Abstract: Treatment Needs of Older Patients with Substance Use Disorders at an Urban Community Health Center (Society for Social Work and Research 31st Annual Conference)

Schedule:

Thursday, January 21, 2027

Golden Gate 5 (Hilton San Francisco Union Square)

* noted as presenting author

Taylor Scott, MSW, Graduate Research Assistant, Rutgers University, New Brunswick, NJ

Jamey Lister, PhD, MSW, Associate Professor, Rutgers University, School of Social Work, New Brunswick, NJ

Holly Lister, PhD, Program Manager & Psychologist, Rutgers University Behavioral Health Care, Behavioral Research and Training Institute, Center for Integrated Care, Piscataway, NJ

Stephanie Marcello, PhD, Chief Psychologist & Assistant Vice President of Academics, Integration and Innovation, Rutgers University Behavioral Health Care, Behavioral Research and Training Institute

Background and Purpose

Older adults in the United States use substances at higher rates than previous generations but treatment uptake is low. To engage this population, primary care-based screening and referrals are recommended. This study examines disparities in treatment utilization among older adults with substance use disorders (SUDs) at a community health center (CHC).

Methods

This study is a secondary analysis of medical charts from an urban CHC (2015-2021). The dataset included 6,890 unique SUD-screened patients. After excluding patients who screened negative, 2,471 patients’ charts were included in analysis for Aim 1. T-tests or chi-squares with adjusted standardized residuals were conducted to identify differences between older (n=695) and younger/middle-aged patients (n=1,774). For Aims 2 and 3, stratified multivariable logistic regression models were fit to each age group to assess associations with substance use treatment utilization at the CHC. The marginal effects of the models were compared for Aim 2 while Aim 3 focused on the model of older patients alone.

Results

The sample was predominantly male (70.3%), racially diverse (43.4% Black, 29.5% White, 20.0% Hispanic/Latine), and averaged 41.2 years (SD=12.4). Most patients had Medicaid (63.0%), often alongside other coverage. Many patients had multiple SUDs (42.2%). Compared to patients 18-49, older adults were more often male (73.5% vs 69.0%;ASR=2.23,p<.05) and less often Hispanic/Latine (15.4% vs 21.8%;ASR=-3.57,p<.01). Older adults were more likely to have opioid (13.2% vs 7.3%;ASR=4.68,p<.001), alcohol (32.2% vs 18.5%;ASR=7.35,p<.001), or cocaine use disorders only (5.5% vs 2.0%;ASR=4.62,p<.001), and less likely cannabis use disorder (4.7% vs 27.0%;ASR=-12.25,p<.001) compared to younger patients.

In stratified models, older adults were 14 percentage points more likely to access treatment for cocaine use disorder compared to older adults with comorbid SUDs, while no significant difference was observed when compared to patients 18–49 (OR=2.65,p<.05;OR=0.45,p=0.19). No other significant substance, demographic, or insurance differences in treatment engagement emerged between age groups.

Among older adults, those with cannabis use disorder only were 12 percentage points less likely to access treatment, which was only significant in the marginal effects (OR=0.30,p<.10). White patients and those with Medicare had lower odds of treatment access (OR=0.54,p<.05;OR=0.42,p<.05;OR=0.31,p<.001). In contrast, psychotherapy utilization and Medicaid coverage were associated with higher SUD treatment participation (OR=3.50,p<.001;OR=10.73,p<.001).

Conclusion and Implications

Older adults in this sample most often had comorbid or alcohol use disorders and a higher prevalence of cocaine use disorder than younger patients. The program appears effective in engaging older adults with cocaine use disorder, while lower engagement among those with cannabis use disorder highlights the need for both improved education on cannabis-related risks, and the promotion of clinician-administered motivational assessment specific to cannabis use. Medicaid coverage facilitated treatment access, though potential policy changes may threaten this pathway. Addressing insurance barriers and substance-specific perceptions may improve treatment engagement among older adults.