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A Pacific Northwest Extension Publication
Oregon State University, Washington State University, University of Idaho
ALCOHOL PROBLEMS IN LATER LIFE
PNW 342
Reprinted November 1998
V L. Schmall, C.L. Gobeli, and R.E. Stiehl
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When Alcohol Use Becomes a Problem
How an Alcohol Problem Develops
Factors contributing to alcohol problems
Recognizing an Alcohol Problem
Changes in drinking patterns
Changes in behavior
Changes in physical condition
Guidelines for Family and Friends
Recognize that alcoholism is a "family
illness"
Get professional help
The Effects of Heavy Drinking
Taking medications
Acknowledge and confront your feelings
and fears
Myths About Alcohol
Take action
Explore treatment options
Recognize the possibility of relapse
Provide continued support
Conclusion
Resources
Alcohol is part of our society. We use it to celebrate
joyous occasions, from weddings to anniversaries, from baseball
games to reunions, from new jobs to retirement. For many people,
alcohol is part of religious observances. But there's a darker
side. For some elderly people, the use of alcohol becomes a problem,
affecting all aspects of life--physical health, emotional well-being,
and family relationships.
This publication is designed to help you understand how
problems with alcohol develop in later life and how you can help
the older person cope with these problems. We will discuss factors
leading to alcohol problems, signs that a problem may exist,
suggestions for discussing your concerns with the older person,
and guidelines for selecting a treatment program.
Although this publication is directed toward the family,
some older adults do not have close family. Close friends, community
service providers, and others who have contact with the older
person may substitute for family.
Helping an older person deal with an alcohol problem
requires that you be informed, involved, and supportive. You
need to learn as much as you can about the disease and confront
your own feelings and fears about alcohol and alcoholism. Older
adults can be treated successfully. This publication will help
you help the older person you know achieve sobriety.
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When Alcohol Use Becomes
a Problem
Hal worries about his 72-year-old father, Harry. Harry
seems withdrawn and doesn't keep up the house and yard as well
as he used to. Last week when Hal went to pick up his dad for
their weekly trip to the farmer's market, he found him sitting
in the darkened living room, in front of the TV, with a can of
beer. Harry said he "forgot" about the outing.
Joe, 62, began drinking in high school to be "one
of the guys." In the service and on his job as a salesman,
drinking was just part of life. Now after early retirement because
of a back injury and heart problems, Joe drinks to fill his days.
His wife complains, but Joe says, "I can quit anytime--if
I wanted to, but I'm not hurting anyone."
Marion began having a glass of wine with dinner when
her husband retired and her last daughter left home. It reminded
her of the gracious parties she used to give when the house was
full of life and people. Lately, she's started to have a glass
of wine before going to bed, too. She says it helps her sleep.
She resents her daughter's suggestions that she's drinking too
much.
Many people use alcohol. Most drink moderately throughout
life without developing a problem. Others have a life-long history
of alcohol abuse and frequently experience alienation from families
and emotional, social, and physical problems because of their
drinking. Finally, some people begin drinking or increase their
use of alcohol in later life, usually in response to stress.
At first, alcohol is used for temporary relief, but later becomes
a problem.
Researchers estimate that as many as 10 percent of the
population age 60 and older have a problem with alcohol. Approximately
two-thirds of this group are "early onset" alcoholics,
having developed problems before age 50; one third are "late
onset." Thus, while most older people with alcohol problems
have had these difficulties for many years, others develop problems
in later life.
Alcohol abuse in later life is often hidden and, consequently,
overlooked. Most older people are retired and don't have work
problems caused by alcohol use. They often live alone. They usually
drink in the privacy of their homes so are less likely to be
disruptive in public or arrested for driving while intoxicated.
Many times, even when family, friends, and professionals
recognize an alcohol problem they are reluctant to confront an
older person. This reluctance may be related to their fear of
making the older person angry, their attitudes or lack of knowledge
about alcohol problems in later life, their own drinking habits,
or the older person's denial of his or her drinking behavior.
When does the use of alcohol become a problem? There
are no easy answers, and the answer may be different for each
individual. Many professionals say that alcohol becomes a problem
when it changes the older person from the way he or she used
to be. Sometimes the family "feels" that something
is wrong. Perhaps neighbors notice changes in the way the person
behaves and bring them to the family's attention.
