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

Table Of Contents

Chapter 4. Age Differences in Multiple Drug Use: National Admissions to Publicly Funded Substance Abuse Treatment

Leigh A. Henderson,* Ph.D.

Abstract: This chapter examines the use of multiple drugs (polydrug use) by age group in national admissions to publicly funded substance abuse treatment with special focus on adults aged 55 or older. Data consist of 1,493,710 admissions aged 10 or older from the 1997 Treatment Episode Data Set (TEDS), a national dataset of admissions to publicly funded substance abuse treatment maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Older adults are seldom admitted to the publicly funded substance abuse treatment system. In 1997, 97 percent of TEDS admissions were younger than 55. Abuse of alcohol alone was the primary problem of the majority of persons aged 50 or older, and the proportion of admissions increased for each age group through age 74. Older persons admitted to publicly funded treatment were less likely to report problems with polydrug use. Peak polydrug use occurred among those younger than 40, with 60 to 70 percent reporting use of multiple substances, but remained a substantial problem for those aged 55 to 79, where 7 to 20 percent reported use of multiple substances. Polydrug use increased among those aged 75 or older to levels comparable with those for persons younger than 40. Abuse of tranquilizers and sedatives, although relatively low, increased with age, and the proportions of admissions for tranquilizers and sedatives were greatest among those aged 75 or older. Beginning at age 55, an increasing proportion of persons entering treatment were doing so for the first time, largely for abuse of alcohol alone. There were indications that the few persons aged 75 or older who entered the publicly funded treatment system had more severe and complex problems than those just a few years younger. They were more likely to be polydrug users and to have been in treatment previously. Referrals to treatment by health care providers increased with age from 6 percent at ages 15 to 19 to 19 percent at ages 75 to 79. Individual or self-referral was responsible for the largest proportion of admissions for those aged 30 to 65 and for those 75 or older.

The purpose of this chapter is to examine the use of multiple drugs (polydrug use) by age in national admissions to publicly funded substance abuse treatment with special focus on adults aged 55 or older. The Treatment Episode Data Set (TEDS), a national dataset of admissions to publicly funded substance abuse treatment (Office of Applied Studies [OAS], 2001), includes a substantial number of older adults and permits examination of the number and types of substances used by this population, their source of referral to treatment, and their prior experience with the substance abuse treatment system.

Polydrug use is a concern because of the potential for additive or interactive effects of the drugs. These may produce different and perhaps more severe adverse consequences. For example, in drug-related deaths reported to medical examiners in 41 metropolitan areas in 1998, an average of 2.5 drugs was found (OAS, 2000). The recent proliferation of prescription psychoactive drugs, and their aggressive marketing, has added significantly to the potential for polydrug use (National Institute for Health Care Management, 2001). Alcohol, illicit drugs, and prescription drugs diverted to the illicit marketplace have been the traditional sources of polydrug use. To these problems is now added the potential for misuse (intentional or unintentional) of one or more drugs prescribed by a medical practitioner. Polydrug use is of particular concern among older adults, where one study estimated that 30 percent of persons over 65 take eight or more prescription drugs daily (Sheahan, Hendricks, & Coons, 1989). Many of these drugs may be psychoactive, taken for sleep disorders, chronic pain, or mood disorders (Center for Substance Abuse Treatment [CSAT], 1998).

Although the problems engendered by polydrug use are drawing increasing attention, indicators of its prevalence nationally and of specific drug combinations are lacking, particularly among older adults. In part, this is because polydrug use has been seen as an illicit drug problem. Research in a longitudinal cohort has indicated that initiation of illicit drug use after age 28-29 is extremely rare (Chen & Kandel, 1995). By age 28-29, some 85 to 95 percent of users of drugs other than alcohol and marijuana had stopped their use (Raveis & Kandel, 1987). However, initiation of use of prescription psychoactives was an exception, and the cohort has not yet been followed beyond the age of 35. Among older adults, prescription polydrug use is more likely to be a problem than is illicit polydrug use.

In the general population, existing studies indicate that polydrug use is fairly widespread among adolescents and young adults. A community-based sample of persons aged 28 to 32 found that 31 percent used marijuana and alcohol, 28 percent used alcohol and illicit drugs other than marijuana, and 22 percent used marijuana and other illicit drugs (Earleywine & Newcomb, 1997). A study among 12th graders found that 29 percent reported simultaneous polydrug use (the use of two or more substances in combination) during the past year (Collins, Ellickson, & Bell, 1998).

Polydrug use has been demonstrated to be common among injection drug users and persons in correctional facilities. A study of injection drug users found that an average of 5.3 of 8 drug classes had been used in the 6 months prior to interview (Darke & Ross, 1997). Similarly, a study of heroin injectors and amphetamine users found that averages of 5.2 and 6.3 of 8 drug classes, respectively, had been used in the past 6 months (Darke & Hall, 1995). In a sample of injection drug users aged 16 to 45, 34 percent had used one substance in addition to their primary substance, 34 percent had used two, 19 percent had used three, and 13 percent had used four or more additional drugs (Klee, Faugier, Hayes, Boulton, & Morris, 1990). Among prison inmates, half reported using 5 or more of a list of 14 drugs (including alcohol), and 20 percent had tried 8 or more (Kassebaum & Chandler, 1994).

