By Mich Magness
Oklahoma Department of Mental Health and Substance Abuse Services Coordinator for Aging and Long Term Care

In the eighteen years following the end of World War II, 1946 to 1964, America experienced a demographic surge that is now called the "baby boom." This generation of Americans is the one that coined the term "recreational drug use," and they are going to bring their old habits with them right along into retirement (Marks, 2002). These baby boomers are the folks who participated most fully in the Vietnam War protests, the sexual revolution, the civil rights marches, and bra-burning feminist awakening. Their cultural icons included Timothy Leary, Gloria Steinham, Sputnik, the Summer of Love and Haight-Ashbury, Woodstock, Malcom X, and Rolling Stone magazine. This generation of Americans came of age during a particular time in our history, and their values and behaviors in their old age will be different from their parents and grandparents because of the unique historical times they experienced as children, teenagers, and young adults.

Current Substance Use & Abuse by Older Adults

"In 2002 and 2003, 17.1 percent of persons aged 50 or older had smoked cigarettes, 45.1 percent drank alcohol, and 1.8 percent had used an illicit drug during the past month" is one finding of the National Survey on Drug Use and Health (Office of Applies Studies, 2005). Older adults are increasingly abusing alcohol and the use of illicit drugs, primarily marijuana, is also on the rise according to the Substance Abuse and Mental Health Services Administration's (SAMHSA) Treatment Improvement Protocol (TIP) Series 26 (1998).

Tip 26 identifies several reasons substance use and abuse in older adults is overlooked by healthcare providers, including "insufficient knowledge, limited research data, and 'hurried office visits." Other factors that further make identification of problems with alcohol and/or drug use in older adults difficult for healthcare providers include ageism and the fact that symptoms of substance abuse may be mistaken for dementia, diabetes, depression, or other common disorders of the elderly. Drug users' problems "often first become evident at work, or in run-ins with the criminal justice system" (Marks, 2002) and older adults are probably going to be retired and are not likely to become criminals to support their drug use. Failure to identify and treat alcohol abuse and substance use in elderly patients can have serious consequences.

The Need for Increased Prevention for Substance Abuse
Treatment is more costly than prevention both in terms of actual costs to treat and in greater societal costs associated with poorer health outcomes as a result of untreated substance abuse. Dr. Fred Blow writes that prevention programs, as well as early intervention programs, are the most appropriate ways to minimize health care costs while maximizing health outcomes for older adults (Bartels, Blow, Brockman, Van Citters, 2005). The area of prevention services for substance abuse has not been well developed for the older adult population. The focus of most substance abuse prevention programs has been on teenagers and youth but not the elderly. Public health programs often overlook older adults as targets for prevention programming.

Some practices have been developed and proven to be effective in preventing substance abuse in older adults. These practices include brief alcohol intervention (Fleming, 1999; Barry 1998). Brief alcohol intervention consists of a series of questions a physician asks an older person to screen for alcohol use and possible abuse and some very brief teaching statements the physician can use to encourage the older adult to stop drinking or reduce their drinking responsibly (Barry 2001). This has been proven to be very effective and not take too much time on the part of physicians. Dr. Fred Blow and Dr. Kristen Barry, both researchers at the University of Michigan, have been pioneers in developing the brief intervention and brief therapy models of substance abuse prevention and treatment. Dr. Barry (1999) was the consensus panel chair for the development of TIP #34, Brief Interventions and Brief Therapies for Substance Abuse.

The mental health and substance abuse systems have been slow to develop elder-specific protocols for alcohol prevention. The development of elder-specific protocols for marijuana prevention is non-existent. It may be safe to assume that screening, brief intervention, and brief therapy methods which are effective for preventing alcohol abuse by elders might also be effective if modified for marijuana prevention; however that remains to be tested. There are dissimilarities between alcohol use and marijuana use that may interfere with the effective cross transfer of these technologies. Alcohol is legal while marijuana is illegal. Today's older adults may be more receptive to interventions by physicians than the baby boomers. The physiological and psychological components of addiction may be different for the two substances.

Conclusions
There is much work to be done to prepare for the retirement and eventual senescence of the baby boom generation. The work of gerontologists and preventionists is to promote successful aging on the individual level, prepare society for demographic changes, and protect the frail elderly. This work is incomplete because there are gaps in our knowledge. These gaps can be closed with scientific study of the biology, sociology, and psychology of aging.

Research must be done to replicate much of the work that has already been done in understanding alcohol interactions with commonly-used prescription drugs and over the counter drugs. This time, however, the interactions must include those with marijuana. Research establishing evidence based practices in both treatment and prevention of substance abuse specific to the unique needs of older adults must be conducted at universities and in clinical trials in doctor's offices and mental health centers. Finally, this research must not sit idly on university professor' shelves, but must reach the intended audience of older adults, aging network professionals, and preventionists. This research will provide the necessary evidence base that will spur funding for treatment and prevention programs.

Mich Magness, M.A., promotes successful aging and protects elderly Oklahomans as the aging specialist for the Oklahoma Department of Mental Health and Substance Abuse Services. Mr. Magness is a gerontologist and is working towards a Ph.D. in Applied Gerontology. A native Oklahoman, he has studied both yoga and aging since his childhood in rural Eastern Oklahoma.

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