Addiction Medicine Made Easy | Fighting back against addiction

Why Substance Use Looks Different After 65

• Casey Grover, MD, FACEP, FASAM

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The most dangerous phrase in senior health might be “I’ve always handled it fine.” We dive into how aging reshapes the risks of alcohol, benzodiazepines, opioids, nicotine, and today’s ultra‑potent cannabis—and why familiar habits can turn hazardous after 65. Drawing on frontline cases and recent research, we unpack the baby boomer lived experience, from “mother’s little helper” to daily cocktail hours in senior communities, then connect it to the biology of aging: slower metabolism, reduced kidney and liver function, impaired balance, and sharper sensitivity to side effects.

You’ll hear why DSM‑5 criteria still apply but require age‑aware interpretation, what “code cannabis” looks like in the ER when edibles or high‑THC products masquerade as stroke, and how subtle red flags—poor sleep, irritability, shakiness, forgetfulness, falls—signal a brewing problem. We get practical about safer detox for older adults, the reality of kindling with alcohol withdrawal, and the medication decisions that matter: when to taper sedatives, how to avoid dangerous interactions, and why nutrition and B‑vitamins can’t be an afterthought. Two real-world cases ground the lessons—titrating decades‑long benzodiazepine and Z‑drug use while reducing fall risk, and using naltrexone strategically for late‑onset alcohol use without tipping a patient into instability.

If you care for an older adult—or you are one—this conversation offers clear steps to lower risk and raise quality of life: rethink sleep meds, reduce alcohol use, check cannabis potency, simplify regimens, and choose therapy and support groups that fit your season of life. Subscribe, share this with a friend or colleague, and leave a review with your biggest takeaway so we can keep building smart, stigma‑free care for older adults.

To contact Dr. Grover: ammadeeasy@fastmail.com

SPEAKER_00:

Welcome to the Addiction Medicine Made Easy Podcast. Hey there, I'm Dr. Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years, I worked in the emergency department, seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started. Today's episode is on addiction in the older adult. As you've heard me say, I am the medical director for one of our local drug and alcohol treatment programs, and I do monthly educational lectures for the staff. And this month, they wanted me to talk about the unique issues that come up when treating a person over 65 who has addiction. So I found a few great articles on PubMed on the topic and combined some great information from those articles with what I am seeing in my practice. And the end result was this lecture. And how timely. I got a call right after I gave the lecture that a local dentist had retired after 45 years of practice and had found that his alcohol consumption had gone up in retirement and he wanted to see me. So with that, let's get into this lecture on addiction in the older adult. Okay, so this lecture is gonna be on addiction in the older adult. And I've not given this one before. This is my first time giving this presentation. Hopefully, we all learn something together. When we speak about older Americans or older people in general, I'm gonna be speaking specifically about what we see in America, but we're speaking about people over age 65. And culturally, there's a lived experience that they've had that we have to understand their relationship with substances. And then we also have to understand for all human beings how the body changes as we age. So for Americans over age 65, we call them the baby boomers. And this was post-World War II America. America's economy was booming, there was a higher quality of life, technology was becoming more prevalent. And we also had pharmaceutical companies making new medicines. So for baby boomers compared to previous generations, baby boomers here in the US had a higher exposure to drugs and alcohol compared to those that came before them. And you've ever heard the term the swinging 60s? The 60s were a time in America of a lot of social change, the civil rights movement, experimentation with drugs and alcohol. And we have to understand that lived experience of a lot of these people. The other thing is I mentioned that pharmaceutical companies started to bring new drugs to market. Unfortunately, some of which were addictive and we didn't really quite understand the impact of them yet. And while the term mother's little helper can be used to refer to a number of different pharmaceuticals that came out during that time, most often mother's little helper refers to diazepam, also known as Valium, which we've talked about as a sedative, and it was widely marketed for all sorts of ailments. And I'll share a brief family story about Valium, just again, give the context for socially what this generation has lived through. So my wife and I were visiting one of our family members, and I think she's in her early 80s, and she struggled with addiction and has been sober now for many years. And