In substance abuse treatment populations, polydrug use has been studied primarily among alcoholics. National treatment population data indicate that use of alcohol and drugs is more common than use of either alone (Martin et al., 1996a). In a study of 212 persons in inpatient treatment for alcoholism (age range from 19 to 63, average 36.4), 61 percent reported current use of other drugs (Jensen, Cowley, & Walker, 1990). An average of 2.3 different combinations were reported. Among males in alcoholism treatment (age range from 20 to 68, average 42), an average of 3 drugs in addition to alcohol were found to have been abused (Martin, Kaczynski, Maisto, & Tarter, 1996b). In a study combining treatment and community populations of adolescents (average age 16.7), those with an alcohol dependence diagnosis had used an average 3.8 of 5 illicit drug classes, those with an alcohol abuse diagnosis had used an average of 3.0 illicit drugs, and those with no alcohol diagnosis had used an average of 1.9 drug classes (Belding, Iguchi, Lamb, Lakin, & Terry, 1995). The majority of subjects in each group had used illicit drugs (from 81 to 98 percent). Polydrug use in methadone maintenance is widely acknowledged (Iguchi, Stitzer, Bigelow, & Liebson, 1988; OAS, 1999), but published quantitative reports are rare.

Although studies have documented polydrug use in various populations, most have been limited in scope, focusing on a particular population (e.g., persons in alcohol treatment, injection drug users, adolescents). In this study, we examine polydrug use by 5-year age group as reported in TEDS, a record-based national data collection system for admissions to publicly funded substance abuse treatment. The substances inventoried in TEDS include alcohol and illicit drugs, as well as prescription drugs when they have caused dependence requiring treatment. This analysis will provide a benchmark against which changes in polydrug use in the treatment system can be measured. As the focus of this report is the baby boom generation born between 1946 and 1964, and what demands they may make on health care resources in the future, emphasis is placed in the analysis on this generation and on current older users of the treatment system. Prior experience with the treatment system and source of referral to treatment are included, as these may affect use of the system.

 

Description of the Dataset

TEDS is maintained by OAS in the Substance Abuse and Mental Health Services Administration (SAMHSA). The TEDS system includes records for some 1.5 million substance abuse treatment admissions annually. TEDS comprises data that are routinely collected by States in monitoring their individual substance abuse treatment systems. It does not include data on facilities operated by Federal agencies (the Bureau of Prisons, the Department of Defense, and the Veterans Administration). Selected data items from the individual State data files are converted to a standardized format consistent across States, and these standardized data constitute TEDS. TEDS consists of a Minimum Data Set collected by nearly all States, and a Supplemental Data Set collected by some States. The Minimum Data Set consists of 19 items that include demographic information; primary, secondary, and tertiary substances of abuse and their route of administration, frequency of use, and age at first use; source of referral to treatment; number of prior treatment episodes; and service type, including planned use of methadone. The Supplemental Data Set consists of 15 items that include psychiatric, social, and economic measures.

 

Study Population

This study is a cross-sectional analysis of 1,493,710 admissions reported to TEDS for 1997. Admissions represent treatment episodes during the year rather than the number of individuals seeking treatment. A person who entered residential treatment in February, transferred from residential to outpatient treatment in March, and completed outpatient treatment in April, but then reentered treatment in November, would be counted as having had two treatment episodes and thus two admissions. The transfer from residential to outpatient treatment is considered a continuation of the same episode and not a new admission. The report excludes 402 admissions who were younger than 10 years old.

 

Analysis

For this analysis, both licit and illicit substances were classified according to the system used throughout this monograph. The following substance classes were used:

All data are reported by 5-year age group, the standard reference for the chapters in this report. The maximum age that the TEDS system could accommodate at the time of data entry was 96. In the tables and Figure 1, the age groups that include the baby boom generation (aged 33 to 51 in 1997) are highlighted.

 

Results

Figure 1 shows the distribution by age of the 1997 TEDS admissions: 97 percent were younger than 55 in 1997, 2 percent were aged 55 to 64, and less than 1 percent were 65 or older. Only 118 were over 89 years of age. The greatest number of admissions were for ages 30 to 39; numbers were significantly lower for each subsequent age group. The baby boom generation made up 48 percent of all those entering treatment in 1997, when they were aged 33 to 51.

Table  1 shows the primary substance class, by age in 1997, reported at admission to treatment. Four substance classes accounted for 99 percent of all admissions. These were alcohol (50 percent), stimulants (20 percent), opiates (16 percent), and cannabinoids (13 percent). In no age group did other substances combined account for more than 4 percent of admissions. The proportion of admissions for primary alcohol abuse increased for each age group through age 74 (from 28 percent of those aged 10 to 14 to 89 percent of those aged 70 to 74), and then declined. Admissions for primary use of other substances peaked at ages 10 to 14 for cannabinoids, ages 25 to 34 for stimulants, and ages 40 to 49 for opiates. The proportions of admissions for tranquilizers and sedatives were greatest among those aged 75 or older.

Figure 1 TEDS Admissions: 1997 Age Distribution

 D

Note: Data for age groups that include the baby boom generation (aged 33 to 51 in 1997) are highlighted.

Source: SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS), April 16, 2001.

Table s  1a and 1b show the same information as in Table  1, but for males and females separately. Men were more likely to be in treatment for alcohol at all but the youngest ages. Women were more likely to be in treatment for "hard" drugs, such as opiates and stimulants.