Whenever drinking interferes with a person's daily
life and relationships or creates difficulties within a family,
there is a problem. Whenever alcohol is more important to the
older person than the problems it's causing, there is an alcohol
problem.
An alcohol problem is a family problem. Families can
be the key--to successful treatment and sobriety or to continued
dependence on alcohol. Recognizing and taking action is critical.
Alcohol abuse is destructive to the older person in many ways.
- Alcohol increases the risk of suicide.
- Alcohol shortens life expectancy.
- Alcohol causes and aggravates many physical health problems.
- Alcohol destroys families and other relationships.
- Alcohol impairs memory.
- Alcohol reduces the quality of life.
- Alcohol kills.
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How an Alcohol Problem Develops
Each person who develops a problem with alcohol has a
unique set of circumstances. It's often difficult to point to
a specific event or cause that led to the problem. However, excessive
use of alcohol in later life is often triggered by major life
changes and stresses--retirement, relationships, and physical
changes--that occur as part of the aging process. To the older
person, these changes typically represent a loss that causes
emotional and/or physical pain. People of all ages experience
losses, but for older people, losses are often irretrievable.
Factors contributing to alcohol
problems
Retirement. Many people welcome retirement
and view it as a chance to finally do what they've always wanted.
But for some people, work has been their primary source of identity.
Work has given their life purpose, structure, and meaning. For
people who have not developed other interests and relationships,
retirement can bring many losses: routine, co-workers, activity,
income, and feelings of productivity. Changes in lifestyle and
disruption of family roles may also occur.
Some older people drink in reaction to the loss of self-worth,
responsibility, and income following retirement. Others can't
adjust to the lack of structured activity and drink out of boredom.
Still others may find themselves in new leisure situations where
"social" drinking is expected; for example, golfing
and finishing at the "19th hole" daily instead of once
a week.
Loss of relationships. Children leave
home, a spouse dies, friends move away or die--the circle of
relationships grows smaller. Physical problems may limit mobility.
Soon, the sense of isolation and loneliness may become unbearable.
Unlike younger people, who often begin drinking to be with friends,
the older person drinks because he or she feels alone. Alcohol
may become "the only friend." Women sometimes increase
drinking in their late 40s or 50s, when children leave the nest,
particularly if they feel "no one needs me anymore."
People are often devastated by the loss of a spouse and
sometimes turn to alcohol to block the pain of their bereavement.
Widowers appear to be most vulnerable.
Poor health. Loss of physical health
can be very stressful, limit mobility, and lead to a negative
self-image for some older adults. Alcohol may be used to block
the emotional pain caused by the loss of physical capabilities
Other older people experience serious and chronic pain and sometimes
use alcohol as a sedative to lessen the physical pain.
Physiological changes. The older person's
diminished physical capacity decreases tolerance for alcohol.
As people age, changes occur in all body systems. The older person's
body loses lean body mass; the amount of fat increases, and the
amount of body water decreases. Alcohol is metabolized and excreted
at a slower rate. All these changes mean that a given amount
of alcohol results in a higher blood alcohol level and quicker
intoxication than in a younger person. The body cannot rid itself
of alcohol as quickly as it once could, and alcohol stays in
the body longer so its effects are prolonged. While a 30-year-old
may feel little effect from two drinks, a 70-year-old is more
likely to become intoxicated.
Because the older person's body doesn't process alcohol
as well as when the person was younger, some people who have
used alcohol in moderation for years begin to experience alcohol-related
problems in later life, even when their drinking has not increased.
Women are at higher risk than men because they have a greater
percentage of body fat, lower amount of body water, and are usually
smaller in size. Older people with a variety of medical problems--for
example, diabetes, heart disease, liver disease, and central
nervous system degeneration--do not tolerate alcohol well.
While it may take a younger adult 10 to 15 years to develop
the disease of alcoholism, an older person can be afflicted in
a few months to a year or two.
