alcohol & other drug training project “older women and substance use: present problems,...
TRANSCRIPT
Alcohol & Other Alcohol & Other Drug Training Drug Training
ProjectProject
www.asaging.org/aodwww.asaging.org/aod
““OLDER WOMEN AND SUBSTANCE USE: OLDER WOMEN AND SUBSTANCE USE: PRESENT PROBLEMS, FUTURE TRENDS”PRESENT PROBLEMS, FUTURE TRENDS”PATRICIA LENAHAN, LCSW, LMFT, BCETSPATRICIA LENAHAN, LCSW, LMFT, BCETS
OBJECTIVESOBJECTIVES
IDENTIFY SUBSTANCES MOST IDENTIFY SUBSTANCES MOST FREQUENTLY MISUSED BY OLDER FREQUENTLY MISUSED BY OLDER WOMENWOMEN
IDENTIFY WOMEN MOST AT RISKIDENTIFY WOMEN MOST AT RISK
OBJECTIVESOBJECTIVES
DISCUSS POSSIBLE TRENDS IN SUBSTANCE DISCUSS POSSIBLE TRENDS IN SUBSTANCE ABUSE AMONG AGING BABY BOOMERSABUSE AMONG AGING BABY BOOMERS
ADDRESS POTENTIAL SERVICE AND ADDRESS POTENTIAL SERVICE AND TREATMENT NEEDSTREATMENT NEEDS
SUBSTANCES MISUSED AND SUBSTANCES MISUSED AND ABUSED BY OLDER WOMENABUSED BY OLDER WOMEN
NICOTINENICOTINE
ALCOHOLALCOHOL
PRESCRIPTION DRUGSPRESCRIPTION DRUGS
ANYTHING ELSE? YES!ANYTHING ELSE? YES!
ILLICIT OR ILLEGAL DRUGS ILLICIT OR ILLEGAL DRUGS
Number of Americans >65 (Millions)
3 59
17
26
3539
53
69
0
10
20
30
40
50
60
70
1900 1920 1940 1960 1980 2000 2010 2020 2030
U.S. Bureau of Census
WHY FOCUS ON OLDER WHY FOCUS ON OLDER WOMEN?WOMEN?
““ADDICTION AMONG OLDER WOMEN IS ADDICTION AMONG OLDER WOMEN IS HIDDEN IN THEIR OWN SHAME, SWEPT HIDDEN IN THEIR OWN SHAME, SWEPT UNDER THE RUG OF DENIAL OF FAMILY UNDER THE RUG OF DENIAL OF FAMILY MEMBERS AND LOST IN THE SHADOWS OF MEMBERS AND LOST IN THE SHADOWS OF MEDICAL PRACTICE.”MEDICAL PRACTICE.”
SUSAN FOSTERSUSAN FOSTER
NATIONAL CENTER ON ADDICTION AND NATIONAL CENTER ON ADDICTION AND SUBSTANCE ABUSE, COLUMBIA UNIVERSITYSUBSTANCE ABUSE, COLUMBIA UNIVERSITY
OLDER WOMEN AND OLDER WOMEN AND SUBSTANCE ABUSESUBSTANCE ABUSE
SYMPTOMS OF SUBSTANCE ABUSE IN SYMPTOMS OF SUBSTANCE ABUSE IN MATURE WOMEN ARE ATTRIBUTED MATURE WOMEN ARE ATTRIBUTED TO OTHER CONDITIONS SUCH AS TO OTHER CONDITIONS SUCH AS ANXIETY AND DEPRESSIONANXIETY AND DEPRESSION
STIGMA: HIDDEN BY WOMEN WHO STIGMA: HIDDEN BY WOMEN WHO ARE IN DENIAL OR ASHAMEDARE IN DENIAL OR ASHAMED
OLDER WOMEN AND OLDER WOMEN AND SUBSTANCE ABUSESUBSTANCE ABUSE
FEAR OF BEING LABELED A “JUNKIE”FEAR OF BEING LABELED A “JUNKIE”
TOLERATED BY FRIENDS AND FAMILY TOLERATED BY FRIENDS AND FAMILY WHO “LET GRANNY HAVE HER WHO “LET GRANNY HAVE HER TRANQUILIZER” BECAUSE IT MAKES TRANQUILIZER” BECAUSE IT MAKES HER FEEL GOOD AND EASIER TO BE HER FEEL GOOD AND EASIER TO BE AROUNDAROUND SIMONI-WASTILA, 2005SIMONI-WASTILA, 2005
PREVALENCE OF ALCOHOL PREVALENCE OF ALCOHOL USE/MISUSEUSE/MISUSE
Depends on definition of at-risk or problem drinking:
1-15% of older adults are at-risk or problem drinkers
Differs with sampling approach Alcohol use problems are the most
common substance issues for older adults. Confounded by prescription, herbal, and over-the-counter medications
