Evidence-Based Reviews

Substance abuse among older adults: A growing problem

Current Psychiatry. 2018 March;17(3):14-20

James Cho, MD

Jay Bhimani, MD

Milapkumar Patel, MD

Matthew Navin Thomas, MBBS

Maintaining vigilance is the key to effective recognition and treatment.

PDF Download

References

1. Kuerbis A, Sacco P, Blazer DG, et al. Substance abuse among older adults. Clin Geriatr Med. 2014;30(3):629-654.
2. Taylor MH, Grossberg GT. (2012). The growing problem of illicit substance abuse in the elderly: a review. Prim Care Companion CNS Disord. 2012;14(4):PCC.11r01320. doi: 10.4088/PCC.11r01320.
3. Cummings SM, Bride B, Rawlings-Shaw AM. Alcohol abuse treatment for older adults: a review of recent empirical research. J Evid Based Soc Work. 2006;3(1):79-99.
4. Substance Abuse and Mental Health Services Administration. Results from the 2012 national survey on drug use and health: summary of national findings, NSDUH Series H-46, HHS Publication No (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Service Administration; 2013.
5. Substance Abuse and Mental Health Services Administration. Results from the 2013 national survey on drug use and health: summary of national findings. NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
6. Ekeh AP, Parikh P, Walusimbi MS, et al. The prevalence of positive drug and alcohol screens in elderly trauma patients. Subst Abus. 2014;35(1):51-55.
7. Wu LT, Blazer DG. Illicit and nonmedical drug use among older adults: a review. J Aging Health. 2011;23(3):481-504.
8. Roe B, Beynon C, Pickering L, et al. Experiences of drug use and ageing: health, quality of life, relationship and service implications. J Adv Nurs. 2010;66(9):1968-1979.
9. Zimmerman JL. Cocaine intoxication. Crit Care Clin. 2012;28(4):517-526.
10. Weber JE, Chudnofsky CR, Boczar M, et al. Cocaine-associated chest pain: how common is myocardial infarction? Acad Emerg Med. 2000;7(8):873-877.
11. Kalapatapu RK, Vadhan NP, Rubin E, et al. A pilot study of neurocognitive function in older and younger cocaine abusers and controls. Am J Addict. 2011;20(3):228-239.
12. Edelman EJ, Cheng DM, Krupitsky EM, et al. Heroin use and HIV disease progression: results from a pilot study of a Russian cohort. AIDS Behav. 2015;19(6):1089-1097.
13. Darke S, Mills KL, Ross J, et al. The ageing heroin user: career length, clinical profile and outcomes across 36 months. Drug Alcohol Rev. 2009;28(3):243-249.
14. West LA, Cole S, Goodkind D, et al. U.S. Census Bureau, P23-212. 65+ in the United States: 2010. Washington, DC: United States Census Bureau; 2014.
15. Boss GR, Seegmiller JE. Age-related physiological changes and their clinical significance. West J Med. 1981;135(6):434-440.
16. Ruiz P, Strain EC, Langrod JG. The substance abuse handbook. Philadelphia, PA: Wolters Kluwer Health; 2007.
17. Gray KM, Watson NL, Carpenter MJ, et al. N-acetylcysteine (NAC) in young marijuana users: an open-label pilot study. Am J Addict. 2010;19(2):187-189.
18. Gray KM, Carpenter MJ, Baker NL, et al. A double-blind randomized controlled trial of N-acetylcysteine in cannabis-dependent adolescents. Am J Psychiatry. 2012;169(8):805-812.
19. Martell BA, Orson FM, Poling J, et al. Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients: a randomized, double-blind, placebo-controlled efficacy trial. Arch Gen Psychiatry. 2009;66(10):1116-1123 
20. Kosten TR, Domingo CB, Shorter D, et al. Vaccine for cocaine dependence: a randomized double-blind placebo-controlled efficacy trial. Drug Alcohol Depend. 2014;140:42-47.
21. Gao Y, Brimijoin S. An engineered cocaine hydrolase blunts and reverses cardiovascular responses to cocaine in rats. J Pharmacol Exp Ther. 2004;310(3):1046-1052.
22. Vadivelu N, Hines RL. Management of chronic pain in the elderly: focus on transdermal buprenorphine. Clin Interv Aging. 2008;3(3):421-430.
23. Al-Tawil N, Odar-Cederlöf I, Berggren AC, et al. Pharmacokinetics of transdermal buprenorphine patch in the elderly. Eur J Clin Pharmacol. 2013;69(2):143-149.
24. Schultz SK, Arndt S, Liesveld J. Locations of facilities with special programs for older substance abuse clients in the US. Int J Geriatr Psychiatry. 2003;18(9):839-843.
25. Schonfeld L, Dupree LW, Dickson-Fuhrman E, et al. Cognitive-behavioral treatment of older veterans with substance abuse problems. J Geriatr Psychiatry Neurol. 2000;13(3):124-129.

Baby Boomers—a term used to refer to individuals born in the United States between 1946 and 1964—are now approaching old age. Surprisingly, these older adults are using illicit substances in a pattern not seen in prior generations of older adults, including developing substance use disorders (SUDs) at increasingly higher rates; in previous generations, the prevalence of such disorders typically lowered with advancing age.

This article discusses how to recognize and treat SUDs in older adults. Alcohol is the most commonly used substance among older adults,¹and there is a largebody of literature describing the identification and treatment of alcohol-related disorders in these patients. Therefore, this article will instead focus on older adults’ use of illicit substances, including marijuana, cocaine, and heroin.

Epidemiology

Prior clinical data regarding substance abuse in older adults focused on alcohol, prescription drugs, nicotine, and caffeine.²In the past, compared with younger adults, older adults had lower rates of alcohol and other illicit drug use.^3,4 Baby Boomers appear to be defying this trend.

A 2013 Substance Abuse and Mental Health Services Administration survey found that the percentage of adults ages 50 to 64 who used illicit substances increased from 2.7% in 2002 to 6.0% in 2013.⁵ Specifically, during that time, past-month illicit substance use increased from 3.4% to 7.9% among those ages 50 to 54, from 1.9% to 5.7% among those ages 55 to 59, and from 2.5% to 3.9% among those ages 60 to 64.⁵

More recently, a 2014 study of geriatric patients found that of the 1,302 patients age ≥65 admitted to a Level 1 trauma center, 48.3% had a positive urine drug screen.⁶Someresearchers have estimated that 5.7 million older adults will require treatment for a substance use disorder in 2020, which is roughly double the 2.8 million who had an SUD in 2002 to 2006.⁷

Risk factors and patterns of substance abuse

Individual, social, and familial factors can contribute to substance use and abuse in late life. The Table¹ outlines some of the potential risk factors for older adults associated with the use of illicit substances. Substance abuse among older adults can be divided into 2 broad categories: early onset (starting before age 50) and late onset (starting after age 50).⁸ While data are limited, in general, early-onset use is a more common pattern; late-onset use represents an estimated <10% of substance use among older adults. The factors that lead some adults to continue substance use in late life, or to begin substance use later in life, have not been thoroughly evaluated.