Older Adults and Substance-Related Disorders: Trends and Associated Costs

Purpose. The aim of this study is to examine the changing service profile of older adults receiving substance abuse services over the past decade and the increased costs of treating this population. Design and Methods. Medicaid claims for mental health and substance abuse services data from a medium sized county in an eastern state were analyzed for individuals aged 50 years and older in calendar year 2000 or 2009. Univariate statistics are presented to describe the substance abuse and mental health services used by older adults in these two years. Results. The number of low-income older adults who accessed services for treatment and who had a substance-related diagnosis grew from 545 individuals in 2000 to 1,653 individuals in 2009. Costs for services utilized by older adults with a substance-related diagnosis rose by 358% from $2.1 million in 2000 to $9.5 million in 2009. Implications. The increase in the number of low-income older adults with a substance-related disorder and the concomitant rise in total spending for Medicaid reimbursed services indicate that local and state social service providers need to prepare for an older adult population who will need appropriate substance abuse prevention and treatment programs. 1. Introduction Between 2006 and 2008, approximately 4.3 million adults aged 50 or older (4.7% of adults over 50) had used an illicit drug in the past year [1]. This has been accompanied by an increased prevalence of substance abuse and dependence reflected in increased alcohol and substance abuse treatment admission rates. Older adult substance abuse treatment admissions (aged 50 or older) increased from 6.6% of all admissions aged 12 years or older in 1992 to 12.2% in 2008 [2, 3]. As compared to earlier generations, a higher proportion of the baby-boom cohort used recreational drugs at a younger age, and many have entered later life with significant histories of drug and alcohol use [4]. In addition, this emerging cohort of older adults has greater access to highly addictive prescription narcotics to treat pain [5]. The graying of the substance abuse treatment population was accompanied by a changing profile of the primary substance that prompted older adults to enter treatment. In 1992, 84.6% of older adults entering treatment reported alcohol as their primary substance of abuse compared to just 59.9% in 2008. During this same time period, the proportion that reported primary heroin abuse more than doubled from 7.2% to 16.0% [2, 3]. While there has been a shift in the age demographics of substance abuse treatment clients in the