Prevalence Prevalence (continued)(continued)
Older adults with alcohol use Older adults with alcohol use problems are not recognized by problems are not recognized by many professionalsmany professionals
Few older adults with alcohol Few older adults with alcohol abuse or dependence seek help abuse or dependence seek help in specialized addiction in specialized addiction treatment settingstreatment settings
Older women are recognized Older women are recognized less often than older males with less often than older males with alcohol problemsalcohol problems
©2002 Microsoft Corporation
Drinking GuidelinesDrinking Guidelines
No more than 1 standard drink No more than 1 standard drink per dayper day
No more than 2-3 drinks on No more than 2-3 drinks on any drinking day (binge any drinking day (binge drinking)drinking)
Limits for older Limits for older women are women are less than for olderless than for oldermenmen
(Source: NIAAA, 1995; (Source: NIAAA, 1995;
Dufour & Fuller, 1995)Dufour & Fuller, 1995)
Drinking Guidelines Drinking Guidelines (continued)(continued)
Recommendations consistent with data Recommendations consistent with data on benefits/risks of drinking in this age on benefits/risks of drinking in this age groupgroup
Lower limits for older adults because: Lower limits for older adults because: IIncreased alcohol sensitivity with agencreased alcohol sensitivity with age Greater use of contraindicated medicationsGreater use of contraindicated medications Less efficient liver metabolismLess efficient liver metabolism Less body mass/fat increases circulating Less body mass/fat increases circulating
levelslevels
AT-RISK DRINKING STUDYAT-RISK DRINKING STUDY
BLOW ET AL, 2000:BLOW ET AL, 2000: NINE OR MORE DRINKS PER WEEK FOR NINE OR MORE DRINKS PER WEEK FOR
WOMENWOMEN TWELVE OR MORE DRINKS FOR MENTWELVE OR MORE DRINKS FOR MEN
THIS IS HIGHER THAN THE NIAAA THIS IS HIGHER THAN THE NIAAA GUIDELINES OF SEVEN DRINKS PER GUIDELINES OF SEVEN DRINKS PER WEEK FOR MEN AND WOMEN OVER THE WEEK FOR MEN AND WOMEN OVER THE AGE OF 65AGE OF 65
AT-RISK DRINKINGAT-RISK DRINKING
FLEMING, 1996FLEMING, 1996
12% OF WOMEN OVER AGE 60 DRANK 12% OF WOMEN OVER AGE 60 DRANK MORE THAN SEVEN DRINKS PER WEEKMORE THAN SEVEN DRINKS PER WEEK
Alcohol Use Patterns Alcohol Use Patterns (continued)(continued)
Older Adults and Alcohol UseOlder Adults and Alcohol Use
Increased risk of:Increased risk of: Stroke (with overuse)Stroke (with overuse) Impaired motor skills (e.g., Impaired motor skills (e.g.,
driving) at low level usedriving) at low level use Injury (falls, accidents)Injury (falls, accidents) Sleep disordersSleep disorders SuicideSuicide Interaction with dementia Interaction with dementia
symptomssymptoms©2002 Microsoft Corporation
Older Adults and Use Older Adults and Use (continued)(continued)WOMEN MAY BE MORE SUSCEPTABLE!!WOMEN MAY BE MORE SUSCEPTABLE!!
