels. Between 2009 and 2020, the number of Americans aged 55 and older admitted to addiction treatment facilities rose sharply by 53%, increasing from 109,412 to 167,200, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Older adults now represent 12% of all individuals seeking addiction treatment, up from just 5% in 2009.
In 2018, nearly one million adults aged 65 and older were living with a substance use disorder, according to SAMHSA’s National Survey on Drug Use and Health. By 2022, that figure had grown to one in every eleven adults over the age of 60, and experts anticipate further increases in the coming years. Alcohol remains the most common substance prompting treatment admissions among older adults. Heroin use is also a major factor, with opioid misuse steadily rising in this demographic.
The impact of substance misuse in later life is increasingly severe. In 2020, alcohol was listed as an underlying cause of death for 11,616 adults aged 65 and older. Alcohol-related deaths in this age group rose by 18.2% from the previous year, according to data from the Centers for Disease Control and Prevention (CDC). Drug overdose deaths among older adults have surged even more significantly. Between the two periods of 2018 to 2020 and 2021 to 2023, overdose deaths rose by 58%. In total, there were 23,000 drug-related deaths among adults aged 65 and over in 2021 to 2023. This marks a rise of 9,350 deaths compared to the previous three-year period.
The data also highlight concerning disparities across racial and gender lines. Black older adults experience drug-related death rates more than 14 times higher than Asian older adults. Men aged 65 and older have a drug death rate 2.6 times greater than women in the same age group. Among American Indian and Alaska Native older populations, the drug death rate more than doubled, increasing by 131% between the two study periods.
Dr Marisa Sisk, chief clinical officer at Refine Recovery and the developer of the centre’s clinical curriculum, explains why older adults are especially vulnerable to addiction. She says biological and social challenges common in ageing populations play a major role in increasing risk. According to Dr Sisk, the ageing brain undergoes natural changes in neurotransmitter systems, such as serotonin and dopamine release, which can alter how substances are processed. These changes, combined with slower metabolism, increase an individual’s sensitivity to drugs and alcohol.
She also notes that the social isolation often experienced in later life can lead to psychological distress and activate stress responses. When older adults lose social connections, the brain begins to seek alternative rewards. Substances can temporarily fill that gap, but in doing so, they intensify the psychological strain. Dr Sisk adds that many older people take multiple medications as part of managing long-term conditions. This routine can normalise pill-taking and blur the line between therapeutic and recreational use.
Refine Recovery tailors its approach to meet these age-specific challenges. The centre uses cognitive behavioural therapy to shift thinking patterns around substance use and incorporates screening tools designed with age-related factors in mind. The programme also addresses the neurological changes brought on by ageing and aims to rebuild social support systems to counter the effects of isolation.
The CDC has highlighted several factors that make addiction more likely in later life. These include social isolation, chronic pain, and easier access to prescription medications. The transition into retirement, the death of loved ones, and shrinking social networks all contribute to increased vulnerability. At the same time, treatment remains hard to access. Stigma, lack of age-specific services, and logistical barriers such as transport all play a role in keeping many older adults from getting the help they need.
