Co-Occurring Disorders in Older Adults

2. SAMHSA�s Co-Occurring Center for Excellence (COCE) 

3. Service Delivery

4. COCE Core Products and Services The COCE Web Site www.coce.samhsa.gov Technical Assistance - direct request to: Email: samhsacoce@cdmgroup.com Phone: 301-951-3369 Meetings and conferences Pilot evaluation of the Performance Partnership Grant (PPG) measure Overview papers, technical reports, and other products

5. COCE Overview Papers

6. Primary COCE Target Audiences for Technology Transfer

7. �Age is only a number� Linkletter

9. Substance Use Problems in Older Adults: Drug Categories  Illicit Drugs Alcohol Prescription/OTC

10. Illicit Drug Use in Older Adults Approx. 3.5% older adults (age 50 and older) have used 1 or more illicit substances in the past year Of these past-year users, 16.0% may have illicit drug abuse or dependence problems 59% are male 41% are female (2002 National Survey on Drug Use and Health) We now from the NSDUH that: READ BULLET 1 READ BULLET 2 Other than alcohol and tobacco, READ BULLET 3 We now from the NSDUH that: READ BULLET 1 READ BULLET 2 Other than alcohol and tobacco, READ BULLET 3

11. Substance Use in Older Adults Alcohol use is also high in 50+ population � 2.3 Million, or 14.1%, meet criteria for alcohol abuse/dependency 1.84 Million are male (80.0%) 459,000 are female (20.0%) (2002 NSDUH) Most of the Rx drugs with addiction potential tend to interact poorly with alcohol. In the elderly, this can become very problematic even at medically-indicated doses. Consequences of concomitant use of ETOH and sedatives, hypnotics, anxiolytics, and opioid analgesics can include increased sedation, dizziness, and other symptoms that can, in turn, result in physical morbidity, difficulty in performing various activities such as driving, and even physical dependency. Thus, although ETOH is not a focus in this presentation, it is important to keep in mind that alcohol abuse and dependency is quite high in the 50+ population: READ SLIDEMost of the Rx drugs with addiction potential tend to interact poorly with alcohol. In the elderly, this can become very problematic even at medically-indicated doses. Consequences of concomitant use of ETOH and sedatives, hypnotics, anxiolytics, and opioid analgesics can include increased sedation, dizziness, and other symptoms that can, in turn, result in physical morbidity, difficulty in performing various activities such as driving, and even physical dependency. Thus, although ETOH is not a focus in this presentation, it is important to keep in mind that alcohol abuse and dependency is quite high in the 50+ population: READ SLIDE

12. Abuse Potential: Medical Exposure General US population Women = 20.0% Men = 12.5% Among elders aged 65 and older, 21.7%, or 7.22M, receive at least 1 abusable Rx annually Women = 24.6% Men = 17.7% In the community-dwelling population of US residents, up to 20 percent of all women have received at least 1 Rx that has abuse potential annually. This compares to only 12.5% of men. Among community-dwelling elders aged 65 and over, 21.7%, or 7.22 M elders, use at least 1 Rx drug w/ abuse potential every year. The percentage of women w/ such medical exposure is greater than men � 24.6% versus 17.7%.In the community-dwelling population of US residents, up to 20 percent of all women have received at least 1 Rx that has abuse potential annually. This compares to only 12.5% of men. Among community-dwelling elders aged 65 and over, 21.7%, or 7.22 M elders, use at least 1 Rx drug w/ abuse potential every year. The percentage of women w/ such medical exposure is greater than men � 24.6% versus 17.7%.

13. Medical Exposure to Abusable Rx Drugs by Gender and Age In addition, we know that this gender differential persists across different age subcategories of elders. Elderly women are at greatest risk for medical exposure to an abusable Rx drug between the ages of 75 � 79, where 28.3% of all women in this age group receive at least 1 abusable Rx drug in a year. This compares to 20.4% of men experiencing such exposure. Please note: By no means am I suggesting that the med use of these drugs is inappropriate, or that their use for med/psych conds should be curtailed; rather, just suggesting that med E+, which may be a platform for actual misuse and abuse, is higher among women than men in all older age groups.In addition, we know that this gender differential persists across different age subcategories of elders. Elderly women are at greatest risk for medical exposure to an abusable Rx drug between the ages of 75 � 79, where 28.3% of all women in this age group receive at least 1 abusable Rx drug in a year. This compares to 20.4% of men experiencing such exposure. Please note: By no means am I suggesting that the med use of these drugs is inappropriate, or that their use for med/psych conds should be curtailed; rather, just suggesting that med E+, which may be a platform for actual misuse and abuse, is higher among women than men in all older age groups.

