From Midlife to Later Life: Addressing the Intersection of Aging, Substance Use, and Mental Health in Men

For many men, midlife and the years that follow bring significant change — retirement, loss of a spouse or close friend, chronic pain, and changing hormones. These transitions can heighten vulnerability to depression, anxiety, and substance misuse, yet the signs may be difficult to recognize or discuss. Bringing greater attention to these challenges can help men recognize when they may need support and understand that help is available and recovery is possible — at all ages.

We Need to Talk about Men’s Mental Health

Males die by suicide at nearly four times the rate of females, accounting for nearly 80% of all suicide deaths in the United States — yet about 40 percent of men living with a mental illness received treatment in the past year.

Men’s symptoms often go unrecognized because depression and anxiety in men more commonly present as irritability, anger, or social withdrawal rather than visible sadness. Cultural expectations of self-reliance and stoicism remain powerful barriers to help-seeking, and for men whose identity may be tied to professional or provider roles, midlife transitions can quietly erode both purpose and well-being.

SAMHSA is working to bring these issues to the forefront. This August, SAMHSA’s Navigating Change: Addressing Age-Related Health Transitions in Men Across the Substance Use Care Continuum symposium brought together researchers, clinicians, funding agencies, policymakers, and individuals with lived experience to examine these intersecting challenges and identify opportunities to strengthen prevention, early identification, treatment, and recovery support for men navigating midlife and aging.

The Aging Male Body: More Than Getting Older

Beginning around age 50, men experience a gradual decline in testosterone that can contribute to depression, fatigue, sleep disruption, and cognitive changes — symptoms often dismissed as normal aging, leading some men to turn to alcohol or other substances to cope. Opioid use (both prescribed and illicit) can further suppress testosterone through opioid-induced androgen deficiency (OIAD), compounding distress. Because SUD symptoms in older men so closely resemble normal aging, diagnoses are frequently missed, closing the window for early intervention.

The Scale of the Challenge

In 2025, SAMHSA’s National Survey on Drug Use and Health found that approximately 44.6 million individuals 12 or older (PDF | 3.1 MB) (about 15.3% of the U.S. population) met the criteria for substance use disorder (SUD) in the past year. The challenge is particularly acute for men in midlife and beyond. Among males aged 26 or older, SUD prevalence stood at 18.4% in 2025. Yet men remain far less likely to seek help, shaped by cultural norms that equate asking for help with weakness and a healthcare system not always designed with their needs in mind. Alcohol, cannabis, and opioids remain the most commonly misused substances in this population. For example, the prevalence of alcohol use disorder among men is 1.6 times higher than women. Co-occurring conditions compound the picture: In 2025, of the 42.7 million adults with a past-year SUD, about two-fifths (approximately 18.5 million people) also had any mental illness; yet, only 12.7% of them received treatment for both conditions.

What Good Care Looks Like

The right support can make a meaningful difference. Routine SUD screening in primary care and behavioral health settings, using age-appropriate tools, can help identify concerns earlier. Integrated care models, telehealth access, and peer support all improve outcomes, particularly for men in rural communities or with mobility limitations. Treatment environments that reduce stigma, acknowledge men’s lived experiences, and involve families when appropriate make meaningful differences.

Recovery Is Possible — and Help Is Available

Recovery is possible at every age, and asking for help is a sign of strength — not weakness: Call or text SAMHSA’s national Suicide & Crisis Lifeline at 988, or chat — or go to FindTreatment.gov, SAMHSA’s national addiction treatment locator to find help for those who are struggling with mental health or substance use challenges.

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