Abstract
With increasing substance misuse among older adults, we examined the question of whether older adults may be less likely to endorse certain DSM-5 criteria for alcohol and cannabis use disorders (AUD and CUD). We used the 2021-2023 National Surveys on Drug Use and Health (N = 17,494 for AUD and N = 12,264 for CUD) and descriptive statistics to compare the 65+ and under 65 age groups in their endorsements of 11 DSM-5 criteria. A multivariable logistic regression model was fitted for each criterion as the dependent variable with the age group as the independent variable and other characteristics as covariates. For AUD, the 65+ age group was associated with lower odds of endorsing seven out of eleven DSM-5 criteria, including social impairments (e.g., failure to fulfill role obligations (aOR = 0.30, 95% CI = 0.16-0.56); social problems (aOR = 0.46, 95% CI = 0.30-0.71); given-up activities (aOR = 0.66, 95% CI = 0.47-0.94); hazardous use (aOR = 0.53, 95% Yes CI = 0.34-0.81); and physical/psychological problems (aOR = 0.51, 95% CI = 0.37-0.70). For CUD, the 65+ age group was less likely than the under 65 age group to endorse hazardous use (aOR = 0.04, 95% CI = 0.01-0.17) and withdrawal (aOR = 0.39, 95% CI = 0.20-0.73 for criterion A and aOR = 0.16, 95% CI = 0.05-0.48 for criterion B). Clinicians should be aware that older adults might not express the full range of symptoms in the same way as the younger age groups. A more nuanced understanding of older adults' social context may be needed for accurate diagnosis.