Research Report: Increase in SUD Treatment Among Older Adults

New Study Shows Diverging SUD Treatment Trends for Older and Younger Adults

Anyone who reads or watches the news in any form – online, on TV, or in print – knows that addiction is a widespread problem in the U.S. For the purposes of this article, we’ll limit the discussion to alcohol and drug addiction. Although other addictions exist – gambling, for instance – our area of expertise is in alcohol and drugs, so that’s what we’ll talk about.

It’s important for anyone interested in learning about addiction to understand that the language we now use to refer to addiction and people with addiction is different than it was twenty years ago. For alcohol addiction, we say alcohol use disorder (AUD). For people with alcohol addiction, we say a person with alcohol use disorder. For drug addiction, we say substance use disorder (SUD). For a person with drug addiction, we say a person with substance use disorder. For drug addiction, experts also specify which one: cannabis use disorder for addiction to marijuana, opioid use disorder for addiction to opioids, and cocaine use disorder for addiction to cocaine.

Why do we use these new words?

Because, according to peer-reviewed research, using person-centered language – which is what we introduce above – leads to better outcomes for people who need support for AUD or SUD. Using person-first, scientifically accurate language reduces stigma and increases participation in AUD/SUD treatment programs. It also decreases self-stigma, a phenomenon which has a negative impact on self-esteem, social functioning, and overall well-being.

This change to person-first language has led to a gradual reduction in stigma around addiction and addiction treatment over the past twenty years. In a practical sense, one thing that means is that more people are willing to admit they have an addiction problem and seek treatment for that problem than they were twenty years ago.

That also begs a question that we can’t really answer:

Is the increase in reported rates of AUD and SUD over the past twenty years, and/or the increase in reported rates of people seeking treatment for AUD and SUD, an indication that more people have AUD or SUD, or simply an indication that more people are willing say they have AUD/SUD and step forward to seek treatment?

Note: this question does not apply to the opioid epidemic. We know how and why that happened and continues to happen. While it’s technically challenging to untangle, evidence shows that use of drugs other than opioids has increased over the past twenty years, independent of the opioid epidemic. However, even that evidence begs the same question, because it’s based on people answering questions in surveys.

But we digress – and now anyone reading this article has an interesting question to think about. And, to be honest, we do have a practical response to that unanswerable question: we’re certainly curious about the answer, but knowing it or not knowing it doesn’t change our daily purpose, which is to help anyone with AUD or SUD get the treatment and support they need, when and how they need it.

With all of that said, we’ll move on to the topic of this article, as indicated in the title: an increase in treatment for SUD for older adults.

New Data on SUD Treatment for People 55 +

A study published recently got our attention: “Increased Admissions of Older Adults to Substance Use Treatment Facilities and Associated Changes in Admission Characteristics, 2000-2017.” We noticed it because we’ve published two articles on related topics, one recently and one back in 2019:

Opioid Overdose Among Older Black Men

Binge Drinking Increase in Adults 65+

The second article identifies and discusses binge drinking among seniors, which creates complications for them since they’re already vulnerable to health problems because of their advanced age. The first article identified an increase in opioid overdose among older black men and identified increases that occurred from 2000-2017 that got very little attention from national news outlets.

One thing about this new study that sets it apart is that rather than rely on questionnaires where people may or may not be entirely forthcoming, it relies on objective admission data collected by the Substance Abuse and Mental Health Service Administration (SAMHSA) from alcohol and substance use disorder treatment centers around the country. SAMHSA publishes this data in a resource called Treatment Episode Data Set (TEDS).

The authors of the study note that although data published in the National Survey on Drug Use and Health (NSDUH) shows that drug use and substance use disorder among older adults is on the rise, no recent research has examined this increase by analyzing the number of treatment episodes for older adults, reported on specific patient characteristics or drugs involved, or compared those statistics with those reported for younger adults.

That’s exactly what this study does.

Let’s take a look at what data researchers used, and then look at the study results.

The Data

• Researchers retrieved admissions to SUD treatment facilities between 2000-2001 and 2016-2017 among adults 55 years and older
• Researchers retrieved admissions to SUD treatment facilities between 2000-2001 and 2016-2017 among adults aged 21 to 54
• Using advanced statistical methods, researchers compared to two data sets to identify any significant differences in trends in admissions to treatment facilities

The Results

• From 2000 to 2017:
  • The number of older adults admitted to SUD treatment facilities increased by 203.7%
  • The number of younger adults admitted to SUD treatment facilities increased by 13.0%
• Admissions per 1,000 adults in the general population moderated these differences to:
  • Older adults: 98.4% increase
  • Younger Adults: 7.2% increase

[Note: the use of the per 1,000 metric mitigates the effect of population increases on the overall percent increase]

• Older adults showed greater increases relative to younger adults in proportions admitted for:
  • Cocaine/crack:
    • In 2017, compared to 2000, older adults were 5.4 more likely to be admitted to a SUD treatment facility for cocaine use disorder, with a crack cocaine specifier, than young adults.
  • Cannabis:
    • In 2017, compared to 2000, older adults were 1.5 times more likely to be admitted to a SUD treatment facility for cannabis use disorder
  • Older adults showed greater decreases relative to younger adults in proportions admitted for:
    • Opiates
      • In 2017, compared to 2000, older adults were 25% decrease less likely to be admitted to a SUD treatment facility for opioid use disorder (OUD) than young adults
    • Alcohol (OR, 0.79; 95% CI, 0.78-0.80) along with changes in some demographics.
  • In 2017, older adults were 73% more likely than younger adults to be admitted to a SUD treatment facility than they were in 2000.