we were just chatting about the work that we do as doctors, my wife and I. If anyone doesn't know, my wife is the very talented Dr. Reb Close. So Reb and I were speaking about our work in addiction, and she talked about really her first experience with drugs and alcohol was with Valium or diazepam. And she was put on it when she was 15. And I remember asking, given what I know and what I do now, why would they put you on Valium when you were 15? And she said, Oh, my mom was on it and she wanted it to be easier to get through my menstrual cycle. And I was just, wait, what? Why was your mother on Valium too? And she said, Oh, she had a husband and children, and Thursdays were really hard. And just culturally, at the time, it was just, don't feel good, take a pill. And benzodiazepines for this generation is something that some of them have been on for decades and decades. I have one patient who has been on a benzodiazepine longer than I've been alive. So, again, that's the social story and lived experience of this generation in America. Now, unfortunately, we also have to consider in the older person, the body changes with time, and that affects how addiction manifests, what substances do the body, and what we need to do for treatment. People's hearing and vision tends to get worse. Cognition or the ability to think through problems and problem solve is decreased. We have less emotional resilience as we age, our balance changes, we lose strength, we specifically lose muscle mass, the function of our organs, heart, kidney, lungs, liver changes. And as we age, we tend to get more medical conditions, we tend to be on more medications, and yet we are increasingly sensitive as we age to medications, specifically around side effects and interactions. And we also are therefore more sensitive to drugs and alcohol themselves. So let's keep that in mind as we start talking through the specific problem of substance use in people over 65. So the first question is how big of a problem is this? Most recent numbers I saw that the estimate of the current prevalence or how common it is to have substance use disorders in people over 65 is 4%. So you might not think that's a huge number. It's definitely higher for the general population. But this population of baby boomers in America is aging, and so we are getting more people in that over 65 category as time goes on. As of 2023, there were approximately 60 million Americans over 65. So you do the math, and that's about 2.5 million Americans over 65 with a substance use disorder. So it adds up. In terms of what they are using, nicotine is very common in people over 65 in America. 14% of people over 65 use nicotine. 11% of Americans over age 65 binge drink. And then, as I referenced, prescription medications are also a big issue for this generation. Around 10% of people over 65 in the US are on benzodazipines, and a similar number are on prescription opioids. Cannabis is on the rise across America in every age group, and the over 65 group is no exception. Currently, about 8% of older adults use cannabis. Over-the-counter meds are a particular concern in people over 65, not so much in that they're crushing and snorting Benadryl to suggest really a use disorder behavior, but more that there's a lot of ongoing symptoms, insomnia, pain, anxiety. And older Americans, when they study it, are shown to be heavy users of over-the-counter medications, often taking more than is recommended on the package. In terms of illicit substances, I have patients in my practice over 65 who use all sorts of stuff that have vitamine, cocaine, fentanyl, whatever. But that tends to be the exception rather than the rule. Illicit substance use over 65 in Americans is less than 1%, but certainly possible. Now, let's explore some of the issues that people over 65 may run into, just given how America has changed since they were born. So the first thing is cannabis is different. So if you went to high school in the 1970s and you used cannabis, it was about 1% THC. And it was really just smoked as joints or just a cannabis cigarette functionally. And you can see here on the screen, as we've bred cannabis to be stronger over time, as of 2022, most cannabis was getting close to 20%. And now most cannabis is 25 to 30% THC. And a lot of my patients over 65 don't realize that. I'll ask them, you're using cannabis, what type? And they'll be like, Doc, it's just pot. And just the industry has changed. And one of my patients, I had to show her on her package that she was using 23% THC cannabis, and she was floored. She just, I didn't know any of this. Cannabis has also changed in its forms. We now have edible cannabis products and cannabis drinks. This is a picture of a cannabis product. It's a two-fluid ounce bottle that's slightly bigger than a shot of liquor. And these beverages contain 100 milligrams of THC. Now, most people don't know what a standard serving of THC is, THC being the downer chemical in cannabis that makes us high. And we as doctors don't actually know either. We think that the recreational dose of cannabis is somewhere between two and a half and 15 milligrams. And so someone who