Substance Use among Older Adults (Age 50+): Current Prevalence and Future Expectations

Substance Use among Older Adults (Age 50+): Current Prevalence and

Future Expectations

Presented by Joe Gfroerer

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services Administration

Office of Applied Studies

2

National Survey on Drug Use and Health (NSDUH)

• Representative of U.S. and each State• Civilian, noninstitutionalized population• Age 12 or older• Anonymous face-to-face interview• Computer-assisted self-interviewing• 67,500 respondents each year• 5,980 respondents age 50+ in 2003

(population 81 million)

3

Patterns of Substance Use

4

Past Month Substance Use: Age 50+, 2003

Alcohol Use 44% (36 million)

Binge Alcohol Use 12% (10 million)

Tobacco Use 21% (17 million)

Illicit Drug Use 2% (1.4 million)

(No statistically significant [.05 level] changes from 2002.)

5

3.8

10.9

19.2

23.3

18.3

13.4

8.8 8.4 8.16.8

3.92.0 1.1 0.6

0.0

5.0

10.0

15.0

20.0

25.0

Illicit Drug Use, by Age: 2003

Age in Years12-13 14-15 16-17 18-20 21-25 26-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Percent Using in Past Month

Age 50+

6

Use of Selected Illicit Drugs:Age 50+, 2002-2003 Annual Averages

Percent Using in Past Month

1.8

1.1

0.7

0.20.03

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Any Drug

Prescription Drug Nonmedically

HallucinogenMarijuana Cocaine

7

Nonmedical Prescription Drug Use: NSDUH Definition

“Not prescribed for you”

OR

“You took the drug only for the experience or feeling it caused”

(Excludes OTC)

8

Types of Drugs Usedby Past Month Illicit Drug Users:

Age 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

9

Types of Drugs Used by Past Month Illicit Drug Users: Age 12 to 49 and 50+,

2002-2003 Annual Averages

Age 12 to 49

Age 50+

55 47

16 3310

619 14

0.0

20.0

40.0

60.0

80.0

100.0

Percent of Current Users

Marijuana & Prescription Drugs Only

Marijuana Only

Prescription Drugs Only

All Other

10

Marijuana and Prescription Drug (Nonmedical) Use, by Gender:

Age 50+, 2002-2003 Annual Averages

1.5

0.60.6

0.9

0.00.20.40.60.81.01.21.41.6

Percent Using in Past Month

MaleFemale

Marijuana Prescription Drug Nonmedically

Note: Difference between male and female rates is statistically significant (.05 level) for marijuana, not prescription drugs.

11

Marijuana and Prescription Drug (Nonmedical) Use, by Gender:

Age 12 to 17, 2003

8.6

3.7

7.2

4.2

0.0

2.0

4.0

6.0

8.0

10.0

Percent Using in Past Month

MaleFemale

Marijuana Prescription Drug Nonmedically

Note: Difference between male and female rates is statistically significant (.05 level) for marijuana, not prescription drugs.

12

Illicit Drug Use, by County Type: Age 50+, 2002-2003 Annual Averages

2.1

1.6 1.5

0.0

0.5

1.0

1.5

2.0

2.5

Large Metro NonmetroSmall Metro

Percent Using in Past Month

Note: No statistically significant differences (.05 level).

13

Illicit Drug Use, by Race/Ethnicity: Age 50+, 2002-2003 Annual Averages

1.9 2.0

1.5

0.0

0.5

1.0

1.5

2.0

2.5

White

Percent Using in Past Month

Black or African American

Hispanic or Latino

Note: No statistically significant differences (.05 level).

14

Past Year Illicit Drug Use, by Serious Mental Illness: Age 50+,

2002-2003 Annual Averages

8.0

3.1

0.01.02.03.04.05.06.07.08.09.0

Percent Using in Past Year

No Serious Mental Illness

Serious Mental Illness

Note: Difference is statistically significant (.05 level).

15

Substance Dependence, Abuse, and Treatment Need(DSM-IV, Past Year)

16

2.2

8.4

16.1

21.1 21.0

15.8

11.19.6 8.5 8.1

6.03.7

1.2 1.6

0.0

5.0

10.0

15.0

20.0

25.0

Illicit Drug or AlcoholDependence or Abuse, by Age: 2003

Percent Dependent or Abusing in Past Year

Age in Years12-13 14-15 16-17 18-20 21-25 26-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Age 50+

17

Substance Dependence or Abuse: Age 50+, 2003

Total 2.5 million (3.0%)

Alcohol Only 2.2 million (90%)

Illicit Drug Only 169,000 (7%)

Both Drugs and Alcohol 73,000 (3%)

(No statistically significant [.05 level] changes from 2002.)

