Illicit Substance Use Among Adults Over 50: A Qualitative Study of Lived Experiences in the UK

Illicit Substance Use Among Adults Over 50: A Qualitative Study of Lived Experiences in the UK | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Illicit Substance Use Among Adults Over 50: A Qualitative Study of Lived Experiences in the UK Christopher Wagstaff, Koushik Siddiraju, Roger Newham, Amelia Swift, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8425220/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Illicit substance use among adults over 50 is a growing yet under-researched phenomenon, often described as a “hidden epidemic.” This group faces unique biological, psychological, and social risks that remain poorly understood. Methods A qualitative study using reflexive thematic analysis of semi-structured interviews with twelve adults aged 50 + in the West Midlands, UK, who currently use illicit substances. Results Two overarching themes emerged: Idiosyncratic Outcomes (normalisation, ritualism, and perceived harmless moderation) and Social Dynamics (stigma, secrecy, strained relationships, and easy access). Participants framed substance use as a coping mechanism for pain, isolation, and aging-related distress, sustained by routine and beliefs in moderation. However, stigma and legal fears compelled concealment, deepening social isolation and reinforcing vulnerability. Conclusion Adults over 50 who use illicit substances navigate a delicate balance: a private world where use is normalised and functional, and a public world where stigma, legality, and ageism compel secrecy. Routine practices and beliefs in moderation make use feel orderly and controlled, yet age‑related vulnerabilities, strained relationships, and social disconnection render this order fragile. Effective support requires moving beyond the narrow label of “addiction” to address the physical, psychological, and social realities of aging. Introduction This study sought to develop a better understanding of the lived experience of people over 50 in the UK who use illicit substances. It is important to clarify what is meant by illicit substances: illicit substance use refers to the non-medical use of drugs prohibited by international drug control treaties, such as cannabis, cocaine, opiates, and amphetamines (Peacock et al., 2018; World Health Organization, 2018). Alcohol, nicotine, and caffeine are not classified as illicit substances as they are legal. The DSM-TR replaced the term “substance abuse” with neutral, descriptive language (e.g., craving, problematic use) to reduce stigma and improve diagnostic clarity (National Institute on Drug Abuse, 2021; American Psychiatric Association, 2022; First et al., 2023). Illicit substance use among adults over 50 is a growing public health concern, described as a “hidden epidemic,” with lifetime use increasing tenfold and treatment-seeking rising since the early 2000s; recent studies confirm continued growth, especially for alcohol and cannabis (Gurnack & Johnson, 2002; Arndt et al., 2011; International Narcotics Control Board, 2020; Hu et al., 2024). This demographic, often overlooked in substance use research, faces unique vulnerabilities that require attention. A complicating factor for people over 50 can be the loss of social support, financial strain, co-occurring medical conditions, and social isolation. Consequences of illicit substance use can be substantial psychological distress and a reduction in overall well-being (Han et al., 2022). In quinquagenarian and sexagenarian illicit drug using populations, psychological distress often manifests through risky behaviours, including aggression toward non-users, driving under the influence, drug dealing, theft, and suicide attempts (Salas-Wright et al., 2017). Moreover, marijuana usage among people over 50 is frequently correlated with life stressors, including family and personal relationship issues, legal troubles, financial problems, homelessness, and victimization (You et al., 2025). This correlation is sometimes associated with a higher incidence of suicide attempts compared to non-users (Shiraly et al., 2024). Recent studies show that marijuana use among older adults has increased significantly, with many continuing or even increasing their consumption rather than reducing it. For example, cannabis use among adults aged 65 and older rose by 46% between 2021 and 2023, and patterns suggest sustained or escalating use rather than reduction (Han et al., 2025). Thus, the phenomenon of people over 50 using illicit substances is increasing and warrants further attention and investigation. Aging introduces biological, psychological and social risk factors that amplify both the likelihood of illicit substance use and its adverse outcomes. Chronic medical conditions, such as cardiovascular disease, diabetes, and osteoarthritis, become more prevalent with age, some often requiring long-term pain management (Jaul and Barron, 2017). However, when older adults experience inadequate pain relief or face barriers to accessing healthcare, they may turn to self-medication, including illicit substances, as a coping mechanism (Voon et al., 2014). Recent reviews confirm that age-related physiological changes, such as reduced hepatic metabolism and declining renal clearance, significantly alter drug pharmacokinetics, prolonging the half-life of substances like opioids and cannabis and increasing overdose risk even at lower doses (Ruiz & DiCristina, 2025). These biological shifts are potentially compounded by polypharmacy, as over 40% of people over 50 use prescription medications that dangerously interact with illicit substances (Qato et al., 2016). Social determinants further exacerbate the risks for people over 50 who use illicit substances. Loss of relationships, retirement, and isolation—common in people over 50 (National Academies of Sciences, 2020) can drive substance use as a coping mechanism for loneliness or grief. Mental health disorders, such as late-onset depression and anxiety, are both triggers and have consequences for people over 50 (Loscalzo et al., 2017). Cognitive decline, including early-stage dementia, may impair judgment, reducing awareness of substance-related harms (Cho et al., 2018). Despite these risks, clinicians often misattribute symptoms of substance use disorders to “normal aging” (Han, Gfrorer, Collver, 2009). Cannabis legalization has significantly influenced public perception, economic behaviour, and policy frameworks, with evidence showing disproportionate social and economic impacts on vulnerable populations, including older adults and those with lower incomes (Salehin & Pillai, 2025). Legalization has shifted public perceptions, reducing the stigma around medical cannabis but not recreational use (Baumbusch, 2022). However, policy disparities create confusion: illicit cannabis remains cheaper than legal alternatives, disproportionately affecting economically disadvantaged people over 50 (Fataar et al., 2021; Shi, 2024). This economic incentive, coupled with aging-related financial strain (e.g., fixed incomes), may push people over 50 toward illicit substance use. Previous studies focused on trends of illicit substance usage amongst ex-users and only a few studies explored the experiences among current people over 50 who use illicit substances. For example, Anderson and Levy (2003) describe the social dynamic of how illicit substance users become marginalised and eventually face victimization and isolation. While previous research has mapped broad social dynamics, these studies have not addressed the current social dynamics or the idiosyncratic outcomes, such as normalisation and ritualism. Understanding these contemporary, lived experiences is essential for updating the healthcare community and developing nuanced interventions that meet the unique needs of this population. This study, therefore, provides a focused exploration of the experiences people over 50 who use illicit substances in the West Midlands, UK. Aims & Objectives The aim of this study is to develop an in-depth understanding of the experiences of people aged over 50 who use illicit substances. The objectives of the study were: To explore the reasons for illicit substance use. To examine the physical and psychological health consequences associated with illicit substance use. To identify factors that enable ongoing use of illicit substances. To understand the worries and concerns participants have regarding their illicit substance use. Method This qualitative study used semi-structured interviews to explore participants’ experiences of illicit substance use, enabling rich, context-specific insights that quantitative methods cannot provide—particularly for deeply personal and culturally embedded behaviours such as illicit substance use among adults over 50 (Whittemore & Grey, 2002). Qualitative description, as Sandelowski (2000) explains, is a pragmatic approach that stays close to the data and privileges participants’ own words. Its strength lies in flexibility and grounding in lived experience, producing findings directly relevant to practice and policy. However, its limited theoretical depth can invite perceptions of superficiality, a risk mitigated through analytical rigor to ensure that description becomes organized, insightful interpretation rather than a mere catalogue of quotes. Setting This qualitative study was conducted within the West Midlands (UK), an area characterized by its diverse communities and varying socio-economic backgrounds. Interviews were conducted in mutually agreed private settings, such as the participants own homes, private rooms in group homes, their places of work or quiet areas of pubs. Recruitment Participants who were 50 years old or older and currently using illicit substances were recruited via snowball recruitment strategies. Snowball sampling is widely recognized as an effective recruitment strategy in qualitative research because it provides access to hard-to-reach or marginalized populations, fosters participant trust through social referrals, and is cost-effective. It also enables researchers to gather rich, contextualized data by leveraging existing social networks (Ungvarsky, 2025). If participants had required support for their illicit substance use or were thinking about stopping, signposting to support would have been offered, although none was requested. Participants’ illicit substance use was considered current if it occurred within