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

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.