Alcohol Abuse and the Elderly: The Hidden Population

As a society, we share a complicated history with alcohol. During the later part of the 19th century, politicians, women’s groups, and churches banded together to convince lawmakers to outlaw alcohol. In 1919, the U.S. Congress passed the 18th Amendment, making the sale and distribution of alcohol illegal. Alcohol consumption declined but did not prevent illegal use and distribution. In 1933, Prohibition ended and as a result, millions of Americans have made alcohol an important part of their social activity. In the 1960s, researcher E.M. Jellinek reported that excessive and abusive use of alcohol was a disease. Within 10 years, a public effort was launched in the United States to educate people that alcoholism was an illness.

In 1980, the American Psychiatric Association’s Diagnostic and Statistical Manual 3rd refined the definition of alcoholism by differentiating between alcohol abuse and dependence. However, people continue to use the term “alcoholism” when they discuss all forms of “problem drinking,” when in fact alcoholism and abuse have specific clinical definitions. Alcoholism, also known as alcohol dependence, is a chronic, progressive, and potentially a fatal disease. The symptoms are: drinking excessive amounts frequently, inability to control drinking despite medical, psychological, or social complications, increased tolerance for alcohol, and serious withdrawal symptoms when the person stop drinking.

On the other hand, alcohol abuse is a chronic disease in which the individual refuses to give up drinking even though it causes the person to neglect important family and work obligations. However, abuse, left untreated, can become dependence. The symptoms are: drinking when it is dangerous (drinking and driving), frequent excessive drinking, interpersonal difficulties with family, friends, and coworkers caused by alcohol, and legal problems related to alcohol use.

The National Institutes of Health (NIH) estimates that in 1998, alcoholism cost society $184.6 billion in lost productivity, medical care, legal services, and cost from traffic accidents. However, these statistics does not address the cost, to society, or the problem of alcohol dependence among the elderly the “hidden population.”

It seems that alcohol abuse among older adults is something few wish to talk about, and a problem for which even fewer seek treatment on their own. Too often, family members are ashamed of the problem and choose not to confront it head on. Health care providers tend not to ask older patients about alcohol use if it wasn’t a problem in their lives in earlier years. This may explain why so many of the alcohol-related admissions to treatment among older adults are for first-time treatment.

Recent studies indicated that between 1.1 and 2.3 million elderly citizens use alcohol to alleviate grief and loneliness. What has been called the “invisible population” is now being discovered and measured. Most individuals tend to restrict their alcohol intake as they advance in age, mainly because of poor health or reduced social activities. However, society has begun to recognize that the incidence of alcoholism among older individuals is on the rise. Despite the numerous studies being done on this subject it is difficult to find reliable statistics on today’s elderly alcoholics. However, some research suggested that as much as 10% to 15% of health problems in this population may be connected to alcohol and substance abuse.

One fact is clear: alcohol-related problems among the elderly are much greater than perceived even a decade ago. It is also clear that the common individual’s response remains devoted to treating their symptoms briefly and directly, rather than getting to the core of the drinking behavior and treating the alcoholism. The general practitioner is without doubt the person with the most opportunity to identify alcoholism in an elderly patient, whose social and family isolation is relatively common. However, the practitioner is often confronted with denial of the problem, by the patient and especially by the family. One reason may be because the effects of alcoholism may mimic those of aging. Making diagnosis of alcoholism difficult because many symptoms, including aches and pains, insomnia, loss of sex drive, depression, anxiety, loss of memory and other mental problems are often confused with normal signs of aging or the side effects of medications.

Another concern is that, too often, when families or professionals try to get help for their love one, identification of a drinking problem may be difficult. For example, many of the criteria necessary to make the proper diagnosis of alcoholism are more appropriate for younger abusers. These traditional criteria may not be appropriate for elderly individuals who may be more isolated or solitary, is less likely to drive and most likely to be retired. In fact, some researchers suggests that the diagnosis of alcoholism, for the elderly, be focused on biomedical, psychological or social consequences.

Although the prevalence of alcohol consumption and alcohol abuse decreases with age, alcoholism in elderly people remains a significant public health problem. It is an increasingly important concern because the elderly is the fastest growing population today, and is expected to continue this trend well into the next decade. There are two forms of alcoholism that can be distinguished in the elderly: alcoholism beginning before the age of 65 years and continuing, and alcoholism beginning after the age of 65 years. As stated before, alcoholism in the elderly is often difficult to diagnose, especially since health problems due to alcohol may be attributed to old age. Also, in the case of alcoholism, elderly patients, taking multiple medications, present an increased risk of medication/alcohol interactions, especially with tranquillisers and sedatives.

At the beginning of this article I suggested that Americans have a complicated relationship with alcohol. Well, to a certain extent, the same can be said about society’s relationship with its elderly citizens. In America we often don’t value our elderly individuals, we sends a double message, some may call it a love hate relationship with our elder population. As a result, some people tend to ignore or shun older people with drinking problems. For example, to ease our own internal conflicts, we say things like “after all they are not hurting anyone. Let them enjoy the time they have left…Who cares?” Often, therapist may be reluctant to work with older alcoholics due to unconscious counter-transference issues. For example, the elderly client triggers the therapist’s own fears about aging. Older clients are often accused of being rigid and unwilling or unable to change. In which case therapists may feel that they are wasting their time working with these individuals. However, researchers who study the science of aging understand that these myths, assumptions and stereotypes are unproven and often harmful to the elderly individuals who can benefit from proper treatment or intervention.

One’s later years does not have to be a time of loneliness, depression, or a life of alcoholism. Many individuals find happiness and even adventure in their advanced years. Those who age successfully tend to have a strong sense of life achievement, high self-esteem and positive attitude. Older individuals who achieve a sense of ego integrity are able to view their past history with a sense of satisfaction. While older individuals who look back with regret and believe that it is too late to make significant changes may experience a sense of despair and depression.

Those who age successfully is able to adjust to the loss of a spouse and other significant relationships, adjust to retirement and reduced income, accept and deal appropriately with declining health and get involved establishing a satisfactory living arrangements.

Unfortunately, not everyone ages successfully. Some individuals cannot accept the physical changes that come with advanced age. Others can’t handle the loss of a spouse or friends, or they find it difficult adjusting to retirement. And, too often, many of these individuals turn to alcohol.

Many of these individuals never had a drinking problem prior to this time in their lives. This is called late onset alcoholism. The bad news is that this type of alcoholism may go unrecognized. The good news is that individuals with late onset alcoholism have a much greater chance of recovery. This is due primarily because these individuals have a history of handling problem successfully.

On the other hand, early onset alcoholics are those individual drinkers who have been drinking excessively for many years. As a result, they may have more difficulty in recovery because of health complications from years of excessive alcohol abuse.

Finally, elderly alcoholics have a wide range of treatment options. After detoxification, when necessary, the elderly client can receive further treatment from inpatient programs, day treatment, outpatient therapy, or community-based groups. Completion rates appear to be modestly better for elderly-specific alcohol treatment programs compared with mixed-age programs. Some seniors find that Alcoholics Anonymous (AA) meetings offer them strength and support to overcome drinking problems. While other seniors feel these groups are stigmatizing and find it more comfortable to seek support from their age-peers at senior citizen programs. What is important to know is that the most effective programs treat the “whole person,” making sure that their health, housing, financial, and social needs are met. This is an important concern because late-onset alcoholism is often associated with stress, isolation, loss, and loneliness. Therefore, effective substance abuse treatment for the elderly should address these underlying issues.