Other effects:Other effects: Higher blood alcohol concentrations Higher blood alcohol concentrations
(BAC) from dose(BAC) from dose More impairment from BACMore impairment from BAC Medication effects:Medication effects:
• Potential interactionsPotential interactions• Increased side effects Increased side effects • Compromised metabolizing Compromised metabolizing
(especially psychoactive medications, (especially psychoactive medications, benzodiazepines, barbiturates, benzodiazepines, barbiturates, antidepressants, digoxin, warfarin)antidepressants, digoxin, warfarin)
©2002 Microsoft Corporation
ALCOHOL AND PAIN ALCOHOL AND PAIN MANAGEMENTMANAGEMENT
(CURRENT OPIN PSYCHIATRY, 2006)(CURRENT OPIN PSYCHIATRY, 2006)
SIGNIFICANT AREA OF NEW SIGNIFICANT AREA OF NEW RESEARCHRESEARCH
USE OF ALCOHOL IN PAIN USE OF ALCOHOL IN PAIN MANAGEMENT WITH OR WITHOUT MANAGEMENT WITH OR WITHOUT DRINKING PROBLEMSDRINKING PROBLEMS
ALCOHOL AND PAINALCOHOL AND PAIN
PROBLEM DRINKERS REPORTED MORE PROBLEM DRINKERS REPORTED MORE SEVERE PAIN LIKELY TO INTERFERE WITH SEVERE PAIN LIKELY TO INTERFERE WITH ADL’S AND MORE FREQUENT USE OF ADL’S AND MORE FREQUENT USE OF ALCOHOL TO MANAGE PAINALCOHOL TO MANAGE PAIN
NEED TO INTEGRATE PAIN ASSESSMENT NEED TO INTEGRATE PAIN ASSESSMENT WITH ALCOHOL SCREENING IN OLDER WITH ALCOHOL SCREENING IN OLDER ADULTSADULTS
General Issues for Older AdultsGeneral Issues for Older Adults
Loss (status, people, Loss (status, people, vocation, health, etc.)vocation, health, etc.)
Social isolation, Social isolation, lonelinessloneliness
Major financial Major financial problemsproblems
Housing changesHousing changes Family concernsFamily concerns Time management Time management
burdenburden
Complex medical Complex medical issuesissues
Multiple medicationsMultiple medications Sensory deficitsSensory deficits Reduced mobilityReduced mobility Cognitive Cognitive
impairmentsimpairments Impaired self-care, Impaired self-care,
loss of independenceloss of independence
Signs of Potential Alcohol ProblemsSigns of Potential Alcohol Problems(ADAPTED FROM BARRY ETAL, 2000)(ADAPTED FROM BARRY ETAL, 2000)
Anxiety, depression, excessive Anxiety, depression, excessive mood swingsmood swings
Blackouts, dizziness, idiopathic Blackouts, dizziness, idiopathic seizuresseizures
DisorientationDisorientation Falls, bruises, burnsFalls, bruises, burns HeadachesHeadaches IncontinenceIncontinence Memory lossMemory loss Unusual response to Unusual response to
medicationsmedications
Poor hygienePoor hygiene Poor nutritionPoor nutrition Sleep problemsSleep problems Family problemsFamily problems Financial problemsFinancial problems Legal difficultiesLegal difficulties Social isolationSocial isolation Increased alcohol toleranceIncreased alcohol tolerance New difficulties in decision New difficulties in decision
makingmaking
Special PopulationsSpecial Populations
Barriers to effective Barriers to effective identification exist for:identification exist for: WomenWomen Certain minority group Certain minority group
members/lack of culturally members/lack of culturally competent tools and competent tools and interventionsinterventions
Individuals with physical Individuals with physical disabilities, comorbiditiesdisabilities, comorbidities
HomeboundHomebound©2002 Microsoft Corporation
Co-morbid ConditionsCo-morbid Conditions
Impaired Activities of Impaired Activities of Daily Living (ADL’s)Daily Living (ADL’s)
Psychiatric symptoms, Psychiatric symptoms, mental disordersmental disorders
Alzheimer’s diseaseAlzheimer’s disease Sleep disordersSleep disorders ©2002 Microsoft Corporation
Co-morbidity is a serious, common Co-morbidity is a serious, common concern among older adults using concern among older adults using alcohol:alcohol:
Risk Factors for Prescription Risk Factors for Prescription Drug Misuse and Abuse - Drug Misuse and Abuse -
General PopulationGeneral Population Most consistent correlates in the Most consistent correlates in the
general population for Rx misuse and general population for Rx misuse and addictionaddiction Female genderFemale gender Young ageYoung age Older ageOlder age White raceWhite race High SESHigh SES Poor physical healthPoor physical health Mental illnessMental illness
