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Correspondence: Address correspondence to Daniel Rosen, School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA, 15260. E-mail: dar15{at}pitt.edu
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Abstract |
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Design and Methods. The current study focuses on a subsample of the larger administrative data of a methadone clinic that is limited to African American and White clients over the age of 50 (N = 143). A logistic regression model tested the relationship between life stressors, exposure to illegal drug use, and a respondent's ability to remain abstinent from illegal drug use in the previous month.
Results. Older methadone clients exposed to illegal drug use in their social networks and neighborhoods were significantly more likely to use illegal drugs in the last month.
Implications. Although demographic trends in the methadone population indicate that this cohort is aging and that their numbers are growing, little research exists on their well-being and service needs.
Key Words: Substance abuse • Opiate addiction • Geriatric services
The aging opiate-addicted cohort from the 1970s is altering the demographic characteristics of individuals in need of services for heroin addiction (Substance Abuse and Mental Health Services Administration [SAMHSA], 2002) and will potentially put a strain on the resources of treatment and clinical programs (Patterson & Jeste, 1999). As opiate-addicted individuals age, health problems may be exacerbated by age-related illness, social isolation, and general physical decline and may require specialized medical approaches. Understanding the service needs of this aging population of methadone clients will be critical in effectively serving this vulnerable older population.
Limited research exists on the well-being of older individuals addicted to opiates, and virtually no research specifically addresses the well-being of older methadone clients. In a 33-year follow-up of male narcotic addicts with a mean age of 57.4, Hser, Hoffman, Grella, and Anglin (2001) identified high rates of health and mental health problems. Heroin abstinence was a particularly important factor in determining whether or not a respondent had a mental health problem.
Whereas scant specific research on older heroin addicts and methadone clients exists, the aging and substance abuse literature provides important insights into key variables for those individuals who are attempting to remain drug-free. For instance, substance-abuse researchers identified retention in treatment as being related to positive social support systems and lower levels of stress among some substance abusers (Dobkin, DeCivita, Paraherakis, & Gill, 2002; Gainey, Wells, Hawkins, & Catalano, 1993). Yet, the specific role of social support for addicted individuals is not well understood, and empirical assessments involving drug-addicted clients are scarce (Anderson, Dimidjian, & Miller, 1995; Anderson, Stewart, & Dimidjian, 1994; Blomqvist, 1996).
Even after controlling for income and education, African Americans appear to be less likely to use mental health and substance-abuse services than Whites (Snowden, 1999). Other studies of African Americans in methadone treatment reveal that African American patients are more likely to receive lower dosages of methadone than their White counterparts (D'Aunno & Pollack, 2002). Despite these variances by race, most research on the service needs of individuals addicted to heroin focuses on White men while ignoring racial and gender differences (Hser et al., 2001).
Research on older methadone clients may provide useful insight into other vulnerable aging populations (i.e., individuals with human immunodeficiency virus [HIV] or mental health disorders) who also will face age-related challenges. Previous studies on HIV concerns for injection drug users over the age of 50 have been funded by the National Institute on Aging and the National Institute on Drug Abuse (Anderson & Levy, 2003; Auberbach, 2003). SAMHSA studies (2002) that examined drug use in people over the age of 50 identified the relationship between aging, drug use, and future treatment needs.
Given the dearth of empirical evidence about the needs and well-being of older methadone clients, the growing size of the population, and the potential impact on service systems, the overall aims of this study are threefold: (a) to describe the life stressors of, exposure to illegal drug use of, and use of illegal drugs by older methadone clients; (b) to examine gender and racial differences in life stressors, exposure to illegal drug use, and illegal drug use of these clients; and (c) to examine the relationship between life stressors and exposure to illegal drug use in a methadone client's ability to remain abstinent from illegal drug use.
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Design and Methods |
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The sample was restricted to African American and White clients as the methadone clinic serves only these populations. All respondents in the study were English speaking. The decision to limit the sample to clients over the age of 50 was driven by an emerging body of research that focuses on this age range of illicit drug use in later life (Gfroerer, Penne, Pemberton, & Folsom, 2003; Levy, 1998).
Demographic characteristics of the sample reveal that 84.6% of the sample (n = 121) are between the ages of 50 and 60. Over two-thirds of the sample is male (69.9%), and slightly more than half the sample (55.2%) is African American.
Measures
Demographic Variables
Respondent's age, gender, and race were sociodemographic control variables used in the multivariate analysis.
Life Stressors
Variables that indicate economic well-being and living situations were specified as life stressors. Economic well-being included whether a respondent was currently employed or receiving public assistance. Employment was defined as working either full or part time at the time of the interview. Public assistance receipt was defined as currently receiving Social Security Insurance or Social Security Disability or General Assistance. Unemployed clients who were currently looking for work at the time of the interview were also considered to have a life stressor. Life stressors related to living situations included whether a client was either temporarily staying with someone else, living in a halfway house, or in a residential treatment program.
