Transcript The Coming Epidemic, Frederic C. Blow, Ph.D.

OlderAdults & Substance Misuse: TheComing Epidemic
Frederic C. Blow, Ph.D.
Professor of Psychiatry, University of Michigan Medical School
Director, University of Michigan Addiction Center
Senior Research Scientist, Center for Clinical Management Research
Ann Arbor VA Healthcare System
Disclosure
Presentation Outline
The Silver Tsunami
www.census.gov
The Demographic Imperative
‘Baby Boomers’ impact
• Roughly 10,000 people will turn 65 today, and about 10,000
more will cross that threshold every day for the next 13
years
• By 2030, 1 in 5 Americans will be 65 or older
• Enormous pressure on retirement systems, health care
facilities, and other services
• Major implications for substance abuse and mental health
prevention and treatment
Pew Research Center. Baby Boomers Retire. Daily Number December 29, 2010. Accessed online at http://www.pewresearch.org/daily-number/baby-boomers-retire/
U.S. Department of Health and Human Services Administration for Community Living. A Profile of Older Americans: 2015.
Sandra L. Colby and Jennifer M. Ortman. 2014. The Baby Boom Cohort in the United States: 2012 to 2060: Population Estimates and Projections. 5: p25-141.
Ethnic/Racial Diversity
• Currently, 18% of older adults are members of racial or ethnic
minority groups:
• 8% African American, 6% Latino, 3% Asian or Pacific Islander, and
<1% American Indian or Native Alaskans.
• By 2030, 26% of older Americans will be members of racial or
ethnic minority groups.
• Changes in ethnic diversity will affect:
• access and barriers to substance abuse prevention and treatment
• older adults and care provider dynamics
• the need to understand cultural differences in perception of MH/SA
problems, care preferences, and response to interventions.
US Administration on Aging
What Makes Older Adults Different?
SubstanceUse and Misuse in Later Life
Rates of Past Month Substance Use in Older Adults
Alcohol
-Current use (not binge) - 41.7%
-Binge - 9.1%
-Heavy use (5+ drinks on 5+ days) - 2.1%
Illicit Drugs (Cocaine, marijuana, heroin, hallucinogens,
inhalants, and prescribed therapeutic drugs used nonmedically) - 3.9%
Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series
H-48, HHS Publication No. (SMA) 14–4863. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Alcohol Use in Older Adults
Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance abuse among older adults. Clinics in geriatric medicine, 30(3), 629-654
Choi, N. G., DiNitto, D. M., & Marti, C. N. (2015). Alcohol and other substance use, mental health treatment use, and perceived unmet treatment need: comparison
between baby boomers and older adults. The American Journal on Addictions, 24(4), 299-307..
Past Month Illicit Drug Use among Adults Aged 50-64
Illicit drug: cocaine, marijuana, heroin, hallucinogens, inhalants, and prescribed therapeutic drugs used non-medically
Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings,
NSDUH Series H-48, HHS Publication No. (SMA) 14–4863. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Rate of Past Month Marijuana Use by Age
SAMHSA. Marijuana (Cannabis). Updated 09.01.2016. Accessed at: http://www.samhsa.gov/atod/marijuana
Opioid Use and Misuse in Older Adults
M. Olfson, S. Wang, M. Iza, et al. National trends in the office-based prescription of schedule II opioids. J Clin Psychiatry, 74 (2013), pp. 932–939
Wu, L. T., & Blazer, D. G. (2011). Illicit and nonmedical drug use among older adults: a review. Journal of aging and health, 23(3), 481-504.
West, N. A., Severtson, S. G., Green, J. L., & Dart, R. C. (2015). Trends in abuse and misuse of prescription opioids among older adults. Drug and alcohol dependence, 149, 117-121.
Substance Abuse Among Older Adults
one in
five
Substance Abuse in Older Adults
The number of adults aged
50 or older with substance
use disorders is projected to
double from 2.8 million
(annual average) in 2002–06
to 5.7 million in 2020.
Substance use disorder among older adults in the United States in 2020. Available from:
https://www.researchgate.net/publication/23768634_Substance_use_disorder_among_older_adults_in_the_United_States_in_2020 [accessed Oct 28, 2016].
Substance Misuse/Abuse in Older Adults
Challenges: Substance Abuse in Older Adults
• Insufficient knowledge (mistaken for
dementia/Alzheimer’s, depression)
• Lack of financial or social support
• Denial / social stigma
• Diagnostic criteria tend to underestimate prevalence
• Shortage of programs designed for older adults
Han, B., Gfroerer, J. C., Colliver, J. D., & Penne, M. A. (2009). Substance use disorder among older adults in the United States in 2020. Addiction,104(1), 88-96.
Douaihy, A. (2013). Late-Life Substance Use Disorders. Geriatric Psychiatry, 281.
Comorbid Mental Health Disorders in Older Adults
Blow FC. New findings in alcohol and comorbid mental health disorders in older adults. American Journal of Geriatric Psychiatry, 22(9):851-3, 2014 Sept. (PMID: 25109419)
Drinking Limits
Recommended Drinking Limits for Older Adults
Drinking Limits
less than one
drink per day on average for older women
Binge drinking
three or more drinks during a single
occasion for women
*Limits are for healthy individuals who do not have a medical condition
worsened by alcoh0l or take any medications that interact with alcohol.
NIAAA; Centers for Disease Control and Prevention, 2006
What is a Drink?
Referral Pathways
Referral Pathways
(OAS, SAMHSA, 2004)
Figure 2. All Admissions, by Age Group and Referral Source:
2001
Source: 2001 SAMHSA Treatment Episode Data Set (TEDS).
Referral Source and Treatment Completion
(Atkinson et al., 2003)
Workforce Needs
Numbers and Training
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Workforce Implications of Effective Aging Delivery
Models
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Conclusions
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Contact Information
Frederic C. Blow, Ph.D.