A fresh look at the hidden epidemic of substance use in the elderly – An Indian perspective

Profiles of lifetime substance use are differentiated by substance of choice, affective motivations for use, and childhood maltreatment

Abstract. Substance use among Nigerian adolescents has increased significantly in the past decade, highlighting the need to implement evidence-based, effective prevention programs as one strategy to help reverse this trend. This study aimed to identify profiles of adolescent substance use and parenting and school correlates of these profiles to inform preventive interventions. Latent class analysis identified four distinct use patterns in 2,004 adolescents (46% male; M = 14.8 years) attending public and private schools in Lagos. Low levels of use distinguished the Low Use class (92.1% of the sample), while use of alcohol, cigarettes, and codeine defined the Alcohol Use class (2.9%). Moderate to high use of tramadol and codeine without a prescription differentiated the Nonmedical Use class (2.8%), and high use of most substances defined the High Use class (2.1%). Males, older youth, and private school students engaged in the riskiest substance use. Students in the Low Use class compared to students in the High Use class were more likely to attend public schools and had parents who solicited less information from them but were more disapproving of substance use. Students in the Low Use class relative to students in the Alcohol Use class also were more likely to attend public schools and had parents who solicited less information but knew more about their child’s activities. These findings suggest that tailored preventive interventions with parents and adolescents could be useful and that more research is needed to understand how the private school context confers risk for substance use.

ABSTRACTBackground: Adolescent substance use is a significant public health concern due to its prevalence and associated negative consequences. Although many adolescents use substances, there is substantial heterogeneity in their use patterns. Identifying risk and protective factors that differentiate adolescents with different substance use profiles is important for preventing negative consequences for those at risk. Objective: This study identified distinct latent profiles of substance use by considering adolescents' involvement in multiple common and illicit substances as well as related problems and examined the extent to which individual and contextual factors in the family, peer, school, and neighborhood environments were related to adolescents' membership of substance use profiles. Method: Data came from 9,155 high school students (51% female; 74% European American) who completed electronic surveys in the 2009 Dane County Youth Assessment (DCYA). Latent class analysis (LCA) was conducted to identify profiles of adolescent substance involvement and related problems. Multinomial logistic regression was conducted to examine associations between individual and contextual factors and latent class membership. Results: LCA identified four distinct profiles of adolescent substance use characterized by both licit and illicit substance use and related problems: Abstainers (56.3%), Alcohol-only users (25.6%), Alcohol-cigarette-marijuana users (13.8%), and Problem polysubstance users (4.3%). Controlling for demographics, individual and contextual factors were associated with adolescents' likelihoods of membership in substance use profiles; notably, the associations varied to some extent across substance use profiles. Conclusions: Substance use is heterogeneous among adolescents. Effects of risk and protective factors on substance use vary depending on adolescents' substance use patterns.

ABSTRACTBackground: The median age of the single adult homeless population is 50 and rising. Although the prevalence of substance use decreases as individuals age, older adults now have a higher prevalence of substance use than older adults did 10 years ago. Homeless individuals have a higher prevalence of substance use disorders than the general population. However, little is known about substance use in older homeless adults. Methods: The objective of the study was to examine prevalence of and factors associated with substance use in a population-based sample (N = 350) of homeless individuals aged 50 and older in Oakland, California. Dependent variables included moderate or greater severity illicit drug symptoms (Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) score >3) and moderate or greater alcohol symptoms (Alcohol Use Disorders Identification Test (AUDIT) score >7). Independent variables included demographics, mental health problems, and negative life course events such as physical and sexual abuse, school expulsion, and onset of homelessness. Results: Almost two thirds of participants, 64.6%, had moderate or greater severity symptoms for at least 1 illicit drug; 25.8% had moderate or greater severity alcohol symptoms. History of psychiatric hospitalization was associated with moderate or greater illicit drug symptoms (adjusted odds ratio [AOR] = 1.9, 1.0–3.6). The presence of major depressive symptoms was associated with moderate or greater severity alcohol symptoms (AOR = 1.8, 1.1–3.0). Conclusions: In this sample of older homeless adults, substance use is common. There is a need for substance use treatment programs, integrated with mental health services, which are targeted towards the needs of older homeless adults.

Substance Use Among Older Adults: Ethical Issues.