Nutritional deficiencies. Loss of taste
and smell, financial hardships, mobility problems, and loneliness
contribute to poor eating habits for some older people. An aged
body weakened by malnutrition will be further weakened by the
effects of alcohol. Alcohol contains only empty calories that
do not substitute for the nutrients necessary to maintain a healthy
body.
Drug interaction. The elderly, who
constitute approximately 12 percent of the population, take 30
percent of the prescription drugs. Many take over-the-counter
drugs as well. Some medications interact with alcohol, increasing
its effect and leading to more rapid intoxication. Many medications
also contain alcohol. Since women tend to use more tranquilizers
and mood-altering drugs, they are at greater risk of alcohol/drug
interactions.
Combining drugs and alcohol can increase the effect of
alcohol; it can also change the effect of drugs and lead to coma
or death.
Psychological factors. For some older
people, alcohol seems the only alternative to a life filled with
loss and pain. Perhaps they used alcohol in the past to cope
with stressful times, so they turn to it again.
For others, growing old lowers self-confidence and causes
them to feel they are no longer useful. At first they may use
alcohol to elevate mood and mask depression, but a problem soon
develops if alcohol becomes necessary to cope with their lives.
Family and friends can help by recognizing the losses
the person experiences and being alert to changes in behavior.
Being realistic about the losses, assisting the person in working
through the grief process, and helping him or her develop alternative
activities may prevent alcohol problems.
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Recognizing an Alcohol Problem
Alcohol problems may not be noticed, especially if the
older person is isolated. In other cases, the signs are mistaken
for "normal aging" or the worsening of a health problem.
And often family, friends, and even professionals are reluctant
to consider alcohol as the cause of changes. Recognizing an alcohol
problem exists is the first step toward treatment and recovery.
Signs of an alcohol problem may show up as changes in
drinking patterns, behavior, or physical condition. Because physical
and behavioral changes can have many possible causes, a thorough
health assessment is essential. However, such changes combined
with changes in drinking patterns should alert you to the possibility
of an alcohol problem.
One sign is not necessarily meaningful, but a cluster
of changes without explanation is a "red flag." The
following checklists are designed to help you determine if you
have a "red flag" situation.
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Changes in behavior
Changes in behavior and physical appearance related to
alcohol are subtle and often overlooked by family and friends.
If you sense there are changes in behavior, use the checklist
below to verify the specific changes. Check the ones you have
noticed.
Neglects
personal appearance and hygiene
Neglects
home, bills, pet
Cigarette
burns on clothing, furniture, or sel
Excessive
use of perfume, mouthwash, breath spray, or breath mint
Erratic
sleep pattern
Increased
irritability, agitation, anxiety
Unreasonable
resentment
Appears
depressed
Loses
interest in activities and people
Neglects
eating--empty cupboard
Withdraws,
stays home
Calls
at odd hour
Recurring
episodes of memory loss and confusion
Frequent,
unusual, or neglected injuries
Bruises,
especially on arms and legs and at furniture height
Financial
difficulties
Slowed
thought processes
Withdraws
from social relationships
Suicidal
thoughts or attempts
Falls
asleep during conversation
Frequent
falls
Does
not answer telephone or door, neglects mail or newspape
Frequent
car accidents or erratic driving
Personality
change
"Nesting"
in front of television with a bottle nearby
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Guidelines for Family and
Friends
You may find it difficult to accept that your family
member or friend has a problem with alcohol. Although our society
condones and even promotes alcoholic beverages, for many people
there is still a strong emotional aversion to its use and abuse.
Recovery begins with the family. Helping the person requires
that you, the family or caregiver, help yourself--to understand
and accept the nature of the alcohol problem and your feelings
about it. You also need to look closely at your interaction with
the person. Many times the family must make changes before a
change will occur in the person abusing alcohol.
Coping with the behavioral, emotional, and physical changes
caused by alcohol abuse places great stress on the family. And
if the older person has had a long history of alcohol abuse,
you may be emotionally exhausted from years of coping.
Professionals agree, however, that the family is often
the key to successful treatment and sobriety. The guidelines
listed below will help you cope with the problem and assist in
the person's recovery. They are discussed in depth further in
this report.
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1. Recognize that alcoholism is a "family illness."
2. Get professional help.
3. Acknowledge and confront your own feelings and
fears.
