Late-onset drinking: The causes and consequences, the differences between late-onset and early-onset drinking and the unique treatment needs of older alcoholics.

This article addresses alcohol rehab for an older adult, the causes and consequences of late-onset drinking, the difference between stages of alcoholism and the unique alcohol treatment needs of older adults.

How can a person abstain or drink sensibly through adulthood only to fall into problem drinking in their retirement years?

Why does this happen, and more importantly, what can you do about it?

Well, if you or someone you love is a late-onset problem drinker, read on to learn more about your situation and to find out:

• How early and late-onset drinking differs.
• About common causes of late-onset problem drinking.
• The consequences of late-onset drinking (these differ from the consequences of early-onset drinking).
• The unique treatment needs of older adults.

What Is Late-onset Alcoholism?

Most older alcoholics begin problem-drinking in their teens or twenties, but a smaller cohort of drinkers avoid alcohol problems until retirement age and then succumb to problem drinking or alcoholism.

• Older adults who start drinking heavily at a young age and drink throughout adulthood are called early-onset problem drinkers. Most older alcoholics, about 2 in 3, are of the early-onset type.
• Older adults who start problem-drinking later in life are called late-onset drinkers. About one in three older alcoholics are of the late-onset type.

The Stages of Alcoholism: Differences between Late-onset and Early-onset

Although there are exceptions to every rule, on average:

• Early-onset drinkers are more likely male and late-onset drinkers are more likely female.
• Early-onset drinkers tend to have lower socioeconomic status and late-onset drinkers have higher socioeconomic status.
• Early-onset problem drinkers often have a family history of alcoholism. Late-onset alcoholics are less likely to have this direct familial history.
• Early-onset problem drinkers are more likely to succumb to an alcohol-related disease at some point in life, such as cirrhosis or pancreatitis. Late-onset drinkers are less likely to experience these types of diseases.
• Early-onset alcoholics typically have physical dependence and withdrawal issues. Late-onset alcoholics may never become physically dependent.¹
• By older age, early-onset drinkers are likely to experience severe cognitive damage. Later onset drinkers experience less cognitive damage.
• Cognitive damage is less reversible in early-onset problem drinkers. Though late-onset problem drinkers do experience some cognitive declines, these are mostly reversible with abstinence.
• Late-onset problem drinkers may be more treatment compliant than early-onset drinkers.²

But though there are many differences, there are also similarities between early and late-onset heavy drinking, for example:

• People from both groups drink more heavily in response to stressors.
• Heavy drinking exacerbates symptoms of other age-related medical conditions, like hypertension or diabetes.

What Causes Late-onset Alcoholism?

So what causes a person to fall into problem drinking or alcoholism after decades of responsible adult drinking?

Well, there’s no single answer, but major life-changes often precede changes to drinking habits; for example:

• Divorce.
• The death of a spouse.
• Retirement.
• A major change in health status.
• Other losses, such as income loss, mobility loss or social network losses.

Also, people who had substance abuse problems early in life are at higher risk to develop drinking problems later in life, even after decades of abstinence or controlled drinking.

Evaluate the Consequences, Not the Quantities

Is the drinking a problem? What if we’re only talking about a few beers or glasses of wine a day? How much is too much?

When assessing for problem drinking and alcoholism you have to consider daily drinking habits, but consumption quantity doesn't tell you everything – focusing on the impact and consequences of the drinking tells you much more about the seriousness of the problem.

And this is doubly so for older adults who may experience serious consequences after seemingly quite moderate consumption. Alcohol tolerance can decline in older age because:

• Older adults have less lean muscle and increased bodily fat. This causes a decrease in blood water content and results in greater blood alcohol levels per unit consumed.
• Liver enzymes needed to process alcohol (dehydrogenase) are less present in older age. It takes longer for an older person to metabolize a single unit of alcohol.³

Warning Signs of an Alcohol Problem

So do you need alcohol treatment?

1. Well, first you need to determine if alcohol causes you problems.
2. If it does, you have to see whether you can stop on your own – and if you can’t, then you need help.

Since older adults can’t metabolize as much alcohol and since medication interactions can intensify alcohol’s effects, you can’t look at the amount consumed as a reliable indicator of a problem; instead, look for signs that point to alcohol causing you life-problems.

Unfortunately, it’s usually up to the individual and those that care about her to identify problem drinking, since many of the symptoms of alcohol disorders are easily misinterpreted as symptoms of other normal age-related conditions.

