# Presentation: 218278

## 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**

## Background

33-year follow-up of a heroin sample
12-year follow-up of a cocaine sample

- 33-year follow-up of a heroin sample
- 12-year follow-up of a cocaine sample

**Relevance**
- Many in old ages
- Natural history data

## Overview

- Long-term substance use trajectories
- Mortality/morbidity
- Mental health

## 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 |  |
|  |  |
| 370 | 63.7% |
| 209 | 36.0% |
| 2 | 0.3% |
|  |  |
|  |  |
|  |  |
|  |  |
|  |  |
|  | 8% |
|  | 56% |
|  | 36% |

| 12-year Follow-up
Cocaine 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 Over Lifespan

## 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 Age

- Heroin Sample Has a Higher Mortality Rate

## Cumulative Percent of Reporting Ever Used by Age at First Use

## Percent of Any Weekly Drug Use Over Time

## 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 High**

**among Older Addicts**

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

| Heroin Sample |  |  |
| --- | --- | --- |
| 55 or Younger
(N = 72) | 56-60

(N = 111) | Older than 60
(N = 59) |
| 37.5 | 50.5 | 50.9 |
| -- | -- | -- |

| Cocaine Sample |  |
| --- | --- |
| 50 or Younger
(N = 174) | Older than 50
(N = 92) |
| -- | -- |
| 49.4 | 56.5 |

|  |
| --- |
|  |
| Heroin |
| Cocaine |

**Increase**

**with Age**

## 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 |

## 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) |
| 78.7 | 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 |

**Worse**

**Health Functioning**

## 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, Other
- 2Asthma, Emphysema/Lung Cancer, TB
- 3Cirrhosis, Hepatitis, Ulcer, Hernia rapture, Spastic colon
- 4AIDS/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 |

**More**

**Health/Medical Conditions**

## Medical Testing Results Show* 

- <date/time>

**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**

## Medical Testing Results Show* 

- <date/time>

**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**

## High

- <date/time>

**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**

## 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

**Increase**

**with Age among Cocaine Sample**

## 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) |
| 76.4 | 70.7 |
| 70.4 | 64.3 |
| 84.0 | 70.6 |
| 86.2 | 79.8 |
| 64.4 | 58.5 |
| 62.0 | 51.1 |

| Cocaine Sample |  |
| --- | --- |
| Abstinent 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 |

**Better**

**Health Functioning**

## 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, Other
- 2Asthma, Emphysema/Lung Cancer, TB
- 3Cirrhosis, Hepatitis, Ulcer, Hernia rapture, Spastic colon
- 4AIDS/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 |

**Better**

**Health/Medical Conditions**

## 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) |
| 1.32 | 1.64 |
| 1.20 | 1.40 |
| 1.37 | 1.54 |
| 1.51 | 1.66 |
| 1.32 | 1.50 |

| Cocaine Sample |  |
| --- | --- |
| Abstinent 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 |

**Better**

**Mental Health**

## 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