4. Take action.
5. Explore treatment options.
6. Recognize the possibility of relapse.
7. Provide continued support.
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Recognize that alcoholism is a "family illness"
Alcoholism is often called a "family disease"
because it affects the entire family. It can be as damaging to
the family as it is to the alcoholic. For the alcoholic to get
well, the family also needs to get well.
Members of a family depend upon one another for mutual
love, care, support, and respect. An older person with an alcohol
problem who exhibits forgetfulness, irritability, or increased
physical problems--any of the behavioral or physical changes
resulting from abuse of alcohol--will disturb the normal, healthy
emotional relationships within a family. A person who neglects
home or self will usually neglect relationships.
Family members confronted with these changes in relationships
may react in a variety of ways--some helpful, others harmful.
Common reactions are uncertainty, denial, shame, fear, guilt,
anger, resentment, and hurt. These emotions often lead to increased
denial, "covering up" problems, or protecting the older
person.
Neither denial nor protecting the older person solves
the problem. Recognizing that a problem exists, learning about
alcohol abuse, and following through with help are actions necessary
for successful recovery.
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Get professional help
Reach out for help. This is critical
to ensure your behavior will encourage recovery and not contribute
to the problem. Talk with medical practitioners, alcoholism counselors,
and treatment center staff, especially those familiar with older
alcoholics.
Check your local library, community alcohol center, mental
health clinic, or senior services agency for literature on alcoholism.
Read and learn as much as you can about the disease and treatment
so you will understand how important you are to your loved one's
recovery.
Support groups--Al-Anon (for relatives and friends of
alcoholics) or Adult Children of Alcoholics (ACOA)--can be a
valuable source of educational information and emotional support.
They can help you understand and better deal with problems related
to a person's drinking.
Alcoholics Anonymous has open meetings which can be attended
by the general public. (Closed meetings are limited to AA members.)
Many communities also have programs designed specifically for
women, "Women for Sobriety." Check your local telephone
book for addresses and telephone numbers. Also check the community
calendar sections of local newspapers for notices of meetings.
Learn about the disease. Helping someone
come to terms with a drinking problem requires a knowledge of
the disease, combined with patience and understanding. One of
the difficult concepts for many people to accept is that alcoholism
and alcohol problems are a disease. However, viewing alcoholism
as a disease is essential in assisting the person to get help.
Until the 1950s, alcoholism was considered to be a "moral
weakness." Many people still believe that a person has ultimate
control over drinking--and that anyone who wants to can just
stop drinking.
This erroneous belief has serious implications for successful
treatment. People who hold this belief have difficulty saying,
"I'm an alcoholic," because to them it means "I'm
weak; I'm no good." This creates a tremendous amount of
shame and further decreases self-esteem. However, even those
who refuse to say they are alcoholics can still be treated successfully.
All they have to admit is that alcohol is causing them problems.
Medical researchers now know that alcohol interacts with
the body's systems in predictable ways to lead to physiological
addiction. They also have found that some people are more susceptible
than others to developing alcohol problems.
--Alcoholism is a disease--a chronic, progressive,
fatal disease if not treated.
Like many other diseases--for example, diabetes--alcoholism
follows a predictable course. And like diabetes, it cannot be
cured, but it can be treated and controlled. Without treatment,
the alcoholism will get worse.
The characteristics of a physiological dependence are
an increased tolerance for alcohol and the experience of withdrawal
symptoms when alcohol is stopped. When the person stops drinking,
he or she experiences definite symptoms such as headaches, excessive
thirst, night sweats, and tremors. The person soon learns that
more alcohol will "treat" these undesirable symptoms--creating
a dangerous, potentially fatal cycle.
Because of the nature of the disease, an afflicted person
cannot "just stop" drinking. Because alcoholism is
a disease, you are not responsible for the older person's problem--and
you cannot control his or her drinking. You must accept that
the person with a drinking problem is ill, so you can help the
person seek help.
Learn about the medical and physical consequences.
Recognizing that alcoholism is a disease is just
the first step. Learning about the medical and physical consequences
may strengthen your resolve to seek help. Older people are particularly
susceptible to the adverse effects of alcohol because their body
systems are already losing function through age-related changes.
