Alcohol & Other Alcohol & Other Drug Training Drug Training

ProjectProject

www.asaging.org/aodwww.asaging.org/aod

““OLDER WOMEN AND SUBSTANCE USE: OLDER WOMEN AND SUBSTANCE USE: PRESENT PROBLEMS, FUTURE TRENDS”PRESENT PROBLEMS, FUTURE TRENDS”PATRICIA LENAHAN, LCSW, LMFT, BCETSPATRICIA LENAHAN, LCSW, LMFT, BCETS

OBJECTIVESOBJECTIVES

IDENTIFY SUBSTANCES MOST IDENTIFY SUBSTANCES MOST FREQUENTLY MISUSED BY OLDER FREQUENTLY MISUSED BY OLDER WOMENWOMEN

IDENTIFY WOMEN MOST AT RISKIDENTIFY WOMEN MOST AT RISK

OBJECTIVESOBJECTIVES

DISCUSS POSSIBLE TRENDS IN SUBSTANCE DISCUSS POSSIBLE TRENDS IN SUBSTANCE ABUSE AMONG AGING BABY BOOMERSABUSE AMONG AGING BABY BOOMERS

ADDRESS POTENTIAL SERVICE AND ADDRESS POTENTIAL SERVICE AND TREATMENT NEEDSTREATMENT NEEDS

SUBSTANCES MISUSED AND SUBSTANCES MISUSED AND ABUSED BY OLDER WOMENABUSED BY OLDER WOMEN

NICOTINENICOTINE

ALCOHOLALCOHOL

PRESCRIPTION DRUGSPRESCRIPTION DRUGS

ANYTHING ELSE? YES!ANYTHING ELSE? YES!

ILLICIT OR ILLEGAL DRUGS ILLICIT OR ILLEGAL DRUGS

Number of Americans >65 (Millions)

3 59

17

26

3539

53

69

0

10

20

30

40

50

60

70

1900 1920 1940 1960 1980 2000 2010 2020 2030

U.S. Bureau of Census

WHY FOCUS ON OLDER WHY FOCUS ON OLDER WOMEN?WOMEN?

““ADDICTION AMONG OLDER WOMEN IS ADDICTION AMONG OLDER WOMEN IS HIDDEN IN THEIR OWN SHAME, SWEPT HIDDEN IN THEIR OWN SHAME, SWEPT UNDER THE RUG OF DENIAL OF FAMILY UNDER THE RUG OF DENIAL OF FAMILY MEMBERS AND LOST IN THE SHADOWS OF MEMBERS AND LOST IN THE SHADOWS OF MEDICAL PRACTICE.”MEDICAL PRACTICE.”

SUSAN FOSTERSUSAN FOSTER

NATIONAL CENTER ON ADDICTION AND NATIONAL CENTER ON ADDICTION AND SUBSTANCE ABUSE, COLUMBIA UNIVERSITYSUBSTANCE ABUSE, COLUMBIA UNIVERSITY

OLDER WOMEN AND OLDER WOMEN AND SUBSTANCE ABUSESUBSTANCE ABUSE

SYMPTOMS OF SUBSTANCE ABUSE IN SYMPTOMS OF SUBSTANCE ABUSE IN MATURE WOMEN ARE ATTRIBUTED MATURE WOMEN ARE ATTRIBUTED TO OTHER CONDITIONS SUCH AS TO OTHER CONDITIONS SUCH AS ANXIETY AND DEPRESSIONANXIETY AND DEPRESSION

STIGMA: HIDDEN BY WOMEN WHO STIGMA: HIDDEN BY WOMEN WHO ARE IN DENIAL OR ASHAMEDARE IN DENIAL OR ASHAMED

OLDER WOMEN AND OLDER WOMEN AND SUBSTANCE ABUSESUBSTANCE ABUSE

FEAR OF BEING LABELED A “JUNKIE”FEAR OF BEING LABELED A “JUNKIE”

TOLERATED BY FRIENDS AND FAMILY TOLERATED BY FRIENDS AND FAMILY WHO “LET GRANNY HAVE HER WHO “LET GRANNY HAVE HER TRANQUILIZER” BECAUSE IT MAKES TRANQUILIZER” BECAUSE IT MAKES HER FEEL GOOD AND EASIER TO BE HER FEEL GOOD AND EASIER TO BE AROUNDAROUND SIMONI-WASTILA, 2005SIMONI-WASTILA, 2005