Changes in demography and cohort attitudes in the older adult population have meant that substance use amongst older adults is emerging as an immense challenge to mental health services. Although the prevalence of alcohol-related problems decreases with age they remain significant in older adults, whilst the use of prescription and over-the-counter drugs increases in this age group. The interplay between substance use and social, psychological and physiological difficulties associated with ageing further underscores the needs for a greater understanding of this problem. The recent insurgence of clinical and research interest in this field has revealed a discrepancy in the identification of substance use in younger and older age groups, this problem remaining frequently hidden and neglected in older adults. The present article reviews assessment and screening tools developed especially for this age group and indicates the need for systematic multidisciplinary screening in older adult services. Differences in psychological approaches to the treatment and clinical management of substance use in older adults are also reviewed. A number of treatment programmes have been adapted for this age group, although greater systematic evaluation of these interventions is required to establish their efficacy. The diverse bio-psycho-social impact of substance use in older adults also indicates the need for comprehensive clinical management. The needs of older adults with substance use problems have required greater health education and integration and liaison between older adult and substance use services.

BackgroundYoung adults involved in the justice system have high rates of substance use disorders and low rates of treatment engagement. Most justice-involved young adults are supervised in the community—not incarcerated in jail or prison—where they have ongoing access to substances and experience significant barriers to care. When they do engage in treatment, they tend to have worse outcomes than justice-involved adolescents and older adults. Despite the need to develop targeted treatments, there are unique challenges in recruiting this population into clinical research. Digital health technology offers many novel avenues for recruiting justice-involved young adults into clinical research studies and disseminating substance use disorder treatments to justice-involved young adults. Because the vast majority of young adults regularly use one or more social media platforms, social media may offer a cost-effective and efficient way to achieve these goals.ObjectiveThis study aimed to describe the process and feasibility of using social media platforms (Facebook and Reddit) to recruit justice-involved young adults into clinical research. Justice-involved young adults recruited from these platforms completed a survey assessing the acceptability of digital health interventions to address substance use in this population.MethodsJustice-involved young adults (aged 18-24 years) were recruited through paid advertisements placed on Facebook and Reddit. Participants responded to a web-based survey focused on their substance use, treatment use history, and acceptability of various digital health interventions focused on substance use.ResultsA national sample of justice-involved young adults were successfully enrolled and completed the survey (N=131). Participants were racially diverse (8/131, 6.1% American Indian individuals; 27/131, 20.6% Asian individuals; 23/131, 17.6% Black individuals; 26/131, 19.8% Latinx individuals; 8/131, 6.1% Pacific Islander individuals; 49/131, 37.4% White individuals; and 2/131, 1.5% individuals who identified as “other” race and ethnicity). Advertisements were cost-effective (US $0.66 per click on Facebook and US $0.47 per click on Reddit). More than half (72/131, 54.9%) of the participants were on probation or parole in the past year and reported hazardous alcohol (54/131, 51.9%) or drug (66/131, 57.4%) use. Most of the participants (103/131, 78.6%) were not currently participating in substance use treatment. Nearly two-third (82/131, 62.6%) of the participants were willing to participate in one or more hypothetical digital health interventions.ConclusionsSocial media is a feasible and cost-effective method for reaching justice-involved young adults to participate in substance use research trials. With limited budgets, researchers can reach a broad audience, many of whom could benefit from treatment but are not currently engaged in care. Proposed digital health interventions focusing on reducing substance use, such as private Facebook groups, SMS text message–based appointment reminders, and coaching, had high acceptability. Future work will build on these findings to develop substance use treatment interventions for this population.

Older Adult Substance Use Treatment First-Time Admissions Between 2008 and 2018

The Evidence for SBIRT in Adolescents

A total of 726 youths presenting a severe addiction were evaluated at the time of their request for services in an addiction rehabilitation center. Results show that the more delinquent youths have a more severe profile of substance use, thus confirming the strong association between psychoactive substance (PAS) use severity and delinquency. Girls being treated for addiction present a more severe profile of substance use than boys treated. No interaction effect was found between gender and level of delinquency. It also appears important that the history of sexual abuse be considered as one of the variables associated with the severity of PAS use.

Background: Substance use severity is shaped by a range of developmental and psychological factors, including the timing of stressor exposure across the lifespan. Previous research identified early-life stressor exposure as a factor in this progression, but emerging research has suggested the importance of considering the timing of stressor exposure across development. Objectives: Here, we tested whether distinct profiles of stressor exposure—in particular, consistent vs. mismatching patterns between early-life and recent stressor exposure—were associated with the severity of alcohol, cannabis, and nicotine use in a young adult sample of 249 college students. Results: A multivariate cluster analysis identified seven profiles of stressor exposure during development. Importantly, both high cumulative stressor exposure and mismatching patterns of early to recent life stressor exposure predicted greater substance use severity. Notably, follow-up ANOVA and regression analyses demonstrated the predictiveness of these stress profiles held even when including other strongly linked psychological predictors within the model. Conclusions: These findings suggest that both stressor patterning and individual attributes contribute to substance use severity, and advance personalized risk profiles of substance use.