18

4228

5872

90

100.0

20.0

40.0

60.0

80.0

100.0

Alcohol and Illicit Drug Dependence or Abuse, as a Percentage of Total Substance

Dependence or Abuse, by Age: 2003

Age12 to 25

Age26 to 49

Age 50+

Percent of Substance Dependence/Abuse

Alcohol Only

Illicit Drug

19

Dependence or Abuse of Illicit Drugs:Age 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)

20

Substance Dependence or Abuse, by Gender: Age 50+, 2002-2003 Annual Averages

5.2

1.4

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Male Female

Percent Dependent or Abusing in Past Year

Note: Difference is statistically significant (.05 level).

21

Substance Dependence or Abuse, by County Type: Age 50+,

2002-2003 Annual Averages

3.5

2.8 2.7

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Large Metro NonmetroSmall Metro

Percent Dependent or Abusing in Past Year

Note: No statistically significant differences (.05 level).

22

Substance Dependence or Abuse, by Race/Ethnicity: Age 50+,

2002-2003 Annual Averages

3.23.6

3.2

0.0

1.0

2.0

3.0

4.0

White

Percent Dependent or Abusing in Past Year

Black or African American

Hispanic or Latino

Note: No statistically significant differences (.05 level).

23

Treatment Need and Specialty Treatment for Alcohol or Drug Abuse: Age 50+,

2002-2003 Annual Averages

Did Not Receive Treatment and Felt Need for Treatment

Did Not Receive Treatment and

Felt No Need for Treatment

85.0%

2.6 Million with Treatment Need(Based on DSM-IV)

Received Treatment

6.5%

8.6%

(44% Made Effort)

24

Expected Future Trends in Substance Use among

Older Adults

25

Alcohol or Illicit Drug Dependence or Abuse, by Lifetime Use of Illicit Drugs:

Age 50+, 20037.4

1.4

0.01.02.03.04.05.06.07.08.0

Percent Dependent or Abusing in Past Year

Never Used Illicit Drugs

Used Illicit Drugs in Lifetime

Note: Difference is statistically significant (.05 level).

26

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: 2002-2003 Annual Averages

Percent Ever UsedBaby Boom Cohort

(Born 1946-64)

27

Illicit Drug Dependence or Abuse, by Age of First Marijuana Use: Lifetime Marijuana Users Age 50+, 2002-2003 Annual Averages

5.3

1.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0Percent Dependent or Abusing in Past Year

First Use at Age 18 or Older

First Use Before Age 18

Note: Difference is statistically significant (.05 level).

28

15

20

25

30

35

40

1930 1940 1950 1960 1970

Age 50 to 69 in 2000 Age 50 to 69 in 2020

Average Age of First Use of Marijuana among Lifetime Marijuana Users, by Year

of Birth: 2002-2003 Annual AveragesAvg. Age of First Use

Baby Boom Cohort (Born 1946-64)

29

Substance Dependence or Abuse: Age 50+, 2000/2001 and 2020

2000/2001 2020 % IncreasePopulation 75m 112m 50%

% Dep/Ab 2.3% 3.9% 70%

# Dep/Ab 1.7m 4.4m 150%

Note: 2000/2001 estimates are not comparable with 2002 and 2003 estimates.

30

Past Year Marijuana Use: Age 50+, 1999-2001 and 2020

1999-2001 2020 % IncreasePopulation 74m 112m 50%

% Use 1.0% 2.9% 190%

# Use 0.7m 3.3m 370%

Note: 1999-2001 estimates are not comparable with 2002 and 2003 estimates.

31

Recent Trends in Substance Abuse Treatment among

Older Adults

(Treatment Episode Data Set)

32

Proportion of Substance Abuse Treatment Admissions Involving an Illicit Drug,

by Age: 2001

71 64 5542 33 26

36 4558 67 74

29

0102030405060708090

100

40-44 45-49 50-54 55-59 60-64 65+

Percent

Alcohol Only

Illicit Drug

Age Group

33

Treatment Admissions for Primary Illicit Drug Problems: Age 50+, 2002

0.4

0.9

2.6

3.1

3.8

12.7

26.6

0 5 10 15 20 25 30

SedativesTranquilizers

StimulantsMarijuana

Other OpiatesCocaineHeroin

Number (in Thousands)

34

Alcohol and Drug Treatment Admissions: Age 50+, 1992-2002

75 75 71 68 68 69 73 74 76 7580

20 2328 29 31

3642

4957

6374

0102030405060708090

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Admissions in Thousands

Alcohol Only

Drugs

35

7.39.1

11.1 11.5 11.513.6 15.2

18.121.6 23

26.6

2.8 3.3 4.2 4.4 5 5.5 6.9 7.69.2 10.3

12.7

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 with Illicit Drug as Primary

Substance: Age 50+, 1992-2002Admissions in Thousands

Heroin

Cocaine

36

Older Adult Substance Use: Conclusions

• Currently, abuse problem is mainly alcohol

• Treatment need will increase due to baby boom cohort

– Population increase

– Higher abuse rate

• Illicit drug problems will become more prominent as cohorts

with drug experience reach age 50

– Evident in treatment admission data since early 1990s