June 17, 2010

Changing Substance Abuse Patterns among Older Admissions: 1992 and 2008

Health care providers often overlook substance abuse and misuse among older adults. Diagnosis may be difficult because symptoms of substance abuse in older individuals sometimes mimic symptoms of other medical and behavioral disorders common among this population, such as diabetes, dementia, and depression.¹ Based on National Survey on Drug Use and Health (NSDUH) data from 2006 to 2008, an estimated 4.7 percent of adults aged 50 or older used illicit drugs in the past year²; in 2008, an estimated 2.9 percent of this age group were either dependent on or abused alcohol.³ Because the U.S. population is aging, and because the number of older adults with substance abuse problems is expected to grow, it is important for public health officials and policy makers to closely monitor the treatment needs of this population.

Data from the Treatment Episode Data Set (TEDS) can be used to examine substance abuse treatment admissions aged 50 or older (hereafter referred to as "older admissions"). This report focuses on the changing substance abuse patterns among older admissions between 1992 and 2008. Older admissions increased from 6.6 percent of all admissions 12 years of age or older in 1992 to 12.2 percent in 2008.

Substances of Abuse

Admissions may report up to three substances of abuse at admission. Their primary substance of abuse is the main substance reported, and the secondary/tertiary substances are other substances also reported. Alcohol was the predominant primary substance of abuse among older admissions in both 1992 and 2008, but the proportion of older admissions reporting primary alcohol abuse decreased from 84.6 percent in 1992 to 59.9 percent in 2008 (Figure 1). By contrast, the proportion of older admissions that reported primary heroin abuse more than doubled (from 7.2 to 16.0 percent), and the proportion that reported primary cocaine abuse quadrupled (from 2.8 to 11.4 percent).

Similar patterns were observed when examining primary, secondary, or tertiary abuse (hereafter referred to as "any abuse") of specific substances. The proportion of older adults that reported any alcohol abuse decreased between 1992 and 2008, from 88.3 to 71.9 percent (Figure 2). Any cocaine abuse more than tripled (from 8.6 to 26.8 percent), as did any marijuana abuse (from 4.1 to 14.3 percent). Any heroin abuse more than doubled between 1992 and 2008, from 8.5 to 19.1 percent.

Substance Combinations

The proportion of older substance abuse treatment admissions that reported multiple substances of abuse nearly tripled between 1992 and 2008, increasing from 13.7 to 39.7 percent (Figure 3). The proportion of older adult admissions that reported any alcohol abuse in combination with any cocaine abuse more than tripled, from 5.3 percent in 1992 to 16.2 percent in 2008. The proportion that reported any abuse of both alcohol and marijuana also increased (from 3.5 to 10.0 percent), as did the proportion that reported any abuse of both alcohol and heroin (from 2.5 to 5.7 percent).

Substance combinations not involving alcohol also increased between 1992 and 2008. In particular, the proportion of older admissions that reported any abuse of both cocaine and marijuana more than tripled, from 1.5 to 5.7 percent, while the proportion that reported any abuse of both cocaine and heroin more than doubled (from 3.2 to 6.7 percent).

Recent Initiators

Older admissions to substance abuse treatment varied in their age of first use of their primary substance of abuse. While more than three quarters of older admissions in 1992 and 2008 initiated use of their primary substance by the age of 25—83.4 percent in 1992 and 78.7 percent in 2008—others began relatively recently.

The proportions of older admissions that reported using their primary substance of abuse for 5 years or less before treatment admission (hereafter referred to as "recent initiators") were similar in 1992 and 2008 (3.2 and 3.8 percent, respectively). However, recent initiators showed different patterns of substance abuse than older admissions with longer histories of abuse, and these differences changed over time. Primary alcohol abuse was reported by 42.9 percent of recent initiators in 1992 compared with only 9.9 percent in 2008 (Figure 4). Recent initiators in 2008 were more likely than those in 1992 to have reported amphetamines (mostly methamphetamine) (8.6 vs. 1.3 percent) or prescription pain relievers⁴ (25.8 vs. 5.4 percent) as their primary substance of abuse.

Discussion

Although older admissions most commonly reported alcohol as the primary substance of abuse in both 1992 and 2008, a smaller proportion reported it in 2008 while a higher proportion reported cocaine, heroin, or other drugs of abuse. A higher proportion also reported multiple substances of abuse. Abuse of multiple substances is a concern because of the potential for adverse health consequences, including death. Older adults in treatment may require services for both the potential health consequences of substance abuse and the chronic illnesses that often appear as a person ages.

In addition, older admissions in 2008 who had recently begun abuse of their primary substance were more likely to have reported primary abuse of prescription pain relievers and less likely to have reported primary alcohol abuse than older admissions in 1992. Raising awareness among older adults of the potential for abuse of prescription pain relievers may help to prevent such admissions in the future. Policymakers also need to be aware that older adults are a growing proportion of substance abusers and are increasingly abusing substances other than alcohol. In addition, physicians should learn to recognize the signs of substance abuse in their older patients and should be prepared to refer them to treatment when necessary.

End Notes

¹ Center for Substance Abuse Treatment. (1998). Substance abuse among older adults (Treatment Improvement Protocol [TIP] Series 26, DHHS Publication No. SMA 98-3179). Rockville, MD: Substance Abuse and Mental Health Services Administration.
² Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (December 29, 2009). The NSDUH report: Illicit drug use among older adults. Rockville, MD.
³ Obtained via data calculations performed for NSDUH 2008 variables DEPNDALC (dependent on alcohol in the past year) and ABUSEALC (abused alcohol in the past year) on February 25, 2010, at http://dx.doi.org/10.3886/ICPSR26701]
⁴ Prescription pain relievers include codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

Suggested Citation

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (June 17, 2010). The TEDS Report: Changing Substance Abuse Patterns among Older Admissions: 1992 and 2008. Rockville, MD.