These numbers are a mixed bag. On the one hand, it’s good that more older adults seek and get the treatment they need. On the other hand, it’s not good that more adults need to seek treatment. The data itself offers no explanation for the relative increases in admission to SUD treatment for older adults. However, according to the online research journal Science Daily, study authors offer two possible hypotheses:

1. Baby Boomers, a generation known for higher use of recreational drugs than previous generations, began the transition to older adulthood between 2001-2017, and it’s realistic to think their default higher rate of drug use explains this increase in admission to SUD treatment programs.
2. There is less stigma attached to substance use disorder, and seeking treatment for substance use disorder than there was in the past. Therefore, older adults may be more likely to seek help.

That second theory is buttressed by SAMHSA data showing that self-referrals, as opposed to forced referrals, accounted for most of the treatment admissions. The second theory is also supported by the simple, common sense question we posed at the beginning of this article: does a reduction in stigma explain the increase in SUD treatment overall?

Now let’s take a look at this data in relationship to another topic we’ve discussed here: the treatment gap.

Hidden in This Data: A Problem With Young Adults

This study shows us that rates of admission to SUD treatment programs increased among older adults relative to younger adults between 2000 and 2017. This is crucial information for us, as treatment providers for SUD. It means that we should prepare for an increase in people over age 55 seeking treatment over the next few months and years, and make plans – if we haven’t already – to adapt treatment strategies to meet the needs of this specific demographic.

That could mean forming community support groups for older adults, tailoring educational workshops to an older population, or anticipating the need to include the adult children of older adults with SUD in family therapy, in addition to welcoming the older adult parents of younger adults to join family SUD therapy sessions.

There’s something else there, though. As the relative rate of SUD treatment seeking increased for older adults along with increasing rates of substance use, the relative rate of treatment seeking for young adults did not keep pace with the increasing rates of substance use. One thing that means is that the SUD treatment gap – the difference between the number of people who need SUD treatment and the number of people who get SUD treatment – is increasing for young adults and decreasing for older adults.

A decreasing treatment gap, relatively speaking, is a good thing. A decreasing treatment gap is always a problem.

We’ll use data from the 2020 National Survey on Drug Use and Health (NSDUH) to illustrate what we mean.

The SUD Treatment Gap: Age 18-25

• People with SUD: 4,878,000
• People who received treatment for SUD: 277,000
  • That’s 5.6%

That means 94.4% of people aged 18-25 diagnosed with SUD did not get treatment for SUD.

The SUD Treatment Gap in 2020: Age 26 +

• People with SUD: 12,304,000
• People who received treatment for SUD: 2,071,000
  • That’s 16.3%

That means 83.7% of people over age 26 diagnosed with SUD did not get treatment for SUD.

We know: these are not the exact same age groups as the study we discuss above. Therefore, by the strict rules of statistics, we can’t make concrete judgments, because we’re not comparing the same groups. With that acknowledged and understood, we’re not comparing apples to oranges. We’re comparing overlapping age groups that include individuals who, over time, move from one age group to the next. And what this comparison shows us is that older adults are stepping up and asking for help at a greater rate than younger adults.

Why?

That’s something we need to find out, and we’re confident that new research will guide our efforts to close the treatment gap. We’re also confident that the new White House National Drug Control Strategy published will have an impact. The strategy prioritizes increasing access to treatment by removing barriers wherever and whenever possible, doubling down on the person-first, person-centered, integrated approach to treatment, and increasing funding for community-based harm reduction programs across the country.

One of the goals of the new strategy is “Building A Recovery-Ready Nation.”

We’re part of that process – and we’re ready to offer help and support to anyone of any age who asks for help. One of our mantras at Pinnacle Treatment is “Any Door is the Right Door.” That means we’re ready to meet people where they are. This new research makes us consider adding this mantra:

“Any Age is The Right Age”

(Caveat: we accept patients over age 18 only)

One More Thing: Words Do Matter

We mentioned, at the beginning of this article, that language matters, and the words we use when we talk about treatment and recovery matter. We stand by that, and we’re happy to share the news that another word/phrase that increases stigma – drug abuse or drug abuser and alcoholism or alcoholic – will disappear from websites associated with the U.S. government and the National Institutes of Health (NIH).

In fact, in the budget proposed by the White House for the fiscal year 2023:

• The National Institute on Alcohol Abuse and Alcoholism will change its name to the National Institute on Alcohol Effects and Alcohol-Associated Disorders
• The National Institute on Drug Abuse will change its name to the National Institute on Drugs and Addiction
• The Substance Abuse and Mental Health Services Administration to the Substance Use And Mental Health Services Administration

We’ve used these new, person-first words for years, and the fact that these changes will be implemented at the national level next year is a clear sign of progress. On a practical note, the fact that the place these planned changes appear is the national budget means the proposals are serious, and likely to be implemented as planned.

That’s good news.

We stand ready to be part of the solution, and help people of all ages get the help they need, where and when they need it.