the past three months, based on self-report (Delphin-Rittmon, 2022). Participants were compensated for their participation; each participant received a £20 voucher. People who solely used nicotine, caffeine, alcohol, vaping, or prescription medication were not included in this study. Ethical approval was from the University of Birmingham (ERN_18-0198A), and the study was carried out in accordance with the Declaration of Helsinki. Full consent was received from each participant before the interview began, with participants choosing a pseudonym to obscure their identity and foster more open and honest conversations. All the participants were considered competent and sober at the time of giving consent, as determined by the lead researcher. All participants had access to a Participant Information Sheet before the research interview, had opportunities to ask questions, and signed a consent form. There were at least seven days between providing information to participants about the research and obtaining their consent, allowing them time to consider their involvement. Additionally, participants were competent English speakers to minimize misunderstandings or misinterpretation of the questions. Rigour and Trustworthiness Rigor and trustworthiness were ensured by addressing credibility, dependability, and transferability, consistent with established principles of qualitative inquiry (Creswell & Poth, 2016). Credibility was strengthened through deep engagement with the data, including repeated, active reading of transcripts to ensure themes accurately reflected participant accounts, capturing both common patterns and unique perspectives presented in the Results section. Dependability was maintained through a transparent, systematic analytic process detailed in the Data Analysis section. Transferability was supported by rich description, including demographic details and direct quotations, enabling readers to assess the applicability of findings to other contexts. Data analysis The interview data were analysed using Reflexive Thematic Analysis, following Braun and Clarke’s six-phase process (2019). This approach was selected for its flexibility, making it well-suited to an inductive exploration of the diverse experiences of the participants. Analysis began with listening to audio recordings and verifying transcripts, followed by repeated, active reading to achieve familiarisation. Initial coding involved systematically assigning codes to meaningful data segments, organised within a codebook to ensure consistency and rigour (Saldaña, 2021). These codes were then collated into preliminary themes, which underwent iterative review and refinement to ensure coherence and distinctiveness. This process culminated in two final themes: Idiosyncratic Outcomes and The Social Dynamics . The systematic approach ensured that themes were firmly grounded in participants’ own words and experiences. Results The participants There were twelve participants, all aged over fifty, who actively used illicit substances. Among them, four were daily users while some were occasional users. The demographics are summarised in Table 1 . Insert Table 1 Themes The analysis of the twelve research interviews generated two major themes. (see Table 2). Theme 1, Idiosyncratic Outcomes, explored the idiosyncratic outcomes of the participants, such as normalisation, ritualism, and physical & psychological adversities. Theme 2, Social Dynamics explored the how participants navigated their usage in society by examining their interpersonal relationships, the prevalence of stigma, social isolation, and easy access to illicit substances. Insert Table 2 Theme1: Idiosyncratic outcomes 1.1 Normalisation Many participants viewed substance use as a regular part of their lives. Kwerky, Freda, John, Clara, and Neil integrated substance use into their lifestyles without dwelling too much on its potential consequences. Brian described a stable pattern, “one or two joints after every day’s work”, framed as relaxing, functional, and an alcohol substitute that “ hasn’t got in the way ” of life, signalling a normalised routine and perceived control over use. Kwerky reported that “most of my friends still dabble in Ecstasy” and many “smoke marijuana on a regular basis,” and she relies on “ people I know ” to source drugs, rendering use ordinary within trusted social circles. Participants explicitly imagine continued, moderate use into later life (“I can always envisage me as an old man on holiday having a spliff”; “we’ve joked about it in our 60s and 70s ”), further cementing use as an enduring, ordinary facet of identity. 1.2 Ritualism Ritualistic substance use was one of the common practices among the participants. Typical ritual use constitutes doing things in a certain pattern so that the familiarity helps create an air of relaxation. Brian, Clara, Freda, Neil, Kwerky, and Rudy all preferred to use their chosen substances in a ritualistic way, for various idiosyncratic reasons. With ritualism, Brian, and Freda claim to gain comfort and increased productivity. But, for Kwerky, the rituals have been pleasurable. “I like the whole procedure of cutting it, getting the crystals down, and divvying it all up.” (Kwerky,54) However, while Rudy felt that illicit substance use compliment drinking alcohol, However, when in public Clara and Neil were less ritualistic users because they preferred to use illicit substances quickly. 1.3 Physical adversity All participants expressed concerns about the physical health risks associated with illicit substance use, though these varied in focus. For example, Clara worried about the impact on her cardiac health, while Kwerky emphasized the importance of safe and informed use. Rudy’s concern centred on the poor quality of available substances. Other reported issues included nighttime panic attacks, sweating, loss of appetite, and weight loss (Baldrick), as well as insomnia (Chris). Unlike Baldrick, Freda did not experience panic when unable to use substances. “ It's not something I panic about if I can’t get hold of any " (Freda, 58) An increase in tolerance was a concern for Sam, Brian, and Chris, while others, such as Rudy and Fred, also reported experiencing drug tolerance without being concerned about it. Most of the participants avoided heroin due to its well-known health risks. James frequently felt exhausted after using illicit substances, whereas some participants believed moderation mitigated harm. For instance, Kwerky claimed to feel “fine” the next day after use. Furthermore, Brian, John, and Clara reported no physical health concerns. Overall, participants perceived moderate illicit substance use as acceptable, viewing it as physically harmless. 1.4 Psychological adversity Most of the participants claimed benefits from using illicit substances, but some acknowledged its psychological risks. Although Baldrick, Chris, and Fred acknowledged their dependency, none of the participants expressed a desire of ability to stop using altogether: “I’m trapped.” (Chris, 55) Baldrick cited a lack of willpower or self-confidence as the reason for recovery failures. Other psychological risks included depression (Sam), anxiety (Freda), and hallucinations during a failed recovery (Brian). Brian also expressed apprehension about psychological issues in social contexts. “I've witnessed cocaine devastate fragile minds and heroin claim the lives of three close friends, so I fully understand the potential dangers." (Brian, 52) Likewise, Clara claimed psychological independence from illicit substance use by abstaining from hallucinogens and opiates, stating, “I can go weeks or months without drugs, so I don't experience psychological dependence." (Clara, 50) Conversely, some reported that illicit substance use yielded enhanced concentration (Freda), confidence, and mood for social interaction (Rudy). Nevertheless, for Brian, Sam, Fred, and Clara the psychological adversities of illicit substance use outweighed its perceived benefits. Theme 2: The Social Dynamics 2.1 Interpersonal relationships Participants’ interpersonal relationships ranged from supportive to strained. For example, Fred viewed illicit substance use as a means of socialization, while Freda and James reported successfully balancing substance use with family commitments through open communication and joint problem-solving. James and Kwerky described receiving encouragement to stop using and openly discussing their experiences with family members. Although Chris was partially estranged from her daughter, some connection remained. Neil, a 53-year-old single male, expressed concern about differing views on substance use in past relationships, though he did not indicate whether a partner’s acceptance would influence his satisfaction. In contrast, Brian, Chris, Clara, Fred, John, and Sam experienced family strain and rejection—manifesting as distancing, emotional unavailability, and infrequent communication—due to relatives’ opposition to substance use, resulting in limited family support. “ I have had a few relationships where they have not been interested in that at all and it has caused a problem.” (Neil, 53) “And there’s the generational thing as well, my mum and dad have been so anti- drugs, always have been, always will be and their lack of experience, lack of awareness, everything else.” (Clara, 50) Chris, James, John, and Sam felt socially isolated and disconnected from society, accepting that illicit substance use was as a coping mechanism for loneliness. Particularly, Sam favoured living alone with his substance use, expressing a desire to disengage from the world. In summary, the participants’ interpersonal relationships showed a blend of acceptance, unacceptance, support, isolation, and a dynamic between social connectivity and dysconnectivity. 