Generational Shift and Drug Abuse in the Aged John White, Ph.D. WKU

1. Generational Shift and Drug Abuse in the Aged John White, Ph.D. WKU David F. Duncan, Dr.P.H. Duncan & Associates Question: Has the Use of Illicit Drugs in the Population Over 50 Increased over the Past Two Decades Introduction Unrecognized Drugs Substance abuse, particularly of alcohol and prescription drugs, among adults 60 and older has been identified as one of the fastest growing health problems facing the nation. Even as the number of older adults suffering from these disorders climbs, the Center for Substance Abuse Treatment warns that the situation “remains underestimated, underidentified, underdiagnosed, and undertreated” (CSAT 1998). Until relatively recently, substance abuse by the elderly was not addressed by either the substance abuse or the gerontological literature (CSAT 1998). Over the past several decades, there has been a growing recognition of abuse of alcohol and of prescription and over-the-counter medications by the elderly. The consensus view has been that alcohol abuse and misuse is the major substance abuse problem among older adults, affecting some 2.5 million older adults, with abuse of legal medications being a smaller problem of unclearly assessed numbers. Abuse of illicit drugs has been seen as not being a problem in this population (Schonfeld &Dupree 1985). We suggest that this assessment of the situation may no longer be valid and that increasing attention needs to be paid to possible abuse of illicit drugs by elder Americans as the “baby boomers” reach retirement age. According to Sigel (1996): “Between 2010 and 2030, the population aged 65 and over is expected to grow by 75 percent to over 69 million. During the 2030 to 2050 period, the growth rate is projected to increase 14 percent, and the number of elderly is expected to increase to about 79 million. Because the growth of the elderly population in the early period is not much different from that of the population under age 65, the proportion of elderly in the population will not change significantly between now and 2010, remaining at approximately 13 percent. However, from 2010 to 2030, the growth rate of the elderly exceeds that of the population under age 65, so that the proportion of the elderly in the overall total increases sharply to 20 percent. Thereafter, at least until 2050, the age segments of the population grow rather evenly and the percentage of the elderly in the overall population remains unchanged.” Given the historically high levels of drug use among this generation, the impact on the prevalence of drug problems among the elderly population should be substantial. It remains to be seen how many baby boomers will continue their drug use in later life. Furthermore, the same amount of drug taken at the age of 25 may have markedly different effects when consumed at the age of 75. It remains uncertain how many baby boomers will develop a problem as a result of continuing to use drugs. Data are from the National Household Survey on Drug Abuse (1985; n=1,103) and the National Survey on Drug Use and Health (2006; n=5830) As can be seen from Table 2, tobacco use has declined over the period. Prevalence of alcohol use has remained largely the same. Current use has increased while the number of abstainers has remained much the same. All estimates are based upon weighted data Prescription Drugs Illicit Drugs Discussion References Our results show, as would be expected, a decline in the prevalence of current (past month) cigarette smoking and an increase in the proportion who never smoked cigarettes among older Americans. Alcohol use, on the other hand, presents nearly identical results among respondents in 2006 and those in 1985. The change in prevalences of prescription drugs is smaller but in all four categories studied there was a decline in the percent that had never used.  We found clear support for our hypothesis that the population of elder Americans in 2006 would contain greater proportions of persons who had used and who currently used illicit drugs than older Americans in 1985. The proportion who had ever used increased for all six categories of illicit drugs studied. Current (past month) use was greater for marijuana (1.6 % v. 0.3%), cocaine (0.3% v 0.1%), and inhalants (0.1% v 0%). While these percentages may look small it should be remembered that this amounts to an estimated increase of 1,268,262 in the number of elder Americans who are currently using marijuana, 140,422 cocaine users, and 56,547 inhalant users.  Of course, not all of these older users of illicit drugs have an addiction or abuse problem. Generally speaking, only about 10% to 20% of the users of a drug (other than tobacco) ever develop an abuse problem (Anthony & Helzer, 1991; Duncan, White & Nicholson, 2003; Nicholson, Duncan & White, 2002). This still suggests that there has been a substantial increase in the numbers of elder Americans who abuse illicit drugs. We can no longer assume that substance abuse among the elderly refers only to problems with alcohol, prescription drugs, and over-the-counter medications.  The NHSDA and its successor the NSDUH are both designed to be highly representative of the U.S. population aged 12 and older but we must keep in mind that it was not designed primarily to be representative of older Americans. In fact, the federal government has no categorization that would be applicable for this group. The only age variable released for public use classifies all persons aged 65 and over together. We are also relying on self-report data with all the limitations inherent in the use of such data. While normally we might expect exaggeration of some behaviors, there is evidence that recreational use of drugs (both prescription and illicit) are underreported in these surveys.  It also should be noted that the increase found in marijuana use may not only be a result of trends that emerged in the 1960s and 1970s but may also represent increased use of medical marijuana in more recent years. While it is unlikely that medical marijuana users will develop an abuse problem, the likelihood that their numbers are increasing is a situation that could present important issues for professionals working with these users, especially in skilled nursing facilities or other residential settings. Anthony, J. C., & Helzer, J. A. (1991). Syndromes of drug abuse and dependency. In L. N. Robins & D. A. Regier (Eds.), Psychiatric disorders in America (pp. 116-154). Free Press, New York.  Center for Substance Abuse Treatment. (1998). Substance abuse among older adults. Treatment Improvement Protocol (TIP) Series, Number 26. DHHS Publication No. (SMA) 01-3496. Rockville, MD: Substance Abuse and Mental Health Services Administration.  Duncan, D., White, J., and Nicholson, T. (2003). Using internet-based surveys to reach hidden populations: Case of nonabusive illicit drug users. American Journal of Health Behavior, 27, 208-218.  Nicholson, T., Duncan, D. F., & White, J. (2002). Is recreational drug use normal? Journal of Substance Use, 7, 116-123. Schonfeld, L., and Dupree, L.W. . Treatment approaches for older problem drinkers. International Journal of the Addictions . 30(13&14):1819-1842, :1995.  Siegel, J. (1996). Aging into the 21st century. Special Report to the Administration on Aging. Access online http://www.aoa.dhhs.gov/prof/Statistics/future_growth/aging21/aging_21.asp