Substance Abuse Comes of Age

Surge of Older Adults & Substance Use Disorder. Are American Providers Prepared?

Copyright © 2017 Michael Walden

The number of older adult, those fifty years of age and older, is growing rapidly. Many older adults use over-the-counter (OTC) and prescription medications. With that aging population there is also a rise in the number of older adults who require treatment for Substance Use Disorder (SUD). Some estimates predict that the number of older adults requiring treatment will grow by over three-hundred percent by the year 2020 (Koechl, et al., 2012).  Research has shown that the current state of Substance Use Disorder treatment methods and resources may not recognize or be prepared for the significant rise in the number of older adults who will need substance use disorder treatment. “A lack of evidence-based studies and tailored treatment options for the aging population is evident” (Koechl, et al. 2012).

Older Adult Population Statistics

There are 108.7 million people age 50-plus in the United States. This includes 76.4 million baby boomers (born 1946-64), compared with 49 million Gen Xers and 82 million millennials. Moreover, the number of people aged 50-plus will continue to grow over the next decade to the tune of 19 million, vs. a growth of only 6 million for the 18-49 population (Gillan, 2014). The aging of the baby boom generation could fuel a seventy-five percent increase in the number of Americans aged 65 or older requiring nursing home care. In 2010 the number was approximately 1.3 million. Current estimates place that number at approximately 2.3 million in the year 2030.

Issues & Implications

Ninety percent of older adults, those 50 years of age or older, use prescription and OTC (over-the-counter) medications and at least twenty-five percent of those use psychoactive medications. It is predicted that by the year 2020 the number of older adults with a “past year” Substance Use Disorder (SUD) will double, growing from approximately 2.8 million in the years 2002 to 2006, to nearly 5.7 million (see chart in Appendix A).

The above estimates are very likely to exceed 5.7 million because people in nursing homes and assisted living residences where access to medications that can be abused is highly likely are often overlooked in screening for SUD. Add to this that those responding to studies may under report substance use and SUD symptoms and the problems involved become nearly overwhelming (Han, et al., 2009). Increased life expectancy and the higher substance use rates of the baby boomer generation additionally affect these estimates (Lintzeris, et al. 2016).

Current Barriers to Effective Treatment

Several studies have shown that substance abuse in older adults is often times misdiagnosed, under-diagnosed, under-treated and, too often, even goes untreated. Symptoms of SUD are overlooked and mistakenly attributed to symptoms of the aging process or common maladies in older adults.

The screening and addressing of SUDs is not a routine function of primary care and specialist physicians. Of the 1,8 million treatment admissions in 2005, only 11,300 (0.06%) were older adults. Substance abuse disorder symptoms can often imitate issues related to aging in older adults. Problems like confusion and mental deterioration make it more difficult to diagnose SUD because of their similarity to dementia or Alzheimer’s disease.

Sociological factors can also play a part as barriers to treatment. Loneliness and isolation along with an increased use of alcohol and the misuse of prescription medications and the late-onset of SUDs often go unnoticed as people age, especially after retirement (Rothrauff, et.al. 2011).

In addition, older adults are less likely and often reluctant to report substance abuse disorder symptoms and ask for help because of the stigma and shame attached to SUDs. In fact, older adults may feel the shame and stigma more strongly because of their age and avoid addressing the problem altogether (Rothrauff, et.al. 2011).

Prescription Medications

Approximately twenty-five percent of prescribed medications are given to older adults. An increase in the prevalence of prescribed medications to older adults has increased those estimates to approximately one-third of all prescribed substances. More alarming is the fact that opioids and benzodiazepines are becoming more frequently prescribed to those over 50 years of age (Koechl, et al., 2012).

Illegal drug abuse or addiction in older adults is relatively low, but as baby boomers age, the numbers are expected to increase. Approximately 2.6% reported the use of marijuana, 0.41% reported cocaine. About 4% of those age 50-64 reported marijuana use while only 0.7% of those 64 and older reported using marijuana (Koechl, et al., 2012).

Treatment Resources

 

As can be seen above, the data from 346 private treatment centers shows that only 63 (18%) of those centers provided “special services (i.e., separate tracks, special groups, or lectures/services) for older adults” (Rothrauff, et.al. 2011).

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that as of 2006 only 7% of substance abuse treatment facilities in the United States had programs designed specifically for older adults.

Treatment Methods

Older adults appear to respond well to a variety of treatment methods but especially to a supportive and non-confrontational atmosphere, a slower treatment pace, cognitive behavioral approaches and methods designed to address the older adult’s distinctive psychosocial and health needs. Integrating primary care with substance abuse disorder treatment has also proven effective. Older adults tend to visit their physicians regularly and because early intervention and continued care are required, primary care physicians can play an important role in screening older adults for substance abuse disorder (Han, et al. 2009).

Conclusion

The population of adults fifty years old and above is taking on a dramatic increase. Along with this increase, the number of those older adults that will require treatment for substance use disorders as well as the other health concerns of older adults is also on the rise.

Though the use of and dependence on illicit drugs is relatively small compared to that of younger adults, issues with prescription medications are increasingly the cause of many SUD situations.

The number of programs designed specifically for older adults is low compared to the predicted needs in the coming years. One of the most effective procedures is to integrate substance use disorder screening with primary care.

Based on current research, it would appear that providers in the United States are not prepared for the problems that are inevitable as the number of older adults rises to levels that are at a historic high. More research into methods and program design are is needed now, before the problems become overwhelming.

References

Gillan, B. (2014, May 14). Top 10 Demographics & Interests Facts About Americans Age 50. Retrieved October 27, 2017, from http://blog.aarp.org/2014/05/14/top-10-demographics-interests-facts-about-americans-age-50/

Han, B., Gfroerer, J. C., Colliver, J. D., & Penne, M. A. (2009). Substance use disorder among older adults in the United States in 2020. Addiction, 104(1), 88-96. doi:10.1111/j.1360-0443.2008.02411.x

Koechl, B., Unger, A., & Fischer, G. (2012). Age-related aspects of addiction. Gerontology, 58(6), 540-544. doi:10.1159/000339095

Lintzeris, N., Rivas, C., Monds, L. A., Leung, S., Withall, A., & Draper, B. (2016). Substance use, health status and service utilisation of older clients attending specialist drug and alcohol services. Drug And Alcohol Review, 35(2), 223-231. doi:10.1111/dar.12266

Mather, M. (2016, January). Fact Sheet: Aging in the United States. Retrieved November 22, 2017, from http://www.prb.org/Publications/Media-Guides/2016/aging-unitedstates-fact-sheet.aspx

Ortman, Jennifer M., Velkoff, Victoria A., and Hogan, Howard (2014). An Aging Nation: The Older Population in the United States, U.S. Census Bureau report # P25-1140

Rothrauff, T. C., Abraham, A. J., Bride, B. E., & Roman, P. M. (2011). Substance abuse treatment for older adults in private centers. Substance Abuse, 32(1), 7-15. doi:10.1080/08897077.2011.540463

Substance Abuse and Mental Health Services Administration. Office of Applied Studies. National Survey of Substance Abuse Treatment Services (N_SSAT): 2006. Data on Substance Abuse Treatment Facilities, DASIS Series: S39, DHHHS publication no. (SMA) 07-4296, Rockville, MD. 2007.

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