Table  2 shows the distribution by age of any use of a substance, either as primary, secondary, or tertiary. The average number of substance classes reported was 1.8 to 1.9 through age 39. This declined with age to 1.1 at ages 65 to 79, but rose again in each subsequent age group, to 1.8 at ages 95 to 96. Abuse of alcohol, either alone or as a secondary substance, was characteristic of most treatment admissions. Overall, 73 percent of all admissions used alcohol, 41 percent used stimulants, 36 percent used cannabinoids, and 19 percent used opiates. Use of alcohol was reported by at least 69 percent of all admissions in each age group, and it tended to increase with age, peaking at 92 percent of admissions aged 70 to 74. Use of alcohol declined after age 85 to 71 percent among those 90 or older.

 

 

Table 1 All Treatment Admissions, by Age Group and Primary Use of Substance, Treatment Episode Data Set (TEDS): 1997

Age at Admission

Total
Number of
Admissions1

 

Primary Substance at Admission

Total

Alco-
hol

Stimu-
lants

Opiates

Can-
nabi-
noids

Hal-
luci-
nogens

Tran-
quil-
izers

Seda-
tives/
Hyp-
notics

Inhal-
ants

Over-
the-
Coun-
ter

Other

All Ages

1,493,710

100.0

49.6

20.0

15.9

13.3

0.3

0.3

0.2

0.1

*

0.2

10-14

22,883

100.0

27.7

4.1

0.5

63.7

0.8

0.1

0.1

1.9

0.2

1.0

15-19

160,773

100.0

32.5

9.3

4.2

51.9

1.0

0.1

0.1

0.4

0.1

0.4

20-24

154,867

100.0

43.3

19.3

13.2

22.9

0.6

0.2

0.1

0.1

*

0.2

25-29

213,360

100.0

44.6

27.8

15.8

10.9

0.3

0.2

0.2

0.1

*

0.2

30-34

272,528

100.0

48.3

28.1

16.1

6.6

0.2

0.3

0.2

*

*

0.2

35-39

273,880

100.0

52.6

23.8

17.8

4.9

0.1

0.3

0.2

0.1

*

0.2

40-44

194,620

100.0

55.5

17.4

22.5

3.6

0.1

0.4

0.3

*

*

0.2

45-49

106,180

100.0

60.5

12.1

23.9

2.6

0.1

0.4

0.2

*

*

0.2

50-54

49,417

100.0

71.5

8.0

17.7

1.8

0.1

0.4

0.3

*

*

0.2

55-59

24,261

100.0

78.8

5.1

13.8

1.2

*

0.5

0.3

*

*

0.2

60-64

11,101

100.0

84.0

3.2

10.7

0.8

0.1

0.6

0.4

*

*

0.2

65-69

5,670

100.0

86.8

2.0

8.7

0.9

0.1

0.5

0.7

--

0.1

0.3

70-74

2,605

100.0

89.2

1.8

6.6

0.7

--

0.8

0.6

--

0.1

0.2

75-79

968

100.0

86.1

2.3

6.4

1.9

0.1

1.9

1.1

--

--

0.3

80-84

343

100.0

83.1

4.1

6.1

3.2

--

1.8

1.5

--

--

0.3

85-89

136

100.0

66.2

14.0

14.0

3.7

--

0.7

1.5

--

--

--

90-94

101

100.0

52.5

13.9

23.8

6.9

--

1.0

2.0

--

--

--

95-96

17

100.0

47.1

29.4

5.9

17.7

--

--

--

--

--

--

* Less than 0.05 percent.
-- Quantity is zero.

Note: Data for age groups that include the baby boom generation (aged 33 to 51 in 1997) are in bold print.

1 Includes 5,013 admissions where sex (i.e., gender) was not reported.

Source: SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS), April 16, 2001.

Use of substances other than alcohol reflected the underlying primary substance patterns. Peak use occurred at different ages for different substances, declined for subsequent age groups, but rose again among those aged 75 or older. Stimulant use increased from 13 percent of those aged 10 to 14 to over half of those aged 30 to 34. Use of marijuana was highest among the youngest age groups—85 percent of those aged 10 to 14 and 80 percent of those aged 15 to 19. Use of opiates increased from 1 percent of those aged 10 to 14 to 28 percent of those aged 45 to 49.

 

 

Table 1a  Male Treatment Admissions, by Age Group and Primary Use of Substance, Treatment Episode Data Set (TEDS): 1997

Age at Admission

Total
Number of
Admissions1

 

