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Substance Use and Associated Health Conditions throughout the Lifespan


A life stage perspective is necessary for development of age-appropriate strategies to address substance use disorders (SUDs) and related health conditions in order to produce better overall health and well-being. The current review evaluated the literature across three major life stages: adolescence, adulthood, and older adulthood.

Findings: 1) Substance use is often initiated in adolescence, but it is during adulthood that prevalence rates for SUDs peak; and while substance involvement is less common among older adults, the risk for health complications associated with use increases. 2) Alcohol, tobacco, marijuana, and, increasingly, prescription medications, are the most commonly misused substances across age groups; however, the use pattern of these and other drugs and the salient impact vary depending on life stage. 3) In terms of health outcomes, all ages are at risk for overdose, accidental injury, and attempted suicide. Adolescents are more likely to be in vehicular accidents while older adults are at greater risk for damaging falls. Adulthood has the highest rates of associated medical conditions (e.g., cancer, sexually transmitted disease, heart disease) and mental health conditions (e.g., bipolar disorder, anxiety disorders, antisocial personality disorder).

Conclusion: Prolonged heavy use of drugs and/or alcohol results in an array of serious health conditions. Addressing SUDs from a life stage perspective with assessment and treatment approaches incorporating co-occurring disorders are necessary to successfully impact overall health.


  1. 1.

    U.S. Department of Justice, National Drug Intelligence Center. The economic impact of illicit drugs use on American society. Washington (DC): U.S. Department of Justice; April 2011. Available from URL: (Accessed 4 February 2014).

  2. 2.

    Bouchery E, Harwood H, Sacks C, Simon C, Brewer R. Economic costs of excessive alcohol consumption in the U.S., 2006. Am J Prev Med. 2011;41:516–24.

  3. 3.

    Centers for Disease Control and Prevention. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. MMWR Morb Mortal Wkly Rep. 2008;57:1226-8. Available from URL: (Accessed 16 September 2013).

  4. 4.

    Steinberg L. A social neuroscience perspective on adolescent risk-taking. Dev Rev. 2008;28:78–106.

  5. 5.

    Brown SA, Tapert SF. Adolescence and the trajectory of alcohol use: basic to clinical studies. Ann N Y Acad Sci. 2004;1021:234–44.

  6. 6.

    Moore AA, Giuli L, Gould R, Zhou K, Reuben D, et al. Alcohol use, comorbidity, and mortality. J Am Geriatr Soc. 2006;54:757–62.

  7. 7.

    Moore AA, Whiteman EJ, Ward KT. Risks of combined alcohol/medication use in older adults. Am J Geriatr Pharmacother. 2007;5:64–74.

  8. 8.

    Moos RH, Brennan PL, Schutte KK, Moos BS. High-risk alcohol consumption and late-life alcohol use problems. Am J Pub Health. 2004;94:1985–91.

  9. 9.

    Baltes PB. Theoretical propositions of life-span developmental psychology: on the dynamics between growth and decline. Develop Psych. 1987;23:611–26.

  10. 10.

    Bronfenbrenner U. The Ecology of Human Development: Experiments by Nature and Design. Cambridge (MA): Harvard University Press; 1979.

  11. 11.

    Lerner RM, Kauffman MB. The concept of development in contextualism. Develop Rev. 1985;5:309–33.

  12. 12.

    Sameroff AJ. The societal context of development. In: Eisenberg N, (editor). Contemporary Topics in Developmental Psychology. New York (NY): Wiley; 1987. p.273–91.

  13. 13.

    Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: summary of national findings. NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville (MD): Substance Abuse and Mental Health Services Administration; September 2012. Available from URL: (Accessed 4 February 2014).

  14. 14.

    Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2000–2010. National admissions to substance abuse treatment services. DASIS Series S-61, HHS Publication No. (SMA) 12-4701. Rockville (MD): Substance Abuse and Mental Health Services Administration; June 2012. Available from URL: (Accessed 4 February 2014).