PREVALENCE OF ALCOHOL PREVALENCE OF ALCOHOL USE/MISUSEUSE/MISUSE

Depends on definition of at-risk or problem drinking:

1-15% of older adults are at-risk or problem drinkers

Differs with sampling approach Alcohol use problems are the most

common substance issues for older adults. Confounded by prescription, herbal, and over-the-counter medications

Prevalence Prevalence (continued)(continued)

Older adults with alcohol use Older adults with alcohol use problems are not recognized by problems are not recognized by many professionalsmany professionals

Few older adults with alcohol Few older adults with alcohol abuse or dependence seek help abuse or dependence seek help in specialized addiction in specialized addiction treatment settingstreatment settings

Older women are recognized Older women are recognized less often than older males with less often than older males with alcohol problemsalcohol problems

©2002 Microsoft Corporation

Drinking GuidelinesDrinking Guidelines

No more than 1 standard drink No more than 1 standard drink per dayper day

No more than 2-3 drinks on No more than 2-3 drinks on any drinking day (binge any drinking day (binge drinking)drinking)

Limits for older Limits for older women are women are less than for olderless than for oldermenmen

(Source: NIAAA, 1995; (Source: NIAAA, 1995;

Dufour & Fuller, 1995)Dufour & Fuller, 1995)

Drinking Guidelines Drinking Guidelines (continued)(continued)

Recommendations consistent with data Recommendations consistent with data on benefits/risks of drinking in this age on benefits/risks of drinking in this age groupgroup

Lower limits for older adults because: Lower limits for older adults because: IIncreased alcohol sensitivity with agencreased alcohol sensitivity with age Greater use of contraindicated medicationsGreater use of contraindicated medications Less efficient liver metabolismLess efficient liver metabolism Less body mass/fat increases circulating Less body mass/fat increases circulating

levelslevels

AT-RISK DRINKING STUDYAT-RISK DRINKING STUDY

BLOW ET AL, 2000:BLOW ET AL, 2000: NINE OR MORE DRINKS PER WEEK FOR NINE OR MORE DRINKS PER WEEK FOR

WOMENWOMEN TWELVE OR MORE DRINKS FOR MENTWELVE OR MORE DRINKS FOR MEN

THIS IS HIGHER THAN THE NIAAA THIS IS HIGHER THAN THE NIAAA GUIDELINES OF SEVEN DRINKS PER GUIDELINES OF SEVEN DRINKS PER WEEK FOR MEN AND WOMEN OVER THE WEEK FOR MEN AND WOMEN OVER THE AGE OF 65AGE OF 65

AT-RISK DRINKINGAT-RISK DRINKING

FLEMING, 1996FLEMING, 1996

12% OF WOMEN OVER AGE 60 DRANK 12% OF WOMEN OVER AGE 60 DRANK MORE THAN SEVEN DRINKS PER WEEKMORE THAN SEVEN DRINKS PER WEEK

Alcohol Use Patterns Alcohol Use Patterns (continued)(continued)

Older Adults and Alcohol UseOlder Adults and Alcohol Use

Increased risk of:Increased risk of: Stroke (with overuse)Stroke (with overuse) Impaired motor skills (e.g., Impaired motor skills (e.g.,

driving) at low level usedriving) at low level use Injury (falls, accidents)Injury (falls, accidents) Sleep disordersSleep disorders SuicideSuicide Interaction with dementia Interaction with dementia

symptomssymptoms©2002 Microsoft Corporation

Older Adults and Use Older Adults and Use (continued)(continued)WOMEN MAY BE MORE SUSCEPTABLE!!WOMEN MAY BE MORE SUSCEPTABLE!!

Other effects:Other effects: Higher blood alcohol concentrations Higher blood alcohol concentrations

(BAC) from dose(BAC) from dose More impairment from BACMore impairment from BAC Medication effects:Medication effects:

• Potential interactionsPotential interactions• Increased side effects Increased side effects • Compromised metabolizing Compromised metabolizing

(especially psychoactive medications, (especially psychoactive medications, benzodiazepines, barbiturates, benzodiazepines, barbiturates, antidepressants, digoxin, warfarin)antidepressants, digoxin, warfarin)

©2002 Microsoft Corporation

ALCOHOL AND PAIN ALCOHOL AND PAIN MANAGEMENTMANAGEMENT

(CURRENT OPIN PSYCHIATRY, 2006)(CURRENT OPIN PSYCHIATRY, 2006)

