Older people must contend with many chronic, or frequent, long-term illnesses. Alcoholism was recognized by the American Medical Society (AMA) as a chronic illness in 1956. As with any chronic disease, alcoholism is progressive and fatal unless treated.
Many older people grew up believing that alcoholism was a moral issue and that overcoming it was a matter of will power. Many still believe this today, making it hard for older people and their families to admit a need for help. Older people may refuse to recognize their alcohol problem. Family members may try to protect rather than confront the older alcoholic.
There are many ideas and feelings that are incorrect and even harmful to older people's quality of life. Like racism, ageism is an attitude of prejudice. For example, some think the older alcoholic cannot be treated as successfully as a young person. Yet older persons' chances of recovering from alcoholism are as good or better than younger alcoholics.
Alcohol's Effects on the Body
Alcohol can cause serious health concerns affecting many of the body's systems.
Effects of Alcohol on the Central Nervous System include:
- Loss of balance and coordination,
- Interference with vision (tracking moving objects, color distinction, and recovery from glare)
- Loss of sensation causing weakness and inability to feel pain
- Delirium tremors from alcohol withdrawal (hallucinations and shading),
- Memory loss and brain damage
- Sleep disorders (sleep apnea and insomnia)
Effects of Alcohol on the Circulatory System include:
- Enlarged heart (cardiomyopathy)
- Irregular heartbeat
- Coronary artery disease
- High blood pressure
- Angina and increased risk of heart attack
Effects of Alcohol on the Digestive System:
- Irritation of the esophagus causing difficulty with swallowing,
- Stomach irritation leading to gastritis and ulcers,
- Liver failure, hepatitis and cirrhosis,
- Digestive problems, nausea, diarrhea, and vomiting
In addition to the body's physical systems, alcohol can have a damaging impact to individuals' emotional well being:
Effects of Alcohol on Personality:
- Loss of inhibition leading to risk-taking,
- Self-destruction or impulsive urges,
- Neglect and violent behavior,
- Mood changes leading to feelings of anger, jealousy and depression,
- Psychological disorders such as self-imposed isolation and anxiety,
- Denial of a problem or distorting reality
Alcohol & Drug Interactions
As people age, they can develop more chronic diseases. Older adults often begin using more over-the-counter and prescribed medications. There is a danger of health problems arising from interactions between alcohol and these other drugs. The elderly should consult with their doctor or pharmacist about drug interactions.
Alcohol Interaction with Over-the-Counter and Prescribed Medications
Alcohol, in combination with other prescription and non-prescription medications, can cause unpredictable and possibly severe reactions. Among them:
- Antihistamines (cold remedies, allergy remedies, etc.) in combination with alcohol can cause extreme drowsiness
- Antihypertensive Agents can react with alcohol to lower blood pressure further than recommended and also can cause dizziness
- Antibiotics can react with alcohol to cause nausea, vomiting, headache, and possible convulsions
- Diuretics, in combination with alcohol, can cause lowered blood pressure, dizziness
- Tranquilizers and alcohol are a dangerous combination, causing decreased alertness and judgment, impairment of voluntary movements, breathing problems, possible death
Alcohol Use & Older Adults
There are different types of later-life alcoholics. Chronic or early-onset alcoholics have abused alcohol throughout their lives. Intermittent alcoholics have experienced periodic bouts with abuse during their lives. Late-onset alcoholics begin seriously abusing alcohol for the first time late in life, often due to age-related stresses (isolation, increased leisure time, family and friend changes or losses, health problems, and possible loss of self-esteem).
Alcoholism is a disease, which becomes worse over time. Denial and enabling behaviors allow the disease to progress. Alcoholics often deny they have an alcohol abuse problem. If family members, friends, or professionals assist older alcohol abusers in denying their disease, they are enabling the problem to continue.
Alcohol has a greater effect on older people. Physical changes caused by aging decreases the body's ability to break down alcohol. The effects of alcohol can be more severe due to sensory losses, which are part of the normal aging process. Also, alcoholism can cause other chronic illnesses among older adults to worsen.
Signs and Symptoms of Alcoholism in Older People
Take these signs and symptoms into consideration when identifying alcoholism in the elderly:
- Hiding drinking
- Drinking more with less visible effects
- Experiencing gaps in memory
- Becoming confused
- Unwilling to discuss drinking
- Making excuses for drinking
- Hiding alcohol to protect supply
- Becoming aggressive or abusive
- Neglecting appearance and hygiene
- Falling repeatedly
- Appearing depressed
- Neglecting home, bills, or pets
- Frequent car accidents
- Poor diet
- Withdrawing from social activities
- Chronic daytime sleepiness
- Talking about or attempting suicide
If you know an older alcoholic, take action to help yourself and the alcoholic. You can seek help from an alcoholism counselor or Al-Anon to cope with your feelings. You can begin allowing the alcoholic to suffer the consequences of his/her drinking. A competent professional can use resulting crises to break through defensive behaviors and help the older person realize his/her problem.
