Alcohol, Tobacco, and Nonmedical Drug Use Disorders in U.S. Adults Aged 65 Years and Older: Data From the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions

doi:10.1097/JGP.0b013e3181e898b4

The American Journal of Geriatric Psychiatry

Volume 19, Issue 3, March 2011, Pages 292-299

https://doi.org/10.1097/JGP.0b013e3181e898b4 Get rights and content

Objectives

To examine the prevalence, sociodemographic, and health-related correlates of substance use disorders, including alcohol, tobacco, and nonmedical drug use among adults aged 65 years and older.

Design

The 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, a cross-sectional survey of a population-based sample.

Setting

The United States.

Participants

Eight thousand two hundred five adults aged 65 years and older.

Measurements

Prevalence of lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, determined alcohol, tobacco, and nonmedical drug use disorders.

Results

Prevalence of any substance use disorder was 21.1% during the lifetime and 5.4% in the past 12 months. Lifetime and past 12-month alcohol use disorders were 16.1% and 1.5%; tobacco use disorders were 8.7% and 4.0%; and nonmedical drug use disorders were 0.6% and 0.2%, respectively. Younger age was associated with greater odds of any lifetime or past 12-month substance use disorders. Men and those who were divorced or separated had greater odds of both lifetime alcohol and tobacco use disorders. Very good or excellent self-rated health was associated with lower odds of lifetime and past 12-month tobacco use disorders. Younger age and being divorced or separated were associated with greater odds of lifetime nonmedical drug use disorder.

Conclusions

More than one in five older adults ever had a substance use disorder, and more than 1 in 20 had a disorder in the past 12 months, primarily involving alcohol or tobacco. Older adults have increased comorbidities and use of medications, which can increase risks associated with substance use. (Am J Geriatr Psychiatry 2011; 19:292–299)

Section snippets

Study Sample

The sample was taken from the 2001–2002 NESARC, a population-based survey sponsored by the NIAAA.²⁷ NESARC included a representative sample of the civilian, noninstitutionalized adult population 18 years and older in the U.S. Face-to-face interviews were conducted with 43,093 respondents, and the overall response rate was 81%. Among respondents, 8,205 (19%) were aged 65 years and older. Blacks, Hispanics, and young adults aged 18–24 years were oversampled. Weighted data were adjusted to be

Sample Sociodemographic and Health-Related Characteristics

The sample was predominantly younger than 75 years, female, white, married or living with someone, and retired. The sample was quite evenly distributed among the three education categories. Most of the sample had annual family incomes of less than $70,000, and reported good or better health (Table 1).

Prevalence of Alcohol, Tobacco, and Nonmedical Drug Use Disorders

More than 20% of the sample had a substance use disorder during their lifetimes and ∼5% of older adults had a substance use disorder during the past 12 months (Table 1). Approximately 16% had a

DISCUSSION

More than 20% of persons aged 65 years and older in 2001–2002 reported having a substance use disorder during their lifetimes and most of them had an alcohol use disorder. Alcohol, tobacco, and nonmedical drug use disorders were more likely in those who were younger, male, or divorced or separated. More than 5% reported having any substance use disorder in the past 12 months, and most of them had a tobacco use disorder. Less than 1% reported having a disorder involving nonmedical use of drugs.