SIGNIFICANT AREA OF NEW SIGNIFICANT AREA OF NEW RESEARCHRESEARCH

USE OF ALCOHOL IN PAIN USE OF ALCOHOL IN PAIN MANAGEMENT WITH OR WITHOUT MANAGEMENT WITH OR WITHOUT DRINKING PROBLEMSDRINKING PROBLEMS

ALCOHOL AND PAINALCOHOL AND PAIN

PROBLEM DRINKERS REPORTED MORE PROBLEM DRINKERS REPORTED MORE SEVERE PAIN LIKELY TO INTERFERE WITH SEVERE PAIN LIKELY TO INTERFERE WITH ADL’S AND MORE FREQUENT USE OF ADL’S AND MORE FREQUENT USE OF ALCOHOL TO MANAGE PAINALCOHOL TO MANAGE PAIN

NEED TO INTEGRATE PAIN ASSESSMENT NEED TO INTEGRATE PAIN ASSESSMENT WITH ALCOHOL SCREENING IN OLDER WITH ALCOHOL SCREENING IN OLDER ADULTSADULTS

General Issues for Older AdultsGeneral Issues for Older Adults

Loss (status, people, Loss (status, people, vocation, health, etc.)vocation, health, etc.)

Social isolation, Social isolation, lonelinessloneliness

Major financial Major financial problemsproblems

Housing changesHousing changes Family concernsFamily concerns Time management Time management

burdenburden

Complex medical Complex medical issuesissues

Multiple medicationsMultiple medications Sensory deficitsSensory deficits Reduced mobilityReduced mobility Cognitive Cognitive

impairmentsimpairments Impaired self-care, Impaired self-care,

loss of independenceloss of independence

Signs of Potential Alcohol ProblemsSigns of Potential Alcohol Problems(ADAPTED FROM BARRY ETAL, 2000)(ADAPTED FROM BARRY ETAL, 2000)

Anxiety, depression, excessive Anxiety, depression, excessive mood swingsmood swings

Blackouts, dizziness, idiopathic Blackouts, dizziness, idiopathic seizuresseizures

DisorientationDisorientation Falls, bruises, burnsFalls, bruises, burns HeadachesHeadaches IncontinenceIncontinence Memory lossMemory loss Unusual response to Unusual response to

medicationsmedications

Poor hygienePoor hygiene Poor nutritionPoor nutrition Sleep problemsSleep problems Family problemsFamily problems Financial problemsFinancial problems Legal difficultiesLegal difficulties Social isolationSocial isolation Increased alcohol toleranceIncreased alcohol tolerance New difficulties in decision New difficulties in decision

makingmaking

Special PopulationsSpecial Populations

Barriers to effective Barriers to effective identification exist for:identification exist for: WomenWomen Certain minority group Certain minority group

members/lack of culturally members/lack of culturally competent tools and competent tools and interventionsinterventions

Individuals with physical Individuals with physical disabilities, comorbiditiesdisabilities, comorbidities

HomeboundHomebound©2002 Microsoft Corporation

Co-morbid ConditionsCo-morbid Conditions

Impaired Activities of Impaired Activities of Daily Living (ADL’s)Daily Living (ADL’s)

Psychiatric symptoms, Psychiatric symptoms, mental disordersmental disorders

Alzheimer’s diseaseAlzheimer’s disease Sleep disordersSleep disorders ©2002 Microsoft Corporation

Co-morbidity is a serious, common Co-morbidity is a serious, common concern among older adults using concern among older adults using alcohol:alcohol:

Risk Factors for Prescription Risk Factors for Prescription Drug Misuse and Abuse - Drug Misuse and Abuse -

General PopulationGeneral Population Most consistent correlates in the Most consistent correlates in the

general population for Rx misuse and general population for Rx misuse and addictionaddiction Female genderFemale gender Young ageYoung age Older ageOlder age White raceWhite race High SESHigh SES Poor physical healthPoor physical health Mental illnessMental illness

Prescription Drug Misuse Prescription Drug Misuse Any Rx drug can be “misused”Any Rx drug can be “misused” Misuse = “Non-medical use” = Any use that is Misuse = “Non-medical use” = Any use that is

outside of medically prescribed regimen, eg:outside of medically prescribed regimen, eg: Non-compliance Non-compliance Taking different doseTaking different dose SharingSharing Obtaining from non-medical sourceObtaining from non-medical source Taking for psychoactive effects Taking for psychoactive effects Use with alcoholUse with alcohol