You need to be supportive of the older alcoholic without enabling her/his drinking to continue. Try to convey these beliefs to the older alcoholic:
- You believe in the strengths and potential of the older person.
- You are hopeful that the person can recover.
- You care about the person and want him/her to receive help.
- You will be nonjudgmental about the person's alcohol abuse but no longer supportive of its consequences.
- You will learn about the disease and encourage the older person to do so.
For the older alcoholic, you can seek help from a community resource person to refer the alcoholic to appropriate care.
- Medical Personnel - Family physicians or addiction specialists certified in substance abuse can help by referring the elderly alcoholic to an appropriate treatment program.
- Pharmacists, psychiatrists, nurses and other medical personnel can also educate and assist the alcoholic in seeking treatment.
- Alcoholism Counselors - Certified alcoholism counselors, social workers, psychologists, and clergy can assist older alcoholics and their families during intervention and treatment.
- Support Groups - Support groups such as Alcoholics Anonymous (AA), Al-Anon, and Adult Children of Alcoholics (ACOA) help others by sharing their experiences and providing emotional support. There may be special groups for older alcoholics in your community.
- Alcohol Treatment Centers - Many hospitals and medical centers provide alcohol treatment on an outpatient or inpatient basis. Some programs are designed for the elderly.
- Community Treatment Programs - Personnel in community mental health centers, offices of the National Council on Alcoholism, senior centers, or other social service agencies may provide services and support groups for older alcoholics.
- Special Services - Visiting nurses, religious organizations, meals-on-wheels, and other community services such as the Area Agency on Aging and Council on Aging can assist with care and support following alcohol treatment programs.
Treatment Intervention -- the first step
The first step toward recovery is the process by which the elderly person is shown that a problem with alcohol exists requiring immediate treatment. This insight may come from a crisis event and/or from interaction with others.
During intervention, medical or counseling personnel assess the person's condition, confront the alcoholic in a caring manner, and discuss alcohol abuse.
The goals of intervention are to:
- Allow the person to become aware of his/her alcohol abuse problem,
- Help the person face reality and experience someone's caring, and to
- Overcome fears regarding the disease and treatment program.
Intervention may take only a single meeting or many visits over a period of months. Motivation is critical to successful intervention. It may take time to help the person overcome feelings of isolation, depression, and dependence to gain the inner desire to seek treatment and recovery.
Treatment plans help alcoholics deal with their alcohol abuse and live without alcohol. Treatment often includes detoxification, education, counseling, and therapies such as medication therapy with antibuse and social therapy.
Although the medical treatment may take only weeks, education and counseling are ongoing until the older person can live without alcohol. This can take several months to a year or longer.
These special needs of the older alcoholic should be considered during treatment:
- Treatment staff must believe that older alcoholics can recover.
- Caring confronting may be more appropriate than a harsh approach.
- Elderly alcoholics may need to be guided to help them admit their problem and share their emotions.
- They may feel uncomfortable in a group with younger participants.
- Treatment staff should be taught about sensitive issues such as age factors, which can have an impact on treatment success.
- For example, older people may not like to be addressed by their first name and may experience greater feelings of shame associated with alcoholism.
- Sensory losses may also require treatment adaptations.
- Social activities are an important part of treatment for older alcoholics.
Aftercare and Recovery
Aftercare is the continued treatment and support for recovery. Alcoholism is characterized by relapses. Factors that help the elderly assume responsibility for their recovery include:
- Continuing, meaningful social relationships through community programs,
- Support groups for those returning to live alone,
- Education on proper nutrition and safe exercise for older persons,
- A meal program, if needed
- Participation in recovery activities of other alcoholics,
- Continuing support from family and friends,
- Ongoing family and personal therapy
Recovery is a life-long process requiring continued attention. Alcoholism is a disease with no current medical cure.
Additional help for yourself or someone you know, contact:
1) The Virginia Department of Behavioral Health and Developmental Services (DBHDS) is the state agency responsible for guiding people to the programs and services they need.
Here are a few specific resources on the DBHDS website:
- Dialing 9-1-1 is always an option in an emergency as well.
- Community Services Boards (CSBs) are the point of entry into the publicly-funded system of services for mental health, intellectual disability, and substance abuse. CSBs provide screening services 24-hours per day, 7 days per week. Use the link provided to find your local CSB, or search this website using the keyword "CSB" and your local zip code.