Transcript Slide 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
Introduction
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.
Thomas Nicholson, MPH, PhD,
John B. White, PhD,
John Bonaguro, PhD, Dean
College of Health and Human Services
Western Kentucky University
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.
Aged 55+ Admissions by Primary Substance
90,000
80,000
70,000
60,000
55+ Admissions
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 highquality services to older adults and that most of America’s 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 boomer’s 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.
Results
50,000
All
Alcohol
40,000
Other
30,000
20,000
10,000
0
Variable
Gender
Level
MALE
FEMALE
All Drug Admits Other Drug Admits
n
%
n
%
734,774
80.4 152,267
77.5
179,388
19.6 44,222
22.5
Ethnicity
ALASKAN NATIVE
AMERICAN INDIAN
ASIAN OR PACIFIC ISLANDER
BLACK
WHITE
OTHER SINGLE RACE
TWO OR MORE RACES
3,912
21,767
5,868
206,241
587,152
79,027
507
0.4
2.4
0.6
22.8
64.9
8.7
0.1
733
1,613
2,746
81,512
77,347
30,864
184
0.4
0.8
1.4
41.8
39.7
15.8
0.1
Marital
Status
NEVER MARRIED
NOW MARRIED
SEPARATED
DIVORCED/WIDOWED
116,189
198,105
54,696
299,029
17.4
29.7
8.2
44.8
30,614
27,007
12,929
49,468
25.5
22.5
10.8
41.2
Education
< 8 Years
9-11
12
13-15
16+ Years
142,747
177,079
331,626
140,887
95,791
16.1
19.9
37.3
15.9
10.8
26,577
48,000
74,653
31,650
12,762
13.7
24.8
38.6
16.3
6.6
Veteran
YES
NO
133,377
391,392
25.4
74.6
15,843
83,666
15.9
84.1
Living
HOMELESS
DEPENDENT
INDEPENDENT
110,097
72,503
522,728
15.6
10.3
74.1
17,269
19,585
95,299
13.1
14.8
72.1
Income
WAGES/SALARY
PUBLIC ASSISTANCE
RETIREMENT/PENSION/DISABILITY
OTHER
NONE
124,041
46,128
118,922
125,345
81,506
25.0
9.3
24.0
25.3
16.4
17,043
12,718
17,763
26,874
16,610
18.7
14.0
19.5
29.5
18.3
Employment FULL-TIME
150,705
17.4 22,618
PART-TIME
44,925
5.2
8,635
UNEMPLOYED
148,916
17.2 40,262
NOT IN LABOR FORCE
523,735
60.3 118,882
Note: n for each variable differs from 918,955 because of missing data.
11.9
4.5
21.1
62.4
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 “clinician’s 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.