HIV Insight: Substance Use Disorders and Psychiatric Comorbidity in Mid and Later Life: A Review

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 ageing-related changes in medical conditions, older substance users are at risk for substance-related consequences.

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.

Among community non-institutionalized adults aged 50+ years, about 60% used alcohol, 3% used illicit drugs and 1–2% used nonmedical prescription drugs in the past year. Among adults aged 50+, 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 65+. Among drug users aged 50+, 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.

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.

Below: Age at admission for substance abuse treatments: Treatment Episode Data Set (TEDS) 1999–2009; U.S. population 2009. Source: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Service Adminstration, Treatment Episode Data Set (TEDS). Data received through 11 March 2010. U.S. Bureau of the Census. Annual State Resident Population Estimates for 6 Race Groups by Age, Sex, and Hispanic Origin: 1 April 2000 to 1 July 2009 (SC-EST2009-ALLDATA6, released June, 2010)