Prescription Drug AbusePrescription Drug Abuse

Abuse = use resulting inAbuse = use resulting in Decline in work, school, or home performanceDecline in work, school, or home performance Legal problemsLegal problems Use in risky situationsUse in risky situations Continued use despite social/personal Continued use despite social/personal

consequences consequences (APA, DSM-IV, 1994)(APA, DSM-IV, 1994)

Prescription Drug DependencyPrescription Drug Dependency

Dependency = use resulting in Dependency = use resulting in ToleranceTolerance Withdrawal sxWithdrawal sx Decline in normal activitiesDecline in normal activities Unsuccessful attempts to cut down or control useUnsuccessful attempts to cut down or control use Use for longer period or larger amounts than intendedUse for longer period or larger amounts than intended Use consumes lot of time to acquire and/or recover from Use consumes lot of time to acquire and/or recover from

effectseffects Continued use despite knowledge that it caused physical Continued use despite knowledge that it caused physical

and/or psychological problems and/or psychological problems (APA, DSM-IV, 1994)(APA, DSM-IV, 1994)

Extent of the Problem: Medical Extent of the Problem: Medical ExposureExposure

General US populationGeneral US population11

Women = 20.0% Women = 20.0% Men = 12.5%Men = 12.5%

Among elders aged 65 and older, 21.7%, Among elders aged 65 and older, 21.7%, or 7.22M, receive at least 1 abusable Rx or 7.22M, receive at least 1 abusable Rx annuallyannually22

Women = 24.6%Women = 24.6% Men = 17.7%Men = 17.7%

1Simoni-Wastila et al, Sub Use and Misuse, 20042Simoni-Wastila et al,, 2004

Risk Factors for Rx Misuse Risk Factors for Rx Misuse and Abuse in Older Womenand Abuse in Older Women

Among older women, possible risk Among older women, possible risk factors include:factors include: Social isolationSocial isolation Lower SES and educationLower SES and education Poor healthPoor health Current or history of behavioral health Current or history of behavioral health

problemsproblems Loss of economic and social supportLoss of economic and social support HC system factorsHC system factors

PRESCRIPTION DRUG ABUSE: IF IT PRESCRIPTION DRUG ABUSE: IF IT FEELS GOOD, DON’T TAKE IT!FEELS GOOD, DON’T TAKE IT!

KAUFMAN STUDY, JAMA, 2002:KAUFMAN STUDY, JAMA, 2002:

STUDIED THE USE OF ALL MEDICATIONS…STUDIED THE USE OF ALL MEDICATIONS…PRESCRIPTION, OTC, VITAMINS AND HERBALPRESCRIPTION, OTC, VITAMINS AND HERBAL

HIGHEST OVERALL PREVALENCE OF MEDICATIN HIGHEST OVERALL PREVALENCE OF MEDICATIN USE WAS AMONG WOMEN AT LEAST 65 YEARS USE WAS AMONG WOMEN AT LEAST 65 YEARS OF AGEOF AGE

• 12% TOOK AT LEAST 10 MEDICATIONS12% TOOK AT LEAST 10 MEDICATIONS• 23% TOOK AT LEAST 5 PRESCRIPTION DRUGS23% TOOK AT LEAST 5 PRESCRIPTION DRUGS

OLDER WOMEN AND OLDER WOMEN AND PRESCRIPTION DRUG ABUSEPRESCRIPTION DRUG ABUSE

GREATER LIKELIHOOD TO EXPOSURE GREATER LIKELIHOOD TO EXPOSURE TO PRESCRIPTIONSTO PRESCRIPTIONS

BIOLOGY: BODY SIZE, HORMONES, BIOLOGY: BODY SIZE, HORMONES, BODY FAT, METABOLIC DIFFERENCESBODY FAT, METABOLIC DIFFERENCES

PROPENSITY FOR SEEKING CARE—PROPENSITY FOR SEEKING CARE—PROPENSITY FOR TREATMENTPROPENSITY FOR TREATMENT

Social Isolation and Health Social Isolation and Health StatusStatus

CharacteristicCharacteristic Annual Prevalence of Annual Prevalence of Abusable Rx E+Abusable Rx E+

