Substance Misuse Prevention Has an Age Problem
Substance misuse prevention is often associated with youth and young adults. This makes some sense, as early prevention remains essential, but the narrow focus overlooks a growing and increasingly vulnerable population: older adults.
Substance misuse affects people across their lives, and as risk factors, social contexts, and health needs change with age, prevention strategies must evolve alongside them—and quickly: More than 61 million people in the United States are now age 65 or older, and this population is projected to grow substantially in the coming decades.
Over the past decade, substance misuse among older adults has increased at a faster rate than in any other age group, contributing to rising rates of substance use disorders, emergency department visits, and substance-related mortality. Yet prevention systems have historically emphasized youth and underage substance use, leaving relatively few evidence-based practices, policies, and programs designed to address substance misuse risk in later life.
To remain effective and equitable, prevention systems must intentionally bring older adults into the center of prevention planning.
Understanding Risks in Later Life
Older adulthood is often shaped by major life transitions, including retirement, bereavement, declining physical independence, and changes in identity or purpose. While these transitions are a normal part of aging, they can increase vulnerability to substance use—particularly when combined with social isolation, depression, or financial strain.
Biological changes further compound risk. Aging bodies metabolize alcohol and other substances more slowly, leading to stronger and longer-lasting effects even at lower levels of use. Older adults are also more likely to experience chronic health conditions and polypharmacy, increasing the risk of medication misuse and dangerous substance–medication interactions.
Too often, substance misuse among older adults is overlooked or misattributed to “normal aging,” resulting in missed opportunities for prevention and early intervention.
Alcohol and Emerging Substance Use Trends
Alcohol remains the most used substance among older adults. National data indicate that more than one-third of adults aged 65 and older report recent alcohol use, and a substantial minority report binge drinking. Because of age-related physiological changes, alcohol use in later life is associated with increased risks of falls, serious injuries, cardiovascular events, and cognitive impairment.
At the same time, substance use patterns among older adults are diversifying. Cannabis use among adults aged 65 and older has increased sharply in recent years, reflecting changing norms and perceptions of low risk—despite limited evidence on safety for older populations. Older adults have also experienced the largest increases in drug-related emergency department visits and treatment admissions of any age group, and they are the only population in which fatal opioid-involved overdoses continued to rise as rates declined among younger adults.
These trends highlight the need for prevention strategies that address both traditional and emerging substance use risks in later life.
What Effective Prevention for Older Adults Looks Like
Prevention across the lifespan is not about adapting youth-focused programs or waiting until substance use becomes severe. It means designing strategies that reflect older adults’ lived realities and service environments.
Several evidence-informed approaches exist that prevention systems can use to address substance use among older adults:
Screening and Brief Interventions
Screening and brief intervention is an effective way to identify substance use risk early and provide timely support. Although older adults are less likely to be screened than younger adults, validated tools such as the Alcohol-Related Problems Survey (ARPS), Comorbidity-Alcohol Risk Evaluation Tool (CARET), and Senior Alcohol Misuse Indicator (SAMI) have demonstrated effectiveness in healthcare and community settings.
Education and Behavior Change
Education and skills-building programs can increase knowledge about age-related substance risks and support healthier decision-making. Evidence-based programs such as the Wellness Initiative for Senior Education (WISE) and Prevention BINGO have been shown to improve understanding of alcohol and medication interactions and reduce risky behaviors among older adults.
Medication Management
Medication management interventions are especially important in later life, when polypharmacy is common. Pharmacist-led programs and home-based medication reviews have the ability to reduce medication-related problems, prevent accidental misuse, and increase awareness of substance–medication interactions.
Effective implementation of these strategies depends on partnerships. Prevention systems can expand their reach by collaborating with aging services, healthcare providers, pharmacies, senior centers, housing communities, and other organizations that already have trusted relationships with older adults.
Challenging Ageism in Prevention
Ageism remains a significant barrier to addressing substance use among older adults. Misconceptions that older adults do not misuse substances—or are unwilling or unable to change—can lead to under-screening, misdiagnosis, and missed prevention opportunities. Addressing ageism within prevention systems is essential to ensuring older adults are included in prevention planning and benefit from early, supportive interventions.
Centering Older Adults in Prevention Planning
As the population ages and accountability for prevention outcomes increases, older adults can no longer remain an afterthought. Integrating older adults into prevention planning strengthens the overall effectiveness of prevention systems, reduces avoidable harm, and supports healthier aging.
Prevention across the lifespan means meeting people where they are—at every stage of life. For prevention systems committed to impact, that includes older adults.