At retirement age, if you drink regularly – and especially if you also take prescription medications - be on the look-out for any of the following warning signs that may indicate a problem:

• Increased anxiety or irritability.
• Hiding your drinking or drinking alone.
• Drinking with medication even when medication warning labels advise against it.⁴
• Increased sadness or depression – or in extreme cases, suicidal thinking.
• Memory problems.
• Concentration problems or problems sustaining attention.
• Decreased interest in activities you used to enjoy.
• Indecisiveness.
• Less interest in personal grooming or personal hygiene.
• Episodes of incontinence.
• Chronic pain or problems with headaches or dizziness.
• Alcohol-related financial or legal problems.
• Loss of appetite.
• Loss of interest in socializing with friends and/or family.
• Falling or injuring yourself.⁵

Recommended Drinking Quantities

Though you shouldn’t assess for a problem by looking at the amount you drink in isolation, if your consumption exceeds recommended safety guidelines, then you may want to cut down for health reasons. According to the National Institute on Alcohol Abuse and Alcoholism, for adults aged 65 and older safe drinking is:

• Not more than 1 standard drink per day or 7 in a week (a standard drink = 1 can of regular strength beer, 5 oz of regular strength wine or 1.5 oz of liquor,)
• Not more than 2 standard drinks per day on any special occasion day (birthday, wedding, etc.)

Why Don’t Older Adults Get Treatment?

Although research shows that older adults respond well to treatment and that reduced drinking leads to big quality of life gains, the majority of problem-drinking older adults never get appropriate addiction treatment. Some factors which explain this inadequate treatment participation include:⁶

• Problem drinkers often get mandated into treatment via employer programs or through interactions with the criminal justice system. Since older adults may no longer work outside of the house or drive a car as frequently, they can more easily hide their drinking.
• Doctors may confuse symptoms related to alcohol abuse for symptoms of common age-related disorders.
• Due to shame and embarrassment, older adults and their families are more likely to hide and minimize their drinking and less likely to initiate treatment. 

Alcoholism Treatment for Older Adults

Late-onset problem drinking or alcohol dependence can lead to severe cognitive, emotional and physical health problems and decreased quality of life, BUT:

• Older adults generally respond very well to treatment. They tend to have better outcomes than younger adults getting similar treatment.
• There is some evidence that late-onset problem drinkers have better treatment compliance and better outcomes than early-onset drinkers.²

Start with Less Intensive Treatment

According to a SAMHSA expert consensus panel, older people with alcohol problems should try less intensive forms of treatment first, before moving on to more disruptive and intensive forms of treatment. Examples of less intensive forms of treatment include:¹

• Brief interventions (one or more sessions with a doctor or other counselor to explore drinking habits and drinking consequences).
• Motivational interviewing – a series of sessions with a counselor. These non-confrontational sessions help people overcome ambivalence to change and develop personally relevant reasons for behavior modification.

If less intensive forms of treatment do not result in decreased drinking, then you would move up to more intensive forms of treatment, such as intensive outpatient programs or residential rehab.

Alcohol Rehab for an Older Adult

There is some evidence that late-onset problem drinkers respond better to less intensive treatment approaches than early-onset problem drinkers. This is likely because late-onset drinkers are more responsive to social pressure and because their alcohol problems tend to be less severe.¹

The Benefits of Alcoholism Treatment and Rehab for Older Adults

Though older adults can get adequate care in a mixed-age adult treatment environment, older-adult specific programs offer a more comfortable social environment and specially tailored treatment. According to SAMHSA, features of effective addiction treatment for older adults include:¹

• Treatment is age-specific and supportive
• Treatment is not confrontational and bolsters self-esteem
• Treatment content is appropriate to an older audience and delivered at a comfortable pace (this may be slower than in a standard adult group). Treatment is flexible and responds to your needs.
• Treatment respects gender differences.
• Treatment addresses bereavement and loss, loneliness and depression.
• Program staff members are experienced and interested in working with older adults. There is a culture of respect within the treatment program.
• There is an explicit effort to expand each person’s social network.
• There is increased case-management and linkages to appropriate medical and social services agencies.

Protective Factors

If alcohol may be an issue for you or someone you love, consider enhancing your life with activities that may protect you from overuse. If possible:

• Get involved in community activities.
• Maintain goals to work toward – keeping a sense of purpose provides direction.
• Cultivate social relationships and embrace familial and friendship relationships that offer emotional and practical support.
• Work on maintaining your independence.
• Keep learning.

Stop Putting Your Independence at Risk

Why try to change at such a late stage in life? Why take away small pleasures from your life? What’s the harm really...?

Well, if you’re asking yourself these types of questions you should think carefully about the likely consequences of your actions. Because beyond impaired physical and mental health, alcohol-abusing older adults also risk their independence.