2.2 Stigma Freda observed that drug-specific stigma, such as that associated with skunk, often reflects broader substance-related stigma. She emphasized that stigma varies by drug type, contrasting with others who perceive it as uniform across substances. Individual experiences highlighted these differences: mamba was considered more stigmatized than heroin (Chris), heroin more than cocaine and ecstasy (Clara), and cannabis as the least stigmatized (Brian). Clara also expressed concern about using certain substances due to stigma, suggesting that stigma operates not only between users and non-users but also among users of different substances. Additionally, John and James reported being labelled with derogatory terms such as “crackhead.” “ From a societal point of view, they are lumped together,” “therefore the whole of it is bad.” (Freda, 58). This stigma compelled participants to live under strict confidentiality. Secrecy was not a choice but a survival strategy to avoid judgment and safeguard professional standing. Rudy, who regularly liaised with police, feared the real-world consequences of exposure, describing her main concern as, “ The legality.” “If I smoked cannabis regularly, I would even keep that private.” “I have to liaise with Police,” “I’d lose my registration.” (Rudy, 53) To cope with this constant legal precarity, some participants developed a specific belief about how law enforcement viewed them as older users. Brian articulated a perception of an "unwritten decriminalization," where police were less concerned with older users who kept to themselves: “ It’s the unwritten law of decriminalization.” (Brian, 52) This belief functioned to manage the fear that stems from societal stigma and the illicit nature of their actions, reinforcing the need to remain hidden from the mainstream. 2.3 Easy access For all participants, friends and family were key sources of illicit substances. Rudy’s case illustrates this, she continues using substances despite knowing her husband is her primary supplier. Her situation underscores the difficulty of breaking the cycle of illicit substance use, even if there was the desire to do so, when access is so easy. “It’s about just having that availability,” he’s the one who will be the driver in terms of having the contacts and organizing it.” (Rudy) In summary, participants exhibited normalisation and ritualism, and easy access to substances helped perpetuate their use. Physical hardships intensified their struggles, while psychological challenges sometimes overshadowed perceived benefits. Family and societal pressures contributed to social isolation, with stigma amplifying this isolation for some. In conjunction with the with the idea that the psychological benefits outweighed the physical hardships, another specific age-based perception coping mechanism was that some of the participants believed that because their illicit substance use was discreet and non-problematic, then they were unlikely to attract attention from the police. Brian noted people openly smoking cannabis on the high street and in pub back yards and describes an “unwritten decriminalisation” for personal amounts—an observation of social and policing norms that frame public use as largely tolerated. However, the fear of legal scrutiny, particularly for those with professional registrations who worried "I’d lose my registration," remains a powerful force that limits their world, confining their use to the home and trusted social circles, and further cementing their isolation from mainstream society. Rudy kept her use private at work due to professional risks and distinguishes between feeling age‑appropriate in pubs versus clubs, “ it just doesn’t fit into society’s norms ”, suggesting normalisation is situational and contingent on audience and place. The Inevitable Consequence: Synthesising the Path to Loss and Fear Normalisation and stigma management involve navigating tangible losses—physical decline, psychological distress, and fears of mortality, incarceration, and illness. Participants experience two major losses: deteriorating physical health and eroding psychological wellbeing. The belief in “harmless moderation,” central to the normalisation narrative, ultimately clashes with the aging body’s physiological reality. Despite efforts to downplay risks, research confirm physical adversities, including organ damage, chronic illness, and increased dependency (Hamilton & Grella, 2009; Roe et al., 2010). Compounding this is profound psychological turmoil, a loss of self-worth and social connection. Literature captures this through expressions of regret, such as: “I’m hurt by a lot of things my addiction took me through that I put on my children by not being the mother I should have been” (Hamilton & Grella, 2009). Internalized shame from fractured family ties deepens isolation, a finding echoed in this study. “I’m trapped,” one participant admits. These accumulated losses fuel pervasive fear, both practical and existential. Legal anxieties, fear of humiliation, and loss of professional standing create chronic stress and concealment. One participant summarizes the stark reality: “ Either I am going to die or I am going to end up in prison or the hospital ” (Hamilton & Grella, 2009, p.119). This encapsulates the three dominant fears among older illicit substance users: death, loss of freedom, and catastrophic health failure. This aligns with the findings of Roe et al (2010), where fear of dying was a prominent experience. Ultimately, this synthesis shows that "Loss and Fear" is not an isolated theme but the culminating point of a journey for people over 50 who use illicit substances. The need to normalise use (Theme 1 of this discussion) and navigate social stigma (Theme 2) creates a life of high-stakes conflict. The fallout from this conflict declining health, broken relationships, constant anxiety constitutes the losses and fears that define the experience. DISCUSSION This study illuminates a persistent tension between the private normalization of illicit substance use among adults over 50 and the external pressures of stigma and legality. Participants framed use as a functional coping strategy for chronic pain, psychological distress, and social isolation, embedding it into everyday routines through normalisation and ritualism. These practices align with work on “integrated and routine use” and “maturing in,” where stability rather than abstinence becomes the goal (Measham, Newcombe and Parker, 1994; Boeri, 2004 ; Cepeda et al., 2016 ). The self‑medication hypothesis offers an explanatory lens: substance use functions to manage psychological and existential pain associated with aging (Khantzian, 1987 ) which does partially complement the experiences of the participants in this study. However, for these participants their illicit substance use was also a continuation of their earlier use that they have enjoyed and never wanted to stop. A core cognitive mechanism underpinning the participants’ routines, and the psychological comfort that they provide, is a belief in benign moderation; participants commonly judged their consumption as controlled and therefore harmless. A study by Quilty-Dunn J. ( 2020 ) showed that individuals define "moderation" when it comes to consumption. people tend to adopt self-serving definitions, interpreting “moderate” as whatever amount they’re already consuming, or just a bit more. This effectively provides psychological comfort: “I’m fine—I’m moderate.” Which mirrors the participants belief in their own benign moderation: participants view their routines as harmless because they see them as controlled. This rationalization comfortably reduces the dissonance between their behavioural self and their aspirational or health-conscious identity. However, these views collide with biomedical reality: age‑related pharmacokinetic and pharmacodynamic changes heighten risk, even at lower doses, and/especially in combination with common prescriptions (Qato et al., 2016 ; Robinson, 2021 ). Thus, the routine’s perceived safety is contingent and fragile. Social context both sustains and constrains use. Easy and reliable access, often through close ties, help maintain routine patterns, yet family relations simultaneously act as sources of strain and support. Some relatives were explicitly anti‑drug, contributing to distancing and isolation; others tacitly enabled use by facilitating supply. This dual role complicates help‑seeking and reinforces concealment (Boeri, 2004 ; Hamilton & Grella, 2009 ; Lin et al., 2023). These dynamics are exacerbated by misconceptions that frame substance use in later life as either a moral failing or a “last pleasure,” obscuring health needs and delaying support (Briggs et al., 2011 ; Rao et al., 2015 ). Stigma emerged as a central external force, operating not only between users and non‑users but also across substances. Participants perceived a hierarchy in which some drugs (e.g., cannabis) were less discrediting than others (e.g., crack, heroin), prompting strategic concealment to protect social standing and professional registration (Goffman, 1963 ; Bottorff et al., 2013 ; Kerridge et al., 2017 ). Ageism intensifies this pressure, compounding shame and barriers to care (Rao et al., 2015 ; Chrisler et al., 2016 ). In response, some participants cultivated a belief in “unwritten decriminalisation” for discreet older users—a coping perception rather than a legal reality that helped manage fear while reinforcing secrecy (Greer et al., 2022 ). The belief that because of their age and their discreet and non-problematic use, that law enforcement would not be issue for them has been seen before. The participants in Greer et al ( 2022 ) pointed out that the police would favour pursuing younger, more visible users. While a general distrust of police is not unique to this demographic (Greer et al., 2022 ), this specific age-based perception appears to be a distinct coping mechanism for people over 50 who use illicit substances. However, this perceived safety is fragile and reinforces the need to remain hidden. This finding gives a contemporary, UK-specific texture to the general fears of incarceration noted Hamilton and Grella ( 2009 ). Synthesising these strands, the lived experience is shaped by an ecosystem of routine (normalisation, ritual), cognition (belief in moderation), access (family and peers), and social control (stigma, legality). The cumulative effects include physical decline, psychological distress, and erosion of social connectedness—losses that amplify fear of death, incarceration, and catastrophic health events (Hamilton & Grella, 2009 ; Roe et al., 2010 ). These findings extend prior literature by showing how age‑specific routines and substance‑specific stigma converge to produce a high‑stakes private world that appears orderly to the user but is precarious under external scrutiny. Implications for practice. Clinicians should shift from problem‑centred to function‑centred inquiry (e.g., pain, sleep, loneliness), using non‑judgmental language to invite disclosure. Harm‑reduction approaches—education about age‑related risks, safer‑use planning, and