Is It the Drinking or Is It Aging? Substance Use in Older Adults

How can I tell if it’s the drinking or just aging?

Often you can’t, at least not on your own. Older people are more sensitive to alcohol’s effects on balance, coordination and attention,⁴ and even a small rise in blood alcohol dulls coordination and judgment.³ In a 75-year-old, that can look like a fall, a “senior moment” or a fender bender. Withdrawal muddies things further: coming off a benzodiazepine can bring anxiety, poor sleep and memory trouble,² and complicated alcohol withdrawal can cause confusion.¹

NIAAA lists memory loss, depression, anxiety, unexplained bruises, falls and sleep problems as possible clues to an alcohol problem in older adults.⁴ You don’t have to work out the cause. What helps the doctor is patterns and timing, written down with dates:

• Falls, bruises or near-misses in the evening or after social events
• Memory slips that come and go rather than slowly building
• Running out of a prescription early, or getting the same drug from more than one doctor
• Drinking alone, hiding bottles, or getting defensive when asked
• Morning shakiness, sweating or anxiety that eases after a drink or a pill

Why are alcohol and pills riskier later in life?

Mostly because of what else they’re taking. Drinking on top of opioid pain pills, sleeping pills or anxiety medicines raises the risk of overdose³ and adds to the risk of falls and memory problems.⁴ A prescription doesn’t make a drug safe, either. The FDA warns that benzodiazepines such as Xanax, Klonopin, Ativan and Valium can cause dependence and addiction even at prescribed doses.²

Stopping carries its own risk. Age over 65 raises the chance of severe alcohol withdrawal,¹ and quitting a daily benzodiazepine abruptly can cause seizures,² so leave the bottles and pills alone and let the doctor plan any cutback (why stopping suddenly is dangerous).

What should I bring to the doctor?

Doctors can only check for interactions they know about, which is why the FDA tells patients to share every medicine they take, including alcohol.² Screening for alcohol and drug use is a normal part of primary care,⁵ and Medicare covers a yearly alcohol misuse screening,¹¹ so asking for one isn’t an accusation. If your parent agrees, go with them and bring your notes.

How do I bring it up with a parent?

Start with their health and independence. A specific, caring observation lands better than a label. There’s more on this in how to start the conversation without a fight.

Your parent is an adult and makes their own decisions about care. If they do enter treatment, federal law gives addiction records extra privacy, so the program usually needs their written consent to share details with you.⁸ See what a release form lets families hear.

What does treatment look like for an older adult?

The same proven options younger people get, fitted to your parent’s health and medications. NIAAA says no single treatment suits everyone, and that medical and mental health problems should be treated alongside the drinking.⁶ For older adults that often means grief, loneliness or depression; retirement or losing a spouse leads some people to drink more to cope.⁴

Care often starts with the regular doctor, who can offer brief counseling and a referral⁵ and can prescribe one of the three medications approved for alcohol use disorder.⁶ Read how addiction medications work. If more support is needed, the options run from outpatient and intensive outpatient through partial hospitalization to residential and inpatient care.⁶ Our overview of the levels of care compares them.

Paying with Medicare

Medicare covers intensive outpatient programs⁹ and treatment for opioid use disorder, including methadone, buprenorphine and naltrexone.⁷ What your parent pays depends on their plan, so read our guide to Medicare coverage for addiction treatment before choosing a program.