Kathleen J. Farkas, PhD  Case Western Reserve University, Mandel School of Applied Social Sciences

Laurie Drabble, PhD  San Jose State University, School of Social Work

Central to the future of knowledge about substance use, abuse, and dependence among older populations are questions about the relationships between substance use, chronological age, and cohort effects. In past decades, epidemiological studies have consistently shown that older people use alcohol and drugs less often and have fewer substance-related problems than do younger cohorts. Past epidemiological studies have also consistently demonstrated that older adults tend to decrease their use of alcohol with age, usually in response to poor health or changing social circumstances. Epidemiological research has documented that a segment of the older population does experience substance-related problems and disorders. Soon the increased size of this segment of older adults, resulting from the entry of the “baby boomers” into this age bracket, will increase the need for substance abuse assessment and treatment services even if prevalence rates remain constant in future older cohorts. Epidemiological research has also indicated that the “baby boom” cohort has used alcohol and other substances, especially marijuana, at higher rates than previous age cohorts, so there is reason to believe the potential exists for changes in the prevalence and incidence rates of substance use and substance-related disorders among future older cohorts.

Large, community-based data sets that include older age groups, such as Treatment Episode Data Set (TEDS) and the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), provide exciting opportunities to understand longitudinal changes in older adults’ alcohol and other drug use. Analysis of these data should focus on the differences between and similarities among age groups of older adults as well as on comparisons between older and younger adults. The growing literature on the complex relationships between alcohol use and beneficial health effects as well as on the relationships between alcohol use and health problems indicates that this is a rich area for future research. Some of the questions raised by the research include:

• To what extent will age-related changes in physical health determine alcohol and/or tobacco use and misuse among healthy older adults?
• To what extent will age-related changes in physical health determine use of over-the-counter drugs and herbal remedies among healthy older adults?
• To what extent will age-related changes in physical health determine other drug use, especially recreational use of marijuana or use of other illicit drugs, among older adults?
• How will social factors, such as widowhood, economic trends, and retirement practices affect substance use among future cohorts of older adults?
• How will minority group status affect prevalence of substance use in older cohorts?
• What, if any, are the relationships between sexual and racial/ethnic identity group status and use of particular types of substances?
• What are the relationships between drinking limits and physical and psychosocial health in samples of community-dwelling older people?
• What is the relationship between chronic pain and substance use and misuse among older adults both in the community and in health care facilities?
• What is the relationship between direct to consumer advertising of abusable prescription medications and prevalence of prescription drug abuse among older adults?

Screening and assessment of substance use and substance-related problems present many opportunities for continued research. The literature has provided some clear evidence about the types of problems and issues most often associated with substance use. However, there are differences in the sensitivity and specificity of various screening tools across settings and populations. With changes in prevalence of substance use in future cohorts, practitioners will need to understand elements of social desirability and social stigma associated with various types of substance use across the range of older age groups. There is also a need to understand gender differences and differences among racial/ethnic and other cultural groups. Some of the research questions include the following:

• What are the differences and similarities in the barriers affecting detection of substance use and abuse among older cohorts?
• Which screening tools demonstrate acceptable levels of sensitivity and specificity in different populations of older people?
• Are there differences in levels of social desirability and social stigma in alcohol and drug use between older age cohorts? Are there differences in levels of social desirability and social stigma in alcohol and other drug use between older racial/ethnic, gender, and other groups? What is the relationship between social desirability, social stigma, and self report of alcohol and other drug use and abuse?
• How will future older cohorts’ attitudes about alcohol be related to decisions about alcohol use?
• Will the future cohorts of older adults experience the same types of alcohol- or other drug-related problems as current cohorts of older adults?
• What factors will determine older adults’ decisions to increase or decrease alcohol and/or other drug use? How will these factors be associated with age-related physical, social, or psychological changes?
• What types of motivational strategies will be effective with future cohorts of older adults in both assessment and referral to treatment for alcohol and other drug problems?
• How can screening and assessment methods be improved for older adults with cognitive impairments and psychiatric illness?

Research in treatment approaches and outcomes has progressed over the past 10 years but many questions remain concerning treatment engagement strategies, elements of effective programming, and treatment outcomes for older adults. Elder-specific programming has been shown effective in some studies, but it is unclear which components of the treatment account for the positive changes in alcohol consumption.

• What are the interactions between age group and type of treatment?
• What are the interactions between age group, drug of choice, and type of treatment?
• Most treatment efforts with older adults have focused on alcohol exclusively. Will these same treatment approaches yield effective results with older adults who are more likely to use other drugs like marijuana and cocaine or prescription drugs?
• What are the interactions between age group, gender, and minority group status, type of treatment, and treatment outcomes?
• Which treatment engagement and treatment approaches will yield effective results with older women and members of ethnic/racial minorities and other minority groups?
• Which treatment engagement and treatment approaches will yield effective results with older lesbian and gay people?
   

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