support for reducing harms rather than insisting on abstinence—are more likely to engage this group (Marlatt et al., 2011 ; Robinson, 2021 ). Psychological interventions (CBT, motivational interviewing) can be tailored to triggers identified here: isolation, chronic pain, and entrenched habits (Kiluk & Carroll, 2013 ). Implications for policy. National strategies (e.g., the UK’s National Combating Drugs Outcomes Framework) should embed discreet, age‑responsive screening and support within trusted settings such as primary care and gerontology services, recognising that many older users do not present to traditional addiction pathways due to stigma and legal fears (HM Government, 2023 ). Clear communication that privileges public‑health responses over punitive ones may reduce concealment and increase engagement. Implications for research. Future work should examine family’s dual role (strain/enabling) and the substance‑specific stigma hierarchy and use larger epidemiological designs to estimate the prevalence of routine patterns and legal fears among older UK users (Cepeda et al., 2016 ). Limitations. Findings reflect a small, snowball‑sampled cohort and self‑report data, potentially over‑representing interconnected networks and under‑representing highly isolated individuals; a single‑analyst approach may also shape interpretation (Podsakoff et al., 2003; Patton, 2014 ; Creswell & Poth, 2016 ). These constraints define scope rather than undermine credibility, supported by reflexive thematic analysis and rich description (Braun & Clarke, 2019 ). CONCLUSION Adults over 50 who use illicit substances navigate a delicate balance: a private world where use is normalised and functional, and a public world where stigma, legality, and ageism compel secrecy. 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Qualitative research & evaluation methods: integrating theory and practice, Thousand Oaks, CA, Sage Publications. PEACOCK, A., LEUNG, J., LARNEY, S., COLLEDGE, S., HICKMAN, M., REHM, J., GIOVINO, G. A., WEST, R., HALL, W. & GRIFFITHS, P. 2018. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction, 113, 1905-1926. PODSAKOFF, P. M., MACKENZIE, S. B., LEE, J.-Y. & PODSAKOFF, N. P. 2003. Common method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of Applied Psychology, 88, 879. QATO, D. M., WILDER, J., SCHUMM, L. P., GILLET, V. & ALEXANDER, G. C. 2016. Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011. JAMA Internal Medicine, 176, 473-482. Quilty-Dunn J. (2020) Rationalization is irrational and self-serving, but useful. Behavioral and Brain Sciences . 43:e42. doi:10.1017/S0140525X19002218 RAO, T., CROME, I., CROME, P., RAMAKRISHNAN, A., ILIFFE, S., WARD, M. & EVANS, V. 2015. Substance misuse in older people: an information guide . Cross Faculty Report FR/OA/A)/01. London: The Royal College of Psychiatrists. London. ROBINSON, P. 2021. Pharmacology, polypharmacy and the older adult: a review. British Journal of Community Nursing, 26, 290-295. ROE, B., BEYNON, C., PICKERING, L. & DUFFY, P. 2010. Experiences of drug use and ageing: health, quality of life, relationship and service implications. Journal of Advanced Nursing, 66, 1968-1979. Ruiz, A. & DiCristina, S. (2025) Absorption to Excretion: The Aging Body’s Take on Drugs – A Review of Pharmacokinetic Changes and their Impact on Medication Management. Curr. Pharmacol. Rep. 11, 42, https://doi.org/10.1007/s40495-025-00425-y SALAS-WRIGHT, C. P., VAUGHN, M. G., CUMMINGS-VAUGHN, L. A., HOLZER, K. J., NELSON, E. J., ABINADER, M. & OH, S. 2017. Trends and correlates of marijuana use among late middle-aged and older adults in the United States, 2002–2014 . Drug and Alcohol Dependence, 171, 97-106. SALDAÑA, J. 2021. The coding manual for qualitative researchers, Thousand Oaks, CA, Sage Publications. SANDELOWSKI, M. 2000. Whatever happened to qualitative description? Research in Nursing & Health, 23, 334-340. Salehin, M., & Pillai, V. K. (2025). Influence of Socio-Ecological and Economic Correlates on Marijuana Legalization Policy Across the States of America. International Journal of Environmental Research and Public Health , 22 (6), 823. https://doi.org/10.3390/ijerph22060823 SHI, J. X. Y. 2024. Cannabis consumers’ preferences for legal and illegal cannabis: evidence from a discrete choice experiment . BMC Public Health, 24, 44. Shiraly, R., Jazayeri, S.A., Seifaei, A. Griffiths, M.D. (2024) Suicidal thoughts and behaviors among untreated illicit substance users: a population-based study. Harm Reduct J 21, 96, https://doi.org/10.1186/s12954-024-01015-9 Ungvarsky, J. (2025) Snowball sampling, Snowball sampling | Research Starters | EBSCO Research {Accessed 28/11/25} VOON, P., CALLON, C., NGUYEN, P., DOBRER, S., MONTANER, J., WOOD, E. & KERR, T. 2014. Self-management of pain among people who inject drugs in Vancouver. Pain Management, 4, 27-35. WHITTEMORE, R. & GREY, M. 2002. The systematic development of nursing interventions. Journal of Nursing Scholarship, 34, 115-120. World Health Organization (2018) https://www.who.int/health-topics/drugs-psychoactive#tab=tab_1,[Accessed 15/12/2025] You, E., Sarkar, S., Pietrzak, R.H. et al. (2025) How Cannabis Use is Associated with the Physical and Mental Health of Older Adults: A US Population-Based Study. Int J Ment Health Addiction, https://doi.org/10.1007/s11469-025-01475-5 Tables Table 1 Demographics of included participants. Participant Gender Age Location Preferred substance Characteristics of substance usage Rudy Female 53 Home Cannabis/ Polydrug user Occasional user Brian Male 52 Home Cannabis Daily user Chris Male 55 Group home Mamba Daily user Clara Female 50 Home Ecstasy Occasional user Fred Male 59 Group home Cannabis/ Polydrug user Daily user Freda Female 58 Work Cannabis Occasional user James Male 59 Group home Crack cocaine Most days John Male 55 Group home Crack cocaine. Occasional user Neil Male 53 Pub Cannabis, Ecstasy Weekly user Sam Male 68 Pub Ecstasy Cannabis Daily user Baldrick Male 58 Group home Mamba Daily user Kwerky Female 54 Home Ecstasy Occasional user Table 2 Themes and Coding Process Quotes Codes Sub-themes Theme “For me, it’s normal behaviour.” Normal Normalisation Idiosyncratic outcomes “I like the whole procedure of cutting it” Ritual Ritualism “I don’t do enough for it to sort of have any health implications” Physical Physical adversity “I’ve seen cocaine destroy some fragile minds” Psychological Psychological adversity “It depends on what type of people you are around, as well.” Relationship Interpersonal relationships Social Dynamics "Crackhead." Stigma Stigma Additional Declarations No competing interests reported. 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It is important to clarify what is meant by illicit substances: illicit substance use refers to the non-medical use of drugs prohibited by international drug control treaties, such as cannabis, cocaine, opiates, and amphetamines (Peacock et al., 2018; World Health Organization, 2018). \u0026nbsp;Alcohol, nicotine, and caffeine are not classified as illicit substances as they are legal. \u0026nbsp;The DSM-TR replaced the term \u0026ldquo;substance abuse\u0026rdquo; with neutral, descriptive language (e.g., craving, problematic use) to reduce stigma and improve diagnostic clarity (National Institute on Drug Abuse, 2021; American Psychiatric Association, 2022; First et al., 2023).\u003c/p\u003e\n\u003cp\u003eIllicit substance use among adults over 50 is a growing public health concern, described as a \u0026ldquo;hidden epidemic,\u0026rdquo; with lifetime use increasing tenfold and treatment-seeking rising since the early 2000s; recent studies confirm continued growth, especially for alcohol and cannabis (Gurnack \u0026amp; Johnson, 2002; Arndt et al., 2011; International Narcotics Control Board, 2020; Hu et al., 2024). \u0026nbsp;This demographic, often overlooked in substance use research, faces unique vulnerabilities that require attention.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A complicating factor for people over 50 can be the loss of social support, financial strain, co-occurring medical conditions, and social isolation. Consequences of illicit substance use can be substantial psychological distress and a reduction in overall well-being (Han et al., 2022). In quinquagenarian and sexagenarian illicit drug using populations, psychological distress often manifests through risky behaviours, including aggression toward non-users, driving under the influence, drug dealing, theft, and suicide attempts (Salas-Wright et al., 2017). Moreover, marijuana usage among people over 50 is frequently correlated with life stressors, including family and personal relationship issues, legal troubles, financial problems, homelessness, and victimization (You et al., 2025). This correlation is sometimes associated with a higher incidence of suicide attempts compared to non-users (Shiraly et al., 2024). \u0026nbsp; Recent studies show that marijuana use among older adults has increased significantly, with many continuing or even increasing their consumption rather than reducing it. For example, cannabis use among adults aged 65 and older rose by 46% between 2021 and 2023, and patterns suggest sustained or escalating use rather than reduction (Han et al., 2025). Thus, the phenomenon of people over 50 using illicit substances is increasing and warrants further attention and investigation.\u003c/p\u003e\n\u003cp\u003eAging introduces biological, psychological and social risk factors that amplify both the likelihood of illicit substance use and its adverse outcomes. Chronic medical conditions, such as cardiovascular disease, diabetes, and osteoarthritis, become more prevalent with age, some often requiring long-term pain management (Jaul and Barron, 2017). However, when older adults experience inadequate pain relief or face barriers to accessing healthcare, they may turn to self-medication, including illicit substances, as a coping mechanism (Voon et al., 2014).