Primary Substance at Admission

Total

Alco-
hol

Stimu-
lants

Opiates

Can-
nabi-
noids

Hal-
luci-
nogens

Tran-
quil-
izers

Seda-
tives/
Hyp-
notics

Inhal-
ants

Over-
the-
Coun-
ter

Other

All Ages

1,045,149

100.0

53.0

16.7

14.7

14.6

0.3

0.2

0.1

0.1

*

0.2

10-14

14,184

100.0

23.4

2.6

0.4

69.9

0.6

0.1

0.1

2.0

0.1

1.0

15-19

118,675

100.0

31.9

6.9

3.4

55.8

1.0

0.1

0.1

0.4

*

0.3

20-24

112,293

100.0

47.0

14.6

11.6

25.5

0.6

0.1

0.1

0.1

*

0.2

25-29

142,126

100.0

50.2

22.1

14.6

12.3

0.3

0.1

0.1

0.1

*

0.2

30-34

177,465

100.0

53.5

23.8

14.8

7.2

0.2

0.2

0.1

*

*

0.2

35-39

183,908

100.0

56.8

21.2

16.2

5.2

0.1

0.2

0.1

0.1

*

0.1

40-44

140,016

100.0

58.2

16.1

21.3

3.7

0.1

0.2

0.2

*

*

0.2

45-49

80,993

100.0

61.7

11.4

23.6

2.7

0.1

0.2

0.1

*

*

0.1

50-54

39,065

100.0

72.6

7.8

17.3

1.8

*

0.2

0.1

*

*

0.2

55-59

19,685

100.0

79.2

5.2

14.0

1.2

0.1

0.2

0.1

*

*

0.2

60-64

9,043

100.0

84.4

3.3

10.8

0.8

*

0.2

0.2

--

*

0.2

65-69

4,539

100.0

87.4

2.0

9.0

0.9

*

0.2

0.2

--

*

0.2

70-74

2,037

100.0

90.6

1.9

6.2

0.7

--

0.2

0.1

--

*

0.2

75-79

708

100.0

88.6

2.4

5.7

2.1

0.1

0.4

0.4

--

--

0.3

80-84

231

100.0

86.1

3.5

5.2

3.5

--

0.4

0.9

--

--

0.4

85-89

104

100.0

72.1

13.5

11.5

2.9

--

--

--

--

--

--

90-94

69

100.0

49.3

13.0

24.6

10.1

--

1.4

1.4

--

--

--

95-96

8

100.0

62.5

--

--

37.5

--

--

--

--

--

--

* Less than 0.05 percent.
-- Quantity is zero.

Note: Data for age groups that include the baby boom generation (aged 33 to 51 in 1997) are in bold print.

Source: SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS), April 16, 2001.

Figure 2 and Table  3 depict polydrug use and polydrug combinations by age group. Overall, 44 percent of treatment admissions reported use of a single substance class, 36 percent reported use of two substance classes, and 20 percent reported use of three substance classes. The number and combination of substances used varied greatly by age. Generally, the likelihood of using a single substance class increased with age to ages 70 to 74. For persons aged 75 or older, the likelihood of using two or three substance classes increased with each age group. Among those reporting single substance classes, alcohol was the most common in all age groups except those younger than 20, where marijuana predominated. Among two-drug combinations, alcohol and marijuana were most common for those younger than 25. For those aged 25 or older, the most frequent combination was alcohol and stimulants. Among three-drug combinations, alcohol, stimulants, and marijuana were most common for all age groups except the youngest (ages 10 to 14), where alcohol, marijuana, and other drugs (primarily hallucinogens) predominated.

 

 

Table 1b  Female Treatment Admissions, by Age Group and Primary Use of Substance, Treatment Episode Data Set (TEDS): 1997

Age at Admission

Total
Number of
Admissions1

 

Primary Substance at Admission

Total

Alco-
hol

Stimu-
lants

Opiates

Can-
nabi-
noids

Hal-
luci-
nogens

Tran-
quil-
izers

Seda-
tives/
Hyp-
notics

Inhal-
ants

Over-
the-
Coun-
ter

Other

All Ages

443,548

100.0

41.0

28.2

18.6

10.4

0.3

0.6

0.4

0.1

0.1

0.4

10-14

8,677

100.0

34.8

6.5

0.6

53.7

1.2

0.2

0.1

1.7

0.3

1.0

15-19

41,934

100.0

34.2

16.0

6.6

40.7

1.1

0.2

0.2

0.4

0.1

0.5

20-24

42,362

100.0

33.2

31.8

17.4

16.1

0.5

0.3

0.2

0.1

0.1

0.3

25-29

70,815

100.0

33.0

39.3

18.2

8.1

0.2

0.4

0.3

0.1

*

0.3

30-34

94,371

100.0

38.2

36.3

18.6

5.5

0.2

0.5

0.4

*

*

0.3

35-39

88,928

100.0

43.4

29.5

21.1

4.3

0.2

0.6

0.5

0.1

*

0.3

40-44

53,669

100.0

47.8

20.9

26.0

3.4

0.1

0.7

0.6

0.1

0.1

0.4

45-49

24,460

100.0

55.2

14.4

25.8

2.4

0.1

0.9

0.6

*

*

0.4

50-54

9,991

100.0

66.4

9.1

19.7

2.2

0.1

1.1

0.8

*

0.1

0.5

55-59

4,335

100.0

76.3

5.1

13.6

1.3

--

1.7

1.4

*

--

0.5

60-64

1,972

100.0

81.5

3.1

10.3

0.6

0.1

2.4

1.3

0.1

0.2

0.6

65-69

1,060

100.0

83.4

2.2

7.7

0.8

0.2

1.7

2.8

--

0.3

0.8

70-74

555

100.0

83.8

1.8

7.9

0.9

--

2.9

2.2

--

0.2

0.4

75-79

248

100.0

78.2

2.0

8.9

1.2

--

6.0

3.2

--

--

0.4

80-84

106

100.0

75.5

5.7

8.5

2.8

--

4.7

2.8

--

--

--

85-89

28

100.0

42.9

17.9

21.4

7.1

--

3.6

7.1

--

--

--

90-94

29

100.0

55.2

17.2

24.1

--

--

--

3.4

--

--

--

95-96

8

100.0

25.0

62.5

12.5

--

--

--

--

--

--

--

* Less than 0.05 percent.
-- Quantity is zero.

