Long-Term Consequences Long-Term Consequences of Heroin and Cocaine of Heroin and Cocaine

AddictionAddiction

Yih-Ing Hser, Ph.D.Yih-Ing Hser, Ph.D.UCLA Integrated Substance Abuse ProgramsUCLA Integrated Substance Abuse Programs

Drug Abuse in the 21st Century: Drug Abuse in the 21st Century:

What Problems Lie Ahead for the Baby What Problems Lie Ahead for the Baby Boomers?Boomers?

September 2004September 2004

BackgroundBackground

33-year follow-up of a heroin sample

12-year follow-up of a cocaine sample

RelevanceRelevance

Many in old ages

Natural history data

OverviewOverview

Long-term substance use trajectories

Mortality/morbidity

Mental health

Sample CharacteristicsSample Characteristics

Mean age

(last interview year)

Birth year

Pre 1941

1941-1945

1946-1950

1951-1955

1956-1960

1961-1965

> 1965

Ethnicity

African American

Latino/Hispanic

White

Baby boomers

33-year Follow-up Heroin Sample

581 male

57

1996/97

370 63.7%

209 36.0%

2 0.3%

8%

56%

36%

12-year Follow-upCocaine Sample

321 male veterans

48

2002/03

9 2.8%

22 6.8%

70 21.8%

89 27.7%

95 29.6%

32 10.0%

4 1.2%

68%

7%

25%

Average Ages at Key Events Average Ages at Key Events Over LifespanOver Lifespan

10

20

30

40

50

60Heroin Sample Cocaine Sample

Mortality Rates

Age Category

in 1992

Under 30

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

> 70

Total

Heroin Sample

N = 581

Deaths by 1997 (%)

117 33.3

245 41.2

124 50.0

63 74.6

21 80.0

11 90.9

581 48.9

Cocaine Sample

N = 321

Deaths by 2003 (%)

17 0

71 7.0

94 5.3

86 14.0

53* 17.0(*45 and older)

321 8.7

Increase with AgeHeroin Sample Has a Higher Mortality Rate

Cumulative Percent of Cumulative Percent of Reporting Ever Used by Age Reporting Ever Used by Age

at First Useat First Use

Cocaine Sample(N = 266)

0

10

20

30

40

50

60

70

80

90

100

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55

Age

Percent

Heroin Sample(N = 242)

0

10

20

30

40

50

60

70

80

90

100

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55

Age

Percent

CocaineCocaine MarijuanaMarijuana HeroinHeroin

AmphetaminAmphetaminee

TobaccoTobacco AlcoholAlcohol

Percent of Any Weekly Drug Percent of Any Weekly Drug Use Over TimeUse Over Time

Heroin Sample(N = 242)

0

10

20

30

40

50

60

70

80

90

20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55

Age

Percent

CocaineCocaine MarijuanaMarijuana HeroinHeroin

Cocaine Sample(N = 266)

0

10

20

30

40

50

60

70

80

90

20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55

Age

Percent

Past Year Use*Past Year Use*

Heroin Sample

55 or Younger(N=72)

56-60

(N=111)

Older than 60(N=59)

66.8 65.8 69.5

30.6 22.5 23.7

54.2 33.3 30.5

23.6 12.6 3.4

26.4 25.2 18.6

55.6 40.5 42.4

Cocaine Sample

50 or Younger(N=174)

Older than 50(N=92)

55.8 66.3

15.7 14.1

44.3 39.1

10.9 2.2

35.1 37.0

3.5 5.4

Tobacco

Daily alcohol

Marijuana

Amphetamine

Cocaine/crack

Heroin

*Based on self-report and urinalysis

Still HighStill High among Older among Older AddictsAddicts

Rates of AbstinenceRates of Abstinence (for 5 or More (for 5 or More Years)Years)

Heroin Sample

55 or Younger(N = 72)

56-60

(N = 111)

Older than 60(N = 59)

37.5 50.5 50.9

-- -- --

Cocaine Sample

50 or Younger(N = 174)

Older than 50(N = 92)

-- --

49.4 56.5

Heroin

Cocaine

IncreasIncreasee

with Agewith Age

Alcohol Dependence in theAlcohol Dependence in the Past 12 Months Past 12 Months

Heroin Sample

55 or Younger(N = 72)

56-60

(N = 111)

Older than 60(N = 59)

18.1% 13.1% 13.8%

Cocaine Sample

50 or Younger(N = 174)

Older than 50(N = 92)

7.5% 10.9%Alcohol dependence

Older Ages ReportingOlder Ages Reporting

SF-36

Physical functioning

Role limitation due to

physical health

Emotional well-being

Social functioning

Pain

General health

Higher scores indicate better functioning and health

Heroin Sample

55 or Younger(N=72)

56-60

(N=111)

Older than 60(N=59)

78.7 74.4 64.8

75.3 65.2 60.5

75.9 77.2 77.8

85.3 82.5 80.4

61.4 60.9 61.8

60.5 56.7 51.1

Cocaine Sample

50 or Younger(N=174)

Older than 50(N=92)

86.6 70.4

82.3 63.9

73.7 69.9

87.5 78.7

67.2 53.8

66.2 52.7

WorseWorseHealth FunctioningHealth Functioning

Older Ages Reporting Older Ages Reporting

On-going

Cardiovascular disease1

Respiratory disease2

TB

Digestive disease3

Hepatitis

Dental problems

Diabetes

Arthritis-Rheumatism

STDs4

1Hypertension, Hardening of arteries/heart attack, Other2Asthma, Emphysema/Lung Cancer, TB3Cirrhosis, Hepatitis, Ulcer, Hernia rapture, Spastic colon4AIDS/HIV, Gonorrhea, Syphilis, Herpes, Others