\u003c/p\u003e\n\u003cp\u003eRecent reviews confirm that age-related physiological changes, such as reduced hepatic metabolism and declining renal clearance, significantly alter drug pharmacokinetics, prolonging the half-life of substances like opioids and cannabis and increasing overdose risk even at lower doses (Ruiz \u0026amp; DiCristina, 2025). These biological shifts are potentially compounded by polypharmacy, as over 40% of people over 50 use prescription medications that dangerously interact with illicit substances (Qato et al., 2016). Social determinants further exacerbate the risks for people over 50 who use illicit substances. Loss of relationships, retirement, and isolation\u0026mdash;common in people over 50 (National Academies of Sciences, 2020) can drive substance use as a coping mechanism for loneliness or grief. Mental health disorders, such as late-onset depression and anxiety, are both triggers and have consequences for people over 50 (Loscalzo et al., 2017). Cognitive decline, including early-stage dementia, may impair judgment, reducing awareness of substance-related harms (Cho et al., 2018). Despite these risks, clinicians often misattribute symptoms of substance use disorders to \u0026ldquo;normal aging\u0026rdquo; (Han,\u0026nbsp;Gfrorer, Collver, 2009).\u003c/p\u003e\n\u003cp\u003eCannabis legalization has significantly influenced public perception, economic behaviour, and policy frameworks, with evidence showing disproportionate social and economic impacts on vulnerable populations, including older adults and those with lower incomes (Salehin \u0026amp; Pillai, 2025). \u0026nbsp;Legalization has shifted public perceptions, reducing the stigma around medical cannabis but not recreational use (Baumbusch, 2022). However, policy disparities create confusion: illicit cannabis remains cheaper than legal alternatives, disproportionately affecting economically disadvantaged people over 50 (Fataar et al., 2021; Shi, 2024). This economic incentive, coupled with aging-related financial strain (e.g., fixed incomes), may push people over 50 toward illicit substance use.\u003c/p\u003e\n\u003cp\u003ePrevious studies focused on trends of illicit substance usage amongst ex-users and only a few studies explored the experiences among current people over 50 who use illicit substances. \u0026nbsp;For example, Anderson and Levy (2003) describe the social dynamic of how illicit substance users become marginalised and eventually face victimization and isolation. While previous research has mapped broad social dynamics, these studies have not addressed the current social dynamics or the idiosyncratic outcomes, such as normalisation and ritualism. \u0026nbsp; Understanding these contemporary, lived experiences is essential for updating the healthcare community and developing nuanced interventions that meet the unique needs of this population. \u0026nbsp; This study, therefore, provides a focused exploration of the experiences people over 50 who use illicit substances in the West Midlands, UK.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims \u0026amp; Objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of this study is to develop an in-depth understanding of the experiences of people aged over 50 who use illicit substances.\u003c/p\u003e\n\u003cp\u003eThe objectives of the study were:\u003c/p\u003e\n\u003cp\u003eTo explore the reasons for illicit substance use.\u003c/p\u003e\n\u003cp\u003eTo examine the physical and psychological health consequences associated with illicit substance use.\u003c/p\u003e\n\u003cp\u003eTo identify factors that enable ongoing use of illicit substances.\u003c/p\u003e\n\u003cp\u003eTo understand the worries and concerns participants have regarding their illicit substance use.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThis qualitative study used semi-structured interviews to explore participants\u0026rsquo; experiences of illicit substance use, enabling rich, context-specific insights that quantitative methods cannot provide\u0026mdash;particularly for deeply personal and culturally embedded behaviours such as illicit substance use among adults over 50 (Whittemore \u0026amp; Grey, 2002). Qualitative description, as Sandelowski (2000) explains, is a pragmatic approach that stays close to the data and privileges participants\u0026rsquo; own words. Its strength lies in flexibility and grounding in lived experience, producing findings directly relevant to practice and policy. However, its limited theoretical depth can invite perceptions of superficiality, a risk mitigated through analytical rigor to ensure that description becomes organized, insightful interpretation rather than a mere catalogue of quotes.\u003c/p\u003e\n\u003cp id=\"_Toc208174288\"\u003eSetting\u003c/p\u003e\n\u003cp\u003eThis qualitative study was conducted within the West Midlands (UK), an area characterized by its diverse communities and varying socio-economic backgrounds.\u0026nbsp;Interviews were conducted in mutually agreed private settings, such as the participants own homes, private rooms in group homes, their places of work or quiet areas of pubs.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc208174289\"\u003eRecruitment\u003c/p\u003e\n\u003cp\u003eParticipants who were 50 years old or older and currently using illicit substances were recruited via snowball recruitment strategies. Snowball sampling is widely recognized as an effective recruitment strategy in qualitative research because it provides access to hard-to-reach or marginalized populations, fosters participant trust through social referrals, and is cost-effective. It also enables researchers to gather rich, contextualized data by leveraging existing social networks (Ungvarsky, 2025). If participants had required support for their illicit substance use or were thinking about stopping, signposting to support would have been offered, although none was requested. Participants\u0026rsquo; illicit substance use was considered current if it occurred within the past three months, based on self-report (Delphin-Rittmon, 2022). Participants were compensated for their participation; each participant received a \u0026pound;20 voucher. People who solely used nicotine, caffeine, alcohol, vaping, or prescription medication were not included in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval was from the University of Birmingham (ERN_18-0198A), and the study was carried out\u0026nbsp;in accordance with the Declaration of Helsinki.\u0026nbsp;Full consent was received from each participant before the interview began, with participants choosing a pseudonym to obscure their identity and foster more open and honest conversations. All the participants were considered competent and sober at the time of giving consent, as determined by the lead researcher. All participants had access to a Participant Information Sheet before the research interview, had opportunities to ask questions, and signed a consent form. There were at least seven days between providing information to participants about the research and obtaining their consent, allowing them time to consider their involvement. Additionally, participants were competent English speakers to minimize misunderstandings or misinterpretation of the questions.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc208174291\"\u003eRigour and Trustworthiness\u003c/p\u003e\n\u003cp\u003eRigor and trustworthiness were ensured by addressing credibility, dependability, and transferability, consistent with established principles of qualitative inquiry (Creswell \u0026amp; Poth, 2016). Credibility was strengthened through deep engagement with the data, including repeated, active reading of transcripts to ensure themes accurately reflected participant accounts, capturing both common patterns and unique perspectives presented in the Results section. Dependability was maintained through a transparent, systematic analytic process detailed in the Data Analysis section. Transferability was supported by rich description, including demographic details and direct quotations, enabling readers to assess the applicability of findings to other contexts.\u003c/p\u003e\n\u003cp id=\"_Toc208174292\"\u003eData analysis\u003c/p\u003e\n\u003cp\u003eThe interview data were analysed using Reflexive Thematic Analysis, following Braun and Clarke\u0026rsquo;s six-phase process (2019). This approach was selected for its flexibility, making it well-suited to an inductive exploration of the diverse experiences of the participants.\u003c/p\u003e\n\u003cp\u003eAnalysis began with listening to audio recordings and verifying transcripts, followed by repeated, active reading to achieve familiarisation. Initial coding involved systematically assigning codes to meaningful data segments, organised within a codebook to ensure consistency and rigour (Salda\u0026ntilde;a, 2021). These codes were then collated into preliminary themes, which underwent iterative review and refinement to ensure coherence and distinctiveness. This process culminated in two final themes: \u003cem\u003eIdiosyncratic Outcomes\u003c/em\u003e and \u003cem\u003eThe Social Dynamics\u003c/em\u003e. The systematic approach ensured that themes were firmly grounded in participants\u0026rsquo; own words and experiences.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe participants\u003c/p\u003e\n\u003cp id=\"_Toc205996745\"\u003eThere were twelve participants, all aged over fifty, who actively used illicit substances. Among them, four were daily users while some were occasional users. The demographics are summarised in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 1\u003c/em\u003e\u003c/p\u003e\n\u003cp id=\"_Toc208174295\"\u003eThemes\u003c/p\u003e\n\u003cp\u003eThe analysis of the twelve research interviews generated two major themes. (see Table 2). Theme 1, Idiosyncratic Outcomes, explored the idiosyncratic outcomes of the participants, such as normalisation, ritualism, and physical \u0026amp; psychological adversities. Theme 2, Social Dynamics explored the how participants navigated their usage in society by examining their interpersonal relationships, the prevalence of stigma, social isolation, and easy access to illicit substances.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 2\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme1: Idiosyncratic outcomes\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003cstrong\u003e1.1 Normalisation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany participants viewed substance use as a regular part of their lives. Kwerky, Freda, John, Clara, and Neil integrated substance use into their lifestyles without dwelling too much on its potential consequences. Brian described a stable pattern, \u0026ldquo;one or two joints after every day\u0026rsquo;s work\u0026rdquo;, framed as relaxing, functional, and an alcohol substitute that \u0026ldquo;\u003cem\u003ehasn\u0026rsquo;t got in the way\u003c/em\u003e\u0026rdquo; of life, signalling a normalised routine and perceived control over use. \u0026nbsp; Kwerky reported that \u0026ldquo;most of my friends still dabble in Ecstasy\u0026rdquo; and many \u0026ldquo;smoke marijuana on a regular basis,\u0026rdquo; and she relies on \u0026ldquo;\u003cem\u003epeople I know\u003c/em\u003e\u0026rdquo; to source drugs, rendering use ordinary within trusted social circles. \u0026nbsp;Participants explicitly imagine continued, moderate use into later life (\u0026ldquo;I\u003cem\u003e\u0026nbsp;can always envisage me as an old man on holiday having a spliff\u0026rdquo;; \u0026ldquo;we\u0026rsquo;ve joked about it in our 60s and 70s\u003c/em\u003e\u0026rdquo;), further cementing use as an enduring, ordinary facet of identity.