  15. 15.

    Menninger JA. Assessment and treatment of alcoholism and substance-related disorders in the elderly. B Menninger Clin. 2002;66:166–84.

  16. 16.

    Hser YI, Hoffman V, Grella CE, Anglin D. A 33-year follow-up of narcotics addicts. Arch Gen Psychiatry. 2001;58:503–8.

  17. 17.

    Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future national results on adolescent drug use: overview of key findings, 2011. Ann Arbor (MI): Institute for Social Research, University of Michigan; February 2012. Available from URL: (Accessed 4 February 2014).

  18. 18.

    Friedman HL. Adolescent and social development: a global perspective. J Adolesc Health. 1993;14:588–94.

  19. 19.

    Jessor R. Adolescent development and behavioral health. In: Matarazzo JD, Perry CL, (editors). Behavioral Health: A Handbook of Health Enhancement and Disease Prevention. New York (NY): Wiley; 1984. p.69–90.

  20. 20.

    Peterson AC, Leffert N, Graham B, Alwin J, Ding A. Promoting mental health during the transition to adolescence. In: Schulenberg J, Maggs JL, Hurrelmann K, (editors). Health Risks and Developmental Transitions during Adolescence. New York (NY): Cambridge University Press; 1997. p.471–97.

  21. 21.

    Centers for Disease Control and Prevention. Youth risk behavior surveillance — United States 2011. MMWR Surveill Summ. 2012;61:1–162.

  22. 22.

    Arria AM, Garnier-Dykstra LM, Caldeira KM, Vincent KB, O’Grady KE, Wish ED. Persistent nonmedical use of prescription stimulants among college students: possible association with ADHD symptoms. J Attention Disorders, 2011;15:347–56.

  23. 23.

    Berenson AB, Wiemann CM, McCombs S. Exposure to violence and associated health-risk behaviors among adolescent girls. Arch Pediatr Adolesc Med. 2001;155:1238–42.

  24. 24.

    Centers for Disease Control and Prevention. Vital signs: HIV infection, testing, and risk behavior among youths — United States. MMWR Morb Mortal Wkly Rep. 2012;61:971–6.

  25. 25.

    Kingree JB, Braithwaite R, Woodring T. Unprotected sex as a function of alcohol and marijuana use among adolescent detainees. J Adolesc Health. 2000;27:179–85.

  26. 26.

    Lowry R, Holtzman D, Truman BI, Kann L, Collins JL, Kolbe LJ. Substance use and HIV-related sexual behaviors among US high school students: are they related? Am J Pub Health. 1994;84:1116–20.

  27. 27.

    Leigh BC, Stall R. Substance use and risky sexual behavior for exposure to HIV: issues in methodology, interpretation, and prevention. Am Psychol. 1993;48:1035–45.

  28. 28.

    Riehman KS, Wechsberg WM, Francis SA, Moore M, Morgan-Lopez A. Discordance in monogamy beliefs, sexual concurrency, and condom use among young adult substance-involved couples: implications for risk of sexually transmitted infections. Sex Transm Dis. 2006;33:677–82.

  29. 29.

    Tapert SF, Aarons GA, Sedlar GR, Brown SA. Adolescent substance use and sexual risk-taking behavior. J Adolesc Health. 2001;28:181–9.

  30. 30.

    Yan AF, Chiu YW, Stoesen CA, Wang MQ. STD-/HIV-related sexual risk behaviors and substance use among US rural adolescents. J Nat Med Assoc. 2007;99:1386–94.

  31. 31.

    Botvin GJ, Griffin KW, Diaz T, Ifill-Williams M. Drug abuse prevention among minority adolescents: one-year follow-up of a school-based prevention intervention. Prev Sci. 2001;2:1–13.

  32. 32.

    Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2011: national estimates of drug-related emergency department visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville (MD): Substance Abuse and Mental Health Services Administration; May 2013. Available from URL: (Accessed 4 February 2014).

  33. 33.

