Traditionally, it was assumed that drug abuse diminished during adulthood (7). However, cumulative evidence has challenged this preconception, suggesting that some people continue to use drugs well into their aging years (2). The trend of older adults’ drug abuse is associated with the prevalence of addiction to prescribed medication within this group (2, 8). It is also associated with the coming of age of individuals who grew up during the 1960s and 1970s—a period of changing attitudes toward drug and alcohol use (9). Another factor linked to this trend relates to changes in the treatment management of opiates during the 1990s (10), namely the use of methadone therapy that led to improved survival rates among people who abuse drugs (11). Despite the rapidly increasing literature concerning older adults’ drug use, there is less research on the subject among prison populations (5, 12). In a recent scoping review on older adults who use illicit opioids, cocaine, or methamphetamine (13), out of 164 papers included in the review, only 15 mentioned participants’ incarceration as part of the study, often referring to incarceration history only when describing the study population or when distinguishing between comparison groups. Similarly, another review by Maschi and Dasarathy (14) concluded that there was a significant unexplored research and practice gap in the literature concerning justice-involved older adults with respect to the prevalence of mental health disorders including drug abuse and other addictions. Thus, the aim of the present study was to target this gap by addressing the role of substance use in the lives of incarcerated older adults.

As noted, limited studies have examined IOAs coping with drug abuse issues (15). Previous research has suggested that IOAs are atypical in their drug abuse habits (16), meaning that although IOAs tend to use more drugs than their age peers living in the community (6), their drug use is markedly lower than that of younger incarcerated individuals (17). In addition, alcohol abuse is the most prevalent substance used by IOAs (5), followed by opioids (18). This contrasts the preference for cannabis that is prevalent among incarcerated individuals who use drugs in general (19). The literature shows that drug use is generally perceived as being a problem of younger incarcerated individuals and, therefore, treatment services are usually designed to cater to the needs of the younger population rather than of IOAs (20, 21). Some IOAs, however, may have a very lengthy substance use career and may have difficulty envisaging the rest of their lives without drugs. Thus, it is surprising that substance abuse treatment programs are rarely offered to IOAs (5, 22). In addition, substance abuse was among the most frequently reported health problems for older offenders according to Solares et al. (23); particularly, use of alcohol, opioids, and cannabis is associated with functional limitations and disability (24). While most existing studies aim to map the landscape of IOAs’ drug abuse, pinpointing primarily epidemiological questions, e.g., How many IOAs use drugs? Which substances are used? (13, 23), the experiences of IOAs who use drugs have received less attention. These experiences were addressed mainly anecdotally, as part of a wider exploration of older adults’ experience of incarceration, or as part of a study of individuals’ substance use experience in prison, when some of the participants happened to be older adults. For example, Shibusawa and Padgett (25) drew a connection between traumatic childhood events, early-onset drug use, and incarceration among formerly homeless adults with chronic mental illness. They focused on the losses caused by substance abuse in the lives of the participants and noted that some of them viewed old age as an opportunity to eliminate substance dependency. Similarly, Pageau (26) found that some IOAs perceived their time in prison as an opportunity to stop consuming drugs. Boeri et al. (27) compared the experiences of early- and late-onset older individuals who use heroin. They found that early-onset drug abuse by IOAs was often exacerbated by either frequent or long periods of institutionalization that hindered their ability to bond with mainstream society. This is consistent with Padgett (28), who brought forth the voices of older adults who had lost contact with their children and other family members as a result of their substance abuse and incarceration periods. However, Pope et al. (29), in their study of former IOAs, noted that the loss of contact with children had led to substance abuse. Moreover, they found that IOAs with drug abuse problems had often been exposed to drug-using parents from early childhood. Finally, Wyse (30) studied the narratives of ex-incarcerated individuals who struggled with lifelong drug addiction. She described prison-enforced detoxification as a turning point that provided the participants in her study with clarity, often followed by a period of reflection and evaluation of their lives. Older age seemed integral for this period of sobriety and reflection to catalyze cognitive change and inspire a new commitment to sobriety. Thus, it seems that narratives related to drug abuse by IOAs may produce a nuanced and complex picture of both the losses and hardships intertwined with healing. Nonetheless, while these findings are compelling, they are still anecdotal.

