1. Long-Term Consequences of Heroin and Cocaine Addiction Yih-Ing Hser, Ph.D. UCLA Integrated Substance Abuse Programs Drug Abuse in the 21st Century: What Problems Lie Ahead for the Baby Boomers? September 2004

2. Background 33-year follow-up of a heroin sample 12-year follow-up of a cocaine sample Relevance Many in old ages Natural history data

3. Overview Long-term substance use trajectories Mortality/morbidity Mental health

4. Sample 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 37063.7% 20936.0% 20.3% 8% 56% 36% 12-year Follow-up Cocaine Sample 321 male veterans 48 2002/03 92.8% 226.8% 7021.8% 8927.7% 9529.6% 3210.0% 41.2% 68% 7% 25%

5. Average Ages at Key Events Over Lifespan

6. 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 (%) 11733.3 24541.2 12450.0 6374.6 2180.0 1190.9 58148.9 Cocaine Sample N = 321 Deaths by 2003 (%) 170 717.0 945.3 8614.0 53*17.0 (*45 and older) 3218.7 Increase with Age Heroin Sample Has a Higher Mortality Rate

7. Cumulative Percent of Reporting Ever Used by Age at First Use CocaineMarijuanaHeroin AmphetamineTobaccoAlcohol

8. Percent of Any Weekly Drug Use Over Time CocaineMarijuana Heroin

9. Past Year Use* Heroin Sample 55 or Younger (N=72) 56-60 (N=111) Older than 60 (N=59) 66.865.869.5 30.622.523.7 54.233.330.5 23.612.63.4 26.425.218.6 55.640.542.4 Cocaine Sample 50 or Younger (N=174) Older than 50 (N=92) 55.866.3 15.714.1 44.339.1 10.92.2 35.137.0 3.55.4 Tobacco Daily alcohol Marijuana Amphetamine Cocaine/crack Heroin *Based on self-report and urinalysis Still High among Older Addicts

10. Rates of Abstinence (for 5 or More Years) Heroin Sample 55 or Younger (N = 72) 56-60 (N = 111) Older than 60 (N = 59) 37.550.550.9 -- Cocaine Sample 50 or Younger (N = 174) Older than 50 (N = 92) -- 49.456.5 Heroin Cocaine Increase with Age

11. Alcohol Dependence in the 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

12. Older 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) 78.774.464.8 75.365.260.5 75.977.277.8 85.382.580.4 61.460.961.8 60.556.751.1 Cocaine Sample 50 or Younger (N=174) Older than 50 (N=92) 86.670.4 82.363.9 73.769.9 87.578.7 67.253.8 66.252.7 Worse Health Functioning

13. Older Ages Reporting On-going Cardiovascular disease 1 Respiratory disease 2 TB Digestive disease 3 Hepatitis Dental problems Diabetes Arthritis-Rheumatism STDs 4 1 Hypertension, Hardening of arteries/heart attack, Other 2 Asthma, Emphysema/Lung Cancer, TB 3 Cirrhosis, Hepatitis, Ulcer, Hernia rapture, Spastic colon 4 AIDS/HIV, Gonorrhea, Syphilis, Herpes, Others Heroin Sample 55 or Younger (N=72) 56-60 (N=111) Older than 60 (N=59) 32.036.944.8 12.511.715.5 0.00.90.0 20.826.132.8 9.78.110.3 20.826.119.0 5.610.813.8 25.033.339.7 4.21.83.5 Cocaine Sample 50 or Younger (N=174) Older than 50 (N=92) 24.152.2 10.315.2 2.33.3 16.726.1 10.420.0 15.019.6 5.812.0 25.327.2 4.010.9 More Health/Medical Conditions

14. 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) High * Heroin subsample Levels of Cardiovascular Risk

15. Medical Testing Results Show* Four-fifths (85.6%) tested positive for Hepatitis B Nearly all (94.2%) tested positive for Hepatitis C Over one-quarter (27.3%) had a positive TB skin test Nearly one-quarter (23.8%) tested positive for syphillis HIV rate was very low (1.8%) *Heroin subsample High Levels of Infectious Diseases

16. High 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 Medical Testing Results Show* Levels of Abnormal Functions

17. 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) 1.531.501.41 1.331.281.30 1.431.461.48 1.571.611.59 1.491.411.33 Cocaine Sample 50 or Younger (N=174) Older than 50 (N=92) 1.481.64 1.291.45 1.411.61 1.531.75 1.531.63 Higher scores indicate greater problem severity Increase with Age among Cocaine Sample

18. Abstinence from Primary Drug Show 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 Abstinent 5 or more years (N = 113) Abstinent less than 5 years (N = 129) 76.470.7 70.464.3 84.070.6 86.279.8 64.458.5 62.051.1 Cocaine Sample Abstinent 5 or more years (N = 138) Abstinent less than 5 years (N = 128) 83.478.4 77.574.2 77.566.9 86.282.5 64.460.5 63.659.3 Better Health Functioning

19. Abstinence from Primary Drug Show On-going Cardiovascular disease 1 Respiratory disease 2 TB Digestive disease 3 Hepatitis Dental problems Diabetes Arthritis-Rheumatism STDs 4 1 Hypertension, Hardening of arteries/heart attack, Other 2 Asthma, Emphysema/Lung Cancer, TB 3 Cirrhosis, Hepatitis, Ulcer, Hernia rapture, Spastic colon 4 AIDS/HIV, Gonorrhea, Syphilis, Herpes, Others Heroin Sample Abstinent 5 or more years (N = 113) Abstinent less than 5 years (N = 129) 30.143.8 12.413.3 0.90.0 18.632.8 7.110.9 15.029.7 16.83.9 32.732.0 1.83.9 Cocaine Sample Abstinent 5 or more years (N = 138) Abstinent less than 5 years (N = 128) 30.437.5 8.715.6 2.92.3 18.121.9 12.315.2 10.922.7 8.77.0 25.426.6 4.48.6 Better Health/Medical Conditions

20. Abstinence from Primary Drug Show Symptom Checklist Depression Anxiety Somatization Obsessive Compulsive Interpersonal sensitivity Higher scores indicate greater problem severity Heroin Sample Abstinent 5 or more years (N = 113) Abstinent less than 5 years (N = 129) 1.321.64 1.201.40 1.371.54 1.511.66 1.321.50 Cocaine Sample Abstinent 5 or more years (N = 138) Abstinent less than 5 years (N = 128) 1.431.66 1.251.45 1.51 1.471.75 1.441.70 Better Mental Health

21. Conclusions Overall Chronicity of addiction Adverse consequences elevated mortality, particularly heroin health/medical problems mental health problems Older ages Substance use (heroin, alcohol) persist in older ages Greater health and mental health problems Abstinence Increases with age Less health and mental health problems