doesn't know anything about cannabis sees this tiny little bottle and is likely going to drink the whole thing. Unfortunately, it was really not well labeled on the package how to portion out each serving because it's meant, you can see on there, they're saying 10 milligrams per serving, and it's supposed to be 100 milligrams in the bottle, but it's really not that well labeled to be able to say this is how I get only this much. Take a look at this. This is actually a THC infused joint. So these pre-rolled joints are 43 and 40% THC. And take a look at the package on the left. That is 864 milligrams of THC in that package, and that's four joints. So that's 215 milligrams of THC per joint. That is drastically stronger than any cannabis that people used of this generation when they were in their teenage years. At the hospital, a code is used to signal some sort of medical emergency or issue. And so we, when we work in the emergency department, if someone has a potential stroke, we will page overhead code stroke so that everybody knows to respond and the person gets the tests and treatments that they need if it is a stroke. And I mentioned my spouse and colleague, Dr. Reb Close, she's done a lot of work studying overdoses here in Monterey County. And she's identified a trend of what she calls code cannabis, where an older person is brought to the hospital with a suspected stroke because they're confused or they or they're dizzy or they can't balance. And it ultimately is found that no stroke has happened, but they consumed cannabis either intentionally and didn't realize how strong it was, or they didn't mean to consume a cannabis product that did, and no one can really tell until they get to the emergency department and run all the tests. So she calls this code cannabis, meaning we think it's a stroke, but it turns out to be cannabis intoxication. And if you take a look, here are some examples of a candy gummy. We all know Sour Patch Kids. And take a look at the label above it, stony patch. The colors are the same, the fonts are almost the same. Sour than sweet is on both packages. And you can see it's fairly subtle if you're not paying attention to realize that the package above has THC and the one below does not. And if you remember, as we age, sometimes we develop issues with vision and being able to see clearly. An older individual who's not able to see the package clearly probably would not be able to distinguish between these, which might result in them taking cannabis without knowing it when they mixed up a package of a gummy versus a THC-infused gummy. Coming back to the cultural experience of Americans over 65, these are some advertisements going back many years advertising cigarettes. If you look on the left, that is a picture of Ronald Reagan advertising Chesterfield cigarettes. Obviously, Ronald Reagan was a very loved president of this generation. Take a look at the middle advertisement. More doctors smoke camels than any other cigarette. Yes, believe it or not, physicians used to recommend cigarettes for weight loss. And I certainly had medical school professors that recalled earlier in their careers they would actually stop to smoke between seeing patients. And again, on the right, that's an ad for Newport, really highlighting the pleasure and joy of smoking. I'm old enough to still remember smoking sections on planes. Culturally, cigarette use was just much more common for Americans over 65 when they were young people. And I've had a number of my patients tell me when I asked them, do you smoke? And they said, well, I used to, but everybody did back then. Now we need to ask the question when we come to make a diagnosis of an addiction, is it the same process for someone who's over 65 versus under 65? And unfortunately, as we age, our body physiologically or in terms of how it works, it changes. We get more mental health conditions, we get more memory issues, we develop more medical problems. And sometimes addiction can actually manifest differently, and we need to look for different things. So you guys have seen this chart before. This is the DSM 5 diagnosis criteria for an addiction. It's the same for every substance. We use the substance for longer periods or in larger amounts. We have a desire to cut down and unsuccessful efforts to cut down when we try. We spend a lot of time to use the substance and get the substance. We get cravings for the substance. We use the substance and then we can't fulfill major role obligations at work, school, and home. We use the substance despite having social and interpersonal problems. We give up social, occupational, recreational activities because of the substance. We use the substance in situations where it's potentially dangerous. The substance is continued despite knowledge of having persistent problems and then tolerance, the need to consume more with time, and then withdrawal, meaning that we need to use the substance to not feel sick. And those 11 criteria are the same for any human being for any substance. You just put in alcohol. Alcohol is often taken larger amounts over a longer period of time. You put in cannabis. Cannabis