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Scientific research, the media, and society have made substantial progress over the last 20 years in recognizing and understanding the significant substance use disorder (SUD) problem in older adults. While evidence has long indicated that there are specific age-related issues with regards to substance abuse, the last 20 years have provided a vast amount of new knowledge about the elderly and SUDs. In this chapter, we present an updated review of geriatric SUDs with a focus on alcohol use disorder and on prescription psychoactive drug use disorder, providing epidemiology, assessment and management, and disorder-specific information.
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Some studies have used large national surveys to extrapolate possible risk factors for the older population. In a study of 8205 adults older than 65 years, Lin et al15 found that being 65 to 74 years old (compared with ≥75 years), white (compared with Asian/Pacific Islander), divorced/widowed, and male were associated with increased risks of lifetime AUD, whereas increased odds of having AUD in the past year were associated with being male and aged 65 to 74 years. Financial strain also places older adults, especially older women, at higher risk for heavy drinking.16
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The prevalence of alcohol, drug, and tobacco use among US middle-aged and older adults is increasing. A subset of this population uses substances to cope with stress, but the characteristics of these individuals, and the association between substance-use coping and health outcomes remain unclear. We identified correlates of substance-use coping and measured its association with self-rated health in a community-based sample of adults aged 54–99 in the Health and Retirement Study (HRS). In the 2008 HRS, 1351 participants reported their frequency of prescription/other drug-, alcohol-, and cigarette-use coping with stress and reported self-rated health (excellent/very good, good, or fair/poor); 1201 of these participants also reported self-rated health in 2010. One in six participants frequently used substances to cope. The oldest participants were least likely to engage in frequent alcohol-use coping. Those with elevated depressive symptoms were more likely to frequently engage in cigarette- and prescription/other drug-use coping. In multivariable-adjusted analyses, participants who frequently used cigarettes (compared to participants who infrequently used cigarettes) to cope had 2.7 times (95% CI = 1.1–6.7) the odds of poor (vs. excellent) self-rated health. Relative to participants who infrequently used prescription/other drugs to cope, participants who frequently used prescription/other drugs to cope had 2.4 times (95% CI = 1.1–5.1) the odds of reporting poor self-rated health. The association between prescription/other drug-use coping in 2008 and self-rated health in 2010 was statistically significant (relative OR = 3.5, 95% CI = 1.7–7.2). Participants engaging in substance-use coping likely have particular demographic and clinical characteristics. Interventions to reduce substance-use coping may prevent adverse health outcomes.
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: This work was supported by National Institute on Drug Abuse (R01DA020944), the National Institute on Alcoholism and Alcohol Abuse (K24AA15957), the National Institute on Aging (P30AG028748), and VA Special Fellowship in Advanced Geriatrics.

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Original ArticleAlcohol, Tobacco, and Nonmedical Drug Use Disorders in U.S. Adults Aged 65 Years and Older: Data From the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions

Objectives

Design

Setting

Participants

Measurements

Results

Conclusions

Section snippets

Study Sample

Sample Sociodemographic and Health-Related Characteristics

Prevalence of Alcohol, Tobacco, and Nonmedical Drug Use Disorders

DISCUSSION

Drug Alcohol Depend

Am J Geriatr Psychiatry

Ann Epidemiol

Am J Geriatr Pharmacother

Am J Geriatr Pharmacother

Am J Geriatr Psychiatry

J Subst Abuse Treat

Compr Psychiatry

Drug Alcohol Depend

Drug Alcohol Depend

Clin Geriatr Med

Am J Geriatr Psychiatry

Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: results of the National Epidemiologic Survey on Alcohol and Related Conditions

J Clin Psychiatry

Use and misuse of alcohol among older women

Alcohol Res Health

An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Alcohol Res Health

Prevalence and cooccurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Arch Gen Psychiatry

Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Arch Gen Psychiatry

An epidemiologic analysis of co-occurring alcohol and drug use and disorders

Alcohol Res Health

Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions

Arch Gen Psychiatry

2000–2050. US Census Bureau [on-line]

Initiation of use of alcohol, cigarettes, marijuana, cocaine, and other substances in US birth cohorts since 1919

Am J Public Health

Substance use disorder among older adults in the United States in 2020

Addiction

Alcohol use, comorbidity, and mortality

J Am Geriatr Soc

Beyond alcoholism: identifying older, at-risk drinkers in primary care

J Stud Alcohol

Original Article
Alcohol, Tobacco, and Nonmedical Drug Use Disorders in U.S. Adults Aged 65 Years and Older: Data From the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions