Substance use disorders and psychiatric comorbidity in mid and later life: a review

Abstract

Background Globally, adults aged 65 years or older will increase from 516 million in 2009 to an estimated 1.53 billion in 2050. Due to substance use at earlier ages that may continue into later life, and ageingrelated changes in medical conditions, older substance users are at risk for substance-related consequences.Methods MEDLINE and PsychInfo databases were searched using keywords: alcohol use disorder, drug use disorder, drug misuse, substance use disorder, prescription drug abuse, and substance abuse. Using the related-articles link, additional articles were screened for inclusion. This review focused on original studies published between 2005 and 2013 to reflect recent trends in substance use disorders. Studies on psychiatric comorbidity were also reviewed to inform treatment needs for older adults with a substance use disorder. ResultsAmong community non-institutionalized adults aged 50þ years, about 60% used alcohol, 3% used illicit drugs and 1-2% used nonmedical prescription drugs in the past year. Among adults aged 50þ, about 5% of men and 1.4% of women had a past-year alcohol use disorder. Among alcohol users, about one in 14 users aged 50-64 had a past-year alcohol use disorder vs one in 30 elder users aged 65þ. Among drug users aged 50þ, approximately 10-12% had a drug use disorder. Similar to depressive and anxiety disorders, substance use disorders were among the common psychiatric disorders among older adults. Older drug users in methadone maintenance treatment exhibited multiple psychiatric or medical conditions. There have been increases in treatment admissions for illicit and prescription drug problems in the United States.Conclusions Substance use in late life requires surveillance and research, including tracking substance use in the racial/ethnic populations and developing effective care models to address comorbid medical and mental health problems.

Chronic Stimulant Use: An Upcoming Cause of Neurocognitive Disorder in Later Life?

“…Giving the rising prevalence of illicit stimulant use among older adults [1], it is possible this condition might occur more often in the future. More attention should be paid to this upcoming cause of neurocognitive disorder.…”

“…The prevalence of illicit substance use among older adults is rising [1], partly as a consequence of the aging of the baby boom generation (born between 1946 and 1964), as within this cohort, drug use during youth has been found to be significantly higher compared to earlier cohorts [2]. It is likely this will be accompanied by greater risks to the older adult, because of age-related changes in drug metabolism and neurotransmitter systems mediating drug effects in the brain [3].…”

The Impact of Misuse and Diversion of Opioid Substitution Treatment Medicines: Evidence Review and Expert Consensus

“…Misuse and diversion may be associated with mental health problems: in the United States, a review of public databases found that 3% of adults older than 50 years receiving outpatient psychiatric treatment used illicit drugs, and that drug users in methadone maintenance treatment exhibited multiple psychiatric or medical conditions [24]. A majority of mental health professionals perceive non-compliance in patients diagnosed with both a mental illness and a substance addiction (dual diagnosis).…”

Disclosure of Use and Abuse of Controlled Substances Among Psychiatric Outpatients

“…13 Psychiatric patients may be especially vulnerable to the potential hazardous outcomes of misuse of controlled substances, possibly secondary to existing substance abuse comorbidities or lack of knowledge leading to failure to disclose the use of controlled substances. [14][15][16] In such cases, potential side effects and interactions among certain medications may not be evaluated by prescribers and pharmacists. To raise awareness among psychiatric service providers about the importance of safe prescribing practices and proactive use of PDMP databases, we examined the prevalence of nondisclosure and/or abuse of controlled substances among the psychiatric outpatients in the Los Angeles County+University of Southern California (LAC+USC) health care system in Los Angeles California by reviewing data from the CURES database.…”