Widowed/Divorced/SeparatedWidowed/Divorced/Separated

MarriedMarried

24.6%24.6%

19.9%19.9%

Lives AloneLives Alone

Lives w/ SpouseLives w/ Spouse

23.8%23.8%

20.0%20.0%

Poor/Fair HealthPoor/Fair Health

Good/Excellent HealthGood/Excellent Health

34.2%34.2%

18.0%18.0%

0 ADLs0 ADLs

1-2 ADLs1-2 ADLs

3-4 ADLs3-4 ADLs

5-6 ADLs5-6 ADLs

17.1%17.1%

31.0%31.0%

39.0%39.0%

40.7%40.7%Simoni-Wastila et al, 2004

CONSEQUENCES OF Rx. CONSEQUENCES OF Rx. MISUSE AND ABUSEMISUSE AND ABUSE

COGNITIVE IMPAIRMENT AND COGNITIVE IMPAIRMENT AND INCREASED SEDATIONINCREASED SEDATION FALLS/INJURYFALLS/INJURY DEPRESSIONDEPRESSION SUICIDESUICIDE INTERACTIONS WITH ALCOHOL AND INTERACTIONS WITH ALCOHOL AND

OTHER DRUGSOTHER DRUGS

Substance Use - Type by Substance Use - Type by Gender – 50 and OlderGender – 50 and Older

57.7

42.3

71.1

28.9

41.9

58.1

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Any Illicit Use Marijuana Prescription

Male Female (2002 NSDUH)

Medical Exposure to Abusable Rx Medical Exposure to Abusable Rx Drugs by Gender and AgeDrugs by Gender and Age

12

18.620.1

27.3

20.4

28.3

19.4

24.8

0

5

10

15

20

25

30

65-69 70-74 75-79 80+

Male FemaleSimoni-Wastila et al, 2004

ETHNICITY AND ETHNICITY AND PRESCRIPTION DRUG USE: PRESCRIPTION DRUG USE:

AN EXAMPLEAN EXAMPLE

Inappropriate use of drugs effected by ethnic/cultural factors (Raji et al. 2003)

Meds may be Meds may be purchased without purchased without prescription in prescription in Mexico and other Mexico and other countries.countries.

The Internet is Becoming a Larger The Internet is Becoming a Larger Source of Prescription DrugsSource of Prescription Drugs

““The internet has become a virtual wild The internet has become a virtual wild west bazaar for “spam” emails and west bazaar for “spam” emails and websites that sell controlled substances websites that sell controlled substances with little or no oversight..” DEA, 2004with little or no oversight..” DEA, 2004

General General Information Information is available is available

on many on many drugsdrugs

(9/9/04)(9/9/04)

There are There are many sites many sites

that sell that sell prescription prescription

drugsdrugs (9/9/04) (9/9/04)

ILLICIT DRUG USEILLICIT DRUG USE

SMALL BUT INCREASING PROBLEMSMALL BUT INCREASING PROBLEM

ANOTHER HIDDEN POPULATIONANOTHER HIDDEN POPULATION

ILLICIT DRUG USE COMBINED WITH ILLICIT DRUG USE COMBINED WITH OTHER SUBSTANCES OTHER SUBSTANCES

Baby Boomers “Come of Baby Boomers “Come of Age ”Age ”

Current Problem: lack of knowledge of Current Problem: lack of knowledge of substance use in elderssubstance use in elders

Substance use in elders will be a huge problem Substance use in elders will be a huge problem in < 20 years b/c boomers:in < 20 years b/c boomers: Accepting of alcohol and drug useAccepting of alcohol and drug use

• Used more in youthUsed more in youth• Use more NOWUse more NOW

Use more psychoactive Rx drugs nowUse more psychoactive Rx drugs now 3-4x more emotional disorders 3-4x more emotional disorders

Deadly... 1994

Or,Just . . . K

eeping

The madness??

