The widespread abuse of drugs by adults in their 40s and 50s has far-reaching consequences for both health care and law enforcement efforts. “We're in the midst of a middle-aged crime scourge that also cannot be discussed. We're seeing huge eruptions in crime and arrests of middle-agers nationally and in California,” said Males, pointing to statistics showing an increase in convictions among adult Californians, from 84,323 in 1975 to 225,217 in 2004. “We have to find ways to deal with this drug problem,” he said. “Locking them up doesn't solve it. There's a 70% recidivism rate.”
“It's important to address multiple things in any drug strategy,” Artigiani emphasized. “We have to be active in prevention; the best thing is to stop people from starting at all. We also need to be able to deal with people who are using drugs now, in terms of treatment resources, housing, child care—a whole range of services. In addition, we need to keep law enforcement involved, so they know what the current trends are and deal with the people who are using the drugs.”
“The nature of the problem is changing,” said Joseph C. Gfroerer, director of the division of population surveys for SAMHSA. “Our treatment programs and policies need to take that into account. We have to consider the need for specialized programs or the expansion of current programs. We're looking at the kinds of issues that are different, taking into account other health problems as well as family issues that require special treatments and interventions.”
Gfroerer said that it is wrong to focus too heavily on the baby boom generation alone. “The cohorts right after the baby boomers have continuing high rates of drug use. The problem is not going to end with the baby boomers, because the next generation also has high rates of use.”
Gfroerer and colleagues recently completed a study of the treatment needs of middle-aged persons projected for the year 2020, based on such predictive factors as the early use of marijuana. According to their findings, the overall number of illicit drug users is projected to increase from 1.6 million in 1999 to 2001, to 3.5 million in 2020. (This estimate is based on increases in population and drug use from 2.2% to 3.1%, a 41% increase.) Distribution by race/ethnicity will not change radically, but the proportion of persons in their 50s will decline from 74% to 51%, while representation of persons in their 60s—men and women currently in their 40s—is expected to increase from 14% to 37%.
The consequences of the shift in use to older adults will present some challenges to health care providers. As Gfroerer's group noted in an article published online November 8, 2005, in Annals of Epidemiology:
Males sees the urgent need for action to cope with this shift in priorities. “First, we've got to admit that there is a problem,” he said. “The current approach to the war on drugs does not stem this problem. It is clear that prison doesn't work. In talking to treatment personnel, it's very different to treat an aging drug abuser. It's not as expensive as imprisoning him, but it's difficult. We'll need to make a radical reinvestment from prisons to innovative therapies designed to deal with aging users. It will take a wholesale attitude change. This generation of drug abusers, after causing tremendous damage, is going to die off. We have to ask ourselves, Have we set the stage for the next generation of users?”