Prescription Drug Misuse Prescription Drug Misuse Any Rx drug can be “misused”Any Rx drug can be “misused” Misuse = “Non-medical use” = Any use that is Misuse = “Non-medical use” = Any use that is
outside of medically prescribed regimen, eg:outside of medically prescribed regimen, eg: Non-compliance Non-compliance Taking different doseTaking different dose SharingSharing Obtaining from non-medical sourceObtaining from non-medical source Taking for psychoactive effects Taking for psychoactive effects Use with alcoholUse with alcohol
Prescription Drug AbusePrescription Drug Abuse
Abuse = use resulting inAbuse = use resulting in Decline in work, school, or home performanceDecline in work, school, or home performance Legal problemsLegal problems Use in risky situationsUse in risky situations Continued use despite social/personal Continued use despite social/personal
consequences consequences (APA, DSM-IV, 1994)(APA, DSM-IV, 1994)
Prescription Drug DependencyPrescription Drug Dependency
Dependency = use resulting in Dependency = use resulting in ToleranceTolerance Withdrawal sxWithdrawal sx Decline in normal activitiesDecline in normal activities Unsuccessful attempts to cut down or control useUnsuccessful attempts to cut down or control use Use for longer period or larger amounts than intendedUse for longer period or larger amounts than intended Use consumes lot of time to acquire and/or recover from Use consumes lot of time to acquire and/or recover from
effectseffects Continued use despite knowledge that it caused physical Continued use despite knowledge that it caused physical
and/or psychological problems and/or psychological problems (APA, DSM-IV, 1994)(APA, DSM-IV, 1994)
Extent of the Problem: Medical Extent of the Problem: Medical ExposureExposure
General US populationGeneral US population11
Women = 20.0% Women = 20.0% Men = 12.5%Men = 12.5%
Among elders aged 65 and older, 21.7%, Among elders aged 65 and older, 21.7%, or 7.22M, receive at least 1 abusable Rx or 7.22M, receive at least 1 abusable Rx annuallyannually22
Women = 24.6%Women = 24.6% Men = 17.7%Men = 17.7%
1Simoni-Wastila et al, Sub Use and Misuse, 20042Simoni-Wastila et al,, 2004
Risk Factors for Rx Misuse Risk Factors for Rx Misuse and Abuse in Older Womenand Abuse in Older Women
Among older women, possible risk Among older women, possible risk factors include:factors include: Social isolationSocial isolation Lower SES and educationLower SES and education Poor healthPoor health Current or history of behavioral health Current or history of behavioral health
problemsproblems Loss of economic and social supportLoss of economic and social support HC system factorsHC system factors
PRESCRIPTION DRUG ABUSE: IF IT PRESCRIPTION DRUG ABUSE: IF IT FEELS GOOD, DON’T TAKE IT!FEELS GOOD, DON’T TAKE IT!
KAUFMAN STUDY, JAMA, 2002:KAUFMAN STUDY, JAMA, 2002:
STUDIED THE USE OF ALL MEDICATIONS…STUDIED THE USE OF ALL MEDICATIONS…PRESCRIPTION, OTC, VITAMINS AND HERBALPRESCRIPTION, OTC, VITAMINS AND HERBAL
HIGHEST OVERALL PREVALENCE OF MEDICATIN HIGHEST OVERALL PREVALENCE OF MEDICATIN USE WAS AMONG WOMEN AT LEAST 65 YEARS USE WAS AMONG WOMEN AT LEAST 65 YEARS OF AGEOF AGE
• 12% TOOK AT LEAST 10 MEDICATIONS12% TOOK AT LEAST 10 MEDICATIONS• 23% TOOK AT LEAST 5 PRESCRIPTION DRUGS23% TOOK AT LEAST 5 PRESCRIPTION DRUGS
OLDER WOMEN AND OLDER WOMEN AND PRESCRIPTION DRUG ABUSEPRESCRIPTION DRUG ABUSE
GREATER LIKELIHOOD TO EXPOSURE GREATER LIKELIHOOD TO EXPOSURE TO PRESCRIPTIONSTO PRESCRIPTIONS
BIOLOGY: BODY SIZE, HORMONES, BIOLOGY: BODY SIZE, HORMONES, BODY FAT, METABOLIC DIFFERENCESBODY FAT, METABOLIC DIFFERENCES
PROPENSITY FOR SEEKING CARE—PROPENSITY FOR SEEKING CARE—PROPENSITY FOR TREATMENTPROPENSITY FOR TREATMENT
Social Isolation and Health Social Isolation and Health StatusStatus
CharacteristicCharacteristic Annual Prevalence of Annual Prevalence of Abusable Rx E+Abusable Rx E+
Widowed/Divorced/SeparatedWidowed/Divorced/Separated
MarriedMarried
24.6%24.6%
19.9%19.9%
Lives AloneLives Alone