““MATURING OUT” OF ILLICIT MATURING OUT” OF ILLICIT DRUG ABUSERSDRUG ABUSERS

THEORY PROPOSED IN THE 1960’STHEORY PROPOSED IN THE 1960’S

BELIEF THAT OLDER ADULTS WOULD NO BELIEF THAT OLDER ADULTS WOULD NO LONGER USE ILLICIT SUBSTANCES LONGER USE ILLICIT SUBSTANCES BECAUSEBECAUSE THEY WOULD DIE OF AN OVERDOSETHEY WOULD DIE OF AN OVERDOSE THEY WOULD BE IN JAILTHEY WOULD BE IN JAIL THEY WOULD SWITCH TO “LEGAL” DRUGS THEY WOULD SWITCH TO “LEGAL” DRUGS

BECAUSE OF THE COSTS BECAUSE OF THE COSTS

ILLICIT DRUG USE AMONG THOSE OVER ILLICIT DRUG USE AMONG THOSE OVER 50 IN LA INNER CITY HOSPITAL, 200450 IN LA INNER CITY HOSPITAL, 2004

COCAINE WITH/WITHOUT ANOTHER COCAINE WITH/WITHOUT ANOTHER ILLEGAL DRUG WAS THE MOST COMMONILLEGAL DRUG WAS THE MOST COMMON

75% OF SUBJECTS WERE AGE 50-65; THE 75% OF SUBJECTS WERE AGE 50-65; THE OLDEST USER WAS A 90 Y.O. FEMALEOLDEST USER WAS A 90 Y.O. FEMALE

4% OF USERS WERE ABOVE AGE 804% OF USERS WERE ABOVE AGE 80

ONE-THIRD WERE FEMALEONE-THIRD WERE FEMALE

ILLICIT DRUG USEILLICIT DRUG USE

OLDER MEN ARE TWICE AS LIKELY TO USE OLDER MEN ARE TWICE AS LIKELY TO USE ILLICIT DRUGS THAN WOMEN…BUT WOMEN ILLICIT DRUGS THAN WOMEN…BUT WOMEN ARE USING THEM!ARE USING THEM!

SIDE EFFECTS OF ILLICIT DRUG USE CAN SIDE EFFECTS OF ILLICIT DRUG USE CAN MIMIC KNOWN DISEASESMIMIC KNOWN DISEASES

THE TYPES OF ILLICIT DRUGS USED MAY THE TYPES OF ILLICIT DRUGS USED MAY DIFFER GEOGRAPHICALLYDIFFER GEOGRAPHICALLY

ILLICIT DRUG USEILLICIT DRUG USE

MAN OLDER ADULTS WHO USE “STREET” MAN OLDER ADULTS WHO USE “STREET” DRUGS DO SO IN THE CONTEXT OF THE DRUGS DO SO IN THE CONTEXT OF THE FAMILY AND CHILDRENFAMILY AND CHILDREN

MANY ILLICIT DRUG USERS WILL USE MORE MANY ILLICIT DRUG USERS WILL USE MORE THAN ONE DRUGTHAN ONE DRUG

• CIGARETTE USE IS OFTEN A CO-EXISTENT PROBLEM CIGARETTE USE IS OFTEN A CO-EXISTENT PROBLEM AS IS MARIJUANAAS IS MARIJUANA

MOTIVATION FOR ILLEGAL MOTIVATION FOR ILLEGAL DRUG USE BY OLDER ADULTSDRUG USE BY OLDER ADULTS

NO GOOD STUDIES, ANECDOTAL NO GOOD STUDIES, ANECDOTAL EVIDENCEEVIDENCE

FAMILIAL PARTICIPATION IN DRUG USEFAMILIAL PARTICIPATION IN DRUG USE KNOWLEDGE OF DRUG AVAILABILITY KNOWLEDGE OF DRUG AVAILABILITY

(PREVIOUS PARTICIPANTS MORE (PREVIOUS PARTICIPANTS MORE FAMILIAR WITH SOURCES)FAMILIAR WITH SOURCES)

HABIT AND ADDICTION (BABY BOOMERS)HABIT AND ADDICTION (BABY BOOMERS)

National Survey on Drug National Survey on Drug Use and Health (NSDUH)Use and Health (NSDUH)

Representative of U.S. and each StateRepresentative of U.S. and each State

Civilian, noninstitutionalized populationCivilian, noninstitutionalized population

Age 12 or olderAge 12 or older

Anonymous face-to-face interviewAnonymous face-to-face interview

Computer-assisted self-interviewingComputer-assisted self-interviewing

67,500 respondents each year67,500 respondents each year

5,980 respondents age 50+ in 20035,980 respondents age 50+ in 2003

(population 81 million)(population 81 million)

Types of Drugs UsedTypes of Drugs Usedby Past Month Illicit Drug Users:by Past Month Illicit Drug Users:

Age 50+, 2002-2003 Annual AveragesAge 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

