LongTerm Consequences of Heroin and Cocaine Addiction

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Long-Term Consequences of Heroin and Cocaine
Addiction

• Yih-Ing Hser, Ph.D.
• UCLA Integrated Substance Abuse Programs
• Drug Abuse in the 21st Century
• What Problems Lie Ahead for the Baby Boomers?
• September 2004

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• Background
• 33-year follow-up of a heroin sample
• 12-year follow-up of a cocaine sample

• Relevance
• Many in old ages
• Natural history data

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Overview

• Long-term substance use trajectories
• Mortality/morbidity
• Mental health

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Sample Characteristics
Baby boomers
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Average Ages at Key Events Over Lifespan
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Mortality Rates
Increase with Age
Heroin Sample Has a Higher Mortality Rate
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Cumulative Percent of Reporting Ever Used by Age
at First Use
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Percent of Any Weekly Drug Use Over Time
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Past Year Use
Still High
among Older Addicts
Based on self-report and urinalysis
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Rates of Abstinence (for 5 or More Years)
Increase
with Age
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Alcohol Dependence in the Past 12 Months
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Older Ages Reporting
Worse
Health Functioning
Higher scores indicate better functioning and
health
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Older Ages Reporting
More
Health/Medical Conditions
1Hypertension, Hardening of arteries/heart
attack, Other 2Asthma, Emphysema/Lung Cancer,
TB 3Cirrhosis, Hepatitis, Ulcer, Hernia rapture,
Spastic colon 4AIDS/HIV, Gonorrhea, Syphilis,
Herpes, Others
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Medical Testing Results Show
High
Levels of Cardiovascular Risk

• Over half (58.3) had hypertension
• One-fifth (22.4) had high total cholesterol
• Over half (54.6) were overweight (using
  body/mass index)

Heroin subsample
Source Hser et al., Journal of Behavioral
Medicine (in press)
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Medical Testing Results Show
High
Levels of Infectious Diseases

• Four-fifths (85.6) tested positive for Hepatitis
  B
• Nearly all (94.2) tested positive for Hepatitis
  C
• Over one-quarter (27.3) had a positive TB skin
  test
• Nearly one-quarter (23.8) tested positive for
  syphillis
• HIV rate was very low (1.8)
• Heroin subsample

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High
Medical Testing Results Show
Levels of Abnormal Functions

• More than half had abnormal liver function by at
  least one indicator (ALT, AST, billirubin)
• 18.8 had diabetes
• 27-35 had abnormal pulmonary function
• Heroin subsample

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Mental Health Problems
Increase
with Age among Cocaine Sample
Higher scores indicate greater problem severity
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Abstinence from Primary Drug Show
Better
Health Functioning
Higher scores indicate better functioning and
health
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Abstinence from Primary Drug Show
Better
Health/Medical Conditions
1Hypertension, Hardening of arteries/heart
attack, Other 2Asthma, Emphysema/Lung Cancer,
TB 3Cirrhosis, Hepatitis, Ulcer, Hernia rapture,
Spastic colon 4AIDS/HIV, Gonorrhea, Syphilis,
Herpes, Others
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Abstinence from Primary Drug Show
Better
Mental Health
Higher scores indicate greater problem severity
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Conclusions

• Overall
• Chronicity of addiction
• Adverse consequences
• elevated mortality, particularly heroin
• health/medical problems
• mental health problems

• Older ages
• Substance use (heroin, alcohol) persist in older
  ages
• Greater health and mental health problems

• Abstinence
• Increases with age
• Less health and mental health problems