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Ritualism\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRitualistic substance use was one of the common practices among the participants. Typical ritual use constitutes doing things in a certain pattern so that the familiarity helps create an air of relaxation. \u0026nbsp;Brian, Clara, Freda, Neil, Kwerky, and Rudy all preferred to use their chosen substances in a ritualistic way, for various idiosyncratic reasons. With ritualism, Brian, and Freda claim to gain comfort and increased productivity. But, for Kwerky, the rituals have been pleasurable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc205996747\"\u003e\u003cem\u003e\u0026ldquo;I like the whole procedure of cutting it, getting the crystals down, and divvying it all up.\u0026rdquo;\u003c/em\u003e (Kwerky,54)\u003c/span\u003e\u003c/p\u003e\n\u003cp id=\"_Toc205996750\"\u003e\u003cspan id=\"_Toc205996748\"\u003eHowever, while Rudy felt that illicit substance use compliment drinking alcohol,\u0026nbsp;However, when in public Clara and Neil were less ritualistic users because they preferred to use illicit substances quickly. \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Physical adversity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants expressed concerns about the physical health risks associated with illicit substance use, though these varied in focus. For example, Clara worried about the impact on her cardiac health, while Kwerky emphasized the importance of safe and informed use. Rudy\u0026rsquo;s concern centred on the poor quality of available substances. Other reported issues included nighttime panic attacks, sweating, loss of appetite, and weight loss (Baldrick), as well as insomnia (Chris). Unlike Baldrick, Freda did not experience panic when unable to use substances.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eIt\u0026apos;s not something I panic about if I can\u0026rsquo;t get hold of any\u003c/em\u003e\u0026quot; (Freda, 58)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn increase in tolerance was a concern for Sam, Brian, and Chris, while others, such as Rudy and Fred, also reported experiencing drug tolerance without being concerned about it. Most of the participants avoided heroin due to its well-known health risks. James frequently felt exhausted after using illicit substances, whereas some participants believed moderation mitigated harm. For instance, Kwerky claimed to feel \u0026ldquo;fine\u0026rdquo; the next day after use. Furthermore, Brian, John, and Clara reported no physical health concerns. Overall, participants perceived moderate illicit substance use as acceptable, viewing it as physically harmless. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Psychological adversity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost of the participants claimed benefits from using illicit substances, but some acknowledged its psychological risks. Although Baldrick, Chris, and Fred acknowledged their dependency, none of the participants expressed a desire of ability to stop using altogether: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;m trapped.\u0026rdquo; (Chris, 55)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBaldrick cited a lack of willpower or self-confidence as the reason for recovery failures. \u0026nbsp;Other psychological risks included depression (Sam), anxiety (Freda), and hallucinations during a failed recovery (Brian). Brian also expressed apprehension about psychological issues in social contexts.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026apos;ve witnessed cocaine devastate fragile minds and heroin claim the lives of three close friends, so I fully understand the potential dangers.\u0026quot;\u003c/em\u003e (Brian, 52)\u003c/p\u003e\n\u003cp\u003eLikewise, Clara claimed psychological independence from illicit substance use by abstaining from hallucinogens and opiates, stating,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I can go weeks or months without drugs, so I don\u0026apos;t experience psychological dependence.\u0026quot;\u003c/em\u003e (Clara, 50)\u003c/p\u003e\n\u003cp\u003eConversely, some reported that illicit substance use yielded enhanced concentration (Freda), confidence, and mood for social interaction (Rudy). Nevertheless, for Brian, Sam, Fred, and Clara the psychological adversities of illicit substance use outweighed its perceived benefits.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: The Social Dynamics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Interpersonal relationships\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants\u0026rsquo; interpersonal relationships ranged from supportive to strained. For example, Fred viewed illicit substance use as a means of socialization, while Freda and James reported successfully balancing substance use with family commitments through open communication and joint problem-solving. James and Kwerky described receiving encouragement to stop using and openly discussing their experiences with family members. Although Chris was partially estranged from her daughter, some connection remained. Neil, a 53-year-old single male, expressed concern about differing views on substance use in past relationships, though he did not indicate whether a partner\u0026rsquo;s acceptance would influence his satisfaction. In contrast, Brian, Chris, Clara, Fred, John, and Sam experienced family strain and rejection\u0026mdash;manifesting as distancing, emotional unavailability, and infrequent communication\u0026mdash;due to relatives\u0026rsquo; opposition to substance use, resulting in limited family support.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eI have had a few relationships where they have not been interested in that at all and it has caused a problem.\u0026rdquo;\u003c/em\u003e (Neil, 53)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;And there\u0026rsquo;s the generational thing as well, my mum and dad have been so anti- drugs, always have been, always will be and their lack of experience, lack of awareness, everything else.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(Clara, 50)\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc201837610\"\u003eChris, James, John, and Sam felt socially isolated and disconnected from society, accepting that illicit substance use was as a coping mechanism for loneliness. Particularly, Sam\u0026nbsp;favoured living alone with his substance use, expressing a desire to disengage from the world. In summary, the participants\u0026rsquo; interpersonal relationships showed a blend of acceptance, unacceptance, support, isolation, and a dynamic between social connectivity and dysconnectivity.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Stigma\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFreda observed that drug-specific stigma, such as that associated with skunk, often reflects broader substance-related stigma. She emphasized that stigma varies by drug type, contrasting with others who perceive it as uniform across substances. Individual experiences highlighted these differences: mamba was considered more stigmatized than heroin (Chris), heroin more than cocaine and ecstasy (Clara), and cannabis as the least stigmatized (Brian). Clara also expressed concern about using certain substances due to stigma, suggesting that stigma operates not only between users and non-users but also among users of different substances. Additionally, John and James reported being labelled with derogatory terms such as \u0026ldquo;crackhead.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eFrom a societal point of view, they are lumped together,\u0026rdquo; \u0026ldquo;therefore the whole of it is bad.\u0026rdquo;\u003c/em\u003e (Freda, 58).\u003c/p\u003e\n\u003cp\u003eThis stigma compelled participants to live under strict confidentiality. Secrecy was not a choice but a survival strategy to avoid judgment and safeguard professional standing. Rudy, who regularly liaised with police, feared the real-world consequences of exposure, describing her main concern as,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eThe legality.\u0026rdquo; \u0026ldquo;If I smoked cannabis regularly, I would even keep that private.\u0026rdquo;\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026ldquo;I have to liaise with Police,\u0026rdquo; \u0026ldquo;I\u0026rsquo;d lose my registration.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(Rudy, 53)\u003c/p\u003e\n\u003cp\u003eTo cope with this constant legal precarity, some participants developed a specific belief about how law enforcement viewed them as older users. Brian articulated a perception of an \u0026quot;unwritten decriminalization,\u0026quot; where police were less concerned with older users who kept to themselves:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eIt\u0026rsquo;s the unwritten law of decriminalization.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(Brian, 52)\u003c/p\u003e\n\u003cp\u003eThis belief functioned to manage the fear that stems from societal stigma and the illicit nature of their actions, reinforcing the need to remain hidden from the mainstream.\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc205996761\"\u003e\u003cstrong\u003e2.3 Easy access\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc205996763\"\u003eFor all participants, friends and family were key sources of illicit substances. Rudy\u0026rsquo;s case illustrates this, she continues using substances despite knowing her husband is her primary supplier. Her situation underscores the difficulty of breaking the cycle of illicit substance use, even if there was the desire to do so, when access is so easy.