Substance Use Disorders Among Older Adults: Five Steps to Improve Outcomes

Friday, July 31, 2020

The number of older adults with a substance use disorders will increase appreciably in the near future.

  - Psychiatric Times co-authored by Deena Tampi, MSN, MBA-HCA; Rajesh R. Tampi, MD, MS, DFAPA;  Michel Farivar, MD.

The population of older adults with SUDs is increasing in the United States.(1)  It has been postulated that by 2020 there will be approximately 5.7 million older adults with SUDs when compared with 2.8 million individuals in 2006.(2) Older adults tend to preferentially abuse alcohol, nicotine, and prescription medications while younger individuals use marijuana, cocaine, and heroin.(3) There is a considerable scarcity of data regarding SUDs among older adults despite concerns of this issue being a major public health concern.

Older adults are considered an at-risk population for using psychoactive drugs, as aging is associated with an increased burden of health-related issues and psychosocial stressors that can increase the risks due to use of psychoactive drugs.(3,4)  It is estimated that at least one in four older adults has used psychoactive medications within a pattern of substance abuse.

The 2005-2007 National Surveys on Drug Use and Health indicated that approximately 43% of individuals aged 65 years or older admitted to using alcohol in the past year with approximately 6.7% of these individuals reporting a pattern of alcohol abuse or dependence symptoms.(5) The 2008-2009 US National Surveys on Drug Use and Health indicated that 14.1% individuals aged 65 years or older reported past-year tobacco use when compared with 30.2% individuals aged 50 to 64 years.(6) 

The 2005 and 2006 National Surveys on Drug Use and Health found that among adults aged 65 years or older, 0.7% had used marijuana and 0.04% had used cocaine in the past year.(7) The rates of past-year use of inhalants, hallucinogens, methamphetamine, and heroin were also low at less than 0.2%. Among individuals aged 50 years or older, the past-year non-medical use of prescription opioids at 1.4% is more prevalent than the non-medical use of prescription sedatives (0.14%), tranquilizers (0.46%), and stimulants (0.16%).(8) In this age group, the past-year prevalence of prescription opioid use disorders was low at 0.13%, but the risk of prescription opioid dependence was higher at 7.6%. Of concern is that in the US, 8.7% of individuals aged 65 to 80 years filled at least one prescription for benzodiazepines in a 1-year period with 31.4% of these individuals receiving benzodiazepines for longer than 120 days in a year.(9) These data suggest a population at increased risk for SUDs and associated comorbidities.

Risk factors

Risk factors for the development of SUDs among older adults include a history of substance use, comorbid psychiatric disorders, and the presence of cognitive impairment.(10) Factors that mitigate the development of SUDs include being married, no previous history of substance use and a religious affiliation. SUDs are moderately to highly heritable, findings indicate that an individual’s risk would be proportional to the degree of genetic relationship to the relative with SUDs. For reference, the heritability rates for hallucinogen use disorder is 0.39 and for cocaine use disorder is 0.72. Read the full article here