Dependence or Abuse of Illicit Drugs:Dependence or Abuse of Illicit Drugs:Age 50+, 2002-2003 Annual AveragesAge 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)

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: Lifetime Use of Illicit Drugs, by Year of Birth: 2002-2003 Annual Averages2002-2003 Annual Averages

Percent Ever UsedBaby Boom Cohort

(Born 1946-64)

7.39.1

11.1 11.5 11.513.6

15.218.1

21.623

26.6

2.8 3.3 4.2 4.4 5 5.56.9 7.6

9.2 10.312.7

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 Major Drugs of Abuse in Treatment Admissions with Illicit Drug as Primary Substance: Age with Illicit Drug as Primary Substance: Age

50+, 1992-200250+, 1992-2002Admissions in Thousands

Heroin

Cocaine

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

Age 50+, 2002-2003 Annual AveragesAge 50+, 2002-2003 Annual Averages

1.5

0.60.6

0.9

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6Percent Using in Past Month

Male

Female

Marijuana Prescription Drug Nonmedically

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

MARIJUANAMARIJUANA

MEDICAL MARIJUANA HERE IN CALIFORNIAMEDICAL MARIJUANA HERE IN CALIFORNIA

FREQUENTLY USED WITH OTHER SUBSTANCES FREQUENTLY USED WITH OTHER SUBSTANCES INCLUDING COCAINE, CIGARETTES AND ALCOHOLINCLUDING COCAINE, CIGARETTES AND ALCOHOL

DRUG INTERACTIONS THAT COULD OCCUR WITH DRUG INTERACTIONS THAT COULD OCCUR WITH PRESCRIPTION MEDICATIONSPRESCRIPTION MEDICATIONS

CAN INDUCE A HEART ATTACK IN OLDER PEOPLECAN INDUCE A HEART ATTACK IN OLDER PEOPLE

CANNABIS AND LATE-LIFE PSYCHOSISCANNABIS AND LATE-LIFE PSYCHOSIS(LANCET, 2007)(LANCET, 2007)

PREVIOUS STUDIES HAVE SUGGESTED PREVIOUS STUDIES HAVE SUGGESTED THAT MARIJUANA CAN PRODUCE THAT MARIJUANA CAN PRODUCE TRANSIENT, USUALLY MILD, PSYCHOTIC TRANSIENT, USUALLY MILD, PSYCHOTIC AND AFFECTIVE EXPERIENCESAND AFFECTIVE EXPERIENCES

WHETHER IT INCREASES THE INCIDENCE WHETHER IT INCREASES THE INCIDENCE OF MENTAL HEALTH DISORDERS SUCH AS OF MENTAL HEALTH DISORDERS SUCH AS SCHIZOPHRENIA OR DEPRESSION IS SCHIZOPHRENIA OR DEPRESSION IS UNCLEARUNCLEAR

CANNABIS AND LATE-LIFE CANNABIS AND LATE-LIFE PSYCHOSISPSYCHOSIS

INDIVIDUALS WHO USED CANNABIS ON A WEEKLY INDIVIDUALS WHO USED CANNABIS ON A WEEKLY OR DAILY BASIS HAD A 2-TO-3-FOLD INCREASE IN OR DAILY BASIS HAD A 2-TO-3-FOLD INCREASE IN RISK FOR PSYCHOTIC OUTCOMESRISK FOR PSYCHOTIC OUTCOMES

EVIDENCE ON RISK FOR DEPRESSION, EVIDENCE ON RISK FOR DEPRESSION, SUICIDALITY, OR ANXIETY WERE LESS SUICIDALITY, OR ANXIETY WERE LESS CONSISTENT VS. STUDIES ON PSYCHOTIC CONSISTENT VS. STUDIES ON PSYCHOTIC DISORDERSDISORDERS

THE MOST FREQUENT USERS SHOWED A 50% TO THE MOST FREQUENT USERS SHOWED A 50% TO 200% INCREASE IN RISK FOR PSYCHOSIS200% INCREASE IN RISK FOR PSYCHOSIS

TREATMENT OPTIONSTREATMENT OPTIONS

SELF-HELP/MUTUAL PEER SUPPORTSELF-HELP/MUTUAL PEER SUPPORT

BRIEF INTERVENTIONS IN THE PRIMARY BRIEF INTERVENTIONS IN THE PRIMARY CARE SETTINGCARE SETTING

CBTCBT

ELDER-SPECIFIC TREATMENTELDER-SPECIFIC TREATMENT

FORMAL SPECIALIZED TREATMENT FORMAL SPECIALIZED TREATMENT APPROACHES FOR WOMENAPPROACHES FOR WOMEN

CSAT RECOMMENDATIONS:CSAT RECOMMENDATIONS:

