1. Resource Review for Teaching Resource Review for Teaching Kathleen J. Farkas, PhD Case Western Reserve University, Mandel School of Applied Social Sciences Laurie Drabble, PhD San Jose State University, School of Social Work Substance Use and Aging

2. Chapter 2: Prevalence of Alcohol, Tobacco, and Other Drug Use & Problems among Older Adults  The Demographic Imperative and Social Work Practice in the Additions  The proportion of older people in the population is expected to increase.  Tomorrow’s older adults will have different experiences, attitudes, and substance use patterns than previous cohorts of older adults.  Future cohorts of older adults will be composed of a greater number of ethnic/racial identity groups.

3.  Substance Use, Abuse, and Dependence: Continuum and Definitions  Definitions of substance use and abuse are especially important to understanding the impact of substances on older adults’ health and wellbeing.  Substance use among older adults is both a current problem and a future concern.

4.  Prevalence of Substance Use, Abuse, and Dependence among Older Adults  Substance use and abuse among older adults involve a range of substances both legal (alcohol, tobacco, and prescription medications) and illegal (street drugs).  Currently, substance use of any kind is less common among older than younger cohorts, but the aging of the baby boomers is expected to increase the prevalence rates of substance use and abuse among older adults.  Prospective epidemiological research will be necessary to understand how patterns of substance use change with age and with culture and living conditions.  Prospective epidemiological research will be needed to understand gender and racial/ethnic differences in the incidence and prevalence of substance related disorders.

5.  Alcohol Use Prevalence  In the 2006 National Survey on Drug Use and Health (NSDUH), among older age groups, the prevalence of alcohol use decreased with increasing age, from 63.5% among 26- to 29-year-olds to 48.0% among 60- to 64- year-olds and 38.4% among people aged 65 or older. http://oas.samhsa.gov/nsduh/2k6nsduh/2k6Results.cfm#3.3  In the 2002 and 2003 NSDUH, 45.1% of persons 50 or older drank alcohol.

6.  Problem Use of Alcohol among Older Adults  In the 2006 NSDUH, persons aged 65 or older had lower rates of binge drinking (7.6%) than adults in other age groups. The rate of heavy drinking among persons aged 65 or older was 1.6%. Binge drinking is defined as five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days (includes heavy use). http://www.oas.samhsa.gov/2k5/olderadults/olderadults.htm.

7.  Problem Use of Alcohol among Older Adults  Unhealthy drinking patterns (monthly use exceeding 30 drinks per typical month and “heavy episodic drinking of four or more drinks in any single day during a typical month in the previous year) were found in 9% of older Medicare beneficiaries. More men (16%) than women (4%) reported unhealthy drinking patterns (Merrick et al., 2008).  Estimates of problem-related drinking among community dwelling older adults ranges widely from 1% to over 15% (Project Mainstream, 2005).  Frail elderly under the care of a county Health and Social Services Department were found to actively use alcohol (24%) and to fall into the category of problem drinkers (17%).

8.  Alcohol Use among Minority Groups  Research reviews indicate that determining risk factors for alcohol problems based on gender and racial/ethnic identity is an imperfect science.  In some studies, African American women are at the lowest risk for alcohol problems and White men are at the highest risk, but in others there are no differences between White and African Americans (Cummings, Bride, & Rawlins-Shaw, 2006).

9.  Alcohol Use among Minority Groups  Rates of drinking do not appear to decline with age among sexual minority populations (Hughes & Eliason, 2002), and population based studies suggest that alcohol dependence and alcohol related problems are significantly higher among lesbian and bisexual women and that rates are elevated, but not always significantly greater, among men (Cochran, Keenan, Schober, & Mays, 2000; Cochran & Mays, 2000; Drabble, Trocki, & Midanik, 2005).  Data from the 1991-1993 national Survey on Drug Abuse found that older Native Americans, South Americans, and non-Hispanic Whites had higher prevalence rates for alcohol abuse than did other racial/ ethnic groups (Gurnack & Johnson-Wendell, 2002).

10.  Alcohol Use Guidelines and Older Adults  U.S. Department of Health and Human Services (1998) have reported that many older adults who experience problems related to alcohol do not meet criteria for abuse or dependence using standard criteria.  Alcohol use and medication interaction is a common problem among older adults.  Epidemiological research should further explore the relationship between drinking limits and physical and psychosocial health in samples of community based older people.