• Alcohol abuse can lead to falls and disability. This occurs through direct intoxication and medication-interaction effects.
• Alcohol abuse increases your risks for a wide array of diseases. Health complications can limit your ability to care for yourself.
• Risky drinking can lead to financial problems. In extreme cases, financial issues may limit independent living options.

Other Consequences

By older age, lifelong heavy drinkers tend to show obvious wear and tear. In contrast, late-onset alcoholics may avoid notice simply because they look too healthy and seem too normal.

But though late starters avoid some of the obvious alcohol-related diseases, heavy drinking still comes with a heavy price tag, such as:

• It exacerbates other existing conditions, such as hypertension or diabetes.
• It increases the odds of depression.
• It increases the risks of cardiovascular disease and stroke.
• It decreases immune system functioning.
• It decreases bone density and increases risks for broken bones (it also increases fall-risks).

Take-Home Message

• Late-onset alcoholics may never develop physiological dependence. So just because a person never gets the shakes or other withdrawal symptoms, this does not exclude the possibility of a serious problem.
• Though late-onset older adults can experience a wide range of serious health consequences, those who seek treatment can expect excellent outcomes. Though a lifetime of heavy drinking can bring about irreversible cognitive damage, for those who started later in life, this damage is almost entirely reversible.
• Treatment doesn’t have to be a ‘big deal’ to make a big difference. Many late-onset problem drinkers respond very well to brief counseling sessions or motivational interviewing.

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When older Americans use drugs it’s often for the same reasons that teenagers do: to cope, out of curiosity, and from a lack of passions. Feelings of mortality, boredom and loneliness are common precursors.

Older Americans use drugs for the same reasons that teenagers do: to cope, out of curiosity, and from a lack of satisfying pursuits or passions. Depression, a sense of one’s mortality, boredom and loneliness are gateway experiences. They are best seen as forms of emptiness that demand to be filled and they will be, whether by default or design. 

Using to Cope

The recovery acronym H.A.L.T. advises that we must never become too Hungry, Angry, Lonely, or Tired. This bit of wisdom is most commonly used to guard against relapse and/or anxiety and depression. It can also be used as a framework for understanding the things that predispose and perpetuate our use of drugs and alcohol.

Hunger

If we dig a bit deeper, we find that we Hunger for much more than food. It takes courage to identify what we truly want because identifying it necessitates going after it.

As we age, our willingness to take risks and try new things tends to decline sharply. Alcohol and drugs offer immediate relief and distraction from the fear of knowing and pursuing our hearts longing.

Anger

We notice that Anger never travels alone but rather is accompanied by unmet needs and conflicting emotions (unresolved grief and loss, having a greater sense of one’s time being limited). Older Americans show a high preponderance of depression.

Unfortunately and dangerously, many of us use alcohol (a known depressant) to cope with depression, which not only fuels feelings of anger, sadness, and loss, it also creates and perpetuates a sense of detachment from self.

Loneliness

We find that Loneliness can occur even when we’re surrounded by others. We struggle because we lack intimacy and connection. As life circumstances change, we often find ourselves bereft of people we strongly identify with and/or feel safe being vulnerable with.

Drinking or drugging alone eliminates the possibility of solitude and perpetuates social isolation.

Tired

We realize that Tired is much more than a matter of sleep. It is a state of being drained, depleted, or burned out. It was a long road to get to retirement. Too many of us find that we lived with only two speeds: all out or dead stop. 

When we lack motivation or compelling reasons to continue growing, we become complacent and stagnant. These are all the disease of addiction requires to take hold.

Using to Offset Boredom

Just as adolescents require outlets and social opportunities, so do the retired and elderly. As one client explained to me, “I’m at an age where everyone I know is either dying or moving to Florida!” For most folks, before we can truly welcome new opportunities to socialize with same aged peers, we must come to terms with aging and the changes it brings to our lives. I routinely point toward senior community centers, outing clubs, and hobby enthusiasts, only to hear, “I don’t want to sit around with a bunch of old people!”

Drugs and alcohol were social lubricant and/or substitutes for companionship and friendships in our youth. Many of us find ourselves regressing to former habits because it’s easier and because it takes less courage to be willing to try new things and meet new people. If we keep at the forefront of our thoughts that these folks are in the same circumstances that we are, we can be open to having more connections and more fun. We never outgrow the need for friendships.

Using Out of Curiosity

It seems that unlike past generations, a high percentage of Baby Boomers have not come to an older age gracefully. A very high percentage of us come with a history of having abused drugs and alcohol in our youth. Curiosity led us to experiment at an early age and in the absence of more enticing options, we find ourselves wondering what the newer stuff is like.