This analysis is underpinned by the life-course perspective (LCP), which is a multidisciplinary holistic approach used to examine aspects of continuity, change, transition, and stability throughout human lives (31, 32). By focusing on the patterns or trajectories of individuals’ lives and the ways in which those patterns are shaped by the broader historical context and social structures, the life-course perspective offers a broadened organizing framework. It potentially allows for characterizing distinctive patterns of drug use trajectories, identifying critical events and factors contributing to persistence or change during the life span, and analytically ordering the events that occur during that course (33). Some key life-course concepts that may be useful for understanding older adult’s drug abuse experience are trajectories and transitions. A trajectory is a pathway or line of development during the life span, such as work life, parenthood, or criminal behavior. Transitions are short-term changes in stages or roles within that same trajectory (e.g., starting or leaving school, starting to use drugs, committing the first crime). Some, but not all, transitions lead to turning points that produce long-term behavioral change (34). Turning points have typically been described as major life events that may redirect an individual’s life path and lead to changes in life trajectories (35). Indeed, some studies, in which the life-course perspective has been applied to the phenomenon of older adults’ drug abuse, have used these concepts and revealed insightful findings (36). For example, a qualitative study based on interviews with 20 older adults with drug abuse problems suggested that older adult with substance abuse problems tended to self-identify as individuals who transitioned into substance abuse at old age whereas, in fact, most of them had long-term substance abuse problems that were exacerbated by age-related events (37). Another life-course-informed investigation of older adults’ drug abuse revealed that, contrary to expectations, those older individuals who use drugs, who’s addiction has started at younger age, were better able to control their drug use habits as well as to maintain mainstream social roles than those who had started later in life (27). In line with these findings are those of Cepeda et al. (38), which indicate that emerging dysfunctions in the heroin lifestyle of older adults who use drugs lead not to cessation but rather to “maturing in”—a specific process of social readjustment that returns the individual to a stable maintenance pattern of use instead of a recovery phase. Finally, Grella and Lovinger (39) identified distinctive trajectory patterns of drug use over a 30-year period among participants in a methadone treatment program. They found that older adults who had used heroin the longest were characterized by relatively higher levels of childhood conduct problems and adult antisocial personality disorder. They suggested that these longstanding drug habits and criminal involvement may be associated with an underlying childhood psychopathology.

While studies using LCP to explore older adults’ experience of drug abuse have produced meaningful findings, the issue of IOAs’ drug abuse, informed by LCP, seems to be absent from the literature, in keeping with the general absence of research on IOAs’ drug abuse experience.

Thus, the aim of the present study was to investigate the ways in which incarcerated older adults give meaning to their drug abuse experiences along the life course.

The research question was as follows: What was the meaning of drugs and drug abuse in IOAs lives? What were the roles drugs played in their lives? How were drugs and drug abuse experienced before or during their incarceration?

The research sample included 28 incarcerated males recruited by the state’s Prison Service. Purposive sampling (46) was used to select information-rich cases. The inclusion criteria specified that participants must be over 55, who either have a history of drug use or use drugs currently, and had no other serious health issues at the time of the interview. This was verified by crosschecking several provisions: The participant’s incarceration history sheet showed at least one drug-related crime in his record; the participant had been offered at least one drug abuse treatment or drug-related therapeutic intervention during his incarceration history, and the participant self-identified as a former or current drug abuser. All drug types were accepted, as well as a combination of drug and alcohol abuse, but IOAs who abused alcohol only were excluded from the study. It is important to note that not all participants were diagnosed with substance use disorder – some participants used drugs occasionally or only as younger men, while others had more severe drug use history. An additional criterion was having served at least 3 years in prison (either consecutively or in separate terms). This criterion was included to make sure that only individuals who had accumulated sufficient prison-life experience would take part in the study. The participants’ ages ranged from 55 to 82, with a mean age of 66.8, and a mean number of 13 years’ incarceration. Additional socio-demographic data regarding the participants is presented in Table 1.

