Elsevier

Drug and Alcohol Dependence

Volume 145, 1 December 2014, Pages 113-120
Drug and Alcohol Dependence

Treatment use, perceived need, and barriers to seeking treatment for substance abuse and mental health problems among older adults compared to younger adults

https://doi.org/10.1016/j.drugalcdep.2014.10.004Get rights and content

Highlights

  • The 50–64 age group was more similar to the younger age groups than to the 65+ age group with respect to SUD and MH treatment use and perceived treatment need.

  • The lack of readiness to stop using was the most frequently mentioned barrier to accessing SUD treatment among the 65+ group.

  • Treatment cost/limited insurance was the most frequently mentioned barrier to accessing MH treatment among younger age groups.

Abstract

Background

This study examined age group differences in and correlates of treatment use and perceived treatment need for substance use disorders (SUD) and mental health (MH) problems as well as self-reported barriers to treatment among people 65+ years old vs. 26–34, 35–49, and 50–64 years old.

Methods

Data are from the 2008 to 2012 National Survey on Drug Use and Health (NSDUH) (N = 96,966). Age group differences were examined using descriptive bivariate analyses and binary logistic regression analyses.

Results

The 65+ age group was least likely to use treatment and perceive treatment need, but the 50–64 age group was more similar to the younger age groups than the 65+ age group. Controlling for age, other predisposing, and enabling factors, alcohol and illicit drug dependence and comorbid SUD and MH problems increased the odds of SUD treatment use. Of MH problems, anxiety disorder had the largest odds for MH treatment use. Bivariate analyses showed that lack of readiness to stop using and cost/limited insurance were the most frequent barriers to SUD and MH treatment, respectively, among older adults, and they were less likely than younger age groups to report stigma/confidentiality concerns for MH treatment.

Conclusions

Older adults will become a larger portion of the total U.S. population with SUD and/or MH problems. Healthcare providers should be alert to the need to help older adults with SUD and/or MH problems obtain treatment.

Introduction

Given longer life spans and the aging baby boom generation, which has had greater exposure to illicit drugs than previous generations, the number of Americans aged 50 years and older with a substance use disorder (SUD) has been increasing and is projected to double from 2.8 million (annual average) in 2002–2006 to 5.7 million in 2020 (Han et al., 2009). Increases are projected to occur in both genders and all racial/ethnic groups (Blow and Barry, 2012). With increasing SUDs among those aged 50+ years, help-seeking and treatment admissions in this age group have also steadily increased during the past decade (Arndt et al., 2011, Oleski et al., 2010, Sacco et al., 2013, Wu and Blazer, 2011). Those aged 50+ were 6.6% of all SUD treatment admissions in 1992 and 12.2% in 2008 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2010). Alcohol remained the primary substance of abuse for most admissions. There was also a significant increase in admissions for a primary drug problem other than alcohol (e.g., 7.2% in 1992 to 16.0% in 2008 for primary heroin abuse).

The prevalence and treatment of mental health (MH) problems among older adults are significantly lower than for younger adults, but there has also been an overall upward trend in diagnosis and treatment among older adults. Medicare claims data from 1992 to 2005 showed that the proportion of older adults who received a depression diagnosis doubled from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups (Akincigil et al., 2011). Of those diagnosed with depression, the proportion receiving any treatment (pharmacotherapy and/or psychotherapy) steadily increased from 64.6% to 71.4% during the study period. Data from the 2004 to 2007 National Survey of Drug Use and Health also found that of the 4.7% of the population aged 65+ that had past-year serious psychological distress, 37.7% received MH services −4.8% received inpatient services, 15.8% received outpatient services, and 32.1% received prescription medications (Han et al., 2011). Use of combined treatment modalities may also be increasing. A study of community-residing older adults aged 70+ years found that antidepressant medication combined with other services from a MH professional increased between 1998 and 2007, while antidepressant use alone decreased (Barry et al., 2012).

The growing evidence base on pharmacotherapy and psychotherapy for SUD and MH problems shows that older adults have the same or more positive treatment outcomes than their younger counterparts (Blazer, 2003, Goncalves and Byrne, 2012, Karlin et al., 2013, Kuerbis and Sacco, 2013, Satre et al., 2012, Weiss and Petry, 2013). A study using National Comorbidity Survey Replication data also found that more than 80% of individuals aged 55+ years reported positive attitudes toward seeking MH services, and more than 70% had positive beliefs about treatment efficacy; these rates were comparable to or higher than those of younger age groups (Mackenzie et al., 2008). However, most older adults do not access SUD and MH treatment (Huang et al., 2013, SAMHSA, 2010). Low treatment utilization rates among older adults may be attributable to denial of problems (thus lack of readiness for treatment), stigma/confidentiality issues, self-sufficiency beliefs (i.e., they could handle the problem themselves), lack of knowledge about treatment programs, and treatment cost (Conner et al., 2010, Jimenez et al., 2013, Keyes et al., 2010, Mackenzie et al., 2008, Mackenzie et al., 2010, Oleski et al., 2010).