While we grew up with no small number of illicit drug choices, we find that things have changed dramatically. Even marijuana, which seemed so benign in our younger years has radically morphed in appearance and potency.¹ Abuse of pain medications was not common for our generation and the plethora of designer drugs available is not only abundant, but potentially only a few mouse clicks away.

In our youth we felt invulnerable. Age and experience have taught us to weigh the risks. Unfortunately, as we consider the pros and cons, many of us feel we have little to lose. Our choices must be made in the full light of day. It may indeed be harder to invest in ourselves as we age, but the alternatives run from unfulfilling to downright dangerous.

Do you need specialized addiction treatment for an older adult? Check out our Featured Rehab Programs for Seniors

Older adults find it difficult to access good, knowledgeable and age-appropriate treatment programs. Here are ten major reasons why seniors are under served in this area.

It's no secret that we, as a society, are growing older more quickly than at any other time in history. When we look at the lack of treatment facilities and programs available to seniors and the comparative lack of discourse regarding this rapidly growing social concern, it is easy to see how the issues around seniors and addictions have crept in quickly and well under the radar of governments and health authorities. 

Addicted seniors are, apparently, a lesser concern than warranted with much of the service dollars going to womens' and youth issues. With a very narrow focus on the wide-spread problem of seniors being active addicts it is little wonder that senior services and research receive a very small portion of the treatment dollars available.

The Barriers to Age-Appropriate Treatment

It is not just the lack of public or governmental recognition of the problem that is troubling. I have compiled a list of ten barriers to treatment for seniors that are a 'MUST' to consider if we are going to head off a growing problem with huge implications for addicted seniors who are in desperate need of support and services:

(in no particular order of importance)

1. Family Secrets

Many families are more likely than not to keep "dad's drinking problem" an internal family issue than to actually deal with it and get the appropriate support necessary. The rally cry is "we can handle this ourselves." After all, we are a very private bunch who likes to keep those secrets-secret. This is especially true if the family has a professional reputation to protect. 

It is not about embarrassment but rather about judgements and a lack of understanding what is required to provide help but not knowing how to keep it 'quiet'.

2. Family Embarrassment

Then there is the 'embarrassment factor'. This is similar to 'Family Secrets' above, but different in that it happens, not from a lack of understanding, but from having to publicly admit that dad or mom is a drunk or an addict. 

What is similar is that the addict doesn't get the support, encouragement or the acceptance they need to get better. They become disconnected from the family system because of damaged familial egos.

Seniors are less motivated to change their lifestyle. In some cases they welcome the negative attention since ANY attention is better than no attention.

3. Costs

Because of the lack of age-appropriate treatment programs covered by public funding, private clinics and facilities tend to be quite expensive. They can range up to $40,000 per month in some cases (and as little as $3,000 per month in more basic no-frills programs). So funds definitely play a role whether focused treatment is an option or not.

4. Inadequate Physicians Training & Frequent Mis-Diagnosis

Even though there are more physicians learning about addictions and treatment and some are beginning to 'specialize' in the treatment business, there are still too few who are making themselves available for every-day service. Many physicians still don't have the assessment skills to pronounce a client with a prescription drug problem or a drinking problem. Unfortunately there are some, for a variety of reasons, who may not want to. They are seeing the presenting symptoms as early onset of dementia or mental health related problems such as depression or some other chronic illness and then end up prescribing a medication that could exacerbate the substance abuse problem an often doesn't do much to deal with the psychological (and philosophical) aspects of what the presenting symptoms are truly indicating.

5. Bad Physician-Client Communication & Follow Up

Seniors don't have a great deal of credibility in the 'system' when it comes to describing their issues - so they give up trying and just 'go with the flow'. The physicians rarely take the time to actually listen to what they are being told. 

Senior clients often don't know how to speak up and say "hey doc, you missed this..." or "what about that?"

Once they are diagnosed and given a script there is a lack of follow-up visits. "How are you doing?", "Has the medication changed the way you...?", "Have things gotten better or worse for you?"

Clients need frequent follow up visits to provide some accountability on the clients part and to determine the outcomes of the treatment protocol as well as the efficacy of the meds prescribed. That doesn't happen nearly as much as it needs to to be effective.

Two weeks in the life of an addict can be a lifetime when considering life-changing events. Much progress or disintegration can occur in two weeks. If a client has not responded well in terms of his/her drinking or using drugs the chances of them having another chance to go to treatment again are very slim. Their reports become untrustworthy.

6. Lack of Senior-Specific Treatment Programs

There really aren't many treatment programs that are senior-specific and many times seniors end up going to a public program that is attended by clients of all ages. 

