Understanding alcohol and drug misuse

Many of us like to have a drink sometimes or use recreational drugs such as cannabis – or we might need to take lots of medication. But if you drink or take drugs in a way that causes you harm, this is called misuse. 

The drugs that older people most commonly misuse are:

• alcohol
• prescribed painkillers
• medication for anxiety and sleep problems. 

There are many reasons why we might misuse alcohol or drugs. For example: 

• you may turn to them to help you cope with difficult times, such as bereavement, retirement, ill health or mobility problems 
• if you’re lonely and isolated, you may use alcohol or drugs to help you deal with boredom or depression
• you may misuse them if you can’t sleep well or you’re in pain 
• you might lose track of how you should take your medication.

Drug and alcohol misuse is often a hidden problem for older people. You might feel ashamed and reluctant to ask for help. You may not be aware that there’s a problem. If you’re not meeting other people, it can go unnoticed. Health professionals may not think to ask you about your alcohol and drug use, which can make it difficult to access treatment.

To begin with, drinking or drugs may make you feel good, or help to relieve stress or pain. But these feelings are only temporary. If you continue to use alcohol or drugs in this way, you risk becoming dependent on them. 

Dependency starts when you crave the feelings of pleasure or ‘high’ and have a strong urge to repeat the experience. The more you do this, the more alcohol or drugs you need to get the same effect. This is called building tolerance. 

If you’re worried, ask yourself the following:

• Do you find it difficult to set limits or to stop yourself drinking or using drugs, even if you want to or you’re experiencing unpleasant side effects?
• Have you been taking a prescription drug for longer than you were advised?
• Have you lost interest in things you used to enjoy because of drinking or drugs?
• Do you have trouble managing your daily life – for example, washing, cooking, cleaning?
• Do you spend a lot of time thinking about alcohol or drugs?
• Is drink or drug use affecting your relationships with those around you?
• Have your family or friends raised concerns about your drug or alcohol use?
• Have you had an accident as a result of alcohol or drugs?

If you answered yes to some of those questions, you may want to seek help.

Government guidelines say we shouldn’t regularly drink more than 14 units of alcohol a week. This is the same for men and women. But even these amounts may be too much for older people. 

It can be difficult to work out how many units you’re drinking. It depends on the strength of the alcohol and the size of the glass, for example. Online calculators, such as the ones on Alcohol Change UK and Count 14, can help you work out the risks. 

The NHS website has more information about the risks of drinking too much.

Ask your pharmacist for advice about any risks associated with your prescription or over-the-counter medication, or check the electronic medicines compendium (emc).

Read the written information that comes with your medication and keep it safe for future reference. Mixing alcohol and other drugs can be dangerous. 

You can get detailed information about the risks of recreational drugs from the national drugs service FRANK. 

The impact of drug and alcohol misuse varies from person to person. 

You become more at risk of:

• problems with your balance, which could lead to falls and injury 
• incontinence
• problems sleeping and tiredness during the day
• blackouts or fits
• medical conditions, such as high blood pressure, cancer, liver disease, heart disease or stroke
• other medication you’ve been prescribed not working as well as it should
• loss of appetite, which could lead to malnutrition.

All drugs and alcohol have some effect on your mental health, changing your mood and the way you see things. The effects depend on what you’re using but could lead to:

• depression 
• confusion 
• memory problems.

Drug and alcohol misuse can have a serious impact on every aspect of your life, including your relationships, finances and housing. 

In some cases, it can lead to addiction. This isn’t a question of ‘willpower’ – addiction is an illness – but with the right support, you can recover.

It may be hard to admit that you have a problem, but there are many ways you can get help.

Start by talking to your GP, even if you’re just a little bit worried about the way you’re using drugs or alcohol.

If you’ve become addicted to a prescribed medication, make sure your GP records this so you’re not prescribed it again.

Your GP should be able to help you if you’re struggling with pain. If you’ve become addicted to an opioid painkiller, you may need another way to deal with pain. Your GP may refer you to a pain clinic, where you could be offered a pain management programme. 

Try to be honest about how much and how often you’re drinking or using drugs. If necessary, your GP can refer you for specialist assessment or treatment.

If you’re not comfortable talking to your GP, you can contact local treatment services yourself. 

