Substance Abuse Trends Upward as Boomers Age

Article excerpt

BETHESDA, MD. -- Current trends in the increase in the number of Americans aged 65 years and older could have significant implications for managing substance abuse in this population.

By 2030, 20% of the population in the United States will be older than 65 years (currently, that percentage is 13) and in 2 years' time, the first wave of Baby Boomers will be eligible for Social Security. Both trends will place pressure on retirement and health care systems in general, and on substance abuse prevention and treatment in particular, Frederic C. Blow, Ph.D., said at the annual meeting of the Association for Medical Education and Research in Substance Abuse. The conference was jointly sponsored by Brown Medical School.

"The number of adults with substance abuse disorders is projected to double from [an annual average of] 2.8 million in 2002-2006 to 5.7 million in 2020," he said. In addition, elderly adults who abuse alcohol or drugs are more likely to have mental health comorbidities, especially depression, cognitive loss, or anxiety or sleep disorders, as well as other comorbidities such as heart disease, diabetes, or conditions that require treatment for pain, all of which add another level of complexity in managing substance abuse in this growing population.

The most common addictions among older adults are to nicotine, alcohol, psychoactive prescription drugs, and other illegal drugs, such as marijuana, cocaine, and narcotics. Estimates suggest that about 19% of older Americans might be affected by combined alcohol and medication abuse, which is more prevalent among men and those aged 50-64 years.

Dr. Blow, of the University of Michigan, Ann Arbor, said aging-related changes make older adults more vulnerable to the adverse effects of alcohol, so that even moderate amounts of alcohol can be riskier for elderly drinkers.

"They are three times more likely to develop a mental disorder with a lifetime diagnosis of alcohol abuse, with common dual diagnoses, including depression [20%-30%], cognitive loss [10%-40%], and anxiety disorders [10%-20%]," said Dr. Blow, who also noted an association between alcohol abuse and suicide. Moreover, "patients with a history of problem alcohol use ... exhibit more behavioral disturbances, including agitation, irritability, and disinhibition," which increases caregiver distress and therefore caregiver burden.

When it comes to screening for alcohol abuse problems, one should ask direct questions, though in doing so, it is preferable to frame the question so that it is linked to a medical condition and avoid using stigmatizing terms such as alcoholic, Dr. …