At the time of the interviews, the participants were housed in three state prisons. Seven participants were living in special rehabilitative wards in a minimum-security prison, nine participants were living in a special ward designated to older adults in a different minimum-security prison, and 12 participants were living in regular wards in a high-security prison. The final sample size was determined according to Morse’s principle of theoretical saturation, which asserts that when repeated content, details, and interpretations emerge across interviews, than data saturation has been reached (47). In the present study, after interviewing 28 participants, saturation has been reached.

Data collection was performed via in-depth, semi-structured phenomenological interviews using an interview guide (48) that addressed the following categories: (1) The experience of drug use through the years (e.g., How did you first start using drugs? What was the role of drugs in your life as a young man?); (2) The meaning of drug use in a criminal lifestyle (e.g., What does it feel like when you use drugs in prison? How has that experience changed during your incarceration?); (3) Aging and drug use (e.g., How has aging changed your drug use habits? Looking back at your time in prison, how did it affect your drug use through the years?).

The research was carried out in collaboration with the state’s Prison Service. Following research approval by the University’s Institutional Review Board (IRB) (approval number AU-SOC-HA-20220724) and the approval of the prison service research committee, a social worker from each prison was appointed as a contact person to coordinate the research. They handed out an explanation sheet with the aims and scope of the research, as well as the research criteria, inside the prison wards, asking IOAs who wished to participate to reach out to them or to one of the wardens who were also aware of the research. The social workers or the wardens referred willing participants, who met the research criteria, to the author, and the social workers coordinated interview times and dates. A total of 31 IOAs expressed willingness to participate in the study. However, three of them changed their minds and canceled their interviews. The interviews themselves were conducted inside the prison ward in a private room in the presence of only the researcher and the IOA; no prison guard was present. Each interview usually lasted from1–2 h depending on the participant’s individual needs and communication abilities.

In light of the sensitivity of the participating population—IOAs sharing details about their drug use habits (49)—special provisions were made to ensure informed consent and confidentiality (50). Written informed consent was obtained from each participant. In addition, the author continuously sought to obtain process consent from those who appeared distressed during the interview (51). If difficult emotions were expressed, the author has advocated for crisis management by the prison’s social worker (52). The interviews were audio-recorded and transcribed verbatim. All identifying details were changed to preserve the participants’ confidentiality. The data collected during the study were kept confidential, stored in a locked computer, and protected with a password known only to me.

Data analysis was conducted according to the guidelines of the interpretive phenomenological analysis (IPA) approach, as suggested by Smith, Flowers, and Larkin (40). First, the transcripts were read several times so the researcher will become as familiar as possible with the text. Then, inductive initial coding was performed by coding the participants’ significant statements, for example, referring to their wide range of feelings about drug use through their life course. The next step involved grouping the statements into subthemes and identifying quotes that captured the essential quality of the participants’ experiences and perceptions. For example, quotes relating to the way participants viewed the role of drug use in their lives were gathered (e.g., depending on drugs, denying their drug problems, using drugs to advance their criminal lifestyle). The next step included making connections, clustering and conceptualizing them these quotes. At this stage, LCP (31) was used heuristically in a deductive way to provide a broader understanding of the findings and to enable identification of four superordinate themes reflecting different roles illicit substances has played in IOAs lives (40). During the textual analysis, the researcher aimed to identify the varying similarities and differences of participants’ accounts. For instance, participants generally viewed themselves as victims of the prison system. However, some made a connection between drug use and incarceration while ots perceived their drug use as a personal problem rooted in their childhood experiences. (40).

Trustworthiness of the findings was ensured as follows: first, audio-recorded interviews and their verbatim transcriptions enabled verification with the original, for referential adequacy (53, 54). Second, experiences and preconceptions regarding older adults, IOAs, and drug use were bracketed by the researcher, to prevent them from influencing the research or its interpretation (55). This was accomplished as described by Moustakas (56), by engaging in repeated rounds of self-reflection on preconceptions and prejudgments. Moreover, an ongoing reflective journal was used, which enabled the expression of thoughts and feelings. Issues that arose from the reflective journal were discussed with a group of colleagues, thus enabling further bracketing (57).

