Bongs, booze and baby boomers
Western countries are sitting on a timebomb of health and social issues arising from drug and alcohol overuse among baby boomers – the generation that won’t slow down.
In both the UK and Australia, risky drinking is declining except among people aged 50 years and older, new research has found.
And the number of people aged over 50 experiencing problems from substance misuse is growing rapidly, with the numbers receiving treatment expected to treble in the United States and double in Europe by 2020.
Researchers at South London and Maudsley NHS Foundation Trust and Flinders University in Australia, who published today in international medical publisher ‘The BMJ’, say here is also a strong upward trend for episodic heavy drinking in this age group.
“Alcohol is the most common substance of misuse among baby boomers which presents the most concern because of the larger number of users and wide range of negative consequences,” says Professor Ann Roche, Director of the National Centre for Education and Training on Addiction at Flinders University.
But this generational trend is not restricted to alcohol.
“Some of the pharmaceutical drugs such as opioids also have severe consequences associated with their use,” Professor Roche says.
In Australia, the largest percentage increase in drug misuse between 2013 and 2016 was among people aged 60 and over, with this age group mainly misusing prescription drugs.
However, people over 50 also have higher rates than younger age groups for both past year and lifetime illicit drug misuse (notably cannabis).
Growing use of alcohol, cannabis and prescription drug misuse among older Australians may increase the risk of falls and other injuries, diabetes, cardiovascular disease, mental health problems including suicide, obesity, liver diseases, early onset dementia and other brain injury, sleep disorders and blood-borne diseases.
“Ageing reduces the body’s capacity to metabolise, distribute and excrete alcohol and drugs, and older people are also more likely to have pre-existing physical or psychological conditions or take medicines that may negatively interact with alcohol and drugs,” Professor Roche says.
“There is also a reduction in lean body mass, resulting in higher alcohol-drug blood concentrations.”
In The BMJ editorial Dr Rahul Rao, a Visiting Researcher at South London and Maudsley NHS Foundation Trust in England, and Professor Roche are calling for a coordinated international approach to tackle this rapidly growing problem.
“The clinical complexity of older adults with substance misuse demands new solutions to a rapidly growing problem. So far, there has been little sign of a coordinated international approach to integrated care,” they say.
Research suggests that treatment programs adapted for older people with substance misuse were associated with better outcomes than those aimed at all age groups.
However, the authors point out that clinicians will need improved knowledge and skills in assessing and treating older people at risk of substance misuse.
“There remains an urgent need for better drug treatments for older people with substance misuse, more widespread training, and above all a stronger evidence base for both prevention and treatment.”
Under-detection of alcohol problems is of immediate concern – and may increase further as baby boomers get older because of their more liberal views towards heavy alcohol use.
A lack of sound alcohol screening to detect risky drinking may result in a greater need for treatment, longer duration of treatment, heavier use of ambulance services, and higher rates of hospital admission.
Dr Rao and Professor Roche say the growing influence of baby boomer substance misuse will “continue to present challenges for healthcare service delivery for older people.
“Clinicians will need improved knowledge and skills in assessing and treating older people at risk of misuse of opiate prescription drugs, cannabis, and, increasingly, gabapentinoid drugs used to treat neuropathic pain and anxiety.
“Professionals need to consider the possibility of coexisting mental disorders such as cognitive impairment and depression (dual diagnosis), as well as complex physical presentations that may include the presence of pain, insomnia, or the non-medical use of prescription drugs.
“Older people with dual diagnosis use both inpatient and outpatient services more frequently than those with substance misuse alone.”
Reference: "Substance misuse in older people"; BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3885 (Published 22 August 2017).
23 August 2017.