Alcohol adds to the rate of loss of function.
Alcohol affects every body system. And alcoholism, if
not treated, can lead to premature death. For many older people,
understanding the potentially life-threatening consequences of
alcohol is a prime motivation to stop drinking.
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Effects of Heavy Drinking
Central nervous system
The central nervous system is especially sensitive to
the effects of alcohol. Alcohol accelerates the loss of brain
cells, impairing mental alertness, judgment, memory, physical
coordination, and reaction time. It increases the incidence of
falls and accidents in the home as well as on the highway.
The effects of alcohol on the nervous system are often
subtle and can be mistaken for senile dementia in an older person.
The person who already has impaired brain function (as a result
of Alzheimer's disease, for example) and abuses alcohol faces
devastating consequences. Over time, continued use can permanently
damage the central nervous system. But if diagnosed and treated
early, the deterioration can be arrested, and an older person
can regain mental alertness.
Because alcohol is a central nervous system depressant,
it can cause depression or intensify an existing depression.
The combination of alcohol and depression places a person at
higher risk for suicide.
Gastrointestinal system
Alcohol increases gastric secretions and decreases the
secretions of digestive enzymes in the pancreas. Excess stomach
acidity can cause heartburn, ulcers, gastritis, and intestinal
bleeding. In chronic, excess drinking, alcohol decreases gastric
motility, thus slowing down the digestive process.
Alcohol also increases the risk of cancer of the mouth,
throat, esophogus, and stomach.
Lungs
People with chronic pulmonary disease such as emphysema
or bronchitis are placed at higher risk by alcohol abuse. Excess
alcohol can interfere with the part of the brain that controls
breathing, causing respiratory failure and death.
Heart
Chronic heavy drinking increases the risk of heart disease.
The anesthetic effect of alcohol can also mask pain, which could
serve as a warning signal of heart problems. Alcohol can make
both high blood pressure and diabetes worse--two very common
risk factors for heart disease. High blood pressure that doesn't
respond to medication is often a signal of alcoholism.
Liver and kidneys
Alcohol adversely affects liver and kidney function and
interferes with the absorption, metabolism, and distribution
of nutrients. Only a few weeks of four or five drinks daily can
lead to fat accumulation in liver cells, a situation that returns
to normal when drinking stops. Excessive and continued use can
cause alcoholic hepatitis (inflammation and destruction of liver
cells) and cirrhosis (scarring and shrinking) of the liver.
Sexual functioning
Although some alcohol may remove inhibitions, larger
amounts decrease sexual interest and performance. Sexual impotence--the
inability to achieve or maintain an erection--is a common effect
of alcohol in males. Even a moderate intake of alcohol can lead
to lower levels of the male hormone testosterone and "feminization"
of the male body, including breast development.
Joints
The abuse of alcohol can greatly increase the inflammation
of joints caused by arthritis, thereby increasing the pain.
Sleep
As a person ages, sleep patterns change. Alcohol, often
used to"help sleep," actually increases sleep disturbances--insomnia,
frequent awakenings, restlessness, and night terrors.
Nutrition
Heavy drinking suppresses appetite. Together with its
effect on metabolism and absorption of nutrients, it increases
the likelihood of malnutrition. Alcohol and malnutrition can
cause confusion and impaired memory in an older adult, producing
symptoms that mimic senile dementia.
Drug and alcohol interactions
Prescribed medications and over-the-counter drugs can
intensify the effects of alcohol, leading to rapid intoxication.
Alcohol, taken with drugs, can lessen, intensify, or neutralize
the effect of medication. About 50 percent of all drugs older
people take can interact with alcohol. Some drugs, such as tranquilizers
or pain killers, taken with alcohol can lead to slowed mental
and physical processes. Alcohol combined with sleeping pills
can severly depress the central nervous system and even lead
to coma or death. Alcohol and insulin can cause a rapid lowering
of blood sugar. Even aspirin and alcohol can interact, causing
bleeding in the stomach and intestines.
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Acknowledge and confront your feelings and fears
Alcoholism triggers strong feelings in people. Helping
an older person who has a drinking problem means being honest
with yourself and with them. How you feel will determine how
you interact with the older person and how helpful you can be.