Lives w/ SpouseLives w/ Spouse
23.8%23.8%
20.0%20.0%
Poor/Fair HealthPoor/Fair Health
Good/Excellent HealthGood/Excellent Health
34.2%34.2%
18.0%18.0%
0 ADLs0 ADLs
1-2 ADLs1-2 ADLs
3-4 ADLs3-4 ADLs
5-6 ADLs5-6 ADLs
17.1%17.1%
31.0%31.0%
39.0%39.0%
40.7%40.7%Simoni-Wastila et al, 2004
CONSEQUENCES OF Rx. CONSEQUENCES OF Rx. MISUSE AND ABUSEMISUSE AND ABUSE
COGNITIVE IMPAIRMENT AND COGNITIVE IMPAIRMENT AND INCREASED SEDATIONINCREASED SEDATION FALLS/INJURYFALLS/INJURY DEPRESSIONDEPRESSION SUICIDESUICIDE INTERACTIONS WITH ALCOHOL AND INTERACTIONS WITH ALCOHOL AND
OTHER DRUGSOTHER DRUGS
Substance Use - Type by Substance Use - Type by Gender – 50 and OlderGender – 50 and Older
57.7
42.3
71.1
28.9
41.9
58.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Any Illicit Use Marijuana Prescription
Male Female (2002 NSDUH)
Medical Exposure to Abusable Rx Medical Exposure to Abusable Rx Drugs by Gender and AgeDrugs by Gender and Age
12
18.620.1
27.3
20.4
28.3
19.4
24.8
0
5
10
15
20
25
30
65-69 70-74 75-79 80+
Male FemaleSimoni-Wastila et al, 2004
ETHNICITY AND ETHNICITY AND PRESCRIPTION DRUG USE: PRESCRIPTION DRUG USE:
AN EXAMPLEAN EXAMPLE
Inappropriate use of drugs effected by ethnic/cultural factors (Raji et al. 2003)
Meds may be Meds may be purchased without purchased without prescription in prescription in Mexico and other Mexico and other countries.countries.
The Internet is Becoming a Larger The Internet is Becoming a Larger Source of Prescription DrugsSource of Prescription Drugs
““The internet has become a virtual wild The internet has become a virtual wild west bazaar for “spam” emails and west bazaar for “spam” emails and websites that sell controlled substances websites that sell controlled substances with little or no oversight..” DEA, 2004with little or no oversight..” DEA, 2004
General General Information Information is available is available
on many on many drugsdrugs
(9/9/04)(9/9/04)
There are There are many sites many sites
that sell that sell prescription prescription
drugsdrugs (9/9/04) (9/9/04)
ILLICIT DRUG USEILLICIT DRUG USE
SMALL BUT INCREASING PROBLEMSMALL BUT INCREASING PROBLEM
ANOTHER HIDDEN POPULATIONANOTHER HIDDEN POPULATION
ILLICIT DRUG USE COMBINED WITH ILLICIT DRUG USE COMBINED WITH OTHER SUBSTANCES OTHER SUBSTANCES
Baby Boomers “Come of Baby Boomers “Come of Age ”Age ”
Current Problem: lack of knowledge of Current Problem: lack of knowledge of substance use in elderssubstance use in elders
Substance use in elders will be a huge problem Substance use in elders will be a huge problem in < 20 years b/c boomers:in < 20 years b/c boomers: Accepting of alcohol and drug useAccepting of alcohol and drug use
• Used more in youthUsed more in youth• Use more NOWUse more NOW
Use more psychoactive Rx drugs nowUse more psychoactive Rx drugs now 3-4x more emotional disorders 3-4x more emotional disorders
Deadly... 1994
Or,Just . . . K
eeping
The madness??
““MATURING OUT” OF ILLICIT MATURING OUT” OF ILLICIT DRUG ABUSERSDRUG ABUSERS
THEORY PROPOSED IN THE 1960’STHEORY PROPOSED IN THE 1960’S
BELIEF THAT OLDER ADULTS WOULD NO BELIEF THAT OLDER ADULTS WOULD NO LONGER USE ILLICIT SUBSTANCES LONGER USE ILLICIT SUBSTANCES BECAUSEBECAUSE THEY WOULD DIE OF AN OVERDOSETHEY WOULD DIE OF AN OVERDOSE THEY WOULD BE IN JAILTHEY WOULD BE IN JAIL THEY WOULD SWITCH TO “LEGAL” DRUGS THEY WOULD SWITCH TO “LEGAL” DRUGS
BECAUSE OF THE COSTS BECAUSE OF THE COSTS
ILLICIT DRUG USE AMONG THOSE OVER ILLICIT DRUG USE AMONG THOSE OVER 50 IN LA INNER CITY HOSPITAL, 200450 IN LA INNER CITY HOSPITAL, 2004
COCAINE WITH/WITHOUT ANOTHER COCAINE WITH/WITHOUT ANOTHER ILLEGAL DRUG WAS THE MOST COMMONILLEGAL DRUG WAS THE MOST COMMON
75% OF SUBJECTS WERE AGE 50-65; THE 75% OF SUBJECTS WERE AGE 50-65; THE OLDEST USER WAS A 90 Y.O. FEMALEOLDEST USER WAS A 90 Y.O. FEMALE
4% OF USERS WERE ABOVE AGE 804% OF USERS WERE ABOVE AGE 80
ONE-THIRD WERE FEMALEONE-THIRD WERE FEMALE
ILLICIT DRUG USEILLICIT DRUG USE
OLDER MEN ARE TWICE AS LIKELY TO USE OLDER MEN ARE TWICE AS LIKELY TO USE ILLICIT DRUGS THAN WOMEN…BUT WOMEN ILLICIT DRUGS THAN WOMEN…BUT WOMEN ARE USING THEM!ARE USING THEM!