is often taken in larger amounts over a longer period of time. It's the same 11 criteria for any addiction. So practically it's the same when it comes to making a diagnosis of addiction in terms of do they meet criteria and which criteria do they meet? But it turns out that actually some of these criteria look different in adults over 65. One of the criteria is that the substance is taken in greater amounts than intended. As we talked about, we are more sensitive to the effects of medications and substances as we age. So a person's use might be the same or even less over time, but as they're older and they weigh less and they can't tolerate it as much, they actually might functionally be using more. For people that have been on substances for decades and decades, they may not realize that their chronic use is problematic. So they really haven't tried or been unsuccessful in cutting down because they didn't think there was a problem. We also have to realize that a lot of older adults stay home. They might be homebound, they might be retired. They don't have a lot of roles in school or workplace or home. So they're not missing any of those obligations because they don't necessarily have those obligations to miss. People give up other activities because of the substance. They may just not have as many activities that they do. And again, you will also see that withdrawal, as we'll talk about shortly, can look different as we age. So it may not be immediately recognized as withdrawal. And unfortunately, we also see that as we age, or our risk of falls goes up and our ability to react quickly while driving goes down. So using substances in what might be considered normal use actually does increase the risk of serious complications. So again, the 11 criteria are the same, but we just have to look for slightly different things. The other thing is that as our organ systems change and our health changes as we age, substance use might just look different. In other words, we might not look for usual things to make us think, gosh, could this be a problem with addiction in the first place? So we see more mental health symptoms with substance use in people over 65, particularly disturbed sleep, anxiety, depression, irritability. Sometimes it's more physical symptoms like being shaky, coordination of balance being more off. The stomach is more sensitive to things like nausea and vomiting. Unfortunately, as we'll talk about, people over 65 are at higher risk of falls and have trouble maintaining good nutrition no matter what. So we may see those problems show up earlier in a person's use of substances. As we age, our brain ages too, and the cognitive changes that happen with aging are gonna be more apparent when someone's using substances. Substances accelerate those cognitive changes. And then a lot of times we'll see just social interactions change. People might be more withdrawn, they might not be as connected to family. So the diagnosis is the same, but we need to look for other things when making those diagnostic decisions with the DSM criteria. And then just could this be a substance use problem in general? We're just going to look for different stuff because it may manifest differently in older adults. Now, in terms of treating addiction at the highest level, there's no difference, right? We have medications, we have mutual support groups, and we have counseling and therapy. And that doesn't change no matter who you are or how old you are. But each of those might be a little bit different when we're working with a person who's over 65. So the first thing is let's talk about detox. And detox is not a medical term, but everybody knows the term. And so I use it to say I need to stop the substance. I've got to get through the withdrawal period. Unfortunately, as we age, we tolerate stress on the body less. And that's in general. When you're 16 years old and you have a urinary tract infection, no big deal, right? Cranberry juice and an antibiotic, and you don't even miss a beat. A person who's 90 years old might have to be hospitalized for several days because of a urinary tract infection. So we just tolerate stress less as we age. We have less reserve, if you will. So we are more sensitive to withdrawal as we age and we tolerate it less well. So adults over 65 when choosing to quit a substance, particularly one with a dangerous withdrawal syndrome like alcohol, may need a very high level of care. Dr. Lee Goldman, he's one of the addiction docs here in Monterey County with me, usually recommends hospitalization for folks over 70 when they're coming off of alcohol, just because they can be much more vulnerable. Now, the other thing is with more years on the planet, people with addiction have had more years to start and stop substances, to go through withdrawal, to try to quit. And unfortunately, like riding a bike, our brain gets good at something we do a lot of, right? So you want to learn a new musical instrument, what do they say? Practice, practice, practice. Unfortunately, when we use a substance and stop, our brain learns the withdrawal pathway. And withdrawal can worsen in time as those brain