Some IOAs, who were not involved in drug offences at this point in their lives, mentioned drugs in their personal history:

This participant vividly described the crime and drug industry that was the backdrop to his adolescence. He portrayed the allure of street life as an irresistible force that dragged him in, offering far better opportunities than his family’s empty house. The dichotomy between “full” and “empty” continued when the participant described his parents as weak and the local drug dealers as role models. Although his own substance use history was minor, it is apparent that growing up in an environment overflowing with drugs and drug dealers had shaped his values and provided him with knowledge about the know-hows of the criminal world.

Another participant, who was peripherally involved in drugs as a younger man, explained the meaning of growing up around drugs:

This participant had undergone intensive psychotherapy during his incarceration and shared his insights regarding his lifelong involvement in crime. He appeared to attribute his tendency to violence and disobedience to growing up with drug-using parents and viewed his and his siblings’ fate as gravely associated with the setting in which they were raised. Specifically, he pinpointed basic life skills, such as differentiating between good and bad, that are usually taught at a young age, either directly or by parents’ personal example. These values were not taught, and profoundly affected the participants’ path into a criminal life.

It is apparent from these narratives that drug abuse, per se, was not a major issue in their lives. Nonetheless, the participants reflected on spending their early life in the local drug scene or living with parents who were drug addicts, and perceived these formative experiences as having laid the foundations for their life-long criminal involvement. That is to say, for these participants, drug abuse was a state of mind and a set of values and attitudes that guided them through life. In this context, the life-course perspective (LCP) views the individual’s own developmental path as embedded and transformed by conditions and events that occurred during the historical period and geographical location in which the person lives (31). Here, the participants described growing up at a time when the streets of some cities had a bustling drug scene. These participants viewed growing up in an environment that was socially receptive toward drug use as an inherent part of their criminal career. Some of them also mentioned their parents’ role in their life choices. The life-course principle of linked lives refers to the interdependence and reciprocal connection of people’s lives and explains how individuals in a significant relationship (e.g., parents and children) share influential, merged, and lifelong developmental trajectories (31). This concept may help explain how parental drug abuse can reverberate through the generations, causing the children who are unwitting, vicarious victims to repeat that behavior.

Participants whose narratives were part of the current theme started using drugs in incarceration, usually when they were in their thirties or forties. These participants described drug use as a lifeline in the grim reality of prison life:

After years of drug-free incarceration, this participant viewed his introduction to the world of drugs as a pathway to liberation within confinement. He voiced the pain and loneliness of being tossed around within the prison system, facing social difficulties, and spending most of his time completely alone. The participant drew attention to the irony of the situation: It was only when he attempted suicide that he received some therapeutic help. The therapy itself did not work, but gave him better access to drugs.

Another IOA described as follows:

This participant described drug involvement as part of a “package deal” for individuals incarcerated for long periods of time. For him, surviving prison was built on engaging socially with other incarcerated individuals and becoming involved in prison life. This involvement included immersion into the drug scene almost carelessly: “I did it without even thinking.” He did, however, appear to feel somewhat deceived while revealing that all his good friends, who had drawn him into the world of drug use, had eventually been released, while he remained in prison.

The offset of drug abuse while incarcerated echoes the LCP perception of trajectories, transitions, and turning points (58). In the present study, the participants narrating this theme had been involved in a drug-free criminal lifestyle (a trajectory). Aging within a criminal lifestyle had summoned new social and behavioral challenges manifested in incarceration, loneliness, suicide attempts, and trying to fit in with the prisoner society (a transition). Some of these transitions became major turning points with introduction of drug abuse as part of the individual’s life in prison.

Some of the participants in the present study perceived themselves as professional criminals who had made drug dealing their career:

This participant seemed to take pride in his work in the drug business, reflecting on its benefits and on his dedication to it. Even then, after years of being in and out of prison for drug crimes, he was still enchanted by the “crazy and adventurous” life as a drug dealer who made “tons of money.” This choice “rescued” him from living what he called a “gray life,” mundane and lacking in adventure. The participant did not see himself as a person who abuse drugs and described refraining from drug use as a deliberate act of good business management. However, he was disappointed to learn that, in the prison setting, drug dealing and drugs were all lumped into one category, and he was being treated in the same way as all the other people who use drugs.

