Risk Factors for Self-reported Driving Under the Influence of Alcohol and/or Illicit Drugs Among Older Adults

Namkee G. Choi, PhD; Diana M. DiNitto, PhD; C. Nathan Marti, PhD

Disclosures

Gerontologist. 2016;56(2):282-291. 

In This Article

Discussion

Older adults have increased susceptibility to the effects of alcohol and drugs and higher fatal injury risks from motor vehicle crashes. In the face of increasing rates of substance use among older adults, this study examined DUI risk factors among the growing older population. The higher rates of substance use, particularly illicit drug use, among 50–64 year olds compared with those aged 65+ indicate that substance use among older adults is likely to continue to increase as those in the younger age group (baby boomers) swell the ranks of older adults. The findings show that substance users tend to be better off economically and are healthier than nonusers. Those with limited financial resources and very poor health may be less likely to drink alcohol or use drugs due to inability to obtain these substances or because they recognize that these behaviors are detrimental to their health. The self-reported DUI rate of 6.19% among substance users in the 65+ age group was significantly lower than 14.54% in the 50–64 age group. However, the DUI rate in the 65+ age group may actually be higher if those who never drove or stopped driving due to age- and disease-related disabilities had been excluded (NSDUH does not include this information). Even a 6% DUI rate is alarming given older adults' higher motor vehicle crash rates per vehicle mile of travel and higher fatal injury risks from these crashes. As DUI offenders are at risk for committing subsequent offenses (Cavaiola et al., 2007), older adults who continue to drive under the influence pose a substantial safety concern.

The findings also provide support for alcohol expectancy theory, psychosocial vulnerability, and poor decision-making tendencies in predicting DUI risks. Higher frequency alcohol use, binge drinking, and marijuana use significantly increased the odds of self-reported DUI in both age groups. These findings indicate that substance use patterns among older DUI reporters do not differ from those of younger age groups for whom binge drinking has consistently been found to significantly predict DUI and DUI recidivism (Brady & Li, 2013; Maxwell, 2011; Romano & Voas, 2011). These studies also found that following alcohol, marijuana/cannabinoids is the second most prevalent substance found in fatally injured drivers, and significant alcohol–drug and drug–drug interactions among polysubstance users were also observed. Our findings also show that DUI reporters were more likely to have a history of substance abuse and encounters with law enforcement. Higher rates of MDE and SPD among the DUI reporters also indicate that this group suffers from substantial emotional distress (i.e., co-occurring mental disorders) that should be addressed in combination with substance use and abuse.

The findings for both age groups regarding DUI sociodemographic risk factors (being male, non-Hispanic white, employed, and having higher education/income) and health-status risk factors (better or similar self-ratings of health and chronic illnesses) are also worth noting. Older drivers tend to have higher socioeconomic and physical, functional, and cognitive health statuses than former drivers, as health deterioration is associated with driving cessation (O'Connor, Edwards, Waters, Hudak, & Valdés, 2013). Although DUI-reporting older adults appear to be more advantaged socioeconomically and more or similarly advantaged in health statuses as their age peers who did not report DUI, their mental health status is worse. Continued heavy drinking and illicit drug use combined with psychological distress may also portend worse health and mental outcomes for these older adults.

The study has a few limitations: (a) The reliability and validity of respondents' self-report of DUI was not ascertained, and underreporting due to recall or social desirability bias is a concern. (b) Respondents' driving status was not available; some nonreporters may not have driven during the survey period. (c) Despite the 5-year pooled data, the small number of older adults reporting DUI hampered more in-depth analysis (e.g., polysubstance use as a risk factor).

Despite its limitations, this study suggests the following policy and practice implications for promoting driving safety by preventing and reducing DUI among the growing number of older drivers: (a) Health and social service providers can educate older, substance-using drivers about age-related changes that affect substance use effects in general and driving safety in particular and motivate those in need to seek treatment. (b) Access to evidence-based treatment needs to be facilitated for older substance abusers in general and DUI reporters in particular, given that approximately one quarter of older DUI reporters perceived the need for treatment but did not receive it. (c) Addressing the emotional distress many DUI reporters experience may also reduce substance use and promote driving safety.

This study also underscores the need for continued research to improve identification of older drivers at high risk of DUI and identify effective intervention approaches. These approaches should take into account older drivers' characteristics, behaviors, and expectations in order to prevent crash and injury while also prolonging their mobility. Suggested steps are as follows: (a) Test improved protocols for assessing older adults' driving safety by screening for substance abuse and comorbid mental health conditions in addition to assessing motor, visuoperceptual, and cognitive functioning. (b) Expand research on nonmedical use of prescription and over-the-counter psychoactive medications and use of multiple medications that may affect older adults' driving safety and DUI. (c) Focus on intelligent transportation system technology that holds promise for maintaining and enhancing safe mobility of older adults (Dickerson et al., 2007). Advanced technology should not just help older adults drive safely but also prevent them from driving when it is not safe, for example, by providing a tool that older adults can easily use to self-screen their substance-impaired driving limitations.

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