SIDE EFFECTS OF ILLICIT DRUG USE CAN SIDE EFFECTS OF ILLICIT DRUG USE CAN MIMIC KNOWN DISEASESMIMIC KNOWN DISEASES
THE TYPES OF ILLICIT DRUGS USED MAY THE TYPES OF ILLICIT DRUGS USED MAY DIFFER GEOGRAPHICALLYDIFFER GEOGRAPHICALLY
ILLICIT DRUG USEILLICIT DRUG USE
MAN OLDER ADULTS WHO USE “STREET” MAN OLDER ADULTS WHO USE “STREET” DRUGS DO SO IN THE CONTEXT OF THE DRUGS DO SO IN THE CONTEXT OF THE FAMILY AND CHILDRENFAMILY AND CHILDREN
MANY ILLICIT DRUG USERS WILL USE MORE MANY ILLICIT DRUG USERS WILL USE MORE THAN ONE DRUGTHAN ONE DRUG
• CIGARETTE USE IS OFTEN A CO-EXISTENT PROBLEM CIGARETTE USE IS OFTEN A CO-EXISTENT PROBLEM AS IS MARIJUANAAS IS MARIJUANA
MOTIVATION FOR ILLEGAL MOTIVATION FOR ILLEGAL DRUG USE BY OLDER ADULTSDRUG USE BY OLDER ADULTS
NO GOOD STUDIES, ANECDOTAL NO GOOD STUDIES, ANECDOTAL EVIDENCEEVIDENCE
FAMILIAL PARTICIPATION IN DRUG USEFAMILIAL PARTICIPATION IN DRUG USE KNOWLEDGE OF DRUG AVAILABILITY KNOWLEDGE OF DRUG AVAILABILITY
(PREVIOUS PARTICIPANTS MORE (PREVIOUS PARTICIPANTS MORE FAMILIAR WITH SOURCES)FAMILIAR WITH SOURCES)
HABIT AND ADDICTION (BABY BOOMERS)HABIT AND ADDICTION (BABY BOOMERS)
National Survey on Drug National Survey on Drug Use and Health (NSDUH)Use and Health (NSDUH)
Representative of U.S. and each StateRepresentative of U.S. and each State
Civilian, noninstitutionalized populationCivilian, noninstitutionalized population
Age 12 or olderAge 12 or older
Anonymous face-to-face interviewAnonymous face-to-face interview
Computer-assisted self-interviewingComputer-assisted self-interviewing
67,500 respondents each year67,500 respondents each year
5,980 respondents age 50+ in 20035,980 respondents age 50+ in 2003
(population 81 million)(population 81 million)
Types of Drugs UsedTypes of Drugs Usedby Past Month Illicit Drug Users:by Past Month Illicit Drug Users:
Age 50+, 2002-2003 Annual AveragesAge 50+, 2002-2003 Annual Averages
Other
Marijuana Only
Only Marijuana and Prescription Drugs
1.4 Million Illicit Drug Users (1.8%)
47%
14%33%
6%
Prescription Drugs Only
Dependence or Abuse of Illicit Drugs:Dependence or Abuse of Illicit Drugs:Age 50+, 2002-2003 Annual AveragesAge 50+, 2002-2003 Annual Averages
5
20
31
38
81
85
108
151
0 20 40 60 80 100 120 140 160
Hallucinogens
Heroin
Stimulants
Sedatives
Tranquilizers
Marijuana
Cocaine
Pain Relievers
Number (in Thousands)
0
10
20
30
40
50
60
70
80
1930 1940 1950 1960 1970Age 50 to 69 in 2000 Age 50 to 69 in 2020
Lifetime Use of Illicit Drugs, by Year of Birth: Lifetime Use of Illicit Drugs, by Year of Birth: 2002-2003 Annual Averages2002-2003 Annual Averages
Percent Ever UsedBaby Boom Cohort
(Born 1946-64)
7.39.1
11.1 11.5 11.513.6
15.218.1
21.623
26.6
2.8 3.3 4.2 4.4 5 5.56.9 7.6
9.2 10.312.7
0
5
10
15
20
25
30
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Major Drugs of Abuse in Treatment Admissions Major Drugs of Abuse in Treatment Admissions with Illicit Drug as Primary Substance: Age with Illicit Drug as Primary Substance: Age
50+, 1992-200250+, 1992-2002Admissions in Thousands
Heroin
Cocaine
Marijuana and Prescription Drug (Nonmedical) Use, Marijuana and Prescription Drug (Nonmedical) Use, by Gender: by Gender:
Age 50+, 2002-2003 Annual AveragesAge 50+, 2002-2003 Annual Averages
1.5
0.60.6
0.9
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6Percent Using in Past Month
Male
Female
Marijuana Prescription Drug Nonmedically
Note: Difference between male and female rates is statistically significant (.05 level) for marijuana, not prescription drugs.
