In 2019, over 67,000 Americans died from drug overdoses. Nearly 15 million abused alcohol regularly. Substance abuse isn’t going away. The COVID-19 pandemic has made the situation worse. But can we predict who will have a substance abuse disorder? Can we use such information to tailor prevention strategies that work?
Research tells us that there are verifiable risk factors connected to the development or onset of substance abuse disorder for all age groups. A research team at Indiana University Purdue University – Indianapolis (IUPUI) has just released the findings of a study on exactly this topic.
Their study, published in Substance Abuse Treatment, Prevention, and Policy, found differences in the risk factors impacting various age groups and how the factors affected people in those groups. They use this information to propose a primary prevention strategy for substance abuse disorder (SUD.) Their approach is unique in that it can be tailored to people within specific age groups.
Their approach contradicts current strategies and practice. Most prevention strategies revolve around individual substances and their abuse within a specific community or population.
“We need to start approaching the problem of substance use disorder from the basis of what makes individuals abuse one or more substances instead of what substances are abused in a community,” said Eric Afuseh, clinical assistant professor at the IUPUI School of Nursing. “The current prevention approach does not consider the fact that what makes a child develop a substance use disorder is different from what will cause an adult or older adult to abuse the same substance.”
The team reviewed over 300 written articles written over a 30+ year period (1989-2019.) They wanted to pinpoint risk factors for SUD in children, young adults, adults and older adults. They evaluated the differences and similarities for risk factors across the age groups.
They identified some risk factors that seemed fairly universal, impacting all age groups. These included trauma, grief and loss, chronic health problems, negative and adverse childhood experiences, family history, social determinants and environmental influences.
In spite of the similarities they found, there were key differences as well. Life challenges and contextual differences impacted the age groups differently.
As you might imagine, childhood trauma and negative experiences, family history of substance abuse, peer pressure and participation in organized sports were risk factors for kids under 18. In the 18 – 25-year old group, the stress of adulthood played a role. So did family history, academic stress, lack of positive parental role models and lack of employment. These factors were influencers regardless of whether there were childhood risk factors involved.
Looking at adults aged 26 – 64, the biggest risk factors are connected to family life and career. The kind of work or career the person was engaged in played a role in the risk of substance abuse. Heavily physical jobs or high-stress jobs like law enforcement, military service and healthcare scored highest for risk factors.
Along with some of the same risk factors as in the younger groups, those aged 65 and older had some unique risk factors as well. They seemed to experience loss and grief more often as a result of the deaths of friends and family. The greater likelihood of chronic illness like arthritis and other conditions prone to chronic pain made substance abuse or misuse more likely in the pursuit of pain relief.
Afuseh’s team thinks that prevention strategies will work best if the screenings for abuse are targeted to the identified risk factors for each age group. In this way, the results can be used to tailor more effective strategies for prevention. These would include targeted communications, mentoring, workplace orientation information, social media strategies and other education and empowerment interventions.
This age-oriented approach doesn’t just allow tailored, individualized prevention, says Afuseh. It also allows family, friends, educators and employers to be involved, thereby reducing the burden of delivery from healthcare workers.
“Federal, state and local agencies have put resources and processes in place to address substance use disorders at different levels of the disease continuum,” Afuseh said. “But those strategies tend to address specific substances at the population level. To be truly effective, we need to account for the unique developmental factors and life stressors in different age groups, the potential misuse of more than one substance at a time and the multiple risk factors for developing a substance use disorder.”
Afuseh has proposed age-related screening, education and empowerment as a framework for primary prevention of SUD. Researchers will now work to design and test screening tools that can be administered to individuals of different age groups with recommended strategies to address each screening result.
The current pandemic situation has seen an increased focus on mental and emotional health issues, many related to the shutdowns and other mitigation tactics. Substance abuse is both a symptom of those issues and a stand-alone mental and public health issue as well. Having more tools – and more effective tools – to prevent it means better health and a better life for a lot more people.
Keep the faith and keep after it!
Journal Reference – Eric Afuseh, Caitlin A. Pike, Ukamaka M. Oruche. Individualized approach to primary prevention of substance use disorder: age-related risks. Substance Abuse Treatment, Prevention, and Policy, 2020; 15 (1) DOI: 10.1186/s13011-020-00300-7