Seniors tend not to do all that well with teenagers, for instance, who have a very different view of the world around them and the seniors tend to feel frightened, lost, disconnected from their 'real' world and angry. They truly don't understand the type of behaviour that passes for OK now.

The biggest drawback, however, is that older adults lose the belief that they can be helped in a place like this and so they give up. They do their time and leave with little benefit because they see themselves and their problems differently from the 'young ones'. Remember seniors are no different from others in that they have a communication network that chats together. Have one senior talk about his/her experience in a "place like that" and that is often enough to put any others who may need the help off from going for help. There is a lack of credible information.

(Check out: Our Featured Rehab Programs for Older Adults)

7. Programs 'Too Remote'

Programs can be quite a distance from their holes, families, neighbourhoods and their friends. They feel isolated and that they are being punished in some way.

8. Denial

The toughest hurdle is their own denial that anything is wrong. They say, "So I have a few too many sometimes-big deal-just leave me alone I've earned the right to enjoy myself" or they forgot to take their meds so they double up thinking that they need to get back on track. They don't want to see the problems with their behaviour and the choices they are making as being potentially harmful.

9. Loneliness

Seniors use because they are lonely and that isn't going to change whether they cut down or quit. If they don't feel they have a place in the family or that they are loved and valued they are likely to increase their use or use more secretly. If family doesn't have the time to spend with them that is the problem not that they treat their loneliness with alcohol or drugs. They use as a replacement for family and social contact. Why would they give that up by cutting down? In this case it's the family and the relationship with the senior that is the barrier.

10. Lack of Peer Support Groups for Seniors

There is a lack of counseling groups specific to this issue available in appropriate settings that have other folks the same age attending so that they can identify with others who have similar things going on in their lives. There needs to be solid and consistent care and support with accurate information available to seniors about health concerns -- truthful but not threatening. They need to understand what is happening and what their options are. 

Taking Care of Our Seniors

Some of the barriers that exist are those created by governments who have lost sight of a whole group of people who need to be represented more energetically. Our seniors need to be acknowledged and treated as equitably as women and youth are when considering treatment solutions. It is true that some of these barriers are created by the seniors themselves but we still need to break them down and make it easier for seniors to accept help. The other part of this is that families need to stop judging their parents or relatives and try to be more supporting, understanding, accepting and caring.

Our seniors are an important resource for us and we need to provide for them at a time when they are most vulnerable. It is time for the rest of us to step up and take care of our seniors just like they took care of us all those years when we needed it the most. We need to represent them publicly. We need to remove the barriers that prevent them from receiving the qualified assistance they deserve. It's called the circle of life.

Do you need specialized addiction treatment for an older adult? Check out our Featured Rehab Programs for Seniors

It's a given that older adults and seniors do better in treatment programs with peers of a similar age, but what else do you need to look for to find a great addiction treatment program that's going to work well for an older adult or a senior?

Older adults and seniors have little in common with people in their 20s and 30s, so it's not surprising that experts recommend age specific treatment for older adults when possible.

But excellent addiction treatment for older adults requires more than age homogeneity. Treatment programs that excel with this demographic are set up to meet the specific needs and wants of their clientele.

Tailored programming can make the difference between continuing treatment and treatment drop-out, and ultimately - between success and a reduction in substance abuse, or failure and a continuation of the problem.

Whether you're looking for yourself or searching for a loved one, finding high quality addiction treatment tailored to the needs of older adults and seniors takes determination.

As a starting place it's helpful to at least know what you're looking for and how to go about evaluating any treatment programs under consideration.

7 Things to Look for in an Addiction Treatment Program for Older Adults and Seniors:

Be Supportive and Non Confrontational

Forget scared-straight and other in your face tactics!

Only a very small percentage of seniors with substance abuse problems ever get any kind of formal addiction treatment, and research suggests that 2 reasons for this under-representation are a fear of failure and a fear of social stigma.

1. Fear of failure - Older adults with long histories of use have likely tried to stop or control their drinking or drug use on multiple occasions. Recurring failure to control use can result in a sense of hopelessness and a fear that any new efforts will also end in failure.
2. Stigma - People from many decades past viewed addiction as a moral failure and people who could not control their drinking or drug use faced considerable social stigma.¹

People already feeling ashamed of themselves do not need confrontation and degradation and people feeling hopeless and scared need encouragement and support - not pressure to succeed at risk of sanction!

Link with Other Health and Social Services

Substance abuse generally degrades physical and mental health and unresolved physical and mental health issues reduce the odds of addiction treatment program completion and increase the odds of relapse.

