Joseph C. Gfroerer

Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort

BACKGROUND There is concern that as the baby boom population ages in the US, there will be a substantial increase in the number of older adults needing treatment for substance abuse problems. To address this concern, projections of future treatment need for older adults (defined as age 50 and older) were made. METHODS Using data from the National Household Survey on Drug Abuse, regression models including predictors of treatment need in 2000 and 2001 were developed. Treatment need was defined as having a DSM-IV alcohol or illicit drug use disorder in the past year. Regression parameters from these models were applied to the projected 2020 population to obtain estimates of the number of older adults needing treatment in 2020. RESULTS The number of older adults in need of substance abuse treatment is estimated to increase from 1.7 million in 2000 and 2001 to 4.4 million in 2020. This is due to a 50 percent increase in the number of older adults and a 70 percent increase in the rate of treatment need among older adults. CONCLUSIONS The aging baby boom cohort will place increasing demands on the substance abuse treatment system in the next two decades, requiring a shift in focus to address the special needs of an older population of substance abusers. There is also a need to develop improved tools for measuring substance use and abuse among older adults.

Substance use in the US college-age population: differences according to educational status and living arrangement.

OBJECTIVES Substance use in the college-age population is an important public health and educational concern. This study compared rates of use among college students and nonstudents, including high school dropouts, from a single data source representative of the nation. METHODS Rates of use were estimated from the combined National Household Surveys on Drug Abuse from 1991 to 1993. Logistic regression models were used to test the effects of educational status and living arrangement. RESULTS Educational status and living arrangement were found to be significant predictors of substance use. Rates of illicit drug and cigarette use were highest among high school dropouts, while current and heavy alcohol use were highest among college students who did not live with their parents. CONCLUSIONS Substantial variation in substance use patterns within the college-age population suggests that overall rates of use for young adults should not be used to characterize specific subgroups of young adults. These data from a single source will thus help planners more clearly distinguish the service needs of the diverse subgroups within this population.

Substance use disorder among older adults in the United States in 2020

AIMS This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020. DESIGN Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002-06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020. SETTING Non-institutionalized US residences. PARTICIPANTS Representative sample of the US civilian, non-institutionalized population. MEASUREMENTS Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. FINDINGS Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002-06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups. CONCLUSIONS Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder.

Pregnancy-related substance use in the United States during 1996-1998

OBJECTIVE To provide a baseline estimate of the national prevalence of pregnancy-related illicit drug use and abstinence rates. METHODS We analyzed data collected between 1996 and 1998 from the National Household Survey on Drug Abuse, a nationally representative sample survey of 22,303 noninstitutionalized women aged 18–44 years, of whom 1249 were pregnant. RESULTS During 1996–1998, 6.4% of nonpregnant women of childbearing age and 2.8% of pregnant women reported that they used illicit drugs. Of the women who used drugs, the relative proportion of women who abstained from illicit drugs after recognition of pregnancy increased from 28% during the first trimester of pregnancy to 93% by the third trimester. However, because of postpregnancy relapse, the net pregnancy-related reduction in illicit drug use at postpartum was only 24%. Marijuana accounted for three-fourths of illicit drug use, and cocaine accounted for one-tenth of illicit drug use. Of those who used illicit drugs, over half of pregnant and two-thirds of nonpregnant women also used cigarettes and alcohol. Among the sociodemographic subgroups, pregnant and nonpregnant women who were young (18–30 years) or unmarried, and pregnant women with less than high school education had the highest rates of illicit drug use. CONCLUSION The continued burden of illicit drug use during pregnancy calls for policy efforts to enable primary care providers to identify and refer women who use substances to treatment and support services. Prevention of uptake of illicit drug use should be an integral part of public health programs for young women.

Prevalence of youth substance use: the impact of methodological differences between two national surveys

This study compared two major Federally sponsored surveys of adolescent substance use and assessed the impact that methodological differences have on the prevalence estimates they generate. The Monitoring the Future Survey, a school-based survey, was compared to the National Household Survey on Drug Abuse, a household survey of the population aged 12 years and older. Response rates were higher in the household survey due to high rates of refusal in the school based survey. The school survey has a larger overall sample size, but sampling errors more similar than one might expect, because of the larger design effects in the school survey. Rates of drug use obtained were larger in the school survey than in the household survey, possibly because of greater under-reporting in the household setting than in the classroom and the different questionnaires used in the two surveys.

Substance Use Among Foreign-Born Youths in the United States: Does the Length of Residence Matter?

The prevention of substance use is a critical component of health promotion among youths. Of the 72.3 million youths under 18 years of age in the United States in 2000, 2.8 million were foreign-born.1 Research has suggested that foreign-born youths experience increasing risk of substance use as they become assimilated into US society (i.e., become acculturated).2,3 This study provides the first national estimates of the prevalence of substance use among foreign-born youths aged 12 to 17 years and explores the association between acculturation, defined as the length of residence in the United States, and substance use.

Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009–2011

Introduction Excessive alcohol consumption is responsible for 88,000 deaths annually and cost the United States

Substance Use Among Women: Associations with Pregnancy, Parenting, and Race/Ethnicity

223.5 billion in 2006. It is often assumed that most excessive drinkers are alcohol dependent. However, few studies have examined the prevalence of alcohol dependence among excessive drinkers. The objective of this study was to update prior estimates of the prevalence of alcohol dependence among US adult drinkers. Methods Data were analyzed from the 138,100 adults who responded to the National Survey on Drug Use and Health in 2009, 2010, or 2011. Drinking patterns (ie, past-year drinking, excessive drinking, and binge drinking) were assessed by sociodemographic characteristics and alcohol dependence (assessed through self-reported survey responses and defined as meeting ≥3 of 7 criteria for dependence in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Results Excessive drinking, binge drinking, and alcohol dependence were most common among men and those aged 18 to 24. Binge drinking was most common among those with annual family incomes of

Marijuana initiates and their impact on future drug abuse treatment need.

75,000 or more, whereas alcohol dependence was most common among those with annual family incomes of less than

The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration analysis

25,000. The prevalence of alcohol dependence was 10.2% among excessive drinkers, 10.5% among binge drinkers, and 1.3% among non-binge drinkers. A positive relationship was found between alcohol dependence and binge drinking frequency. Conclusion Most excessive drinkers (90%) did not meet the criteria for alcohol dependence. A comprehensive approach to reducing excessive drinking that emphasizes evidence-based policy strategies and clinical preventive services could have an impact on reducing excessive drinking in addition to focusing on the implementation of addiction treatment services.