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s about just having that availability,\u0026rdquo; he\u0026rsquo;s the one who will be the driver in terms of having the contacts and organizing it.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(Rudy)\u003c/p\u003e\n\u003cp id=\"_Toc208174296\"\u003eIn summary, participants exhibited normalisation and ritualism, and easy access to substances helped perpetuate their use. Physical hardships intensified their struggles, while psychological challenges sometimes overshadowed perceived benefits. Family and societal pressures contributed to social isolation, with stigma amplifying this isolation for some.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn conjunction with the with the idea that the psychological benefits outweighed the physical hardships, another specific age-based perception coping mechanism was that some of the participants believed that because their illicit substance use was discreet and non-problematic, then they were unlikely to attract attention from the police. Brian noted people openly smoking cannabis on the high street and in pub back yards and describes an \u0026ldquo;unwritten decriminalisation\u0026rdquo; for personal amounts\u0026mdash;an observation of social and policing norms that frame public use as largely tolerated.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, the fear of legal scrutiny, particularly for those with professional registrations who worried \u0026quot;I\u0026rsquo;d lose my registration,\u0026quot; remains a powerful force that limits their world, confining their use to the home and trusted social circles, and further cementing their isolation from mainstream society. \u0026nbsp;Rudy kept her use private at work due to professional risks and distinguishes between feeling age‑appropriate in pubs versus clubs, \u0026ldquo;\u003cem\u003eit just doesn\u0026rsquo;t fit into society\u0026rsquo;s norms\u003c/em\u003e\u0026rdquo;, suggesting normalisation is situational and contingent on audience and place.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Inevitable Consequence: Synthesising the Path to Loss and Fear\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNormalisation and stigma management involve navigating tangible losses\u0026mdash;physical decline, psychological distress, and fears of mortality, incarceration, and illness. Participants experience two major losses: deteriorating physical health and eroding psychological wellbeing. The belief in \u0026ldquo;harmless moderation,\u0026rdquo; central to the normalisation narrative, ultimately clashes with the aging body\u0026rsquo;s physiological reality. Despite efforts to downplay risks, research confirm physical adversities, including organ damage, chronic illness, and increased dependency (Hamilton \u0026amp; Grella, 2009; Roe et al., 2010).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompounding this is profound psychological turmoil, a loss of self-worth and social connection. Literature captures this through expressions of regret, such as: \u0026ldquo;I\u0026rsquo;m hurt by a lot of things my addiction took me through that I put on my children by not being the mother I should have been\u0026rdquo; (Hamilton \u0026amp; Grella, 2009). Internalized shame from fractured family ties deepens isolation, a finding echoed in this study. \u0026ldquo;I\u0026rsquo;m trapped,\u0026rdquo; one participant admits.\u003c/p\u003e\n\u003cp\u003eThese accumulated losses fuel pervasive fear, both practical and existential. Legal anxieties, fear of humiliation, and loss of professional standing create chronic stress and concealment. One participant summarizes the stark reality: \u0026ldquo;\u003cem\u003eEither I am going to die or I am going to end up in prison or the hospital\u003c/em\u003e\u0026rdquo; (Hamilton \u0026amp; Grella, 2009, p.119). This encapsulates the three dominant fears among older illicit substance users: death, loss of freedom, and catastrophic health failure.\u003c/p\u003e\n\u003cp\u003eThis aligns with the findings of Roe et al (2010), where fear of dying was a prominent experience. Ultimately, this synthesis shows that \u0026quot;Loss and Fear\u0026quot; is not an isolated theme but the culminating point of a journey for people over 50 who use illicit substances. The need to normalise use (Theme 1 of this discussion) and navigate social stigma (Theme 2) creates a life of high-stakes conflict. The fallout from this conflict declining health, broken relationships, constant anxiety constitutes the losses and fears that define the experience.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study illuminates a persistent tension between the private normalization of illicit substance use among adults over 50 and the external pressures of stigma and legality. Participants framed use as a functional coping strategy for chronic pain, psychological distress, and social isolation, embedding it into everyday routines through normalisation and ritualism. These practices align with work on \u0026ldquo;integrated and routine use\u0026rdquo; and \u0026ldquo;maturing in,\u0026rdquo; where stability rather than abstinence becomes the goal (Measham, Newcombe and Parker, 1994; Boeri, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Cepeda et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The self‑medication hypothesis offers an explanatory lens: substance use functions to manage psychological and existential pain associated with aging (Khantzian, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1987\u003c/span\u003e) which does partially complement the experiences of the participants in this study. However, for these participants their illicit substance use was also a continuation of their earlier use that they have enjoyed and never wanted to stop.\u003c/p\u003e \u003cp\u003eA core cognitive mechanism underpinning the participants\u0026rsquo; routines, and the psychological comfort that they provide, is a belief in benign moderation; participants commonly judged their consumption as controlled and therefore harmless. A study by Quilty-Dunn J. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) showed that individuals define \"moderation\" when it comes to consumption. people tend to adopt self-serving definitions, interpreting \u0026ldquo;moderate\u0026rdquo; as whatever amount they\u0026rsquo;re already consuming, or just a bit more. This effectively provides psychological comfort: \u0026ldquo;I\u0026rsquo;m fine\u0026mdash;I\u0026rsquo;m moderate.\u0026rdquo; Which mirrors the participants belief in their own benign moderation: participants view their routines as harmless because they see them as controlled. This rationalization comfortably reduces the dissonance between their behavioural self and their aspirational or health-conscious identity. However, these views collide with biomedical reality: age‑related pharmacokinetic and pharmacodynamic changes heighten risk, even at lower doses, and/especially in combination with common prescriptions (Qato et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Robinson, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Thus, the routine\u0026rsquo;s perceived safety is contingent and fragile.\u003c/p\u003e \u003cp\u003eSocial context both sustains and constrains use. Easy and reliable access, often through close ties, help maintain routine patterns, yet family relations simultaneously act as sources of strain and support. Some relatives were explicitly anti‑drug, contributing to distancing and isolation; others tacitly enabled use by facilitating supply. This dual role complicates help‑seeking and reinforces concealment (Boeri, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Hamilton \u0026amp; Grella, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Lin et al., 2023). These dynamics are exacerbated by misconceptions that frame substance use in later life as either a moral failing or a \u0026ldquo;last pleasure,\u0026rdquo; obscuring health needs and delaying support (Briggs et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Rao et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStigma emerged as a central external force, operating not only between users and non‑users but also across substances. Participants perceived a hierarchy in which some drugs (e.g., cannabis) were less discrediting than others (e.g., crack, heroin), prompting strategic concealment to protect social standing and professional registration (Goffman, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1963\u003c/span\u003e; Bottorff et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Kerridge et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Ageism intensifies this pressure, compounding shame and barriers to care (Rao et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Chrisler et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In response, some participants cultivated a belief in \u0026ldquo;unwritten decriminalisation\u0026rdquo; for discreet older users\u0026mdash;a coping perception rather than a legal reality that helped manage fear while reinforcing secrecy (Greer et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe belief that because of their age and their discreet and non-problematic use, that law enforcement would not be issue for them has been seen before. The participants in Greer et al (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) pointed out that the police would favour pursuing younger, more visible users. While a general distrust of police is not unique to this demographic (Greer et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), this specific age-based perception appears to be a distinct coping mechanism for people over 50 who use illicit substances. However, this perceived safety is fragile and reinforces the need to remain hidden. This finding gives a contemporary, UK-specific texture to the general fears of incarceration noted Hamilton and Grella (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSynthesising these strands, the lived experience is shaped by an ecosystem of routine (normalisation, ritual), cognition (belief in moderation), access (family and peers), and social control (stigma, legality). The cumulative effects include physical decline, psychological distress, and erosion of social connectedness\u0026mdash;losses that amplify fear of death, incarceration, and catastrophic health events (Hamilton \u0026amp; Grella, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Roe et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). These findings extend prior literature by showing how age‑specific routines and substance‑specific stigma converge to produce a high‑stakes private world that appears orderly to the user but is precarious under external scrutiny.