Substance Abuse by Older Adults:  Estimates of Future Impact on the Treatment System

Overview

This report provides evidence concerning the projected demand for substance abuse treatment services for older Americans over the next 20 to 30 years and suggests approaches for refining these projections. It was developed in response to two trends in the United States—the aging of the population and the higher consumption of alcohol and illicit substances by people born between 1946 and 1964 (the baby boom generation) than was true in earlier cohorts. A work group of Federal agency representatives and university researchers was established by the Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies (OAS), to examine and assess the ability of available data to provide sufficient information to guide planning to address the possible doubling of the number of those older adults requiring substance abuse treatment services. The work group identified and reviewed available information, gaps in data, assumptions concerning data collection and analysis, important variables, and estimation methods and models. This report includes original analyses of a wide variety of data sources undertaken by an invited panel of experts. It was prepared to demonstrate approaches to the issues raised and the suggestions of the Federal work group.

The chapters in this report review the issues in anticipation of the substance abuse treatment needs of the future elderly. To make reliable forecasts of the demand for substance abuse treatment services, more updated and expanded information is needed concerning the life course of persons who abuse substances and are in recovery, those who continue to abuse substances throughout their lives and may or may not be in treatment, and those who begin abusing substances later in life. Patterns of relapse and recovery must be better understood. The report highlights uses of available data and provides examples of analyses and methodological issues required to refine forecasts of the demand for substance abuse treatment services emerging over the next several decades. The final chapter discusses the implications and suggests approaches to extending our knowledge in the area.

Key highlights include the following:

• Demographic projections suggest that the proportion of the population 65 years or older in the United States will rise from the current 12 percent to 20 percent by the year 2030. Moreover, the population will become more ethnically and racially diverse, live longer, and face higher health care service and prescription drug costs than ever before (Chapter 1).
• Abuse of alcohol and drugs, licit and illicit, is currently a serious health problem among older Americans, affecting up to 17 percent of adults aged 60 or older (approximately 8 million adults) (Chapter 8).
• Estimates using data from the 1999 National Household Survey on Drug Abuse (NHSDA) suggest that the number of adults with substance abuse problems will double to 5 million during the time period from 1999 to 2020 (Chapter 5).
• Many data resources exist for measuring substance misuse and abuse across the life cycle. However, most fail to provide direct measures of age-specific recovery, relapse, and mortality of substance abusers (Chapter 2).
• Analysis of existing data on high-risk substance abusers indicates that age-related drug use progression and recovery appear to differ depending on the type of drug abused (Chapter 3).
• An analysis of the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) data indicates that substantial changes in the patterns of substance use/abuse over different age cohorts will dramatically affect future treatment and prevention for senior adults (Chapter 7).
• An analysis of the National Health and Nutrition Examination Survey (NHANES) Longitudinal Analysis of Drinking Over the Life Span indicates that the baby boom generation is likely to maintain a higher level of alcohol consumption than previous generations' cohorts (Chapter 8).

• An analysis of the Department of Veterans Affairs (VA) inpatient utilization data indicates that the baby boom generation uses the largest proportion of substance abuse treatment services provided by the VA. Furthermore, there is little evidence of declining need for treatment or "aging out" among this group of substance-using veterans (Chapter 9).
• Treatment Episode Data Set (TEDS) data for 1997 indicate that alcohol abuse was the primary problem of those aged 50 or older who were admitted to publicly funded substance abuse treatment. Abuse of tranquilizers and sedatives increased with age and was consistent with problem prescription drug use among older adults, especially when combined with alcohol (Chapter 4).
• The NHSDA in its current form is capable of producing limited estimates for projecting substance abuse in an older population, but changes to the survey could facilitate the use of a follow-up life table to track a cohort of substance-abusing baby boomers as they move into old age by 2020 or 2030 (Chapter 6).
• The health care system in the United States does not yet appear to have recognized or to be effectively dealing with the increased and increasing use and abuse of licit and illicit psychoactive substances by older populations (Chapter 10).
• The organization and financing of health care and related services also are factors in the underdiagnosis and undertreatment of elderly substance abusers (Chapter 1).
• The development of innovative and effective screening and treatment methods for substance misuse among older adults is an important focus of future research (Chapter 7).
• Analyses of existing data underscore the need to develop and include improved measurement of substance abuse/dependence in the elderly, as well as the need to improve sampling methods to ensure the representativeness of the older population in datasets. There is also a need for longitudinal data to better understand the "life course" of substance use and recovery (Chapter 10).

In summary, this report underscores the expected change in the magnitude of the requirement for substance abuse treatment in future generations of older Americans. Complementing the accelerated aging and changing demographic profile of the U.S. population will be a new constellation of factors, including longer life span, increased per capita use of multiple prescription drugs, increased pressure to retain older people in the workforce, and the enhanced propensity of those entering their senior years to abuse both licit and illicit drugs. These factors will have an impact on both the Nation's substance abuse treatment and the greater health care system. Therefore, it is suggested that more informed policy will require new approaches, including the following:

• data-related collection strategies, methods, and analyses designed specifically with an emphasis appropriate to documenting substance abuse in the elderly, including the identification of polydrug use in the elderly;
• an ongoing, expanded, and better targeted review of the literature to identify new conceptual and methodological insights in the specific older populations at risk;
• prevention, treatment, and management strategies specifically tailored for the elderly from different ethnic, gender, and racial groups, including immigrant populations, monitoring the demographic shifts in heterogeneous elderly populations; and
• long-term projections of the demand for expanded clinical and public health services for substance abusers.

This page was last updated on June 16, 2008.

SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.