Note: Data for age groups that include the baby boom generation (aged 33 to 51 in 1997) are in bold print.

Source: SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS), April 16, 2001.

Table  4 shows the distribution by age of the number of prior treatment episodes. Overall, 42 percent of admissions were entering treatment for the first time. The proportion was high among the younger age groups, then declined to 33 percent of those aged 40 to 49. Among those aged 45 or older, the proportion of those entering treatment for the first time increased steadily until age 85.

Table  5 shows the distribution by age of the source of referral to treatment. Overall, 35 percent of admissions were referred through the criminal justice system, 33 percent through individual or self-referral, 13 percent from other substance abuse treatment providers, and 7 percent through other health care providers. The criminal justice system was the most frequent source of referral to treatment for persons younger than 30 and for those aged 65 to 74. Individual or self-referral was responsible for the largest proportion of admissions for those aged 30 to 65 and for those 75 or older. Schools referred substantial proportions of those under 20 to treatment, but employee assistance programs (EAPs) contributed little to treatment entry in these publicly funded facilities. The proportion referred to substance abuse treatment through health care providers increased steadily from 6 percent at ages 15 to 19 to 19 percent at ages 75 to 79. Health care providers were the third leading source of treatment referral for persons aged 60 to 89.

 

Figure 2 Polydrug Use, by Age Group

 D

Source: SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS), April 16, 2001.

 

 

Table 2 Treatment Admissions, by Age Group and Any Use of Substance, Treatment Episode Data Set (TEDS): 1997

Age at
Admission

Total
Number of
Admissions

Average
Number of
Drug
Categories

Alco-
hol

Stimu-
lants

Can-
nabi-
noids

Opi-
ates

Hal-
luci-
no-
gens

Tran-
quil-
izers

Seda-
tives/
Hyp-
notics

Inhal-
ants

Over-
the-
Coun-
ter

Other

All Ages

1,493,710

1.8

73.0

41.2

36.4

19.2

1.9

1.6

0.8

0.4

0.2

1.0

10-14

22,883

1.9

69.8

13.1

85.0

1.3

7.1

0.6

0.5

4.5

0.5

2.9

15-19

160,773

1.9

70.7

23.1

80.1

5.9

8.2

1.0

0.6

1.4

0.3

1.8

20-24

154,867

1.8

68.9

38.6

54.7

15.8

3.3

1.2

0.7

0.4

0.1

1.0

25-29

213,360

1.9

70.5

51.8

40.1

18.9

1.4

1.5

0.7

0.2

0.1

0.9

30-34

272,528

1.8

72.8

53.3

32.2

19.6

0.8

1.6

0.8

0.1

0.1

0.9

35-39

273,880

1.8

74.1

48.4

26.4

21.8

0.7

1.9

1.0

0.1

0.2

0.9

40-44

194,620

1.7

73.4

39.9

20.6

27.2

0.5

2.1

1.1

0.1

0.1

0.9

45-49

106,180

1.6

75.0

31.4

16.0

28.4

0.4

1.8

0.9

0.1

0.2

0.9

50-54

49,417

1.4

81.2

21.9

11.0

21.0

0.3

1.6

0.8

0.1

0.1

0.9

55-59

24,261

1.3

85.4

14.3

7.0

15.9

0.2

1.3

0.8

*

0.1

0.8

60-64

11,101

1.2

88.8

8.7

4.1

11.9

0.2

1.3

0.7

*

0.1

0.9

65-69

5,670

1.1

89.5

4.9

3.0

9.9

0.1

1.2

1.0

--

0.1

1.0

70-74

2,605

1.1

92.1

3.7

2.6

7.1

0.1

1.6

0.8

0.1

0.2

0.8

75-79

968

1.1

89.1

6.8

4.9

7.3

0.4

2.3

2.3

--

0.1

0.7

80-84

343

1.2

88.3

9.6

7.0

8.2

0.3

2.9

2.0

--

0.3

0.6

85-89

136

1.4

76.5

26.5

14.7

17.6

0.7

1.5

2.2

--

--

1.5

90-94

101

1.6

71.3

32.7

23.8

29.7

--

4.0

2.0

--

--

1.0

95-96

17

1.8

70.6

47.1

41.2

5.9

--

5.9

--

--

--

5.9

* Less than 0.05 percent.
-- Quantity is zero.

Note: Data for age groups that include the baby boom generation (aged 33 to 51 in 1997) are in bold print.

Source: SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS), April 16, 2001.