Heroin Sample

55 or Younger(N=72)

56-60

(N=111)

Older than 60(N=59)

32.0 36.9 44.8

12.5 11.7 15.5

0.0 0.9 0.0

20.8 26.1 32.8

9.7 8.1 10.3

20.8 26.1 19.0

5.6 10.8 13.8

25.0 33.3 39.7

4.2 1.8 3.5

Cocaine Sample

50 or Younger(N=174)

Older than 50(N=92)

24.1 52.2

10.3 15.2

2.3 3.3

16.7 26.1

10.4 20.0

15.0 19.6

5.8 12.0

25.3 27.2

4.0 10.9

MoreMoreHealth/Medical ConditionsHealth/Medical Conditions

Medical Testing Results Show* Medical Testing Results Show*

Over half (58.3%) had hypertension

One-fifth (22.4%) had high total cholesterol

Over half (54.6%) were overweight (using body/mass index)

Source: Hser et al., Journal of Behavioral Medicine (in press)

HighHigh

**Heroin subsampleHeroin subsample

Levels of Cardiovascular Levels of Cardiovascular RiskRisk

Medical Testing Results Show* Medical Testing Results Show*

Four-fifths (85.6%) tested positive for Hepatitis BNearly all (94.2%) tested positive for Hepatitis COver one-quarter (27.3%) had a positive TB skin testNearly one-quarter (23.8%) tested positive for syphillisHIV rate was very low (1.8%)

*Heroin subsample*Heroin subsample

HighHighLevelsLevels ofof InfectiousInfectious DiseasesDiseases

HighHigh

More than half had abnormal liver function by at least one indicator (ALT, AST, billirubin)

18.8% had diabetes

27-35% had abnormal pulmonary function

*Heroin subsample*Heroin subsample

Medical Testing Results Show* Medical Testing Results Show*

Levels of Abnormal FunctionsLevels of Abnormal Functions

Mental Health Problems Mental Health Problems

Symptom Checklist

Depression

Anxiety

Somatization

Obsessive Compulsive

Interpersonal sensitivity

Heroin Sample

55 or Younger(N=72)

56-60

(N=111)

Older than 60(N=59)

1.53 1.50 1.41

1.33 1.28 1.30

1.43 1.46 1.48

1.57 1.61 1.59

1.49 1.41 1.33

Cocaine Sample

50 or Younger(N=174)

Older than 50(N=92)

1.48 1.64

1.29 1.45

1.41 1.61

1.53 1.75

1.53 1.63

Higher scores indicate greater problem severity

IncreaseIncrease with Age among Cocaine with Age among Cocaine SampleSample

Abstinence from Primary Drug Abstinence from Primary Drug ShowShow

SF-36

Physical functioning

Role limitation due to

physical health

Emotional well-being

Social functioning

Pain

General health

Higher scores indicate better functioning and health

Heroin SampleAbstinent 5 or more

years (N = 113)

Abstinent less than 5 years

(N = 129)

76.4 70.7

70.4 64.3

84.0 70.6

86.2 79.8

64.4 58.5

62.0 51.1

Cocaine SampleAbstinent 5 or more

years(N = 138)

Abstinent less than 5 years

(N = 128)

83.4 78.4

77.5 74.2

77.5 66.9

86.2 82.5

64.4 60.5

63.6 59.3

BetterBetterHealth FunctioningHealth Functioning

Abstinence from Primary Drug Show Abstinence from Primary Drug Show

On-going

Cardiovascular disease1

Respiratory disease2

TB

Digestive disease3

Hepatitis

Dental problems

Diabetes

Arthritis-Rheumatism

STDs4

1Hypertension, Hardening of arteries/heart attack, Other2Asthma, Emphysema/Lung Cancer, TB3Cirrhosis, Hepatitis, Ulcer, Hernia rapture, Spastic colon4AIDS/HIV, Gonorrhea, Syphilis, Herpes, Others

Heroin Sample

Abstinent 5 or more

years (N = 113)

Abstinent less than 5 years

(N = 129)

30.1 43.8

12.4 13.3

0.9 0.0

18.6 32.8

7.1 10.9

15.0 29.7

16.8 3.9

32.7 32.0

1.8 3.9

Cocaine Sample

Abstinent 5 or more years

(N = 138)

Abstinent less than 5 years

(N = 128)

30.4 37.5

8.7 15.6

2.9 2.3

18.1 21.9

12.3 15.2

10.9 22.7

8.7 7.0

25.4 26.6

4.4 8.6

BetterBetter Health/Medical Health/Medical ConditionsConditions

Abstinence from Primary Drug Abstinence from Primary Drug ShowShow

Symptom Checklist

Depression

Anxiety

Somatization

Obsessive Compulsive

Interpersonal sensitivity

Higher scores indicate greater problem severity

Heroin SampleAbstinent 5

or more years

(N = 113)

Abstinent less than 5

years(N = 129)

1.32 1.64

1.20 1.40

1.37 1.54

1.51 1.66

1.32 1.50

Cocaine SampleAbstinent 5

or more years

(N = 138)

Abstinent less than 5 years

(N = 128)

1.43 1.66

1.25 1.45

1.45 1.51

1.47 1.75

1.44 1.70

BetteBetterr

Mental HealthMental Health

ConclusionsConclusionsOverall

Chronicity of addiction

Adverse consequences elevated mortality, particularly heroin health/medical problems mental health problems

Older agesSubstance use (heroin, alcohol) persist in older ages

Greater health and mental health problems

AbstinenceIncreases with age

Less health and mental health problems