pathways strengthen. And we know this best with alcohol. It's called kindling, which is basically that it's been studied that as people start and stop alcohol multiple times, the withdrawal usually gets worse each time. So a great question to ask someone when they're deciding to quit substances what's the worst withdrawal that you have? And someone who's had really bad alcohol withdrawal is likely to have it again, particularly as they've started and stopped multiple times and they get older. Now, I mentioned that as we age, we tend to have more medical issues. The two organs that do the vast majority of breaking down the medications and substances that we put in our body are the liver and kidney. And years of stress on the body in general means that the liver and kidney function may decrease over time. And so we often have to either avoid certain classes of medications or adjust the dosing because the person's not able to tolerate it because their liver and kidney function has changed with time. So gabapentin, for example, which we use very liberally in addiction medicine, it turns out is only secreted by the kidneys. So somebody who has kidney problems, we really don't use it. We can use it with a mild amount of kidney dysfunction, but for severe kidney dysfunction, we really avoid it. Now, the other thing is as we have more medical conditions, we tend to be put on more medications. And the more medications we take, the more likely we are to have medication interactions. And for example, let's say somebody who has chronic back pain and got all put on opioids, and then they start to develop an opioid use disorder, their back pain's still there. And let's say they're on a blood thinner because of a regular heartbeat, it reduces the number of classes of medications that we can use to treat their pain because it might have a dangerous interaction with their blood thinner. A couple other things that are unique to older adults. The first is poor nutrition. It turns out our hunger and thirst reflexes decrease as we age, and food may not taste as good as we age as well. So older adults tend to eat and drink less. They're more likely to develop malnutrition and also dehydration. And particularly with alcohol, some people will really just drink alcohol and not eat. And it really puts people at risk for malnutrition, particularly with B vitamins. So usually when we get people off of alcohol, we want to get them on B vitamins. And this can happen with other substances, but it's a unique additional problem with alcohol. Dementia is the process where the brain ages and our short-term memory starts to decline. Initially, we might see what's called mild cognitive impairment or some inability to remember certain things, and it progresses to dementia. And it can be really hard when we're trying to get someone into treatment and you need to take this medicine at this time and go to this appointment, and you need to go to therapy at this time. And what did your therapist talk about? When they have trouble remembering, it makes it much harder to follow through on the treatment recommendations. And then the last thing is falls. We see so many falls in the over 65 group. We lose muscle mass, our balance changes, we may get neuropathy in our feet. And falls are a big problem because when you are bedbound after a bad fracture of a leg, for example, you lose muscle mass so fast and it's hard to get it back. It's just hard to eat, it's hard to toilet if you've broken an arm. Pain control can be challenging. And so, as you can imagine, any substance that's going to impair someone's ability to function, like alcohol or cannabis or anything, is going to increase the risk of falls as well. Now, there are other more social issues that come up that are that develop newly after age 65. And an article that I was reading on this topic talked about early onset and late onset substance use in older people. And what they talk about is some people start using substances at an early age, say in their 20s, and they continue it through their life. That's what's called early onset. Late onset is where people start having a problem with a substance much later in life, let's say 65, 70, and beyond. And a lot of the late onset group comes from major life changes. So retirement, right? Getting up every day, having a purpose, staying busy, having to stay sober, we do see an increase in some people in the use of particularly alcohol after retirement when they're bored and don't know what else to do. Loss of a spouse. You can imagine how isolating losing a spouse that you've had for decades is. People might find that they're just home by themselves all the time with nothing to do. We also find that culturally human beings love alcohol, and that continues into senior and retirement communities. Some national data here in the US: two-thirds of Americans in senior and retirement communities drink, and up to 15% are heavy drinkers. And I will share personally, my grandparents spent the last years of their life at a senior community here in Monterey County. And yeah, there were drinking events almost every day, wine tastings, cocktail