Prevention Update

Improving Quality of Life: Substance Use and Aging, the latest report in the Substance Use in Canada series, provides a summary of the best available evidence on substance use among older adults.

Adults aged 55 and over represent the fastest growing subgroup of the Canadian population, and are estimated to account for approximately one-quarter of the Canadian population by 2036. As older adults continue to make up a larger proportion of the population, substance use among them will also continue to rise. It will become increasingly important to understand the needs of older adults and how the Canadian healthcare system can adapt to those needs. It is essential to develop strategies to promote healthy aging and take into account the impacts of substance use when planning for the future of the Canadian healthcare system.

Improving Quality of Life: Substance Use and Aging will give decision makers, policy makers, nurses, geriatricians, researchers and others working with older adults an opportunity to consider the evidence as they develop and employ more effective prevention and intervention programs aimed at addressing substance use among older adults. The objectives of this report were:

1. To consider the impact of the aging population and the increases of problematic substance use among older adults on health outcomes, the Canadian healthcare system and healthcare expenditures;
2. To identify gaps in our knowledge about the harms associated with substance use and their impacts on healthy aging to inform policy, practice and programs for older adults; and
3. To summarize the best available evidence on effective ways to prevent, identify, assess and treat problematic substance use in the older adult population.

Some of the key findings from this report include:
• As the number of older adults in Canada increases, the number of older adults experiencing problems related to substance use is also expected to increase.
• Age-related changes in physiology render older adults more susceptible to experiencing harms associated with substance use.
• Older adults are often prescribed multiple medications and are more at-risk for the harms related to poly-substance use compared to other subgroups of the Canadian population.
• While older adults use substances less frequently than do younger adults, those who do use substances experience more harms associated with them compared to younger adults.
• To better support older adults, service providers need more evidence-informed resources tailored to the older adult population to prevent, detect, diagnose, assess and treat substance use among older adults.

Planned Release Date: March 2018

Youth are an important population for prevention and early intervention efforts, as many adult mental health and substance use disorders emerge during the adolescent years. Strategies to engage youth are key to successful prevention and intervention efforts. A new review by Canadian researchers, Dunne, Bishop, Avery and Darcy (2017), published in the Journal of Adolescent Health, analyzed youth engagement strategies used during mental health and substance use interventions. The researchers reviewed 40 studies and reports published between 2004 and 2014 that described engagement strategies used with youth aged 11 to 29 years to improve mental health and substance use outcomes. Their analyses led to six overarching themes for youth engagement:
1) Youth empowerment through participation in program development
• Examples: filling out feedback surveys, becoming peer support workers, participating in program design, implementation and evaluation, sitting on boards or committees
• Possible outcomes: development of coping and professional skills, improved relationships with clinicians, greater recovery focus, decrease in substance use

2) Engagement through parental relations
• Examples: strengthening parent-child relationship, increasing positive parental behaviours, supporting parents to advocate for their child’s care, family interventions
• Possible outcomes: engagement in treatment, reduced risky behaviours, reduced substance use

3) Engagement through technology
• Examples: computer-, texting- and Internet-based interventions (easy access, low costs, confidentiality and anonymity)
• Possible outcomes: reduced symptoms for depression, anxiety, stress, post-traumatic stress, first episode psychosis and eating disorders; engages traditionally hard to reach youth (e.g., adolescent males, marginalized youth, youth not attending school or living in remote areas)

4) Engagement through medical or mental health clinic
• Examples: housing clinics within schools, increasing accessibility of location, communication and spaces geared towards youth, flexibility, diverse services, continuity of care, privacy, including family in treatment
• Possible outcomes: increased seeking of help

5) Engagement through school
• Examples: increasing student connectedness with school and teachers, screening at schools to help identify at-risk youth
• Possible outcomes: lower use of substances, lower emotional distress and suicide-related thoughts or attempts

6) Engagement through social marketing
• Examples: social media campaigns (most effective when included as part of an integrated intervention strategy)
• Possible outcomes: reduced stigma, less substance use, changed beliefs about alcohol, increased skills in reducing alcohol-related harms

The main conclusion from this review was that there is no single method of engagement that is most effective, and successful mental health and substance use interventions likely involve a combination of strategies that is shaped by local needs, goals and resources. Ideally, youth should be involved in the design and implementation of interventions and programs should address any barriers to participation. For more information, please see the review article.

Reference Dunne, T., Bishop, L., Avery, S. & Darcy, S. (2017). A review of effective youth engagement strategies for mental health and substance use interventions. Journal of Adolescent Health, 60(5), 487–512.