Substance Use Disorders Among Medicare Beneficiaries: Prevalence, Mental and Physical Comorbidities, and Treatment Barriers


      This study aimed to determine the prevalence of treated and untreated substance use disorders among Medicare beneficiaries, the characteristics of Medicare beneficiaries with substance use disorders, and reasons for their unmet needs.


      This study used data from the National Survey of Drug Use and Health, 2015–2019. Substance use disorder was defined based on DSM-IV dependence or abuse criteria. Descriptive analyses were conducted in 2021, including testing for differences in unadjusted means.


      Approximately 1.7 million Medicare beneficiaries were estimated to have past-year substance use disorder (8% of Medicare beneficiaries aged <65 years and 2% aged ≥65 years). Overall, 77% had an alcohol use condition, 16% had a prescription drug use condition, and 10% had a marijuana use condition. Of those who had past-year substance use disorder, 11% received treatment for their condition. Common reasons for not receiving treatment were lack of motivation (41%), financial barriers (33%), concern about what others might think (24%), logistical barriers such as lack of transportation (21%), and uncertainty about treatment efficacy (13%). Medicare beneficiaries with substance use disorders were more than twice as likely to have past-year serious psychological distress as those without substance use disorders (44% vs 21%, p<0.001 for those aged <65 years; 14% vs 4%, p<0.001 for those aged ≥65 years). Percentages of past-year suicidal ideation were also much higher among Medicare beneficiaries with substance use disorders than without (24% vs 6%, p<0.001 for those aged <65 years; 7% vs 2%, p=0.006 for those aged ≥65 years).


      Few Medicare beneficiaries who need substance use disorder treatment receive it. Reducing Medicare coverage gaps and stigma may help meet this need.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Total number of Medicare beneficiaries. State health facts. Kaiser Family Foundation.,%22sort%22:%22asc%22%7D. Updated 2022. Accessed August 2, 2021.

        • Han BH
        • Moore AA
        • Sherman S
        • Keyes KM
        • Palamar JJ.
        Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005-2014.
        Drug Alcohol Depend. 2017; 170: 198-207
        • Huhn AS
        • Strain EC
        • Tompkins DA
        • Dunn KE.
        A hidden aspect of the U.S. opioid crisis: rise in first-time treatment admissions for older adults with opioid use disorder.
        Drug Alcohol Depend. 2018; 193: 142-147
        • Peters JL
        • Durand WM
        • Monteiro KA
        • Dumenco L
        • George P.
        Opioid overdose hospitalizations among Medicare-disability beneficiaries.
        J Am Board Fam Med. 2018; 31: 881-896
        • Kuo YF
        • Baillargeon J
        • Raji MA.
        Overdose deaths from nonprescribed prescription opioids, heroin, and other synthetic opioids in Medicare beneficiaries.
        J Subst Abuse Treat. 2021; 124108282
        • Maust DT
        • Blow FC
        • Wiechers IR
        • Kales HC
        • Marcus SC.
        National trends in antidepressant, benzodiazepine, and other sedative-hypnotic treatment of older adults in psychiatric and primary care.
        J Clin Psychiatry. 2017; 78: e363-e371
        • Shoff C
        • Yang TC
        • Shaw BA.
        Trends in opioid use disorder among older adults: analyzing Medicare data, 2013-2018.
        Am J Prev Med. 2021; 60: 850-855
        • Mark TL
        • Yee T
        • Levit KR
        • Camacho-Cook J
        • Cutler E
        • Carroll CD.
        Insurance financing increased for mental health conditions but not for substance use disorders, 1986-2014.
        Health Aff (Millwood). 2016; 35: 958-965
        • Lehmann SW
        • Fingerhood M.
        Substance-use disorders in later life.
        N Engl J Med. 2018; 379: 2351-2360
        • Yuan Z
        • Dawson N
        • Cooper GS
        • Einstadter D
        • Cebul R
        • Rimm AA.
        Effects of alcohol-related disease on hip fracture and mortality: a retrospective cohort study of hospitalized Medicare beneficiaries.
        Am J Public Health. 2001; 91: 1089-1093
        • Jayadevappa R
        • Chhatre S.
        Association between age, substance use, and outcomes in Medicare enrollees with prostate cancer.
        J Geriatr Oncol. 2016; 7: 444-452
      2. SUPPORT for Patients and Communities Act, H.R.6, 115th Cong. (2017-2018). Accessed March 14, 2022.

