Rx = recipe. Note: Substance use includes all illicit drugs, kratom, alcohol and tobacco. Note: The estimated number of current users of various substances is not mutually exclusive, as people may have used more than one type of substance in the past month. Of the prescription drugs featured in this report, prescription painkillers were most commonly used by people 12 years of age and older. The 16.3 million people who abused prescription psychotherapies in 2019 included 9.7 million people who abused prescription painkillers, 4.9 million people who abused prescription stimulants, and 5.9 million people who abused prescription tranquilizers or tranquilizers (including 4.8 million benzodiazepines last year) (Figure 10). The acute subjective effects of cocaine are euphoria, increased energy, increased alertness, sexual arousal, increased sociability and chatter. Physiologically, there may be acute negative effects on breathing and the cardiovascular and central nervous systems: increased heart rate, blood pressure and body temperature, as well as dilation of the pupils. All of these effects occur almost immediately, but also decrease rapidly (after about 15-30 minutes when the drug is snorted and 5-10 minutes when smoked), since cocaine is rapidly metabolized by the body (NIDA, 2004). When the acute effects wear off, users experience a recovery period („crash”) that may include restlessness, anxiety, restlessness and insomnia. This can lead the user to use cocaine to displace these negative effects. Chronic cocaine abuse can lead to increased paranoia, lack of concentration, sexual dysfunction, and cognitive deficits. Substance use disorders in older adults may be a continuation of excessive drug and alcohol use initiated at a younger age, but for some, substance use begins during periods of transition or loss. In a national study of Medicare beneficiaries, excessive alcohol consumption doubled the risk of hip fractures.111 All of this can lead to costly hospitalizations and longer stays.

Cannabis use generally begins in early adolescence, with the highest use occurring among 15- to 24-year-olds (Harkin et al., 1997), which may be explained in part by strong peer influences (Frischer et al., 2005). Most consumption declined steadily from the mid-20s to the early 30s (Bachman et al., 1997). Cannabis dependence, which persists into adulthood, is more prevalent among frequent and persistent users, up to 40% among those who use it almost daily (Kandel & Davies, 1992). Care planning should consider the following when developing a treatment or management plan: Although post-traumatic stress disorder (PTSD) is also classified as an anxiety disorder, it distinguishes its core component, which results from a traumatic event. The lifetime prevalence of PTSD in the general population is estimated to be less than eight percent;92,93 However, the lifetime prevalence rate of PTSD among adults with drug or alcohol use disorder ranges from one-quarter to one-half in clinical samples.94,95 The relationship between trauma and SUDs is thought to be bidirectional. Excessive drug and alcohol use puts people at risk of victimization; and vice versa, those who have experienced a traumatic event deal with symptoms (e.g., insomnia, overexcitement, intrusive thoughts) often with drugs and alcohol.90,96,97 Ouimette and colleagues97 demonstrated the effects that PTSD symptoms and substance use have on each other by monitoring twice-diagnosed outpatients for 26 weeks. The results showed that PTSD symptoms and alcohol and cocaine symptoms fluctuated simultaneously from week to week.