Baby Boomers and Drug Abuse
Illicit drug use generally declines as individuals move through young adulthood into middle adulthood and maturity, but research has shown that the baby-boom generation (persons born between 1946 and 1964) has relatively higher drug use rates than previous generations. It has been predicted that, as the baby boom generation ages, past year marijuana use will almost triple between 1999/2001 and 2020 among persons aged 50 or older. Nonmedical use of prescription-type drugs also has been identified as a concern for this population. Although use of illicit drugs is problematic for individuals of all ages, it may be of particular concern for older adults because they experience physiological, psychological, and social changes that place them at greater risk of harm from illicit drug use. The increasing prevalence and effects of illicit drug use among older adults suggest the need both to better understand illicit drug use among this population and to plan for and develop age-appropriate prevention and treatment services.
The National Survey on Drug Use and Health (NSDUH) asks persons aged 12 or older to report their use of illicit drugs in the past year. NSDUH defines illicit drugs to include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used non-medically. This issue of The NSDUH Report presents estimates of past year use of illicit drugs among persons aged 50 or older. Findings in the report are annual averages based on combined 2007 to 2009 NSDUH data.
An estimated 4.8 million adults aged 50 or older, or 5.2 percent of adults in that age range, had used an illicit drug in the past year. The most common illicit drug among older adults was marijuana (3.2 percent or 3.0 million users), followed by nonmedical use of prescription-type drugs (2.3 percent or 2.1 million users). About 0.8 percent (761,000 users) of older adults reported use of an illicit drug other than marijuana or nonmedical use of prescription-type drugs, including 0.6 percent for cocaine, 0.1 percent for heroin, 0.1 percent for hallucinogens, and 0.1 percent for inhalants. Among older adults, the prevalence rates of any illicit drug use, marijuana use, and nonmedical use of prescription-type drugs were higher for adults aged 50 to 59 than for those aged 60 or older.
Comparing the types of substances used in the past year, marijuana use was more common than nonmedical use of prescription-type drugs among adults aged 50 to 59 (5.9 vs. 3.6 percent). Among adults aged 60 or older, the rate of nonmedical use of prescription-type drugs was similar to the rate of marijuana use (1.2 and 1.1 percent, respectively). Among adults aged 50 or older, the prevalence rates of any illicit drug use and marijuana use in the past year were higher among males than females. These patterns were generally consistent across age groups. For example, 8.0 percent of males aged 50 to 59 used marijuana compared with 3.9 percent of same-aged females. Males and females, however, had similar rates of nonmedical use of prescription-type drugs overall and within both age groups.
Comparing the types of substances used in the past year, marijuana use was more common than nonmedical use of prescription-type drugs among all males aged 50 or older (4.7 vs. 2.5 percent) and among males aged 50 to 59 (8.0 vs. 3.9 percent). Among all females aged 50 or older, the rates of marijuana use and nonmedical use of prescription-type drugs were similar (1.9 and 2.1 percent, respectively), but the rate of marijuana use was lower than the rate of nonmedical use of prescription-type drugs among females aged 60 or older (0.5 vs. 1.1 percent).
Among adults aged 50 or older who used illicit drugs in the past year, 45.2 percent used only marijuana, 31.5 percent used only prescription-type drugs non-medically, and 5.6 percent used only other illicit drugs (including cocaine, heroin, hallucinogens, or inhalants) with the remainder using other combinations of illicit drugs.
Although some prescription-type drug users initiated their nonmedical use of these drugs late in life, most used for the first time more than 10 years ago. Nearly all of the marijuana users initiated marijuana use more than 10 years ago. Differences were seen between males and females. For example, the percentage using marijuana only was higher among males than females (49.2 vs. 38.8 percent), while the percentage reporting nonmedical use of prescription-type drugs only was higher among females than males (44.4 vs. 23.4 percent).
Despite the perception that illicit drug use is a behavioral health issue only for adolescents and young adults, it is also a serious and growing health concern for older adults. Research shows that illicit drug use is more common among the baby-boom generation than previous cohorts, leading researchers to estimate that the number of older adults with a substance use disorder will double by 2020. This report shows that nearly 4.8 million adults aged 50 or older used an illicit drug in the past year and that patterns of use vary by gender and age group. Together, these data highlight the importance of prevention and treatment efforts targeting older adults. Like younger age groups, effective treatment for older adults begins with accurate screening, assessment, and diagnosis. However, addressing the needs of older adults presents different challenges than younger age groups and requires different strategies.
For example, screening and assessment tools designed for younger adults may use criteria not relevant to older adults (e.g., the negative impact of substance use on work or school), which calls for the development and use of age-specific tools to properly recognize and diagnose substance abuse problems among older adults. Importantly, age-appropriate screening can help clinicians intervene early and may improve medical care because many health conditions are associated with illicit drug use. In addition, while conducting screenings, clinicians should ask older adults about the specific types of drugs used and the duration of use because these factors tend to affect decisions about appropriate treatment. For example, use of marijuana may be a decades-long experience for some older adults, indicating a different intervention than one that is appropriate for those with an abuse history of a few years. Finally, treatment of older adults must be adjusted to account for the life stage of the
individual and the aging process and should be expanded to settings that are convenient and comfortable, such as retirement communities and senior centers. Also, treatment planning and approaches that include adult children and friends of substance-abusing older adults may be critical to treatment initiation, engagement, and recovery.