Exposure to Drug Use in Social Networks and Neighborhoods
Exposure to drug use referred to a client who had either a romantic partner or a nonromantic adult member of the household who was involved with illicit drugs. Involvement with illicit drugs is defined as having a romantic partner or an adult member of the household who is either currently abusing illegal drugs and/or currently in need of drug treatment. Clients also identified whether or not they were currently living in a place with either frequent or very frequent drug abuse or trafficking. In addition, a dichotomous variable that referred to any exposure to illegal drug use, which included a romantic partner and/or adult member of the household with the above-mentioned substance abuse problems and living in a neighborhood with drug abuse/trafficking, was created.
Illegal Drug Use in the Last Month
The methadone clinic conducted monthly urine tests to examine whether or not a client had remained abstinent from illegal drug use in the last month. The results from these urine tests were coded "0" for no drug use detected in the last month and "1" for the presence of benzodiazepines, barbiturates, cocaine, opiates, or other illegal substances in the last month.
Analyses
The initial research question for this study examines the demographic factors, life stressors, and exposure to illegal drugs and their relationship to an older methadone client's ability to remain abstinent from illegal drug use (based on the results from monthly urine tests). Data were analyzed by using SPSS 11.0 (Chicago, IL). Descriptive analyses were used to present differences by both gender and race on the independent variables. 
2 tests were used for all comparisons. A logistic regression was employed to test the relationship between life stressors and a respondent's ability to remain abstinent from illegal drug use in the previous month. The multivariate model adds in each of the independent variables related to life stressors (the various life stressors and exposure to drug use) to determine which variables show statistical significance when controlling for demographic factors.
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Results |
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The cohort of respondents who were over the age of 60 had three and a half times more African Americans than Whites (22.8% vs. 6.3%). White respondents were more likely (9.4% vs. 1.3%) to have an adult member of the household in need of drug treatment than African American respondents. In addition, Whites had significantly higher rates of any drug exposure than African Americans (35.9% vs. 20.3%).
Table 2 presents a logistic regression model of the association among demographic variables, life stressors, exposure to illegal drugs, and remaining abstinent from illegal drug use in the last month for methadone clients over the age of 50. A dichotomous variable was created for exposure to illegal drug use that included respondents who had a significant other who was abusing illegal substances or in need of drug treatment, an adult member of their household in need of drug treatment, or living in a neighborhood with drug sales. In this model, exposure to illegal drugs was significantly associated with having used illegal drugs in the last month. Financial life stressors and living in an unstable environment were not significantly associated with illegal drug use in the last month; nor was race or gender. Specific items in the dichotomous variable for exposure to illegal drugs were also tested individually, and none was found to be significant (analysis not reported).
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Discussion |
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These findings have important implications for policy initiatives and funding of opiate addiction programs at both the federal and the state levels. The data indicate that as this population ages, there is still a relatively high rate of drug usage, with nearly one-third of older clients using illegal drugs in the last month. The increased service needs of an aging opiate-addicted population will place a financial strain on existing resources. Funding programs that are directed to this aging population may help to decrease overall expenditures in the health and mental health field for seniors addicted to opiates by allowing them to receive care in appropriate settings.
There is also the potential that future research about the lives of older methadone clients will help in the intervention and treatment strategies of younger opiate-addicted individuals. Heroin addiction and its effect on one's lifestyle can have a devastating impact on an individual's health and, in many cases, can be fatal. Understanding the pathways that allow opiate-addicted individuals to enter old age may provide insight into strategies for intervening with younger addicts.
Historically, the lives of older methadone clients have remained relatively hidden. Yet, older methadone clients may also provide useful insight into other vulnerable aging populations (i.e., individuals with HIV or mental health problems) who will face additional challenges as they age. Findings on the relationship between exposure to illegal drug use in one's social network and neighborhood are similar to initial observations that physical locations and social circumstances within which people interact can promote or discourage HIV risk behaviors (Schensul, Levy, & Disch, 2003; Zinberg, 1984). The findings presented in this article indicate that future research and interventions for this population will need to consider the interaction between behaviors and settings of long-term opiate addiction.
The limits of administrative data were present in this review, including the inability to generalize from the data and the omission of key variables. Future research with this population will benefit from the use of age-appropriate measures for social support and evaluation of life stressors for an older population. More extensive questions regarding social support and the continuum of support that is available may be important factors to consider in evaluating an older methadone client's ability to remain abstinent from illegal drug use.
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Footnotes |
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Decision Editor: Linda S. Noelker, PhD
Received for publication June 26, 2003. Accepted for publication February 16, 2004.
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