    Mertens JR, Flisher AJ, Fleming MF, Weisner CM. Medical conditions of adolescents in alcohol and drug treatment: comparison with matched controls. J Adolesc Health. 2007;40:173–9.

  34. 34.

    Myers MG, Brown SA. Smoking and health in substance abusing adolescents: a two year follow-up. Pediatrics. 1994;93:561–6.

  35. 35.

    Myers MG, Brown SA. Cigarette smoking four years following treatment for adolescent substance abuse. J Adolesc Subst Abuse. 1997;7:1–15.

  36. 36.

    Kochanek KD, Kirmeyer SE, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2009. Pediatrics. 2012;129:338–48.

  37. 37.

    Martin JA, Kung HC, Mathews TJ, Hoyert DL, Strobino DM, et al. Annual summary of vital statistics: 2006. Pediatrics. 2008;121:788–801.

  38. 38.

    Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, et al. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry. 2013;70:300–10.

  39. 39.

    Bukstein OG, Brent DA, Perper JA, Moritz G, Baugher M, et al. Risk factors for completed suicide among adolescents with a lifetime history of substance abuse: a case-control study. Acta Psychiatr Scand. 1993;88:403–8.

  40. 40.

    Wu P, Hoven CW, Liu X, Cohen P, Fuller CJ, Shaffer D. Substance use, suicidal ideation and attempts in children and adolescents. Suicide Life Threat Behav. 2004;34:408–20.

  41. 41.

    Storr CL, Pacek LR, Martins SS. Substance use disorders and adolescent psychopathology. Pub Health Rev. 2012;34:442–84. Available from URL: (Accessed 4 February 2014).

  42. 42.

    Kaminer Y, Bukstein OG, (editors). Adolescent Substance Abuse: Psychiatric Comorbidity and High Risk Behaviors. New York (NY): Taylor and Francis; 2007.

  43. 43.

    Roberts RE, Roberts CR, Xing Y. Rates of DSM-IV psychiatric disorders among adolescents in a large metropolitan area. J Psych Res. 2007;41:959–67.

  44. 44.

    Couwenbergh C, van den Brink W, Zwart K, Vreugdenhil C, van Wijngaarden-Cremers P, van der Gaag RJ. Comorbid psychopathology in adolescents and young adults treated for substance use disorders. Eur Child Adolesc Psychiatry. 2006;15:319–28.

  45. 45.

    O’Neil KA, Conner BT, Kendall PC. Internalizing disorders and substance use disorders in youth: comorbidity, risk, temporal order, and implications for intervention. Clin Psychol Rev. 2011;31:104–12.

  46. 46.

    Bukstein OG, Glancy LJ, Kaminer Y. Patterns of affective comorbidity in a clinical population of dually diagnosed adolescent substance abusers. J Am Acad Child Psychiatry. 1992;31:1041–5.

  47. 47.

    McGuinness TM, Dyer JG, Wade EH. Gender differences in adolescent depression. J Psychosoc Nurs Ment Health Serv. 2012;50:17–20.

  48. 48.

    Nolen-Hoeksema S. An interactive model for the emergence of gender differences in depression in adolescence. J Research Adolesc. 1994;4:519–34.

  49. 49.

    Shrier LA, Harris SK, Kurland M, Knight JR. Substance use problems and associated psychiatric symptoms among adolescents in primary care. Pediatrics. 2003;111:699–705.

  50. 50.

    Biederman J, Wilens T, Mick E, Faraone SV, Weber W, et al. Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. J Am Acad Adolesc Psychiatry. 1997;36:21–9.

  51. 51.

    Molina BS, Pelham Jr, WE. Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. J Abnorm Psychol. 2003;112:497–507.

  52. 52.

    Costello EJ, Erkanli A, Federman E, Angold A. Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. J Clin Child Psychol. 1999;28:298–311.

  53. 53.

    Zucker RA, Heitzeg MM, Nigg JT. Parsing the undercontrol/disinhibition pathway to substance use disorders: a multilevel developmental problem. Child Dev Perspect. 2011;5:248–55.