A Canadian study of older adults and seniors in an alcohol treatment program found that older alcohol abusers were far more likely than seniors from the general population to suffer from age-related health complaints, for example:

• 11% had cancer, which was 250% the rate of older adults and seniors without substance abuse problems
• 20% had depression
• 33% had mobility problems
• 28% had memory problems
• 1 in 8 had liver disease
• Only 3% of people in the program were considered 'healthy'²

Addiction treatment should meet the holistic needs of the individual, and for many seniors and older adults, this means referrals and access to outside physical and mental health services.

Focus on the Social and Psychological Needs of Older Adults (Loneliness, Loss, Depression etc)

Many older adults initiate or accelerate substance abuse as a response to the developmental challenges of aging, such as:

• The changing roles of retirement
• Dealing with ill health or a loss of mobility
• The loss of a spouse or partner
• Depression related to major life changes

Effective substance abuse programs will address the developmental challenges of aging as they relate to substance abuse and when applicable, teach self care or positive attitude skills which can alleviate some of the distress of such changes.

Focus on Rebuilding Social Support Networks

Older adults with substance abuse programs often become socially isolated from friends and family.

Helping older adults in recovery reconnect and reconcile with loved ones and forge new social networks is necessary for lasting improvement.

Teaching Speed and Content Should Be Matched to an Older Audience

Older adults recovering from alcohol or drug addiction may have greater memory and cognitive deficits so the pace of delivery needs to be matched to the abilities of the audience. 

Additionally, program staff need to:

• Account for increased visual and auditory impairment in all presentation materials and environments
• Minimize distractions during group or education sessions, as these can be quite disruptive to an older audience
• Be aware that some older adults may find sitting in one place for long sessions physically uncomfortable

The Program and Staff Need to Offer Respect

Staff should be qualified and experienced in working with older adults, but more than this, staff need to enjoy working with seniors and create an environment of respect that is mindful of the expectations and cultural values of an older audience, for example:

• Staff should always speak directly to the client about treatment matters, even when other family members are present and involved
• Staff should respect requests to see doctors and specialists and try to accommodate these requests as quickly as possible
• Staff should address people by formal title (Mr. Mrs. etc.) unless they ask permission to be more informal
• Staff should strictly avoid any behaviors that could be interpreted as patronizing or condescending
• Staff should make informal conversation whenever possible, to humanize the relationship

Program Duration Should Be Individualized and Flexible

A set in stone program duration does not effectively serve a population of people who will learn and recover at very individual rates of speed.³

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Seniors do very well in alcohol rehab, and since the risks of drinking increase as we age, older women who drink too much need help right now.

Alcohol Rehab for Older Women

Post menopausal women who abuse alcohol are at a much greater risk for certain cancers. Old age compounds the negative health effects of alcohol and as we age we lose our resiliency to the damage of abuse.

Health Risks

Older women who abuse alcohol:

• Are 50% more likely to get breast cancer
• Post-menopausal women who consume just two drinks a day double their risk for endometrial cancer (the most common cancer of the female reproductive system, accounting for 6% of all cancer diagnoses in women)
  
• Are at greatly increased risks for liver, gastrointestinal and pancreatic cancers

Medication Interactions

As people age they often take more prescription medicines and so risk negative drug interactions and increasing intoxication or exacerbated physical damage. Age also leads to weakened bones and an increased risk for drunken injuries, most notably falls that lead to fractures or mobility-compromising injuries such as broken hips.

Why We So Rarely Intervene When Older Women Drink too Much…

It's not fair, but women suffer more from alcohol consumption than men, and the rate of increased damage just gets worse with age. Problematically, although relatively few men start drinking very late in life, a lot of women do - and they are also among the least likely group to ever seek help for their drinking.

We Don't Do Them A Favor By Letting Them Drink

We too often deny seniors treatment out of misguided feelings of compassion. In reality, by trying to spare the elderly the pain of treatment, we shorten their life, ruin their health, and greatly diminish their quality of life.

If mom or grandma is drinking too much, she deserves to be treated with respect and with humanity. The elderly, especially the young-old, should have decades to enjoy their freedom and their grandchildren - and through inaction we rob them of what they deserve.

Alcohol Rehab for Older Women

No reason, whether grief, illness or loneliness ever justifies alcohol abuse or dependency; and alcohol is not a healthy or effective solution to the problems of aging.

Older people may feel embarrassed to need treatment, and these feelings of shame too often deter them from getting help. Therefore, families need to act and get them into  treatment - regardless of the age of onset.

The elderly do very well in addiction treatment and tend to comply with treatment directives better than younger participants.

Treatments Work

Older women with alcohol abuse problems or alcoholism can get effective treatment in any mixed-age alcohol treatment program. Though they do not require age-specific treatment, finding a treatment program targeted at older adults may help alleviate some embarrassment.