 

 

Table 3 Polydrug Combinations, by Age Group, Treatment Episode Data Set (TEDS): 1997

Age at
Admission

Total Number of Admissions

One-Drug Category

Two-Drug Categories

Three-Drug Categories

 

 

 

 

 

 

 

 

 

 

Other
Combi-
nations*

Alcohol

Alcohol

Alcohol

Other
Combi-
na-
tions*

 

 

 

 

 

Alcohol

Alcohol

Stimu-
lants

Stimu-
lants

Alcohol

Stimu-
lants

Stimu-
lants

Mari-
juana

Alcohol

Opiates

Stimu-
lants

Mari-
juana

Other**

Mari-
juana

Stimu-
lants

Opiates

Mari-
juana

Opiates

Mari-
juana

Opiates

Other**

Total

1,493,710

28.0

6.5

5.5

4.0

0.4

12.7

11.5

3.7

3.4

2.1

2.3

11.2

3.2

1.6

3.9

10-14

22,883

9.8

0.1

1.1

20.9

1.7

41.7

0.7

0.1

2.1

0.1

3.1

7.1

0.1

8.7

2.8

15-19

160,773

11.7

1.2

1.7

15.2

0.5

36.5

1.8

0.7

4.1

0.3

3.0

10.7

0.5

7.2

4.9

20-24

154,867

20.8

4.8

4.8

7.4

0.4

20.1

6.5

2.6

5.6

1.1

2.7

13.3

2.0

2.3

5.4

25-29

213,360

21.7

6.1

7.3

3.0

0.3

11.2

13.4

3.7

5.1

1.6

2.1

15.8

3.3

1.0

4.4

30-34

272,528

24.0

6.3

7.7

1.8

0.4

8.6

16.7

4.1

3.9

2.0

1.9

14.4

3.8

0.6

3.7

35-39

273,880

28.6

7.2

6.9

1.4

0.4

7.6

16.1

4.5

2.8

2.6

2.1

11.5

4.1

0.6

3.6

40-44

194,620

34.4

9.6

5.3

1.1

0.4

6.5

12.8

5.3

1.8

3.6

2.4

7.9

4.6

0.5

3.7

45-49

106,180

42.6

10.9

3.7

0.8

0.4

5.6

9.6

5.4

1.1

4.1

2.3

5.5

4.3

0.5

3.2

50-54

49,417

57.6

8.6

2.6

0.6

0.5

4.3

7.1

4.0

0.7

3.0

2.1

3.4

3.0

0.3

2.1

55-59

24,261

69.4

7.5

1.8

0.4

0.6

2.7

4.7

2.6

0.5

2.4

1.8

2.2

1.9

0.2

1.3

60-64

11,101

77.9

6.3

1.3

0.3

0.9

1.8

3.0

1.5

0.3

1.8

1.8

1.0

1.2

0.1

0.9

65-69

5,670

82.6

6.0

1.1

0.3

1.1

1.4

1.4

1.0

0.2

1.4

1.7

0.6

0.4

0.1

0.7

70-74

2,605

85.8

4.6

0.7

0.3

1.3

1.1

1.2

0.5

0.1

1.0

1.6

0.7

0.3

0.1

0.7

75-79

968

81.1

4.2

1.1

0.4

2.6

1.3

1.6

0.8

0.6

0.6

2.3

1.7

0.6

0.2

0.8

80-84

343

76.4

3.2

1.5

0.9

2.3

3.2

2.9

1.5

0.9

1.5

2.3

1.7

1.2

--

0.6

85-89

136

53.7

5.1

2.2

2.2

2.2

2.9

10.3

4.4

3.7

3.7

2.9

2.9

0.7

--

2.9

90-94

101

31.7

10.9

4.0

2.0

3.0

8.9

8.9

4.0

2.0

5.9

3.0

6.9

5.9

1.0

2.0

95-96

17

23.5

5.9

5.9

5.9

--

5.9

17.6

--

11.8

--

5.9

11.8

--

5.9

--

* No combination was reported by more than 2 percent of total admissions or by more than 2 percent of any age group.
** Drugs other than alcohol, opiates, stimulants, or marijuana.
-- Quantity is zero.

Note: Data for age groups that include the baby boom generation (aged 33 to 51 in 1997) are in bold print.

Source: SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS), April 16, 2001.

 

 

Table 4 Treatment Admissions, by Age Group and Number of Prior Treatments, Treatment Episode Data Set (TEDS): 1997

Age at Admission

Total Number of Admissions1

Total

Prior Treatment Episodes

None

1

2

3

4

5 or More

All ages

1,319,276

100.0

41.5

23.0

12.5

7.2

4.1

11.8

10-14

19,386

100.0

76.0

16.5

4.5

1.4

0.5

1.1

15-19

141,561

100.0

64.0

21.8

7.8

3.2

1.2

2.0

20-24

138,890

100.0

52.4

23.9

10.5

5.2

2.7

5.3

25-29

189,233

100.0

41.6

24.5

13.1

7.4

4.0

9.5

30-34

241,386

100.0

36.5

24.0

14.0

8.3

4.8

12.4

35-39

241,702

100.0

34.4

23.3

14.2

8.5

5.0

14.6

40-44

171,410

100.0

33.4

21.9

13.6

8.6

5.2

17.3

45-49

93,048

100.0

33.2

21.7

13.0

8.3

5.1

18.6

50-54

43,259

100.0

35.4

21.1

12.2

7.7

4.8

18.8

55-59

21,258

100.0

38.5

20.8

11.2

7.0

4.5

18.0

60-64

9,673

100.0

40.5

20.9

11.2

6.3

4.1

17.0

65-69

4,883

100.0

43.9

21.2

10.1

6.3

3.8

14.6

70-74

2,258

100.0

46.9

21.5

9.8

5.6

3.1

13.2

75-79

828

100.0

53.6

19.7

9.2

4.8

2.3

10.4

80-84

291

100.0

56.0

19.9

9.3

3.4

1.4

10.0

85-89

106

100.0

53.8

19.8

11.3

3.8

4.7

6.6

90-94

91

100.0

39.6

25.3

12.1

9.9

6.6

6.6

95-96

13

100.0

53.8

7.7

15.4

23.1

--

--

-- Quantity is zero.

