Substance Use Prevalence. Source: 2012 SAMHSA NSDUH

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1 US Census Data Ortman, Jennifer M., Victoria A. Velkoff, and Howard Hogan. An Aging Nation: The Older Population in the United States, Current Population Reports, P U.S. Census Bureau, Washington, DC

2 US Census Data

3 Substance Use Prevalence Source: 2012 SAMHSA NSDUH

4 Baby Boom Cohort! In 2012, only 19.3 percent of persons aged 65 or older (i.e., born before 1948) had ever used illicit drugs in their lifetime, while the lifetime rates of use were 47.6 percent for those aged 60 to 64 (born in 1948 to 1952) and were above 50 percent for each age group from ages 20 to 59 (born after 1952). By 2012, the 50 to 64 age group consisted entirely of the baby boom cohort.

5 SUD Treatment Data! National drug admissions among those 55 and older increased by 97% between 1997 and During the same time overall drug admissions for those aged 49 and younger grew 16% (SAMHSA TEDS, 2008)! In the same period, national drug admissions for those aged grew 152%

6 SUD Treatment Data Table: Primary Substance of Abuse at Admission for Individuals 55+ in 2012 Substance Primary Substance of Abuse % ALCOHOL 63.8 COCAINE/CRACK 8.5 MARIJUANA/HASHISH 2.4 HEROIN 18.5 NON-PRESCRIPTION METHADONE 0.3 OTHER OPIATES AND SYNTHETICS 3.5 OTHER SUBSTANCES 3.0 Source: SAMHSA Treatement Episode Data Set (TEDS)

7 Treatment Data! The percentage of adults ages 55 and older reporting heroin as their primary substance of admission grew from 11.7% in 2000, to 15.5% in 2006, to 18.5% in 2012! In 2012, 7.9% of treatment admissions reported nonmedical use of other opiates/ synthetics (besides heroin), compared to 4.7% in 2006

8 SUD Treatment in New York! The number of older adult (ages 55+) treatment admissions in NY almost doubled from 13,900 in 2000 to 26,220 in 2011 (an 89% increase)! The percentage of 55+ admissions in NY for heroin increased from 10.4% in 2000 to 16.8% in 2011 (62% increase). The percentage increase for nonmedical use of other opiates/ synthetics (besides heroin), jumped from 0.8% to 3.6% (350% increase) in the same time period

9 Physical and Mental Health

10 Depression! A 2007 Healthy Aging report by the CDC, identified depression as an emerging public health issue that affects older adults (CDC, 2007)! Prevalence of depression in community dwelling older US adults is as high as 20% (DHHS, 1999)! Older alcoholics are 3x as likely to exhibit a major depressive disorders than non-alcoholics (SAMHSA, 2005)

11 Chronic Conditions Chronic Conditions Source: Health and Retirement Study 2012

12 SUD Screening! Where to screen? Physicians offices Dentists offices Nursing Homes/Assisted Living Communities NORCs Elderly Community Center Programs Visiting nurse programs Elderly nutrition programs Emergency Rooms Family Members?

13 Screening Protocols! Alcohol and Drug Screening Michigan Alcoholism Screening Test- Geriatric Version (MAST-G) Alcohol Use Disorders Identification Test (AUDIT) Drug Abuse Screening Test (DAST)! Depression Screening Geriatric Depression Scale (GDS) Center for Epidemiologic Studies Depression Scale (CES-D)! Health/Functioning Screening Health Screening Survey, Revised (HSS) Index of Activities of Daily Living (ADLs) Instrumental Activities of Daily Living (IADL) SAMHSA TIP 26

14 Barriers to Care! Barriers to treatment and reporting include: fear of social stigma misdiagnosis by medical professionals systems barriers to culturally competent care! Accessibility 1915i-like services may play a key role with this population

15 Odyssey House ElderCare SUD Program Data! Odyssey House s ElderCare Program Demographics (2014): 65% African-American, 20% Hispanic, 15% White 84% Male, 16% Female Average age: 60.8 (SD 5.2) Age Range: % report completing HS or obtaining GED 55% have criminal justice involvement at admission 57% are homeless Approximately 40% of ElderCare residents report a mental health condition at admission 45% report having a major physical health condition 86% report having at least one prior treatment episode

16 Odyssey House ElderCare Program Data Odyssey House s ElderCare Program Substance of Abuse (2014):! Primary Substances of Abuse Alcohol (51.0%) Crack/cocaine (21.2%) Heroin (22.1%)! 60.0% report poly-substance use disorders! Forty-three percent (43%) have a primary medical diagnosis of hypertension, 20% are HIV +, 15% have asthma, and 10% have heart problems

17 Odyssey House ElderCare Program 2014 Utilization/Treatment Outcomes Utilization Rate (68 beds) 99% 1 Month Retention 99% 3 Months Retention 85% % Completing or Referred 73%

18 Odyssey House Integrated Care Grant for Older Adults! Results to Date: 52% of ElderCare clients have been identified of being at-risk or have a physical or mental health condition 67% of clients identified as at risk are at risk for anxiety 56% of clients identified as at risk are at risk for depression

19 Odyssey House Integrated Care Grant for Older Adults! 2 year project funded by New York State Office of Mental Health! Purpose is to establish behavioral health care services in a physical health care setting! The target population for the this program is individuals 55 years and older, who suffer from a substance use disorder and/or cooccurring SUD and mental health disorder

20 Recommendations! Increase resources dedicated to identifying and treating older adults with alcohol and substance abuse! Need for more specialized treatment services conforming to the special needs of older adult addicts! More research into alternate therapies/ pharmacology for older adults with substance use disorders! Regulatory Relief (HCBS services, Integrated Clinic Licensure)

21 References! Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.