MARIJUANAMARIJUANA
MEDICAL MARIJUANA HERE IN CALIFORNIAMEDICAL MARIJUANA HERE IN CALIFORNIA
FREQUENTLY USED WITH OTHER SUBSTANCES FREQUENTLY USED WITH OTHER SUBSTANCES INCLUDING COCAINE, CIGARETTES AND ALCOHOLINCLUDING COCAINE, CIGARETTES AND ALCOHOL
DRUG INTERACTIONS THAT COULD OCCUR WITH DRUG INTERACTIONS THAT COULD OCCUR WITH PRESCRIPTION MEDICATIONSPRESCRIPTION MEDICATIONS
CAN INDUCE A HEART ATTACK IN OLDER PEOPLECAN INDUCE A HEART ATTACK IN OLDER PEOPLE
CANNABIS AND LATE-LIFE PSYCHOSISCANNABIS AND LATE-LIFE PSYCHOSIS(LANCET, 2007)(LANCET, 2007)
PREVIOUS STUDIES HAVE SUGGESTED PREVIOUS STUDIES HAVE SUGGESTED THAT MARIJUANA CAN PRODUCE THAT MARIJUANA CAN PRODUCE TRANSIENT, USUALLY MILD, PSYCHOTIC TRANSIENT, USUALLY MILD, PSYCHOTIC AND AFFECTIVE EXPERIENCESAND AFFECTIVE EXPERIENCES
WHETHER IT INCREASES THE INCIDENCE WHETHER IT INCREASES THE INCIDENCE OF MENTAL HEALTH DISORDERS SUCH AS OF MENTAL HEALTH DISORDERS SUCH AS SCHIZOPHRENIA OR DEPRESSION IS SCHIZOPHRENIA OR DEPRESSION IS UNCLEARUNCLEAR
CANNABIS AND LATE-LIFE CANNABIS AND LATE-LIFE PSYCHOSISPSYCHOSIS
INDIVIDUALS WHO USED CANNABIS ON A WEEKLY INDIVIDUALS WHO USED CANNABIS ON A WEEKLY OR DAILY BASIS HAD A 2-TO-3-FOLD INCREASE IN OR DAILY BASIS HAD A 2-TO-3-FOLD INCREASE IN RISK FOR PSYCHOTIC OUTCOMESRISK FOR PSYCHOTIC OUTCOMES
EVIDENCE ON RISK FOR DEPRESSION, EVIDENCE ON RISK FOR DEPRESSION, SUICIDALITY, OR ANXIETY WERE LESS SUICIDALITY, OR ANXIETY WERE LESS CONSISTENT VS. STUDIES ON PSYCHOTIC CONSISTENT VS. STUDIES ON PSYCHOTIC DISORDERSDISORDERS
THE MOST FREQUENT USERS SHOWED A 50% TO THE MOST FREQUENT USERS SHOWED A 50% TO 200% INCREASE IN RISK FOR PSYCHOSIS200% INCREASE IN RISK FOR PSYCHOSIS
TREATMENT OPTIONSTREATMENT OPTIONS
SELF-HELP/MUTUAL PEER SUPPORTSELF-HELP/MUTUAL PEER SUPPORT
BRIEF INTERVENTIONS IN THE PRIMARY BRIEF INTERVENTIONS IN THE PRIMARY CARE SETTINGCARE SETTING
CBTCBT
ELDER-SPECIFIC TREATMENTELDER-SPECIFIC TREATMENT
FORMAL SPECIALIZED TREATMENT FORMAL SPECIALIZED TREATMENT APPROACHES FOR WOMENAPPROACHES FOR WOMEN
CSAT RECOMMENDATIONS:CSAT RECOMMENDATIONS:
CBTCBT GROUP-BASED APPROACHESGROUP-BASED APPROACHES INDIVIDUAL COUNSELINGINDIVIDUAL COUNSELING MEDICAL/PSYCHIATRIC APPROACHESMEDICAL/PSYCHIATRIC APPROACHES
