It is ordinarily believed that elder adults are not the usual suspects when it comes to substance abuse disorders. But what do we actually know about how common substance abuse is in the elderly? Is this truly a problem? Should we do more to screen for substance abuse? Dan Blazer helped resolve some of these queries at the UCSF Division of Geriatrics Grand Rounds when he described some of his most recent work looking at substance use in the elderly.
Dr. Blazer and his co-worker at Duke, Li-Tzy Wu, worked with data from the public use files of the 2005 and 2006 National Survey on Drug Use and Health (NSDUH), a nationwide representative annual survey of noninstitutionalized civilians aged 12 years or older. They limited their studies to the 10,953 survey subjects age 50 years and older, and further divided them into two groups that included 6,717 subjects age 50–64 years and 4,236 subjects age 65+ years.
What they found was the following:
Illegal substance use was very modest (2.6% marijuana, and 0.41% cocaine), although steeper in the 50-64 year age group than the 65+ group.
Drug abuse was very, very low (only 0.33% for any abuse or dependence, 0.12% for marijuana abuse or dependence, and 0.18% for cocaine abuse or dependence).
The relative frequency of nonprescription use of prescription pain medicines was low, although those in the 50-65 year age group exhibited broader preponderance of use
At risk and binge drinking was common in both age groups (although higher in the 50-64 age group). In the 65+ age group, 13% of men and 8% of women reported at risk use and over 14% of men and 3% of women reported binge drinking. This was in comparison to the 22% of men and 9% of women aged 50 to 64 who reported binge drinking
Binge drinking is basically drinking to get drunk, and was evaluated as having more than five beverages on at least one day within the past 30 days. Most of us probably associate it with college years, however binge drinking in elderly adults can be associated with significant likely personal and public health hazards. Dr. Blazer referenced one of the most serious - binge drinkers are 14 times more likely to drive while impaired by alcohol compared to non-binge drinkers.
What should we do with this data? Dr. Blazer recommended that we should make note of the high values of binge drinking found in aging adults when we screen for substance abuse. This is because standard screening instruments, such as the CAGE questionnaire, is of little value in identifying individuals who binge drink. He added that we should ask one more question specifically directed to patients about having multiple beverages during a brief period of time. This makes me believe that perhaps we should re-think the CAGE as more of a CAGE-B (B for Binge)?
For more on the report check out: Blazer DG, Wu LT: The epidemiology of at-risk and binge drinking among middle-aged and elderly community adults: National Survey on Drug Use and Health. Am J Psychiatry 2009; 166:1162–1169
Monday, May 24, 2010
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