Dr. Nora Volkow and Dr. George Koob have written a joint article entitled, Saving a “Lost Generation”: The Need to Prevent Drug and Alcohol Abuse in Midlife. As the respective directors of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, Dr. Volkow and Dr. Koob are two of the most respected voices in the recovery community. Writing together, they express their worry about a disturbing trend of increased use.
The investigation examines the problem of increased substance use and alcohol consumption in the middle-aged demographic of the youngest baby boomers and the oldest Generation Xers. Coming of age during the decadence of the late 1970s and the cynicism of the early 1980s, they traditionally have had a more relaxed attitude towards drinking and using. A study funded by the National Institute on Aging, however, revealed the dangerous legacy of such attitudes. If the tide is not turned, there will be even more disastrous consequences to come.
Dr. Volkow and Dr. Koob rely heavily on the work of Princeton University economists Anne Case and Angus Deaton. Their recent study pointed out the frightening rise in all-cause mortality among white middle-aged (ages 45-55) Americans between 1999 and 2013. Largely caused by the devastating impact of substance use and emotional distress, the rise in the mortality rate can be accounted for by an increase in drug overdoses, alcohol poisonings and suicides. Escalating access to and use of prescription opioids have led to most of the drug overdoses.
In light of recent advances in healthcare, any increase in mortality is alarming. If mortality had continued to decline at the rate seen in the previous two decades, then half a million deaths would have been avoided. The rise also paralleled a greater number of self-reports of poor health, chronic pain, psychological distress, and difficulties with daily living. Could all of this be linked to substance abuse?
A number of contextual factors, including growing financial insecurity, declining economic prospects and more stressors, may also be involved. Dr. Volkow and Dr. Koob fear the resulting substance abuse problems may be leading to a “lost generation” with both a less prosperous and less healthy future than their parents.
The question is, what prevention and treatment techniques can be used to lower drug and alcohol abuse in this population? Dr. Volkow and Dr. Koob argue for greater integration of drug and alcohol education in primary medicine. Primary care physicians not only can ask about substance use, they also can track their patients’ use from visit-to-visit. Still, considering the severity of this threat, there is no magic bullet to address the problem.