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplications for practice.\u003c/b\u003e Clinicians should shift from problem‑centred to function‑centred inquiry (e.g., pain, sleep, loneliness), using non‑judgmental language to invite disclosure. Harm‑reduction approaches\u0026mdash;education about age‑related risks, safer‑use planning, and support for reducing harms rather than insisting on abstinence\u0026mdash;are more likely to engage this group (Marlatt et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Robinson, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Psychological interventions (CBT, motivational interviewing) can be tailored to triggers identified here: isolation, chronic pain, and entrenched habits (Kiluk \u0026amp; Carroll, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplications for policy.\u003c/b\u003e National strategies (e.g., the UK\u0026rsquo;s National Combating Drugs Outcomes Framework) should embed discreet, age‑responsive screening and support within trusted settings such as primary care and gerontology services, recognising that many older users do not present to traditional addiction pathways due to stigma and legal fears (HM Government, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Clear communication that privileges public‑health responses over punitive ones may reduce concealment and increase engagement.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplications for research.\u003c/b\u003e Future work should examine family\u0026rsquo;s dual role (strain/enabling) and the substance‑specific stigma hierarchy and use larger epidemiological designs to estimate the prevalence of routine patterns and legal fears among older UK users (Cepeda et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations.\u003c/b\u003e Findings reflect a small, snowball‑sampled cohort and self‑report data, potentially over‑representing interconnected networks and under‑representing highly isolated individuals; a single‑analyst approach may also shape interpretation (Podsakoff et al., 2003; Patton, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Creswell \u0026amp; Poth, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). These constraints define scope rather than undermine credibility, supported by reflexive thematic analysis and rich description (Braun \u0026amp; Clarke, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eAdults over 50 who use illicit substances navigate a delicate balance: a private world where use is normalised and functional, and a public world where stigma, legality, and ageism compel secrecy. Routine practices and beliefs in moderation make use feel orderly and controlled, yet age‑related vulnerabilities, strained relationships, and social disconnection render this order fragile. Effective support requires moving beyond the narrow label of \u0026ldquo;addiction\u0026rdquo; to address the physical, psychological, and social realities of aging. Harm‑reduction, empathetic communication, and age‑specific outreach offer a credible pathway to engagement and meaningful help for this hidden population.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eThere was no funding for this research.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003eAmerican Psychiatric Association (2022) \u003cem\u003eDiagnostic and statistical manual of mental disorders\u003c/em\u003e (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787 \u003c/p\u003e\n\u003cp\u003eANDERSON, T. L. \u0026amp; LEVY, J. A. 2003. Marginality among older injectors in today\u0026apos;s illicit drug culture: assessing the impact of ageing. \u003cem\u003eAddiction,\u003c/em\u003e 98, 761-770. \u003c/p\u003e\n\u003cp\u003eARNDT, S., CLAYTON, R. \u0026amp; SCHULTZ, S. K. 2011. 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\u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePreferred substance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCharacteristics of substance usage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRudy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCannabis/ Polydrug user\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOccasional user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBrian\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDaily user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChris\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMamba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDaily user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClara\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEcstasy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOccasional user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFred\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCannabis/\u003c/p\u003e \u003cp\u003ePolydrug user\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDaily user \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFreda\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOccasional user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJames\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCrack cocaine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMost days\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJohn\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCrack cocaine.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOccasional user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeil\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePub\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCannabis, Ecstasy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWeekly user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSam\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePub\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEcstasy \u003c/p\u003e \u003cp\u003eCannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDaily user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaldrick\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMamba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDaily user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKwerky\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEcstasy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOccasional user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eThemes and Coding Process\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuotes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCodes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;For me, it\u0026rsquo;s normal behaviour.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormalisation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIdiosyncratic outcomes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I like the whole procedure of cutting it\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRitual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRitualism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I don\u0026rsquo;t do enough for it to sort of have any health implications\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical adversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I\u0026rsquo;ve seen cocaine destroy some fragile minds\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePsychological adversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;It depends on what type of people you are around, as well.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterpersonal relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSocial Dynamics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\"Crackhead.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStigma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStigma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8425220/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8425220/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIllicit substance use among adults over 50 is a growing yet under-researched phenomenon, often described as a \u0026ldquo;hidden epidemic.\u0026rdquo; This group faces unique biological, psychological, and social risks that remain poorly understood.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative study using reflexive thematic analysis of semi-structured interviews with twelve adults aged 50\u0026thinsp;+\u0026thinsp;in the West Midlands, UK, who currently use illicit substances.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwo overarching themes emerged: \u003cem\u003eIdiosyncratic Outcomes\u003c/em\u003e (normalisation, ritualism, and perceived harmless moderation) and \u003cem\u003eSocial Dynamics\u003c/em\u003e (stigma, secrecy, strained relationships, and easy access). Participants framed substance use as a coping mechanism for pain, isolation, and aging-related distress, sustained by routine and beliefs in moderation. However, stigma and legal fears compelled concealment, deepening social isolation and reinforcing vulnerability.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAdults over 50 who use illicit substances navigate a delicate balance: a private world where use is normalised and functional, and a public world where stigma, legality, and ageism compel secrecy. Routine practices and beliefs in moderation make use feel orderly and controlled, yet age‑related vulnerabilities, strained relationships, and social disconnection render this order fragile. Effective support requires moving beyond the narrow label of \u0026ldquo;addiction\u0026rdquo; to address the physical, psychological, and social realities of aging.\u003c/p\u003e","manuscriptTitle":"Illicit Substance Use Among Adults Over 50: A Qualitative Study of Lived Experiences in the UK","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 11:37:31","doi":"10.21203/rs.3.rs-8425220/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"02493af3-9118-46ca-8c07-3860e6c38e05","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-13T11:13:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 11:37:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8425220","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8425220","identity":"rs-8425220","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}