Another participant adds:

This participant used to be the member of a gang centered around drug manufacturing and dealing. Despite his history of drug use and his assertion that “everybody uses,” he insisted on making a clear distinction between people who use drugs, who are “poor junkies,” and people who deal drugs. It seems that, over the years, he had softened his dismissive agenda toward people who use drugs. At the time of the interview, he was able to relate to them, not as one of them but as a mentor who shared his experiences with them.

These participants used the drug industry to advance themselves economically and professionally in the criminal world. They did not perceive themselves as having a drug problem, and even looked down on others who were dependent on them to deliver the drugs. In that sense, these participants saw themselves as in control of their drug use habits. These findings may be understood using the concepts of agency and control in the LCP. According to the life-course perspective, individuals are active agents in their lives who not only mediate the effect of social structure but also make decisions and set goals that shape the social structure (59). Parallel to this idea is the concept of control cycles whereby individuals modify their expectations and behavior in response to changes in needs or resources, and construct, negotiate, and traverse life-course events and experiences. Thus, participants in the present study perceived drugs as a lucrative resource and viewed their drug involvement as mostly beneficial. This agentic, non-victim-like perception gave them a sense of well-being, despite having spent their aging years in prison, just like other substance abuse victims.

The final theme represents the narratives of individuals who started using drugs either as teenagers or in their early twenties and became individuals with a long-term substance abuse problem as well as recidivist offenders:

This participant described an entire lifetime devoted to drug use, and a criminal career to sustain the flow of drugs. He focused on key resources that were missing from his life in old age, such as youthfulness and a home—and money and time that were wasted on drugs. No longer under the drugs’ captivating power, he became aware of the reality of the losses they had caused.

Another participant narrated as follows:

This participant described his tragic life story of childhood neglect that seemed to have pushed him into a life of drug abuse and delinquency. He portrayed drugs as loyal companions in the absence of actual human relationships and parental care. The remark “drugs were like my parents—they put me to sleep at night, they woke me up in the morning” exposes the extent of the void in his life, driving him to “adopt” drug use as a parental substitute. Paradoxically, after failing to adapt to life in the community, this participant found a home in prison. Aging in prison seemed to have given him some sense of safety and shelter, as well as adequate health care and drug rehabilitation that had been missing from his life throughout the years.

The participants presenting the current theme described drug use as intertwined with experiences of childhood abuse and neglect and identified it as an inherent part of their identity. LCP postulates that the past has the potential to shape the present and the future, and that early life-course decisions, opportunities, and conditions affect later outcomes. In particular, LCP emphasizes the chain of events or the ripple effect that can begin in early childhood (e.g., parental neglect, going through the foster care system and using drugs to numb the pain). It creates a long-term pattern of cumulative disadvantage (e.g., multiple incarcerations and drug addiction) that is valuable for understanding social inequality in later life, such as that experienced by individuals with lifelong substance abuse problems (60).

The aim of the present study was to explore the different ways in which IOAs narrated their drug abuse experiences. However, to provide a multidimensional understanding of IOAs’ drug abuse, future studies may triangulate between the participants’ own narratives and quantitative data regarding the amount and types of drugs used in different trajectories along the life course. Moreover, this study is limited in its generalization ability due to its small sample size and qualitative nature. Future studies, using quantitative methods, could be helpful for gathering more comprehensive data on this phenomenon. In addition, the participants in the present study volunteered to take part and were eligible if they had the capacity to conduct a meaningful hour-long conversation. Therefore, the experiences of other IOAs affected by drug use, who may have been suffering from psychological and cognitive effects that prevented their participation, are not reflected in the findings. Finally, the study did not differentiate between the participants’ experiences based on drug types and the length and magnitude of abuse. It is possible that abuse of different types may lead to different experiences.

The research findings pinpoint on the unique interplay between old age, incarceration, and drug abuse. It seems that, in some cases, prison might serve as a nurturing environment in which drug abuse can thrive. Thus, the different ways in which IOAs narrate drug abuse experiences can serve as a framework for developing tailored interventions for IOAs struggling with drug abuse. Finally, hearing the participants’ narratives in their own voices may help professionals relate to the subjective meanings attributed to IOAs’ drug abuse. Understanding the story behind drug abuse and relating to the social and familial trajectories that led to it may prepare the ground for more effective interventions.