Gender Differences in Substance Abuse Treatment Completion Among the Elderly Population

Background and Purpose: Substance use disorders among the older adult population, particularly of alcohol and prescription drugs, is one of the fastest growing health problems facing the U.S. (Gfroerer, Penne, Pemberton, & Folsom, 2003). Despite this, the numbers of older adults affected by substance use disorders are often under reported, underdiagnosed, and undertreated (Kuerbis & Sacco, 2013). In light of the huge growth of older adults driven by the aging of the Baby Boomer generational cohort, there is an increasing need to better understand their substance use patterns and design an age-appropriate treatment. However, little is known about the substance abuse treatment outcomes among the elderly. Even less is known about the gender difference. The purpose of this study is to examine gender differences in substance abuse treatment outcomes among the elderly.

Methods: This study analyzed the 2011 Treatment Episode Datasets-Discharge (TEDS-D) dataset which collects all admissions and discharges information of inpatients receiving alcohol and drug treatment. Participants ages 55 or above were stratified for our sample and the final sample size was 106,843 (female, n = 25,244; male, n = 81,599). Treatment outcome variables included successful treatment completion and length of stay in treatment. The successful treatment completion was a dichotomous variable and defined as “treatment completed” versus all other reasons. The length of stay in treatment was also a dichotomous variable and defined as “less than or equal to 90 days” versus “more than 90 days”. Chi-square tests and t-tests were used to compare treatment outcome differences across demographics and treatment characteristics for female and male elderly. Propensity score weighting (PSW) was used to account for sample selection biases.

Results: The treatment completion rate for male was 55.27% and for female was 48.42% (χ² = 363.02, p < .000). The length of stay less than or equal to 90 days for male was 27.2% and for female was 31.73% (χ² = 195.56, p < .000). Male elderly were 13.3% more likely to complete the substance abuse treatment than female elderly (OR = 1.13; 95% CI: 1.05, 1.22), controlling for the effects of demographic and treatment characteristics. However, when controlling for confounding effects, no difference exist in length of stay by gender (OR = 1.01; 95% CI: 0.93, 1.10). Participants who were having psychiatric problems, court referral, use methamphetamine, using other drugs only, or using alcohol and other drugs tended to stay in treatment longer than their counterparts.

Conclusions and Implications: Consistent with previous research, this study found that there were gender differences in substance abuse treatment completion among the elderly (see Bornstein et al., 2015). Male elderly were more likely to complete treatment rather than terminate services earlier. This finding implies female elderly may be a subpopulation at higher risk of treatment attrition. Practitioners should recognize these barriers and design age- and gender-appropriate treatments to deliver to the elderly women population. Future research should detect the mechanisms how gender differences lead to treatment completion outcomes to further understand the substance abuse patterns among the elderly.