1 Excludes 174,434 admissions where number of prior treatment episodes was not reported.

Note: Data for age groups that include the baby boom generation (aged 33 to 51 in 1997) are in bold print.

Source: SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS), April 16, 2001.

 

 

Table 5 Treatment Admissions, by Age Group and Source of Referral to Treatment, Treatment Episode Data Set (TEDS): 1997

Age at Admission

Total Number of Admissions1

Total

Source of Referral to Treatment

Criminal Justice System

Individual

Substance Abuse Treatment Provider

Community Referral

Other Health Care Provider

School/EAP

All Ages

1,453,152

100.0

35.1

33.4

12.8

8.7

7.4

2.6

10-14

22,021

100.0

36.1

19.5

7.6

11.3

7.5

18.0

15-19

155,047

100.0

49.9

19.4

8.5

8.2

6.1

8.0

20-24

150,624

100.0

48.3

26.7

9.9

8.5

5.5

1.2

25-29

208,073

100.0

37.2

33.4

12.3

9.5

6.4

1.2

30-34

265,693

100.0

32.6

35.5

13.9

9.5

7.0

1.4

35-39

266,845

100.0

30.2

37.0

14.4

8.8

7.7

1.8

40-44

189,560

100.0

27.9

39.1

14.7

8.1

8.4

2.0

45-49

103,364

100.0

26.6

39.8

14.5

7.7

9.0

2.4

50-54

48,003

100.0

28.1

37.3

14.5

7.3

10.2

2.5

55-59

23,539

100.0

29.1

35.9

14.4

7.1

11.2

2.3

60-64

10,796

100.0

32.8

34.2

12.0

6.7

12.6

1.8

65-69

5,530

100.0

35.0

32.8

11.8

5.1

14.1

1.2

70-74

2,540

100.0

33.4

31.8

12.3

5.2

16.6

0.7

75-79

947

100.0

32.1

35.1

8.3

5.0

19.0

0.5

80-84

328

100.0

25.9

40.9

10.7

7.0

14.6

0.9

85-89

128

100.0

21.1

44.5

11.7

7.8

12.5

2.3

90-94

97

100.0

22.7

39.2

12.4

16.5

4.1

5.2

95-96

17

100.0

29.4

41.2

17.6

--

11.8

--

-- Quantity is zero.

1 Excludes 40,558 admissions where referral source was not reported.

Note: Data for age groups that include the baby boom generation (aged 33 to 51 in 1997) are in bold print.

Source: SAMHSA, Office of Applied Studies, Treatment Episode Data Set (TEDS), April 16, 2001.

 

Conclusions

Older adults are seldom admitted to the publicly funded substance abuse treatment system. This may be because of reasons unrelated to the level of substance use problems in this population.

Abuse of alcohol alone was the primary problem of the majority of persons aged 50 or /older who were admitted to publicly funded substance abuse treatment during 1997. This is in contrast to the younger treatment population, where admissions for polydrug use exceeded those for alcohol alone.

Older persons admitted to publicly funded treatment were less likely to report problems with polydrug use. Clinical reports indicate that older persons may be unaware that prescription drugs, in combination with each other or with alcohol, may contribute to a substance abuse problem. However, although peak polydrug use occurred among those younger than 40, with 60 to 70 percent reporting use of multiple substances, it remained a substantial problem for those aged 55 to 79, where 7 to 20 percent reported use of multiple substances. Polydrug use increased among those aged 75 or older to levels comparable with those for persons younger than 40.

Abuse of tranquilizers and sedatives, although relatively low, increased with age. This is consistent with reports in the clinical literature of problem prescription drug use among older adults.

TEDS data indicate that, beginning at age 55, an increasing proportion of persons entering treatment are doing so for the first time, largely for abuse of alcohol alone. This is consistent with reports of late-onset alcoholism (CSAT, 1998). There are indications in TEDS that the few persons aged 75 or older who entered the publicly funded treatment system had more severe and complex problems than those just a few years younger. They were more likely to be polydrug users and to have been in treatment previously.

Referrals to treatment by health care providers increased with age, possibly indicating an underlying increased use of health care providers. Older persons may be more likely to seek treatment for substance abuse from traditional health care providers if they are experiencing medical problems in addition to drug use.

Further research is needed on changes in substance abuse treatment admission patterns. Future TEDS research could include analysis of patterns among birth cohorts, and also analysis of drug use initiation cohorts, both for age at initiation and historical period of initiation.

 

Limitations

Although TEDS is an exceptionally large and statistically powerful dataset, care must be taken that interpretation does not extend beyond the limitations of the data. TEDS does not represent the total national demand for substance abuse treatment, but it does comprise a significant proportion of all admissions to substance abuse treatment and includes those admissions that constitute a burden on public funds. SAMHSA has estimated that the TEDS system, for 1997, captured about two thirds of all admissions to substance abuse treatment (OAS, 1999). In general, facilities reporting TEDS data are those that receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of substance abuse treatment services. TEDS does not include facilities operated by Federal agencies (the Bureau of Prisons, the Department of Defense, and the Veterans Administration). Hospital- and/or correctional system-based substance abuse treatment facilities, if not licensed through the State substance abuse agency, may also be excluded from the TEDS system.