14. Prescription Drug Misuse Any Rx drug can be �misused� Misuse: outside of medically prescribed regimen, eg: Non-compliance Taking a different dose Sharing drug with others Obtaining drug from non-medical source Taking drug for psychoactive effects Using the drug with alcohol Simoni-Wastila et al, Sub Use and Misuse, 2004 READ SLIDEREAD SLIDE

15. Substance Use Type by Gender � 50 and Older In this age group, we find that men tend to outnumber women in terms of any past-year illicit substance use (57.7% vs. 42.2%, respectively) and in any past-year marijuana use (71.1% vs 28.8%, respectively). However, women report more past-year nonmedical use of prescription drugs with addiction potential than do their male peers � 58.1% versus 41.9%.In this age group, we find that men tend to outnumber women in terms of any past-year illicit substance use (57.7% vs. 42.2%, respectively) and in any past-year marijuana use (71.1% vs 28.8%, respectively). However, women report more past-year nonmedical use of prescription drugs with addiction potential than do their male peers � 58.1% versus 41.9%.

16. The Internet: a Significant Source for Prescription Drugs �The internet has become a virtual wild west bazaar for spam emails and websites that sell controlled substances with little or no oversight..� Drug Enforcement Administration, 2004

17. Baby Boomers �Come of Age� Current Problem: minimal knowledge of substance use and co-occurring disorders in older adults Substance misuse in older adults expected to be a growing problem due to �boomers�: More accepting of alcohol and drug use Used more in youth Use more NOW Use more psychoactive Rx drugs now 3-4x more emotional disorders Problem right now about Rx and other substance use in elders is a general lack of knowledge about prevalence, risk factors for use, and how to prevent, identify, and treat Rx problem use in elders. This places us at a tremendous disadvantage when thinking about where we need to be in less than 20 years. You have all it heard it � the baby-boomers are coming! The baby-boomers are coming! The huge demographic shift of this group entering maturity will have a huge impact on all of our health and medical resources, and resources needed to address substance abuse in elders is no exception. Coupled with just the sheer number of elderly expected over the next 20-40 years, baby-boomers, especially women, may be particularly at risk for Rx and other substance use b/c: Accepting of drug use, both licit and illicit Used many more substances in their youth and young adulthood (and continue to use). Indeed, in 1997, current baby-boomers accounted for 48% of all substance use treatment admissions). Currently use more psychoactive Rx drugs, probably b/c They have 3-4x more emotional disorders (such as depression and anxiety) than do today�s elders.Problem right now about Rx and other substance use in elders is a general lack of knowledge about prevalence, risk factors for use, and how to prevent, identify, and treat Rx problem use in elders. This places us at a tremendous disadvantage when thinking about where we need to be in less than 20 years. You have all it heard it � the baby-boomers are coming! The baby-boomers are coming! The huge demographic shift of this group entering maturity will have a huge impact on all of our health and medical resources, and resources needed to address substance abuse in elders is no exception. Coupled with just the sheer number of elderly expected over the next 20-40 years, baby-boomers, especially women, may be particularly at risk for Rx and other substance use b/c: Accepting of drug use, both licit and illicit Used many more substances in their youth and young adulthood (and continue to use). Indeed, in 1997, current baby-boomers accounted for 48% of all substance use treatment admissions). Currently use more psychoactive Rx drugs, probably b/c They have 3-4x more emotional disorders (such as depression and anxiety) than do today�s elders.

18. Increased Spending Primarily Due to Increased Use

19. Under-Use of Medications May be Increasing �Two-thirds of older patients reduce use of medications due to cost� (Archives of Internal Medicine, 2004)

20. Prescription Drug Abuse (cont) Scope of use 30% of prescription consumed by 12% of population >65 years $15 billion/year in elderly (4x�s younger individuals) Access to prescription drugs is easier than ever before

21. Where Do We Go From Here? Improve diagnostic criteria Focus research on compliance Develop integrated treatment programs tailored to older adults Explicate age related changes in drug abuse Examine impact of internet/foreign purchase of med�s

22. COD Resources SAMHSA�s Co-Occurring Center for Excellence at www.coce.samhsa.gov Co-Occurring Dialogues Discussion List: Membership is free and unrestricted and can be done by sending an e-mail to dualdx@treatment.org. Co-Occurring State Incentive Grants (COSIG) and Policy Academies: see SAMHSA website for information at www..samhsa.gov Reports (see COCE website)