Tailoring Treatment for Substance Use Disorders in Older Adults: A Mixed-methods Study

The number of persons in mid-to-late life with substance use disorders (SUDs) in the United States has tripled over the past 2 decades, with opioid use disorder largely accounting for this increase. Older individuals with SUDs have unique medical, psychological, and social needs. Despite these needs and growing demand for SUD treatment within this age group, little is known regarding availability of specialized SUD treatment programs for older persons and barriers or facilitators to implementing these services.

We conducted a mixed-methods study, first conducting qualitative interviews with counselors at outpatient SUD treatment facilities in Connecticut (N = 10). We then used these qualitative interview findings to guide analysis of quantitative data from SAMHSA's National Substance Use and Mental Health Services Survey (N-SUMHSS) and the National Survey of Substance Abuse Treatment Services (N-SSATS) survey.

Using the Behavioral Model of Health Services Utilization for Vulnerable Populations and Framework Analysis, we identified predisposing (eg, treatment attitudes), enabling (eg, transportation), need-based (eg, comorbidities; integrated care), and healthcare system-related (eg, insurance) characteristics affecting older adults' SUD treatment engagement. SUD treatment facilities offering "a tailored program for seniors or older adults" increased steadily in Connecticut, and the United States overall, between 2010 and 2022. Of the 74 (43%) Connecticut facilities offering tailored older adult services, social, structural, and mental health services were offered at high rates (64%-86%), but medical services were offered at lower rates (39%-52%).

Our findings indicate a gap between the treatment needs of older adults with SUDs and available services. Greater attention to integrated medical services, screening for geriatric-specific syndromes that could impede treatment access (eg, cognitive impairment; mobility), and appropriate workforce training is needed to optimize treatment for older adults with SUD, especially considering the opioid use disorder epidemic in the United States.