October 28, 2015

Cocaine Use in Older Adults

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Stephanie Yarnell, MD, PhD

Yale University, New Haven, Connecticut


Since the time of Sigmund Freud, psychiatry has had a complicated affair with cocaine. Besides the field of psychiatry, the entertainment field has also been linked with cocaine use. Los Angeles has been called a “coke town,” with celebrities reporting cocaine use as being casual and common, whether at parties or during daily life. Famously, cocaine and other illicit substances have long been associated with the Rock ‘n’ Roll movement (and other music genres since); from almost the very beginning, the two have been intertwined. Pulling out records (cassettes, CDs, mp3s) from those times, one will have no trouble finding songs written about cocaine. Famous musicians like Keith Richards, Neil Young, Eric Clapton, Stevie Nicks, Bob Dylan, and Johnny Cash and bands such as Lynyrd Skynyrd, Guns ‘n’ Roses, The Eagles, The Grateful Dead, and The Rolling Stones all wrote songs “about, influenced by, and more than likely written on clouds of Peruvian marching powder.” Many of these artists have been to substance use disorder rehabilitation (some multiple times), and some musicians, actors, and others in the entertainment field have died as a result of their substance use.

What is perhaps less well known is what happened to all of the less famous people who grew up with these cultural influences. The Baby Boomer generation, born from 1946 to 1964, lived through Woodstock, the disco revolution, cocaine parties of the 1980s, the prescription drug boom, and the general acceptance of the “sex, drugs, and rock and roll” mentality, so it should come as no surprise that a large percentage of Baby Boomers have tried illicit drugs. Compared with earlier generations, many Baby Boomers have experienced life-long issues with substance use, including alcohol, cocaine, and heroin. Some Boomers never stopped using substances, while others exhibited a chronic pattern of sobriety and relapse.

Illicit substance use, cocaine in particular, in advanced age is a relatively novel trend. Prior to the Baby Boomer generation, substance use disorders had primarily been seen as a disease of younger people and something that many outgrew. The latest data, described in my recent review article, however, paint a different picture. Increasingly, older individuals are presenting for substance abuse treatment, with some studies estimating upwards of 5.7 million older individuals needing treatment for a substance use disorder by 2020. Cocaine use in older age also carries significant health risks, including increased rates of heart attacks, strokes, and cognitive impairment. Despite these risks, this population largely goes unidentified because physicians often assume older persons do not use cocaine. As the population ages, more individuals will need treatment. Clinicians should be aware of the need for screening and identification of substance use in older individuals. Additionally, as a society, we should question whether the existing infrastructure is ready to handle this population with diverse social, medical, spiritual, and practical problems not typically accounted for in current treatment paradigms.

Financial disclosure:Dr Yarnell had no relevant personal financial relationships to report.​

Category: Substance Use Disorder
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