Substance Use Disorders in Later Life: A Review and Synthesis of the Literature of an Emerging Public Health Concern

•What is the primary question addressed by this study?—Are substance use disorders becoming more common and why does this matter?•What is the main finding of this study?—With the Baby Boomer generation aging into the geriatric cohort, they bring with them a life time of experiences and habits, including substance use disorder. Despite this, substance use disorders in the elderly remain underestimated, underidentified, underdiagnosed, and undertreated.•What is the meaning of the finding?—Older individuals are using illicit drugs and meeting criteria for SUDs at higher rates than previous geriatric cohorts resulting in substantial negative impacts on medical and psychiatric conditions. Substance use disorders (SUDs) among older persons are among the fastest growing health problems in the United States. The number of older persons is projected to exceed 72.1 million persons by 2030, following a trend of general population growth in the mid-1940s to 1960s. The generation, known as “baby boomers,” who refashioned drug use during their 20–30s, are increasingly continuing drug habits into later life. This review aims to assess the epidemiology, impact, and treatment of geriatric SUDs. Academic databases including PubMed, PsychInfo, Ovid, and Medline, were queried up to December 2018 for terms of “geriatric,” “older,” “elderly,” “substance abuse,” “drug,” “drug use,” “drug abuse,” “drug dependency,” “illicit drugs,” and “geriatric psychiatry.” Articles identified included 17 government documents, 29 studies based upon government documents, 43 studies not related to US government surveys, 19 review articles, 9 commentary pieces, 4 newspaper articles, 2 textbooks, and 1 published abstract. Evaluated studies and documents together suggest that older individuals are using illicit drugs and meeting criteria for SUDs at higher rates than previous geriatric cohorts resulting in substantial negative impacts on medical and psychiatric conditions. These findings represent a novel trend since previous cohorts of older individuals were thought to rarely use illicit substances. Current treatment models are inadequate to address the new wave of older individuals with SUDs. The fields of geriatrics, addiction, and geriatric psychiatry must work together to establish comprehensive care models and treatment modalities for addressing this emerging public health concern.