hour, champagne brunch. And my grandparents actually commented that their alcohol use went up when they went into the senior retirement community. Unfortunately, being over 65 poses some unique barriers to getting into addiction treatment. One of them might just be feeling out of place in a treatment program, particularly residential. Not all residential programs or even outpatient programs are designed to accommodate the needs of people as they age. There might not be as much equipment around to accommodate people with limited uh mobility. They might not have bars to get up off the toilets, for example. Limited mobility is a major challenge. Getting in and out of a car into a wheelchair to go to an appointment. Transportation in and of itself is also challenging. Limited finances and insurance, and you can see where this all mixes together. Let's imagine a person's over 65, they're wheelchair dependent after a stroke, they didn't have a lot of extra income, they're surviving on Social Security, they don't have a car, they don't have the money to pay for a taxi ride. They might be just really isolated in their home because they really can't get anywhere. It's hard, time-consuming, and expensive to get to appointments. So that this can be a challenge as well. Now, the last thing is our behavioral interventions to treat addiction. And those include things like therapy and mutual support groups. And those are largely unchanged. If you're under 65 or over 65, just a few comments that I would make. If someone's going to be seeing a therapist, they're going to need to have some experience in working with Americans over 65, or I should say, people over 65 in general, just because they have a unique lived experience and face some unusual and different challenges as they age. Again, things like the loss of a spouse, retirement, changes in mobility, et cetera. As I tell my patients, you know what? Picking a therapist is like going to a car dealership and buying a car. You and I might go together, you like the sedan, I like the truck. We're both right. You go to a therapist, that's a sedan. When you need a truck, just say thank you, and that you need to find a therapist that's right for you. And mutual support meetings are the same way, right? If you go to an AA meeting and you don't get a good vibe, it doesn't mean meetings are not for you. You've just got to find the right meeting where you feel at home. The other thing I mentioned that I skipped over, unfortunately, is sometimes people over 65 feel very out of place getting treatment for addiction because they think there's a bunch of young people. They've been homeless, they were using meth, they were using fentanyl. I worked my whole life. I have a 401k. I just have alcohol as a problem. And I've seen it both ways. I've had young people go to programs where they feel like it's too many folks that are over 50 drinking alcohol if that's that's their problem, and they feel out of place as a young person. And I've had my older patients say, I don't like that. It's all these young folks that I don't understand. So it's really just finding a place where people feel comfortable. Okay, let's go through a couple of cases that just illustrate some of the points that we made, and then we can stop and take questions. So these are two of my patients. I've changed their information, so you can't identify them. Okay. 75-year-old me was referred to me to quote, take over my Xanax and Ambien. He'd been with a primary care physician for many years, was on four milligrams of alprazelam, that's Xanax, and 12.5 milligrams of zulpadem, that's ambient. And this is somebody who really hadn't had any mental health services besides working with a therapist a little bit. This was a gentleman who had a stroke. He was in a wheelchair, he had atrial fibrillation and had required treatment with a blood thinner. He had problems with his prostate, which had led to urinary incontinence, so he had a catheter in place, and then high blood pressure, high cholesterol, depression, anxiety. I put his medications up on the screen. You can see this person's on seven different meds and actually no history of addiction. We'll talk about that in just a sec. This patient was referred to me because the primary care doctor was not comfortable managing these potentially addictive medications. Alprazolam is a benzodazepine, and ambien is a Z drug, which is like a cousin of a benzedazpine for sleep. And so I started digging into the history what's going on, what resources does this person have? This man lives alone. He cannot drive because of his stroke. He has no family nearby. He drank alcohol. Socially and smoke cigarettes regularly, didn't think either one was a problem. So, what did we do? Uh, the first thing is we said the Z drug, the ambience, is gonna put you at a high risk for a fall. So we changed the sleeping med from zolpidam or ambien to ramaron, also known as retazepine. We were a little nervous about sleeping meds in general, but this person was just adamant that he could not sleep. And then we started the process of weaning him down on his alpraisolam. So came to me on four milligrams