  54. 54.

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington (DC): The Association; 2000.

  55. 55.

    Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry. 2003;60:837–44.

  56. 56.

    Donovan JE, Jessor R, Costa FM. Adolescent health behavior and conventionality-unconventionality: an extension of problem-behavior therapy. Health Psychol. 1991;10:52–61.

  57. 57.

    White W. Recovery across the life cycle. Alcohol Treat Q. 2006;24:185–201.

  58. 58.

    Windle M. A multilevel developmental contextual approach to substance use and addiction. Biosocieties. 2010;5:124–36

  59. 59.

    Paulozzi LJ, Annest J. Unintentional poisoning deaths—United States, 1999–2004. MMWR Morb Mortal Wkly Rep. 2007;56:93–6.

  60. 60.

    Kertesz SG, Pletcher MJ, Safford M, Halanych J, Kirk K, et al. Illicit drug use in young adults and subsequent decline in general health: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Drug Alcohol Depend. 2007;88:224–33.

  61. 61.

    Richter KP, Gibson CA, Ahluwalia JS, Schmelzle KH. Tobacco use and quite attempts among methadone maintenance clients. Am J Pub Health. 2001;91:296–9.

  62. 62.

    Hurt RD, Offord KP, Croghan IT, Gomez-Dahl L, Kottke TE, et al. Mortality following inpatient addictions treatment. JAMA. 1996;275:1097–103.

  63. 63.

    Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert. Alcohol Res Health. 2007;71:1–6.

  64. 64.

    National Institute on Drug Abuse. Medical Consequences of Drug Abuse. May 2005. Available from URL: (Accessed 2 July 2013).

  65. 65.

    Boffetta P, Hashibe M. Alcohol and cancer. Lancet Oncology. 2006;7:149–56.

  66. 66.

    Polen MR, Sidney S, Tekawa IS, Sadler M, Friedman GD. Health care use by frequent marijuana smokers who do not smoke tobacco. West J Med. 1993;158:596–601.

  67. 67.

    Moore BA, Auguston EM, Moser RP, Budney AJ. Respiratory effects of marijuana and tobacco use in a U.S. sample. J Gen Intern Med. 2005;20:33–7.

  68. 68.

    Kontos MC, Jesse RL, Tatum JL, Ornato JP. Coronary angiographic findings in patients with cocaine-associated chest pain. J Emerg Med. 2003;24:9–13.

  69. 69.

    Chou SP, Grant BF, Dawson DA. Medical consequences of alcohol consumption—United States, 1992. Alcohol Clin Exp Res. 1996;20:1423–9.

  70. 70.

    Gutjahr E, Gmel G, Rehm JUR. Relation between average alcohol consumption and disease: an overview. Eur Addict Res. 2001;7:117–27.

  71. 71.

    Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2001;38:1112–7.

  72. 72.

    Clark L. Alcohol-induced hypertension: mechanisms, complications, and clinical implications. J Natl Med Assoc. 1985;77:385–9.

  73. 73.

    Klatsky AL, Gunderson E. Alcohol and hypertension: a review. J Am Soc Hypertens. 2008;2:307–17.

  74. 74.

    Potter JF, Beevers DG. Pressor effect of alcohol in hypertension. Lancet. 1984;323:119–22.

  75. 75.

    Hillbom M, Saloheimo P, Juvela S. Alcohol consumption, blood pressure, and the risk of stroke. Curr Hypertens Rep. 2011;13:208–13.

  76. 76.

    Bourgois P, Lettiere M, Quesada J. Social misery and the sanctions of substance abuse: confronting HIV risk among homeless heroin addicts in San Francisco. Social Problems. 1997;44:155–73.

  77. 77.

    Koester S, Glanz J, Baron A. Drug sharing among heroin networks: implications for HIV and hepatitis B and C prevention. AIDS Behav. 2005;9:27–39.

