In general, alcohol use declines with age and use of illicit drugs is less common in older people than in their younger counterparts. However, as the Royal College of Psychiatrists highlighted in its 2011 report Our invisible addicts, the number of older people with substance use problems is increasing rapidly. The European Monitoring Centre for Drugs and Drug Addiction has estimated that the number of older people with substance use problems or requiring treatment for substance misuse will more than double between 2001 and 2020. In spite of this, older people with substance use problems have historically been a marginalised group, whose particular needs have not been well met.

It’s about time: Tackling substance misuse in older people brings together information about older people and substance misuse – including use of alcohol, illicit drugs and prescribed and over-the-counter medications – from a range of sources, including published research and reports, service visits and a roundtable attended by academics, policy specialists, practitioners and former service users. In doing so, it aims to identify some of the key issues and problems in this area, and makes strategic and policy recommendations for change, as well as good practice recommendations for substance misuse and older people’s services.

Key recommendations include:
• A range of interventions are needed for older people with substance use problems, from age-appropriate, non-time limited treatment and support for those who are drug and/or alcohol dependent, to brief interventions for those who are drinking at risk. Support for those with problems with prescription and/or over-the-counter medications also needs to be available.
• Many of the services we visited during the research process for the briefing were delivering positive outcomes but faced a discontinuation of their funding. Independent and statutory funders and commissioners need to recognise the importance of services and interventions for older people and to consider options for sustainable funding going forward, particularly as research indicates increased prevalence and need.
• Substance misuse services can implement a range of measures to help ensure the accessibility and relevance of services for older people, including specific groups or times for older people, satellite services operating out of community provision aimed specifically at older people – for instance, local support groups – and home visits.
• Older people with substance misuse problems may come into contact with a number of health and social care professionals, including those working in primary care settings, older people’s mental health services, residential services, and for social care providers. With particular reference to alcohol, these professionals should be trained to deliver brief interventions (IBA) and ‘sensible drinking’ advice to those who are not dependent, but are drinking at risk. Links with specialist support should be developed for referral of those with serious substance misuse problems.