Age considerations in substance use and addictive behaviours

The developing brain of an adolescent is more sensitive than the adult brain to long-term damage from substance use and addictive behaviours; decision-making and academic performance can be harmed and the risk of substance dependence in adulthood is increased by early substance useJordan, 2017Silins, 2015. Some young people present because of others’ concerns about their substance use. Family therapy may be needed to agree goals and the pace at which changes are made. Activity therapy (programs that engage young people in fun activities while also providing psychoeducation) has been very effective in some situations, for example in treating volatile inhalant use. For resources to support management of substance use and addictive behaviours in young people, see Substance use and addictive behaviours in young people: additional resources for clinicians.

In older people, physical and mental illnesses (including chronic pain, grief and isolation), multiple medications and adverse effects increase risk of harms (eg cognitive impairment and falls) from substance use or addictive behavioursAustralian Institute of Health and Welfare (AIHW). Long-term substance use increases the risk of age-related disease (eg cognitive decline, which can limit the use of treatments that require learning new skills). Tobacco causes most harm, followed by alcohol. The prevalence of hazardous alcohol use is rising in people older than 50 yearsRoche, 2019, and those older than 70 years are most likely to report daily drinkingHaber, 2021. Ask also about illicit drug use; older people may not be considered likely to use drugs, but one-third of those on treatment for opioid dependence are 50 years or older. Consider the effect of age when assessing and managing substance use, because older people are at greater risk of toxicity (eg from benzodiazepines, zolpidem and zopiclone). The Older Wiser Lifestyle (OWL) Program is the first drug and alcohol service specific to the needs of adults aged 60 years and older.