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Why do older people become addicts? What drugs are they likely to abuse? What to do if you suspect your beloved senior citizen relative is using drugs.

We don't often think of the elderly as becoming addicted to drugs. Why would somebody start a habit like that after living more than 70 years? Sure there are older people who have been abusing substances for many years, but it is hard to imagine grandma drinking herself to sleep every night after she has been the scion of the family for so many years.

But it happens. More often than we like to believe. So it becomes a hidden and potentially very serious problem. Anybody who loves an older person should know more about this problem.

What Substances Do the Elderly Abuse?

The oldest baby boomers are now 67 years old. They were the kids of the 60's who began the modern drug culture. The generation before that had alcohol as a respectable recreational drug. Most of the people over 70 years old who get caught in the web of addiction will use either alcohol or prescription drugs. It has been estimated that 10% of the women over 65 and 20% of the men over 65 drink more than is considered healthy.

People who grew up in the 30's and 40's were taught that alcohol and cigarettes were sexy. If you watch the movies from those years, you'll see what I mean. Think of Dean Martin of the "rat pack" fame. (OK, if you are unfamiliar, google it.) There was nothing wrong with having a martini before dinner, a few glasses of wine with dinner, and a "nightcap" before going to bed.

The Influence of Depression and Loneliness

But when you get in your 70's and beyond, life changes. Friends begin to disappear. There might be more loneliness, boredom and depression. In fact, depression is more common in the elderly than any other age group. There might be stresses of chronic pain. That might be physical pain, but it could also be psychological pain, such as when children live far away and do not keep in contact.

One big problem is that many elderly people now live on their own so the usage is easily undetected. Wanting to maintain independence, the older person will hide or not share their difficulties with the people they are close to. Other elderly have no problem sharing their pains, but can be viewed as constant complainers and consequently have their complaints ignored. It is difficult for loved ones to see past these obstacles.

Prescription Drugs and Medication Interactions

Older people often need to take other medications. This can contribute to the abuse of prescribed drugs, but it can also cause alcohol to be a problem. Many medicines interact with alcohol and make the effects of alcohol stronger. As people get older many become lax with their prescriptions, sometimes taking them, sometimes not. Or sometimes renewing the prescriptions, and sometimes just using what has been in the house for years. If the prescriptions are not working (because they are not being taken properly or not at all) it is more likely that he or she will turn to self-medication with alcohol.

Excessive alcohol use is not good for anyone, but it can be extremely dangerous for the elderly. Alcohol greatly increases the chance of stroke, dementia and other maladies. While it is true that some alcohol related dementia can be reversible after at least two months of complete sobriety, the brain damage from a stroke is less likely to be repaired. Also, falls are more dangerous for the elderly, and they are more likely to happen when inebriated.

How to Intervene - What to Look For

First, do not dismiss the possibility that grandma or grandpa have a drinking or drug problem. It might be unlikely, but it could happen. It even happens to the most unlikely people. And if it does the risks are great.

If your loved one is taking other medications on a regular basis, discuss whether or not there should be any drinking at all. Or even if there should be alcohol in the house. If it seems OK, talk about limiting the intake. It would be better if the drink is slowly sipped and always after a meal.

Warning Signs

• Be on the lookout for changes in sleeping patterns. These are usually brushed off since it is common for the elderly to have different sleep habits. Although healthy older adults sleep less, you should expect normal patterns.
• Look for changes in appetite, or complaints of nausea or vomiting. These can be easily caused by substance abuse.
• Frequent and unexplained falls are an important red flag. Even if it is not because of substance abuse it is a problem. But the possibility of substance abuse needs to be looked into right away. One explanation that might be heard is that there is just less strength so there are more falls. Well, the lack of strength can be from the use of a substance.

Intervening

• If you suspect something, first talk to your loved one. If there is a problem and you are lucky he or she will admit to it and you can look for help. More often, like addicts of other ages, there will be denial. Check the fridge. I have seen and heard many stories of water bottles filled with vodka and apple juice bottles filled with whiskey.
• Talk about the other medications. Check to see if the prescriptions are up to date. If mom or dad don't want to show you, you might have to check when they are not watching. I know it seems inappropriate to snoop in mom and dad's medicine cabinet, but you are doing it to save their lives. If you find that things are not quite right offer to do some medication monitoring. Offer to make sure the prescriptions are up to date. If you see some medicine that has an alcohol warning, talk about it.
• Don't be embarrassed to talk to their physician. Sometimes, especially with the pre-baby boomer population, the doctor is the trusted professional that is most likely to be listened to. Explain your concern. Mention the signs that you noticed and why you think there might be a problem. Tell the doctor that you want him or her to talk to your loved one about this.

