Changes In Substance Abuse By The Elderly

1
Changes In Substance Abuse By The Elderly The
Increasing Contribution Of Illicit Drugs
David F. Duncan, DrPH, Duncan Associates
Addiction Technology Transfer Center of New
England, Brown University Thomas Nicholson, MPH,
PhD, John B. White, PhD, John Bonaguro, PhD,
Dean College of Health and Human Services Western
Kentucky University
Introduction
Results
Between now and 2030 the number of adults aged 65
and older in the United States will almost
double, from around 37 million to more than 70
million, an increase from 12 percent of the U.S.
population to almost 20 percent. While this is
partly due to increasing longevity and partly to
a declining birth rate, it is principally due to
the maturing of the postwar "baby boom" of
persons born in the U.S. between 1946 and 1964 .
In 2011 the first baby boomers will turn 65, and
by 2030 the entire baby boom generation will be
65 or older. This demographic change has great
importance for America's health care system
because older persons make considerably greater
use of health care services than do younger
Americans and have health care needs that are
often more complex. The Institute of Medicine
(IOM) (2008) has warned that the American health
care system is already struggling with the
challenge of delivering high-quality services to
older adults and that most of Americas health
care professionals lack adequate education and
training with respect to the health care needs of
older adults. Unmentioned in the IOM report is
any difference in substance abuse prevalence
between baby boomers and previous generations.
The National Academies Keck Futures Initiative
similarly ignores drug abuse as an issue in the
elderly, implying that it is an issue only in
young people. Until relatively recently,
substance abuse by the elderly apparently was not
addressed by either the substance abuse or the
gerontological literature. It was long held
that, with only a few isolated exceptions,
substance abuse simply did not exist among the
elderly. Alcoholism was described as a
self-limiting condition with an early life onset,
which ended in either abstinence or death before
old age was reached and the elderly were seen as
non-users of other recreational drugs. When this
view was challenged by researchers in the last
quarter of the Twentieth Century, a new consensus
emerged asserting that alcohol abuse and misuse
was the substance abuse problem of concern among
older adults, affecting some 2.5 million of them.
This growing recognition that the aged may
suffer from alcohol abuse and alcoholism has not
been limited to the United States finding a
place in the medical literature in such other
nations as Germany, New Zealand, and Poland. We
have suggested that this assessment of the
situation may no longer be valid and that
increasing attention needs to be paid to the
possible abuse of illicit drugs by elder
Americans as baby boomers (i.e., those born
between 1946 and 1964 in the USA) reach
retirement age. In this previous analysis of
data from an annual national survey of drug use
we found support our view that the baby boomers
were showing higher levels of drug use later in
life. While the proportion reporting use of
alcohol remained relatively stable, the
proportion that had ever used each of six
categories of illicit drugs studied increased.
Of this sample 80.4 were male, a majority
(64.9) were white, the largest proportion were
divorced or widowed (44.8), and a quarter of
them were veterans (25.4). Most had completed
high school (64.0) and were not in the labor
force (60.3). A surprisingly high percentage of
them were homeless (15.6). Over the time
period 1992 to 2006, the proportion of
individuals admitted for alcohol abuse declined
from 81.7 to 51.6, respectively. The
proportion of individuals admitted for other
drug use accounted for 32.5 of admissions in
2006 compared to 1992 when it accounted for only
10.3 of total admissions age 55 and older. As
can be seen in the figure, total numbers of
admissions of persons aged 55 and older have
grown over the fifteen year period. Total
admissions with a primary drug problem with
alcohol have remained relatively stable over this
time. Admissions for problems with a primary
drug other than alcohol have shown a steady and
substantial increase.
Discussion
The admissions for a primary problem with a drug
other than alcohol bore some noteworthy
distinctions from all admissions of persons aged
55 and older (see table). Most notable is the
difference in ethnicity, with a majority of all
admissions (64.9) being White while only a
minority (39.7) of those admitted for problems
with other drugs were White. The proportion of
African-Americans was 22.8 in the total sample
but 41.8 among those whose problem was with
drugs other than alcohol. This is striking given
that a majority of drug users in America are
White but such over-representations of minorities
are not an uncommon feature of the operations of
drug policy in the United States. In making
policy analyses based on clinical data one should
always be aware of the possibility of the
clinicians fallacy in generalizing from
patient populations to the true prevalence or
distribution of a disorder in a community. The
two groups also differed in terms of veteran
status, with 25.4 of total admissions being
veterans compared to 15.9 of other drug
admissions. Differences in living arrangements
may also be meaningful, with 15.6 of total
admissions being homeless and 10.3 in a
dependent living situation, while 13.1 of other
drug admits are homeless and 14.8 are in a
dependent living arrangement. Given the large
sample size, all differences reported in the
table are likely to meet a test of significance,
leaving the real life importance of these
observed differences open to subjective
interpretation. We found support for the
hypothesis that the aging of the baby boom
generation will be reflected in increased
treatment admissions of older persons with abuse
and addiction problems involving the currently
illicit drugs. Treatment programs and referrers
need to be aware of this shift and prepare for
it. Educational and training programs for health
care providers should reflect the need to screen
for illicit drug abuse as well as alcohol and
prescription drug abuse in the elderly. To the
extent that these older illicit drug users and
abusers are at risk of entry into the criminal
justice system they may present serious new
challenges for an already overburdened system not
prepared to deal with the greater health care
needs of the aged.
Approach

• Given the historically high levels of drug use
  among the baby boom generation we would expect
  a growing impact on admissions of older patients
  to substance abuse treatment programs.
• In order to test this hypothesis, we examined
  treatment admissions data for persons 55 and
  older in the Treatment Episode Data Set (TEDS)
  over the fifteen year period from 1992 through
  2006.