of alpraisolam, and we've weaned him down to two and a half to three milligrams a day, and we're just going really slow because this guy's been on alpraisolam for longer than I've been alive. I we, as we spoke about, he's very isolated, really can't get mental health services via telemedicine. So I keep trying to find him someone in person that he can get to, or an inexpensive way to get him to the peninsula to get services. And I think I may have a lead, but I've been working on it for quite a while. So, what can we learn from this first case? Case in point, more medical conditions, more complicating factors, harder to get around with mobility. And then the catheter obviously provides an issue as well, and the transportation is limited. We didn't really talk about this, but Medicare sometimes is great insurance and sometimes it's not. And here in Monterey County, mental health services for Medicare is definitely under resourced. And then the other thing is, this man is really not addicted to his sleeping meds or his alpraza lam. His doctor just did not want to prescribe them after his primary retired and he got referred to a new primary doctor. Physicians are much more cautious now with controlled substances. And I call this individual a medication orphan because no one knows what to do with him. So, of course, they sent him to addiction medicine. And I'm like, it's not really an addiction. You're not craving, you're not compulsively using. And so the best thing we're trying to do is get in mental health services and try to wean him down off some of those meds to reduce his fall risk. Okay, case two. A 79-year-old female was referred to me, quote, because I drink too much. She was also beginning to have some issues with her memory, talked to her primary doctor, and she was motivated to quit alcohol. Her pattern of drinking involved cocktails every evening, usually about 5 p.m. or so. Medical history included anxiety, hypertension, diabetes, and acid reflux on four different medications, including insulin. Alcohol, if you didn't know, does really affect our body's use of energy and storing of energy. And it makes us more prone to both high and low blood sugars, depending on where we are in our cycle of alcohol consumption. And this person lives in a beautiful senior community here in Monterey County where there are a lot of social events. So this person wanted to quit alcohol. And so I said, why don't we try a naltrexone? We've talked about naltrexone. It reduces the pleasure in alcohol and makes cravings less intense. So I said, We tend to drink around maybe four or five. Why don't we take a naltrexone an hour before? And I said, I just want to make sure you're not going to have any withdrawal. Have you had any withdrawal in your life? And she said, Nope, no withdrawal. I think I'm going to be A-OK. And just my gut instinct was just, oh gosh, Casey, I just, you didn't really do a good enough job finding out if she's going to have withdrawal. And I just cold called her and I said, It's Dr. Grover, I'm just worried about you. Are you having any withdrawal? And she goes, Doc, I think I am. Second day off of alcohol, she got some withdrawal, she got some shakiness, she got some nausea. So we put her on a little bit of Valium, needed just a few doses. And then she was able to stop and get through it, and we kept her on naltrexone. She is still sober. I saw her a couple of weeks ago. She and her husband love to travel. And of course, every trip they go on, there's wine testing and bars at their senior community. There's loads of wine tasting and social cocktail events. But the naltrexone's really been working. Unfortunately, my patient developed some dizziness. She felt very unsteady on her feet. And so she saw neurology, she saw physical therapy. We went through this whole big workup. And ultimately, it was felt to be a side effect of naltrexone. And we weighed the risks and benefits and decided to discontinue the naltrexone because of the risk of falling. But we ultimately decided to switch it to only as needed naltrexone that if she decided she was having a craving, she could take it. So, case two, take home points. As I mentioned, be wary of withdrawal. As we age, we are more sensitive to it and less tolerant of it. Social circumstances, particularly in senior communities, can be very triggering. And then again, medications are great, but unfortunately, we do often get more side effects and we don't tolerate those side effects as well. Before we wrap up, a huge thank you to the Montage Health Foundation for backing my mission to create fun, engaging education on addiction. And a shout out to the nonprofit Central Coast Overdose Prevention for teaming up with me on this podcast. Our partnership helps me get the word out about how to treat addiction and prevent overdoses. To those healthcare providers out there treating patients with addiction, you're doing life-saving work, and thank you for what you do. For everyone else tuning in, thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together, we can make it happen. Thanks for listening. And remember, treating addiction saves lives.