Most importantly, do not give up. There is no reason for an 70, 80, 90 year old (or more) to suffer with an addiction problem.

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We don't customarily consider that there is much of a need for drug and alcohol rehab for seniors, but the reality of senior drug and alcohol abuse requires us to shift our thinking, and get more seniors the help they need for what is becoming a growing societal problem.

Although the proportion of seniors in drug and alcohol rehab remains relatively low, this does not accurately reflect the level of drug and alcohol abuse amongst seniors. Tragically, seniors abusing drugs or alcohol, although desperately in need of rehab or other treatments, are statistically the least likely to be offered the assistance they need.

Seniors are the least likely to seek out treatment on their own, medical professionals are far less likely to appropriately diagnose abuse when it occurs, and family and friends remain reluctant to get involved, erroneously thinking that at such a late stage in life, nothing can really be done.

The fact is though that seniors respond very well to drug and alcohol rehab programs, and actually have a better success rate than the general population; and since the effects of drug and alcohol abuse are particularly damaging on the frailer bodies of the elderly, it is imperative that drug and alcohol abusing seniors get the rehab treatment they need.

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Estimates put the number of alcohol dependent seniors in the millions, and only a fraction of these are getting the help they need. For a number of reasons, alcohol abuse in the elderly often goes undiagnosed; and too often, elderly alcoholics are never presented with the treatment options that could greatly improve their health and quality of life. Old age is not a valid reason for self destructive drinking, and families do not offer kindness to older relatives when they attempt to spare them the pain and difficulty of addictions treatment. The elderly deserve the same access to treatment as the rest of the population, and since alcohol is especially debilitating to older bodies, the time for any needed treatment is now.

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Older Alcoholics

A recent Penn State University study on alcohol use and abuse amongst the elderly¹ concluded that approximately half of all older alcoholics are never appropriately diagnosed, and as a result are never presented with appropriate alcohol abuse treatment options. Another independent study reported that as many as 1 in 6 seniors has an alcohol abuse problem; and if you do the math…that's a lot of people being left to suffer the pain of addiction.

Why No One Intervenes

There are a number of reasons why elderly alcohol abuse is so underreported. Firstly, the elderly in general have less contact with the outside world, and as a result are less likely to get noticed for their problem drinking. The elderly are far less likely to drive drunk, get in a bar fight, or lose a job, and as such they can often drink to very harmful levels before anyone notices.

Secondly, there is a seeming reluctance for health care professionals to make a diagnosis of alcohol abuse in the elderly. Often, alcohol may be involved in an emergency room visit, as a result of a fall or other injury, and although doctors and health professionals may suspect alcohol abuse, they are statistically very unlikely to diagnosis it as such. They may be uncomfortable with the diagnosis, or even be unsure on how the treatment is possible for an older adult.

The third reason for the under diagnosis is both an unwillingness for older adults, particularity older women, to request treatment at their own behest, as well as a reluctance on the part of families or friends to intervene in a senior's drinking. The elderly seem far more concerned about the embarrassment of being labeled an alcoholic, and families seem to feel that there is little point in intervening…that it's too late for change…that it doesn't do much harm…that it's their only comfort left.

Alcohol Abuse Does Great Harm to the Elderly

The fact is though, although alcohol abuse is harmful at any age, it is never more harmful than on the elderly. The impact of alcohol related injuries is much more severe, the risk of harmful medication interactions is much greater, and the general physical effects of the alcohol are more debilitating. Alcohol ages and reduces the quality of life of elderly patients at an alarming rate.

The ideation that the elderly are too set in their ways, or that it is too late to start treatment at this late stage in life, also seems to be myth. Older alcoholics are far more likely to attend their recommended treatment programs to their conclusion, and continue with after care programming for the full recommended duration. The successful abstinence rate for seniors is actually quite good.

Get Them the Help They Deserve

Older adults deserve the same access to treatment and quality of life as do younger adults, and any attempts to "spare" them from treatments actually does them a great disservice, and significantly reduces the quality of life of their golden years.

If you are concerned about the drinking of an elderly relative or friend, do not attempt to spare them the embarrassment or difficulty of treatment; it is not a kindness that you do to them. If you care, take action, and improve their health, their cognitive functioning, and their ultimate lifespan as you get them the treatment they need, and the treatment they deserve.

Alcohol is not a "comfort" and although life changes like the loss of  a spouse, a troubling retirement or ill health, are not to be taken lightly, neither are they an appropriate excuse for self destructive behavior, at any age.

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