  78. 78.

    Koester S, Heimer R, Barón AE, Glanz J, Teng W. RE: “Risk of Hepatitis C virus among young adult injection drug users who share injection equipment”. Am J Epidemiol. 2003;157:376.

  79. 79.

    Centers for Disease Control and Prevention. Drug-associated HIV transmission continues in the United States. Atlanta (GA): CDC; 8 March 2007. Available from URL: (Accessed 2 July 2013).

  80. 80.

    Azevedo RCSD, Botega NJ, Guimaraes LAM. Crack users, sexual behavior and risk of HIV infection. Rev Bras Psiquiatr. 2007;29:26–30.

  81. 81.

    Collins CL, Kerr T, Tyndall MW, Marsh DC, Kretz PS, et al. Rationale to evaluate methodically supervised safer smoking facilities for non-injection illicit drug users. Can J Pub Health. 2004;95:344–7.

  82. 82.

    McCoy CB, Lai S, Metsch LR, Messiah SE, Zhao W. Injection drug use and crack cocaine smoking: independent and dual risk behaviors for HIV infection. Ann Epidemiol. 2004;14:535–42.

  83. 83.

    Buchacz K, McFarland W, Kellogg TA, Loeb L, Holmberg SD, et al. Amphetamine use is associated with increased HIV incidence among men who have sex with men in San Francisco. AIDS. 2005;19:1423–4.

  84. 84.

    Molitor F, Truax SR, Ruiz JD, Sun RK. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. West J Med. 1998;168:93–7.

  85. 85.

    Celetano DD, Latimore AD, Mehta SH. Variations in sexual risks in drug users: emerging themes in a behavioral context. Curr HIV/AIDS Rep. 2008;5:212–8.

  86. 86.

    Kessler RC. The epidemiology of dual diagnosis. Biol Psychiatry. 2004;56:730–7.

  87. 87.

    O’Brien CP, Charney DS, Lewis L, Cornish JW, Post RM, et al. Priority actions to improve the care of persons with co-occurring substance abuse and other mental disorders: a call to action. Biol Psychiatry. 2004;56:703–13.

  88. 88.

    Conway KP, Compton W, Stinson FS, Grant BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006;67:247–57.

  89. 89.

    Goodwin RD, Stein DJ. Anxiety disorders and drug dependence: evidence on sequence and specificity among adults. Psychiatry Clin Neurosci. 2013;67:167–73.

  90. 90.

    Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, et al. Comorbidity of mental disorders with alcohol and other drug abuse. JAMA. 1990;264:2511–8.

  91. 91.

    Grella CE, Karno MP, Warda US, Niv N, Moore AA. Gender and comorbidity among individuals with opioid use disorders in the NESARC study. Addic Behav. 2009;34:498–504.

  92. 92.

    National Center for PTSD. Facts about PTSD. Psych Central; 2006. Available from URL: (Accessed 19 September 2013).

  93. 93.

    Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62:593–602

  94. 94.

    Mills KL, Lynskey M, Teesson M, Ross J, Darke S. Post-traumatic stress disorder among people with heroin dependence in the Australian treatment outcome study (ATOS): prevalence and correlates. Drug Alcohol Depend. 2005;77:243–9.

  95. 95.

    Reynolds M, Mezey G, Chapman M, Wheeler M, Drummond C, Baldacchino A. Co-morbid posttraumatic stress disorder in a substance misusing clinical population. Drug Alcohol Depend. 2005;77:251–8.

  96. 96.

    Riggs DS, Rukstalis M, Volpicelli JR, Kalmanson D, Foa EB. Demographic and social adjustment characteristics of patients with comorbid posttraumatic stress disorder and alcohol dependence: potential pitfalls to PTSD treatment. Addict Behav. 2003;28:1717–30.

  97. 97.

    Ouimette P, Read JP, Wade M, Tirone V. Modeling associations between posttraumatic stress symptoms and substance use. Addict Behav. 2010;35:64–7.

  98. 98.

    Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.

  99. 99.

    Kessler RC, Berglund P, Demler O, Jin R, Koretz D, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003:289:3095–105.

  100. 100.

    Kessler RC, Crum RM, Warner LA, Nelson CB. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997;54:313–21.

  101. 101.

    Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61:807–16.

  102. 102.

    Merikangas KR, Herrell R, Swedsen J, Rossler W, Ajdacic-Gross V, Angst J. Specificity of bipolar spectrum conditions in the comorbidity of mood and substance use disorders: results from the Zurich cohort study. Arch Gen Psychiatry. 2008;65:47–52.

  103. 103.

    Dalton EJ, Cate-Carter TD, Mundo E, Parikh SV, Kennedy JL. Suicide risk in bipolar patients: the role of co-morbid substance use disorders. Bipolar Disord. 2003;5:58–61.

  104. 104.

    Hser YI, Lanza HL, Li L, Kahn E, Schulte M. Maternal mental health and children’s internalizing and externalizing behaviors: beyond maternal substance use disorders. Manuscript under review, 2013.

  105. 105.

    Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–27.

  106. 106.

    Fazel S, Danesh J. Serious mental disorder in 2300 prisoners: a systematic review of 62 surveys. Lancet. 2002;359:545–50.

  107. 107.

    Hare RD. Diagnosis of antisocial personality disorder in two prison populations. Am J Psych. 1983;140:887–90.

  108. 108.

    Ford JD, Gelrnter J, DeVoe JS, Zhang W, Weiss RD, et al. Association of psychiatric and substance use disorder comorbidity with cocaine dependence severity and treatment utilization in cocaine-dependent individuals. Drug Alcohol Depend. 2009;99:193–203.

  109. 109.

    Mueser KT, Gottlieb JD, Cather C, Glynn SM, Zarate R, et al. Antisocial personality disorder in people with co-occurring severe mental illness and substance use disorders: clinical, functional, and family relationship correlates. Psychosis. 2012;4:52–62.

  110. 110.

    Gabbard GO, Gunderson JG, editors. Psychotherapy for Personality Disorders. 1st ed. Vol. 19, Review of Psychiatry. Arlington (VA): American Psychiatric Publishing; 2000. p.192.

  111. 111.

    Patterson TL, Jeste DV. The potential impact of the baby-boom generation on substance abuse among elderly persons. Psychiatr Serv. 1999;50:1184–8.

  112. 112.

    Yuan Z, Dawson N, Cooper GS, Einstadter D, Cebul R, Rimm AA. Effects of alcohol-related disease on hip fracture and mortality: a retrospective cohort study of hospitalized Medicare beneficiaries. Am J Public Health. 2000;91:1089–93.

  113. 113.

    Royal College of Psychiatrists. Our invisible addicts: first report of the Older Persons’ Substance Misuse Working Group of the Royal College of Psychiatrists. College Report CR165. London: Royal College of Psychiatrists; June 2011. Available from URL: (Accessed 4 February 2014).

  114. 114.

    Bucholz KK, Sheline Y, Helzer JE. The epidemiology of alcohol use, problems, and dependence in elders: a review. In: Beresford TP, and Gomberg E, (editors). Alcohol and Aging. New York (NY): Oxford University Press; 1995. p.19–41.

  115. 115.

    Reid MC, Anderson PA. Geriatric substance use disorders. Med Clin North Am. 1997;81:999–1016.

  116. 116.

    Sorock GS Shimkin EE. Benzodiazepine sedatives and the risk of falling in a community dwelling cohort. Arch Intern Med. 1988;148:2441–4.

  117. 117.

    Field TS, Gurwitz JH, Avorn J, McCormick D, Jain S, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med. 2001;161:1629–34.

  118. 118.

    Sheahan SL, Coons SJ, Robbins CA, Martin SS, Hendricks J, Latimer M. Psychoactive medication, alcohol use, and falls among older adults. J Behav Med. 1995;18:127–40.