For alcohol support services, visit NHS England. Or call Drinkline – a free, confidential helpline – on 0300 123 1110 or Drinkline Scotland on 0800 731 4314. 

You can find directories of drug treatment services on FRANK and the NHS website.

For drug and alcohol services in Scotland, visit NHS inform. In Wales, visit DAN 24/7.

Charities or support groups can be helpful in dealing with alcohol or drug misuse. They will have different approaches, so you might need to find one that is right for you. Your GP or NHS services should give you information about these groups and services.

Organisations that can help include:

• Alcohol Change UK
• Alcoholics Anonymous
• Drinkaware
• LGBT Foundation
• Mind
• Narcotics Anonymous
• Rehab 4 Addiction
• Rehab 4 Alcoholism
• Turning Point
• We Are With You.

If you’re struggling with pain, you could try The Pain Toolkit  or contact:

• The British Pain Society
• Pain Concern
• organisations that deal with specific conditions. 

Your treatment will depend on what you’re using and what you want to achieve. You might just want help to cut down or you may need to stop completely.

It’s important to be honest about your drinking or drug use. For example, if you’re prescribed medication, it could interact with whatever you’re using.

If you’re referred to a local drug and alcohol treatment service, you should be given a keyworker. They will make a care plan with you and see you on a regular basis.

Your treatment may include:

• psychological or talking therapies, such as counselling or cognitive behavioural therapy (CBT). These can help change the way you think and act, and may be one-to-one or in groups
• detoxification (detox) treatments to help you stop drinking or using drugs. You may have to do this in a hospital or clinic
• medication – you may need medication to control cravings or to help with withdrawal symptoms. For example, you may be prescribed medication that gives you an unpleasant reaction when you drink. 

You may need a combination of treatments. You should also be offered help to deal with other problems that might have caused you to start using in the first place or that have been made worse by it.

• Set yourself goals.
• Reduce your intake gradually. It can be dangerous to stop suddenly. Make sure you get help.
• Set a budget so you know how much you’re spending.
• Let people know – tell family and friends, and explain why you’re cutting down so they can support you.
• Keep track of how much you’re using by writing it down.
• Keep a diary to help you work out the things that make you want to take a drug or have a drink.
• If you’re tempted, remind yourself of the negative consequences and why you want to change.
• Reward your progress – for example, you could spend the money you save on something for yourself.

You can get worksheets and other useful resources from some support organisations to help you manage your drinking or drug use.

Drug and alcohol dependency is a long-term condition and relapse is a common part of the recovery process. It’s understandable if you start misusing drugs or alcohol again after starting recovery. 

Try not to be hard on yourself if you have setbacks. If you can, build a support network of people who understand. It’s okay to ask for help – for example, if you’re struggling with withdrawal symptoms. 

Talking to other people in a similar situation can be helpful – support organisations can put you in touch with local groups and online support.

Rehabilitation and recovery programmes can help you stay on track. You might find it helpful to attend meetings such as those run by UK Smart Recovery or Alcoholics Anonymous. 

Try to work out what makes you want to go back to drinking or taking a drug. You might want to stay away from the people or situations that make you want to start using again. 

Your friends and family may be able to help you find ways to keep busy that don’t involve alcohol or drugs. You could go back to a hobby or start a new one that helps to distract you.

Our page Looking after your mental health has information about practical ways you can look after yourself and where you can find help.

If you’re concerned that someone you know might be misusing drugs or alcohol, try speaking to them and encourage them to get help. Be patient – it can take time for someone to admit they have a problem. Reassure them that they won’t be judged. 

Help them to find the right support. You could go with them to appointments if they would like you to. 

For general advice on helping somebody else, see our page If you're worried about someone's mental health.

Many people recover from drug or alcohol problems, but it can take a long time. If they have setbacks, encourage them to return to their recovery plan.

Older people who misuse alcohol or drugs can be at increased risk of self-neglect, abuse or injury. If you’re worried about someone you know, you can contact the adult social services department at their local council. Find out more on our page Protecting someone from harm.

Living with someone who is misusing drugs or alcohol can be extremely stressful. You may feel worried and alone. Make sure you get support for yourself as well.

Some organisations have support groups or helplines specifically for families and carers, including:

• Al-Anon family groups
• Adfam
• Addiction Family Support 
• Scottish Families Affected by Alcohol & Drugs.

Your GP may have details of other organisations that could help.