        • Steinberg D
        • Weber E
        • Woodworth A.
        Medicare’s discriminatory coverage policies for substance use disorders.
        Health Affairs, Bethesda, MD2021 (Accessed September 16, 2021)
      3. Weber E, Steinberg D. Medicare coverage of substance use disorder care: a landscape review of benefit coverage, service gaps and a path to reform. New York, NY: Legal Action Center; Published 2021. Accessed August 13, 2021.

        • U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2015–2019)
        National Survey on Drug Use and Health 2016 (NSDUH-2015-DS0001 through NSDUH-2019-DS0001).
        2021 (PublishedAccessed February 10, 2022)
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        2000 (4th Ed., Text Rev.)
        • Substance Abuse and Mental Health Services Administration
        Treating substance use disorder in older adults.
        Substance Abuse and Mental Health Services Administration, MD: Rockville2020
        • Vespa J
        • Armstrong DM
        • Medina L.
        Demographic Turning Points for the United States: Population Projections for 2020 to 2060.
        U.S. Census Bureau, Washington, DC2020
        • Kuerbis A
        • Sacco P
        • Blazer DG
        • Moore AA.
        Substance abuse among older adults.
        Clin Geriatr Med. 2014; 30: 629-654
        • Han BH
        • Moore AA.
        Prevention and screening of unhealthy substance use by older adults.
        Clin Geriatr Med. 2018; 34: 117-129
        • Harris SJ
        • Abraham AJ
        • Andrews CM
        • Yarbrough CR.
        Gaps in access to opioid use disorder treatment for Medicare beneficiaries.
        Health Aff (Millwood). 2020; 39: 233-237 00309
        • Le Roux C
        • Tang Y
        • Drexler K
        Alcohol and opioid use disorder in older adults: neglected and treatable illnesses.
        Curr Psychiatry Rep. 2016; 18: 87
        • van Duijvenbode N
        • VanDerNagel JEL
        • Didden R
        • et al.
        Substance use disorders in individuals with mild to borderline intellectual disability: current status and future directions.
        Res Dev Disabil. 2015; 38: 319-328
        • Leung G
        • Zhang J
        • Lin WC
        • Clark RE.
        Behavioral disorders and diabetes-related outcomes among Massachusetts Medicare and Medicaid beneficiaries.
        Psychiatr Serv. 2011; 62: 659-665
        • Luo TD
        • Vakharia RM
        • Gwam CU
        • Zuskov A
        • Plate JF
        • Roche MW.
        A matched control analysis on the effects of alcohol use disorder after primary total knee arthroplasty in Medicare patients.
        J Am Acad Orthop Surg. 2021; 29: e593-e600
        • Baker JG
        • Doxbeck DR
        • Washington ME
        • Horton A
        • Dunning A.
        Substance use identification and follow-up rates among commercial and Medicare health insurance members in primary care and other settings.
        BMC Fam Pract. 2020; 21: 223
        • Choi NG
        • DiNitto DM.
        Alcohol use disorder and treatment receipt among individuals aged 50 years and older: other substance use and psychiatric correlates.
        J Subst Abuse Treat. 2021; 131108445
        • Wieben ES
        • Nielsen B
        • Nielsen AS
        • Andersen K.
        Elderly alcoholics compared to middle-aged alcoholics in outpatient treatment −6-month follow-up.
        Nord J Psychiatry. 2018; 72: 506-511
      4. Suicide by age, United States 2010-2019. Suicide Prevention Resource Center. Updated August 2021. Accessed August 2, 2021.

        • Carvalho ML
        • Costa APC
        • Monteiro CFS
        • Figueiredo MDLF
        • Avelino FVSD
        • Rocha SSD.
        Suicide in the elderly: approach to social determinants of health in the Dahlgren and Whitehead model.
        Rev Bras Enferm. 2020; 73e20200332
      5. Commonly used drugs charts. National Institute on Drug Abuse. Updated August 20, 2020. Accessed November 15, 2021.

        • Wang SM
        • Han KD
        • Kim NY
        • et al.
        Association of alcohol intake and fracture risk in elderly varied by affected bones: a nationwide longitudinal study.
        Psychiatry Investig. 2020; 17: 1013-1020
        • Woods AJ
        • Porges EC
        • Bryant VE
        • et al.
        Current heavy alcohol consumption is associated with greater cognitive impairment in older adults.
        Alcohol Clin Exp Res. 2016; 40: 2435-2444