CSAT RECOMMENDATIONS CSAT RECOMMENDATIONS (CONTINUED)(CONTINUED)
MARITAL AND FAMILY MARITAL AND FAMILY INVOLVEMENT/FAMILY THERAPYINVOLVEMENT/FAMILY THERAPY
CASE MANAGEMENT/COMMUNITY-CASE MANAGEMENT/COMMUNITY-LINKED SERVICES AND OUTREACHLINKED SERVICES AND OUTREACH
FORMAL ALCOHOL SERVICESFORMAL ALCOHOL SERVICES
COGNITIVE-BEHAVIOR COGNITIVE-BEHAVIOR THERAPY (CBT):THERAPY (CBT):
EXAMPLES:EXAMPLES:
TEACH OLDER ADULTS SKILLS TEACH OLDER ADULTS SKILLS NECESSARY TO REBUILD SOCIAL NECESSARY TO REBUILD SOCIAL SUPPORT NETWORKSSUPPORT NETWORKS
USE SELF-MANAGEMENT APPROACHES USE SELF-MANAGEMENT APPROACHES FOR OVERCOMING DEPRESSION, GRIEF, FOR OVERCOMING DEPRESSION, GRIEF, LONELINESSLONELINESS
CBTCBT
SUCCESSFUL IN REDUCING OR SUCCESSFUL IN REDUCING OR STOPPING ALCOHOL USESTOPPING ALCOHOL USE
BLOW ET AL (2000); SCHONFELD ET AL BLOW ET AL (2000); SCHONFELD ET AL (2000)(2000)
CASE MANAGEMENTCASE MANAGEMENT
MAY BE BEST WAY TO PROVIDE MAY BE BEST WAY TO PROVIDE OUTREACH SERVICESOUTREACH SERVICES
TRADITIONAL RESIDENTIAL TRADITIONAL RESIDENTIAL ALCOHOLISM TREAMENT PROGRAMS ALCOHOLISM TREAMENT PROGRAMS GENERALLY TREAT FEW OLDER GENERALLY TREAT FEW OLDER ADULTSADULTS
CASE MANAGEMENTCASE MANAGEMENT
MAY BE BEST WAY TO PROVIDE MAY BE BEST WAY TO PROVIDE OUTREACH SERVICESOUTREACH SERVICES
TRADITIONAL RESIDENTIAL TRADITIONAL RESIDENTIAL ALCOHOLISM TREAMENT PROGRAMS ALCOHOLISM TREAMENT PROGRAMS GENERALLY TREAT FEW OLDER GENERALLY TREAT FEW OLDER ADULTSADULTS
FUTURE DIRECTIONS, NEEDS FUTURE DIRECTIONS, NEEDS AND RESEARCHAND RESEARCH
LACK OF ASSESSMENT INSTRUMENTS LACK OF ASSESSMENT INSTRUMENTS ADDRESSING OLDER WOMEN, ILLICIT DRUG USE, ADDRESSING OLDER WOMEN, ILLICIT DRUG USE, CO-MORBIDITIES, PRESCRIPTION DRUG ABUSECO-MORBIDITIES, PRESCRIPTION DRUG ABUSE
RISKS OF SIMULTANEOUS USE OF ALCOHOL AND RISKS OF SIMULTANEOUS USE OF ALCOHOL AND PRESCRIPTION DRUGSPRESCRIPTION DRUGS
UNDER REPRESENTATION OF OLDER WOMEN IN UNDER REPRESENTATION OF OLDER WOMEN IN RANDOMIZED TRIALS OF ALCOHOL TREATMENTRANDOMIZED TRIALS OF ALCOHOL TREATMENT
DIVERSITY ISSUES: DISABLED, CULTURE, DIVERSITY ISSUES: DISABLED, CULTURE, ETHNICITYETHNICITY