A relational agent for treating substance use in adults: A randomized controlled trial with a psychoeducational comparator.

Background: While previous research has documented the impact of violence on substance use, none has looked longitudinally across the lifespan to measure independent effects of direct and indirect violence exposure. Objective: To examine independent associations between adolescent experiences of violence and subsequent substance use in adolescence and adulthood in the United States. Method: Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we examined being shot or stabbed (“experienced”), being threatened with a knife or gun (“threatened”), and seeing someone either shot or stabbed (“witnessed”) during adolescence (Wave I) as correlates of substance use in adolescence and adulthood (Wave IV) via logistic regression. Results: Violence exposure was a significant correlate of drug use in adolescence and several associations remained significant in adulthood. Witnessing violence had the highest point estimates in the adjusted models in adolescence for each substance use outcome (e.g., Cocaine-Adjusted Odds Ratios [AOR] = 2.59, 95% confidence interval [CI] = 1.21, 5.54). However, the point estimates for threatened with violence or experienced violence were highest in three out of the four drug outcomes in adulthood (e.g., Threatened with violence: Binge drinking-AOR = 1.41, 95% CI = 1.08, 1.83). Conclusion/Importance: Adolescent exposure to witnessing violence had stronger effects on substance use in adolescence, while experiencing and being threatened with violence in adolescence had stronger effects on substance use in adulthood. Violence prevention efforts targeted toward adolescents may lead to a reduction in substance use throughout the life-course, and clinicians and policy makers should be aware of the downstream effects of violence experienced in adolescence.

COVID-19 quarantine showed an increase in opioid-related deaths partially due to the limited capacity of clinics and treatment centers. Digital health interventions (DHIs) such as telehealth have improved access to treatment, reduced psychosocial barriers, and helped patients with substance use disorder (SUD). An in-depth literature review was conducted to gauge the efficacy and usefulness of DHIs on substance use disorder. PubMed was used with string search terms to identify studies analyzing telehealth for substance use disorders. Studies were eligible and selected if they used health interventions (HIs) and reported outcomes on the efficacy of DHIs, benefits of DHIs, and limitations of DHIs. The Agency of Healthcare Research and Quality (AHRQ) was used to analyze the impact of DHIs on SUD. Lastly, Apple's App Store was used to identify the current DHI available.The analysis indicated that mobile phone apps were the most appropriate sources to use for patients with substance use disorders. The search also found 36 mobile applications available on the market for patients, containing mainly pain medication diaries and trackers. The study did not find any apps for clinical usage that met the standards necessary for adequate healthcare in the opioid crisis, largely due to a lack of clinician involvement in using applications. Developing adequate DHIs has the potential to improve outcomes in patients with SUD and aid in recovery time.The research concluded that physicians looking to develop DHIs should take into consideration the mode of delivery of DHI, the aim to produce specific health outcomes as opposed to multiple outcomes, and clinician involvement in DHI development. DHIs can become a vital tool for medical professionals, especially during the COVID-19 crisis, as the use of healthcare technology has limited in-person contact, maintained current doctor-patient relationships, and allowed for contact tracing of the disease.

Purpose of reviewSubstance use disorders are becoming increasingly prevalent in the geriatric population, necessitating an updated understanding of the existing literature. This review aims to describe the epidemiology, special considerations, and management of substance use disorders in older adults.Recent findingsPubMed, Ovid MEDLINE, and PsychINFO databases were searched from their inception through June 2022 using the following keywords: “substance use disorder,” “substance abuse,” “abuse,” “illicit substances,” “illicit drugs,” “addiction,” “geriatric,” “elderly,” “older adults,” “alcohol,” “marijuana,” “cannabis,” “cocaine,” “heroin,” “opioid,” and “benzodiazepine.” Our findings suggest an increasing trend in substance use in older adults despite medical and psychiatric consequences when using such substances. The majority of older patients admitted to substance abuse treatment programs were not referred by healthcare providers, suggesting room for improvement in the screening and discussion of substance use disorders. Our review also suggests that there should be careful consideration of COVID-19 and racial disparities when screening, diagnosing, and treating substance use disorders in the older population.SummaryThis review provides updated information on epidemiology, special considerations, and management of substance use disorders in older adults. As substance use disorders become more prevalent in older adults, primary care physicians must be prepared to recognize and diagnose substance use disorders as well as collaborate with and refer patients to geriatric medicine, geriatric psychiatry, and addiction medicine.