11.  Tobacco Use Prevalence  In the 2006 NSDUH, 26.7% of the population aged 50- 54 had smoked cigarettes in the past month compared to 22.7% of 55-59 year olds, 18.6% of 60-64 year olds, and 9.5% of people aged 65 and older.  Combined 2002 and 2003 NSDUH data indicated that an estimated 17.1% of persons aged 50 or older (13.7 million persons) had smoked cigarettes in the past month.  Among older adults, the leading cause of premature death is cigarette smoking, and mortality linked to tobacco smoking is expected to increase worldwide (World Bank, 1999).

12.  Tobacco Use Among Minority Groups  In a small study of African Americans aged 50 to 91, who attended senior activity centers (n=102), current smokers were younger on average than nonsmokers and men were more likely than women to be current smokers (Williams et al., 2001).  Population-based studies indicate that smoking is more prevalent among both lesbians and gay men than among heterosexuals (Burgard et al., 2005; Dilley et al., 2005; Greenwood et al., 2005; Gruskin et. al., 2007; Tang et al., 2004).

13.  Illicit Drug Use Prevalence  Among adults aged 50 to 59, the rate of current illicit drug use increased between 2002 and 2005, then remained unchanged in 2006. For those aged 50 to 54, the rate increased from 3.4% in 2002 to 6.0% in 2006. Among those aged 55 to 59, current illicit drug use showed a mixed trend with no significant difference between the rates in 2002 and 2006 (NSDUH, 2006).  Combined 2002 and 2003 NSDUH data showed an estimated 1.8% of older adults (1.4 million persons) had used an illicit drug in the past month. Marijuana was the most commonly used illicit drug (1.1%, followed by prescription drugs used non-medically (0.7%) and cocaine (0.2%).

14.  Illicit Drug Use Among Minority Groups  These patterns and trends may partially reflect the aging into these age groups of the baby boom cohort, whose lifetime rates of illicit drug use—especially marijuana use—are higher than those of earlier cohorts. (Substance Abuse and Mental Health Services Administration, 2006).  Emerging research on middle-aged cohorts indicated that patterns of illicit drug use continue throughout life (Anderson & Levy, 2003).  Prospective epidemiological research will need to include older adults and to monitor changes in illicit drug use among these older cohorts.

15.  Illicit Drug Use Among Minority Groups  In younger groups, marijuana use is higher among sexual minority women and men than among heterosexuals and other illicit drug use and abuse appears to be particularly pronounced among sexual minority men (Cochran et al., 2004; Stall et al., 2001; Woody et al., 2001).  Analysis of the 1991-1993 National Survey on Drug Abuse found that older Native Americans, Puerto Ricans, Mexicans, and non-Hispanic Blacks had higher prevalence rates for misuse of illicit drugs than other racial/ethnic groups (Gurnack & Johnson-Wendell, 2002).  Data from the Treatment Episode Data Set (TEDS) indicate increased prevalence of cocaine use among older African Americans in treatment for substance abuse (Gurnack & Johnson-Wendell, 2002).

16.  Prescription Medications and Medication Misuse Prevalence  Poly-pharmacy is a broadly based term used to describe medication use that is not clinically warranted (Zarowitz, 2006); prescription stimulants, sedatives, tranquilizers, and analgesics are all subject to misuse.  Lack of a standard definition for prescription drug abuse has limited epidemiological research (Isaacson et al., 2005).  The nonmedical use of psychoactive prescription drugs by adults age 50 and older is expected to increase from 911,000 in 2001 to nearly 2.7 million in 2020 (Colliver et al., 2006).

17.  Prescription medications and Medication Misuse Prevalence  According to the 2003 NSDUH, older adults (65 years and older) comprised 13% of the population, but used approximately 33% of all prescribed medications in the U.S. (National Institute on Drug Abuse, 2007).  Risks associated with medication error include adverse physical reactions, cognitive impairments, falls, and bone fractures. (National Institute on Drug Abuse Research Report Series, undated).  Intentional medication overuse among older adults may be associated with efforts to deal with chronic, undertreated pain.  Further research is needed, including research with individuals in long-term care facilities and emergency rooms, as well as in the community (Simoni-Wastila & Yang, 2006).

18.  Herbal Remedies  Herbal remedies have become an important aspect in self-care among older adults.  Approximately 25% of Asians and Hispanics in a large population study reported using herbal remedies. Close to 10% of African American and White older adults reported use of herbal remedies (Arcury et al., 2007).