TEDS probably underestimates the number of drug classes used because it requires reporting only of primary, secondary, and tertiary substances of abuse. The substances reported are those that led to the treatment episode and are not necessarily a complete enumeration of all drug classes used at the time of admission. Twenty percent of all admissions reported the abuse of three drug classes (most frequently alcohol and two drugs). Some proportion of these undoubtedly abused additional substances. Assignment of drugs as primary, secondary, or tertiary may be influenced by the treatment reimbursement system in effect. It is generally accepted that treatment resources are inadequate to serve all those who desire treatment. Resources may be constrained by mandatory set-asides for treatment of specific drug problems. Thus, someone with both cocaine and alcohol addictions may find it easier obtain treatment as a primary cocaine addict than as a primary alcohol abuser with a secondary cocaine problem. Similarly, lack of resources may make it necessary to practice a triage system, admitting to treatment those who are addicted to "harder" (usually illicit) drugs.

 

References

Belding, M. A., Iguchi, M. Y., Lamb, R. J., Lakin, M., & Terry, R. (1995). Stages and processes of change among polydrug users in methadone maintenance treatment. Drug and Alcohol Dependence, 39(1), 45-53.

Center for Substance Abuse Treatment. (1998). Substance abuse among older adults (DHHS Publication No. SMA 98-3179, Treatment Improvement Protocol [TIP] Series 26; available at http://www.health.org/govpubs/BKD250/). Rockville MD: Author.

Chen, K., & Kandel, D. B. (1995). The natural history of drug use from adolescence to the mid-thirties in a general population sample. American Journal of Public Health, 85, 41-47.

Collins, R. L., Ellickson, P. L., & Bell, R. M. (1998). Simultaneous polydrug use among teens: Prevalence and predictors. Journal of Substance Abuse, 10, 233-253.

Darke, S., & Hall, W. (1995). Levels and correlates of polydrug use among heroin users and regular amphetamine users. Drug and Alcohol Dependence, 39, 231-235.

Darke, S., & Ross, J. (1997). Polydrug dependence and psychiatric comorbidity among heroin injectors. Drug and Alcohol Dependence, 48, 135-141.

Earleywine, M., & Newcomb, M. D. (1997). Concurrent versus simultaneous polydrug use: Prevalence, correlates, discriminant validity, and prospective effects on health outcomes. Experimental and Clinical Psychopharmacology, 5, 353-364.

Iguchi, M. Y., Stitzer, M. L., Bigelow, G. E., & Liebson, I. A. (1988). Contingency management in methadone maintenance: Effects of reinforcing and aversive consequences on illicit polydrug use. Drug and Alcohol Dependence, 22(1-2), 1-7.

Jensen, C. F., Cowley, D. S., & Walker, R. D. (1990). Drug preferences of alcoholic polydrug abusers with and without panic. Journal of Clinical Psychiatry, 51, 189-191 [Comment in Journal of Clinical Psychiatry, 1990, 51, 440].

Kassebaum, G., & Chandler, S. M. (1994). Polydrug use and self control among men and women in prisons. Journal of Drug Education, 24, 333-350.

Klee, H., Faugier, J., Hayes, C., Boulton, T., & Morris, J. (1990). AIDS-related risk behaviour, polydrug use and temazepam. British Journal of Addiction, 85, 1125-1132.

Martin, C. S., Clifford, P. R., Maisto, S. A., Earleywine, M., Kirisci, L., & Longabaugh, R. (1996a). Polydrug use in an inpatient treatment sample of problem drinkers. Alcoholism: Clinical and Experimental Research, 20, 413-417.

Martin, C. S., Kaczynski, N. A., Maisto, S. A., & Tarter, R. E. (1996b). Polydrug use in adolescent drinkers with and without DSM-IV alcohol abuse and dependence. Alcoholism: Clinical and Experimental Research, 20, 1099-1108.

National Institute for Health Care Management. (2001, November). Prescription drugs and mass media advertising, 2000 (available at http://www.nihcm.org/ and http://www.nihcm.org/DTCbrief2001.pdf). Washington, DC: Author.

Office of Applied Studies. (1999). Treatment Episode Data Set (TEDS): 1992-1997: National admissions to substance abuse treatment services (DHHS Publication No. SMA 99-3324, Drug and Alcohol Services Information System Series S-7; available at /dasis.htm#teds2). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Office of Applied Studies. (2000). Drug Abuse Warning Network: Annual medical examiner data 1998 (DHHS Publication No. SMA 00-3408, Drug Abuse Warning Network Series D-13). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Office of Applied Studies. (2001). Treatment Episode Data Set (TEDS): 1994-1999: National admissions to substance abuse treatment services (DHHS Publication No. SMA 01-3550, Drug and Alcohol Services Information System Series S-14; available at /dasis.htm#teds2). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Raveis, V. H., & Kandel, D. B. (1987). Changes in drug behavior from the middle to the late twenties: Initiation, persistence, and cessation of use. American Journal of Public Health, 77, 607-611.

Sheahan, S. L., Hendricks, J., & Coons, S. J. (1989). Drug misuse among the elderly: A covert problem. Health Values, 13, 22-29.

________

* To whom correspondence should be sent at Synectics for Management Decisions, Inc., 1901 North Moore Street, Suite 900, Arlington VA 22209. Telephone: 410-235-3096. E-mail: LeighH@smdi.com.

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