Elderly male with late-onset heroin dependence

Substance use disorders usually have their onset during the adolescent period. However, in rare cases environmental and psychosocial factors can contribute toward a later onset. We describe a case of an elderly male who initiated his heroin use for the first time at 65 years of age and eventually developed dependence. This late-onset of heroin use was mediated by contextual factors such as loneliness, boredom, and easy access to heroin while craving and withdrawal symptoms served as maintaining factors. He responded well to a combination of opioid antagonist and nonpharmacological approaches focusing on activity scheduling and social support. As the demographic transition and societal changes take place, the elderly population with substance use problems will increase. There is an urgent need to upgrade substance abuse treatment services to meet the specific needs of the elderly using supportive and nonconfrontational approaches with special focus on improving social support access.