  119. 119.

    Mukamal KJ, Chung H, Jenny NS, Kuller LH, Longstreth WT, et al. Alcohol use and risk of ischemic stroke among older adults: the cardiovascular health study. Stroke. 2005;36:1830–4.

  120. 120.

    Cox JL. Smoking cessation in the elderly patient. Clin Chest Med. 1993;14:423–8.

  121. 121.

    Mamun AA, Peeters A, Barendregt J, Willekens F, Nusselder W, Bonneux L; NEDCOM, The Netherlands Epidermiology and Demography Compression of Morbidity Research Group. Smoking decreases the duration of life lived with and without cardiovascular disease: a life course analysis of the Framingham Heart Study. Euro Heart J. 2004:25:409–15.

  122. 122.

    Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, et al. SEER cancer statistics review, 1975–2009 (Vintage 2009 populations). Bethesda (MD): National Cancer Institute; 2009.

  123. 123.

    Adams WL, Yuan Z, Barboriak JJ, Rimm AA. Alcohol-related hospitalizations in elderly people: prevalence and geographic variation in the United States. JAMA. 1993;270:1222–5.

  124. 124.

    Gramenzi A, Caputo F, Biselli M, Kuria F, Loggi E, et al. Review article: alcoholic liver disease–pathophysiological aspects and risk factors. Aliment Pharmacol Ther. 2006;24:1151–61.

  125. 125.

    U.S. Department of Health and Human Services. Mental health: a report of the Surgeon General. Rockville (MD): DHHS; 1999. Available from URL: (Accessed 4 February 2014).

  126. 126.

    Victor M, Adams RD, Collns GH. The Wernicke-Korsakoff Syndrome and Related Neurologic Disorders due to Alcoholism and Malnutrition (Vol. 30). Philadelphia (PA): FA Davis Company; 1989.

  127. 127.

    Zuccala G, Onder G, Pedone C, Cesari M, Landi F, et al. Dose-related impact of alcohol consumption on cognitive function in advanced age: results of a multicenter survey. Alcohol Clin Exp Res. 2001;25:1743–8.

  128. 128.

    Peters R, Peters J, Warner J, Beckett N, Bulpitt C. Alcohol, dementia and cognitive decline in the elderly: a systematic review. Age Ageing. 2008;37:505–12.

  129. 129.

    Blow FC. Substance Abuse among Older Adults: Treatment Improvement Protocol (TIP). Rockville (MD): USDHSS/PHS/SAMHSA Center for Substance Abuse Treatment; June 2001.

  130. 130.

    Simoni-Wastila L, Yang HK. Psychoactive drug abuse in older adults. Am J Geriatr Pharmacother. 2006;4:380–94.

  131. 131.

    Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47:30–9.

  132. 132.

    King-Kallimanis B, Gum AM, Kohn R. Comorbidity of depressive and anxiety disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry. 2009;17:782–92.

  133. 133.

    Pedersen T. Depression, anxiety ups addiction among older Americans. Psych Central; 18 April 2012. Available from URL: (Accessed 2 July 2013).

  134. 134.

    National Institute of Mental Health Online. NIH Senior Health. About anxiety disorders: anxiety disorders in older adults. 2010. Available from URL: (Accessed 2 July 2013).

  135. 135.

    Blow FC, Brockmann LM, Barry KL. Role of alcohol in late-life suicide. Alcohol Clin Exp Res. 2004;28:48–56.

  136. 136.

    Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, RTI International. The NSDUH report: illicit drug use among older adults. Rockville (MD): Center for Behavioral Health Statistics Quality and SAMHSA; 1 September 2011. Available from URL: (Accessed 4 February 2014).

  137. 137.

    Compton WM, Thomas YF, Stinson FS, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States. Arch Gen Psychiatry. 2007;64:566–76.

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Correspondence to Marya T. Schulte PhD.

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Key Words

  • Substance use disorder
  • psychiatric disorder
  • medical condition
  • comorbidity