Older adults with untreated SUDs and/or mental disorders have substantially greater medical comorbidity than those without these disorders (Chapman and Perry, 2008, Lin et al., 2011). Given increasing rates of SUD and mental disorders among the growing population of older adults, it is important to examine correlates of their treatment use as well as self-reported reasons for not seeking treatment. Using multi-year epidemiologic data, this study compared adults aged 65+ years with younger adults aged 26–34, 35–49, and 50–64 years old on (1) rates of SUD and MH treatment use and perceived treatment need in the preceding 12 months; (2) sociodemographic, health, and clinical correlates of treatment use and perceived treatment need; and (3) self-reported reasons for not seeking treatment among those with perceived treatment need.

Andersen's (1995) behavioral model of health service use posits that health service access and utilization is a function of (1) predisposition to service use, including individuals’ demographic characteristics and attitudes, values, and knowledge about health and health services that might impact their perceptions of need and health service use; (2) personal and system-level factors that enable or impede use, including social support, income, insurance coverage, availability and accessibility of services, transportation to treatment, and waiting times; and (3) individuals’ perceived treatment need, which tends be more important than predisposing and enabling factors. For example, alcohol problem severity has been found to be a stronger factor for treatment seeking than sociodemographic characteristics (Saunders et al., 2006, Weisner et al., 2002). Based on the literature review and Andersen's behavioral model, the following hypotheses are proposed: (H1) controlling for other predisposing, enabling, and need factors, older adults (65+ years) will be less likely than younger adults to have used SUD and MH treatment and perceived treatment need; (H2) regardless of age, symptom severity (i.e., alcohol and drug dependence than abuse and MH diagnoses) will increase the odds of treatment use and perceived treatment need; and (H3) older adults will be more likely than younger adults to report lack of readiness, stigma, self-sufficiency beliefs, and lack of knowledge about treatment programs as barriers to treatment use.

Section snippets

Data and sample

Data came from the public use files of the 2008 to 2012 National Survey of Drug Use and Health (NSDUH), the largest population-based survey that measures substance use and MH problems and treatment use among the civilian, non-institutionalized, U.S. population aged 12 years or older (Inter-University Consortium for Political and Social Research [ICPSR], 2012). The survey included questions based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) that

Sample characteristics

Table 1 shows that of all respondents, 6.94% had a SUD and 15.25% had a MH problem. As expected, the 65+ age group had the lowest rates of SUD (1.78%), MH problems (8.58%), and comorbid SUD and MH problems (0.33%) of all age groups, while the 26–34 age group had the highest rates of SUD (13.50%), MH problems (19.60%), and comorbidity (5.23%).

Age group differences in past-year SUD: Sociodemographics, SUD treatment use, and perceived need for treatment

Table 2 shows that of all respondents with SUD, 5.14% and 20.77% were in the 65+ and 50–64 age groups, respectively. The main effect of age group was

Discussion

The 65+ age group remained a small proportion of those with any SUD or MH problem. Study findings support H1, since controlling for other predisposing, enabling, and need factors, adults aged 65+ with SUD or MH problems were significantly less likely to have used treatment and to report perceived treatment need than those in the 35–49 age group. Also of interest was that the 50–64 year olds did not differ from 35 to 49 year olds in SUD treatment use, perceived SUD treatment need, and MH

Role of funding source

The study was funded by the University of Texas at Austin's Internal Research grant for secondary data analysis.

Contributors

All three authors contributed to and have approved the final manuscript. Namkee Choi and Diana DiNitto conceptualized the paper and conducted the literature review. Namkee Choi conducted statistical analysis, and both Namkee Choi and Diana DiNitto wrote the manuscript. C. Nathan Marti reviewed the statistical analysis and the manuscript and commented on them.

Conflict of interest statement

No conflict declared.

References (33)

  • P. Sacco et al.

    Help seeking for drug and alcohol problems among adults age 50 and older: a comparison of the NLAES and NESARC surveys

    Drug Alcohol Depend.

    (2013)
  • S.M. Saunders et al.

    Person-related and treatment-related barriers to alcohol treatment

    J. Subst. Abuse Treat.

    (2006)
  • A. Akincigil et al.

    Diagnosis and treatment of depression in older community-dwelling adults: 1992–2005

    J. Am. Geriatr. Soc.

    (2011)
  • R.M. Andersen

    Revisiting the behavioral model and access to medical care: Does it matter?

    J. Health Soc. Behav.

    (1995)
  • D.G. Blazer

    Depression in late life: review and commentary

    J. Gerontol. A Biol. Sci. Med. Sci.

    (2003)
  • F.C. Blow et al.

    Alcohol and substance misuse in older adults

    Curr. Psychiatry Rep.

    (2012)
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