CBTCBT GROUP-BASED APPROACHESGROUP-BASED APPROACHES INDIVIDUAL COUNSELINGINDIVIDUAL COUNSELING MEDICAL/PSYCHIATRIC APPROACHESMEDICAL/PSYCHIATRIC APPROACHES

CSAT RECOMMENDATIONS CSAT RECOMMENDATIONS (CONTINUED)(CONTINUED)

MARITAL AND FAMILY MARITAL AND FAMILY INVOLVEMENT/FAMILY THERAPYINVOLVEMENT/FAMILY THERAPY

CASE MANAGEMENT/COMMUNITY-CASE MANAGEMENT/COMMUNITY-LINKED SERVICES AND OUTREACHLINKED SERVICES AND OUTREACH

FORMAL ALCOHOL SERVICESFORMAL ALCOHOL SERVICES

COGNITIVE-BEHAVIOR COGNITIVE-BEHAVIOR THERAPY (CBT):THERAPY (CBT):

EXAMPLES:EXAMPLES:

TEACH OLDER ADULTS SKILLS TEACH OLDER ADULTS SKILLS NECESSARY TO REBUILD SOCIAL NECESSARY TO REBUILD SOCIAL SUPPORT NETWORKSSUPPORT NETWORKS

USE SELF-MANAGEMENT APPROACHES USE SELF-MANAGEMENT APPROACHES FOR OVERCOMING DEPRESSION, GRIEF, FOR OVERCOMING DEPRESSION, GRIEF, LONELINESSLONELINESS

CBTCBT

SUCCESSFUL IN REDUCING OR SUCCESSFUL IN REDUCING OR STOPPING ALCOHOL USESTOPPING ALCOHOL USE

BLOW ET AL (2000); SCHONFELD ET AL BLOW ET AL (2000); SCHONFELD ET AL (2000)(2000)

CASE MANAGEMENTCASE MANAGEMENT

MAY BE BEST WAY TO PROVIDE MAY BE BEST WAY TO PROVIDE OUTREACH SERVICESOUTREACH SERVICES

TRADITIONAL RESIDENTIAL TRADITIONAL RESIDENTIAL ALCOHOLISM TREAMENT PROGRAMS ALCOHOLISM TREAMENT PROGRAMS GENERALLY TREAT FEW OLDER GENERALLY TREAT FEW OLDER ADULTSADULTS

CASE MANAGEMENTCASE MANAGEMENT

MAY BE BEST WAY TO PROVIDE MAY BE BEST WAY TO PROVIDE OUTREACH SERVICESOUTREACH SERVICES

TRADITIONAL RESIDENTIAL TRADITIONAL RESIDENTIAL ALCOHOLISM TREAMENT PROGRAMS ALCOHOLISM TREAMENT PROGRAMS GENERALLY TREAT FEW OLDER GENERALLY TREAT FEW OLDER ADULTSADULTS

FUTURE DIRECTIONS, NEEDS FUTURE DIRECTIONS, NEEDS AND RESEARCHAND RESEARCH

LACK OF ASSESSMENT INSTRUMENTS LACK OF ASSESSMENT INSTRUMENTS ADDRESSING OLDER WOMEN, ILLICIT DRUG USE, ADDRESSING OLDER WOMEN, ILLICIT DRUG USE, CO-MORBIDITIES, PRESCRIPTION DRUG ABUSECO-MORBIDITIES, PRESCRIPTION DRUG ABUSE

RISKS OF SIMULTANEOUS USE OF ALCOHOL AND RISKS OF SIMULTANEOUS USE OF ALCOHOL AND PRESCRIPTION DRUGSPRESCRIPTION DRUGS

UNDER REPRESENTATION OF OLDER WOMEN IN UNDER REPRESENTATION OF OLDER WOMEN IN RANDOMIZED TRIALS OF ALCOHOL TREATMENTRANDOMIZED TRIALS OF ALCOHOL TREATMENT

DIVERSITY ISSUES: DISABLED, CULTURE, DIVERSITY ISSUES: DISABLED, CULTURE, ETHNICITYETHNICITY