Your emotions are yours--they are real, they are okay.
Although you may not be able to change them, what you can do
is acknowledge those feelings--and change the way you act on
them. You do control your behavior.
Confront myths about alcohol. Confronting
myths about alcohol problems may help you clarify your feelings
and fears. Misconceptions about alcohol can be destructive and
prevent getting help for the person who has the problem with
drinking--and help for yourself.
Myths are barriers to identifying, intervening with,
and treating a person who needs help. Examine honestly and critically
the beliefs you hold. Confronting these beliefs, testing to see
if they are fact or myth, is crucial. Myths don't solve the problem;
they just make it worse. Remember, too, the person with the alcohol
problem may believe these myths to be fact.
Stop ignoring, denying, or feeling responsible. Because
of strong negative emotional reactions to alcoholism, family
members may ignore the problem. Families may assume behavioral
or physical changes in the older person are the result of senile
dementia or just a normal part of aging.
Sometimes, attitudes about the elderly in our society
lead to ignoring the problem. These may be expressed as "Who
is she hurting?" or "It's the only pleasure he has
left." At other times, the family may be afraid to confront
the older person, believing the person is too fragile or may
become angry.
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Taking medications
You can help prevent drug/alcohol interactions by encouraging
the older person to follow these simple precautions:
- Always make sure you understand directions. Ask the
doctor to clarify anything confusing.
- If you drink, ask your doctor or pharmacist if the prescribed
drug will interact with alcohol.
- Inform the doctor about all medications, including over-the-counter
drugs, you are taking.
- Find out if you should avoid certain foods while taking
the drug.
- Use a single pharmacist.
- Always store drugs in the original container.
- Never change the dosage without checking with your doctor.
- Always read the label:
- When picking up the bottle
- When opening the bottle and taking out the pill
- When replacing the cap
- Never share drugs with friends.
- Know how to store medications.
- Always tell your doctor about any adverse drug reactions.
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Myths About Alcohol
Myth: The alcoholic is a
street bum, down and out.
Fact: Only three percent of
alcoholics fit this stereotype. Anyone--rich, poor, young, old,
men, women--can develop problems with alcohol.
Myth: Alcoholism is a sign
of moral weakness. A person who drinks is a moral degenerate.
Fact: Alcoholism is a disease.
It's not a matter of willpower. A person becomes physically dependent,
ill, and cannot stop drinking without help. Like diabetes or
high blood pressure, the disease can be treated.
Myth: You can't teach an old dog
new tricks--older adults cannot be treated successfully; they
are too old to be helped.
Fact: Older adults, especially those who
begin drinking later in life, can be successfully treated. In
fact, they may have a better chance of recovery than younger
persons because they tend to stick with treatment programs.
Myth: Drinking is an older
person's last remaining pleasure. It's wrong to intervene. Fact:
Excess alcohol seriously impacts physical health
and quality of life, and it causes more psychological pain than
pleasure. It promotes, rather than reduces, loneliness, isolation,
or depression. People are much happier when they stop abusing
alcohol. Life can be better without alcohol.
Myth: Little old ladies can't
be alcoholics.
Fact: Although the stigma of
drinking is much harsher for women, they can and do have problems
with alcohol. Women may hide their drinking more and feel greater
shame and guilt. Physical differences may also lead to quicker
development of problems and serious health consequences.
Myth: Only people who drink
large quantities of alcohol on a frequent basis are alcoholic.
Fact: A person need not drink
large quantities frequently before developing significant problems--even
physical dependence. It's not the quantity of alcohol consumed
that is crucial in determining an alcohol abuse problem--it's
what alcohol does to the person.
Myth: Alcohol is good for
lifting a person's mood.
Fact: Alcohol is not an effective
mood lifter. As alcohol depresses the brain, a person may lose
his or her inhibitions for a short time. But this is soon followed
by irritability. Regular use of alcohol increases depression.
Myth: Alcohol helps digestion:
it's good for the appetite.
Fact: A very small amount of
alcohol does stimulate the appetite. However, in greater amounts
it does the opposite--it decreases appetite. A common result
is malnutrition. Alcohol contains many empty calories, which
cannot substitute for the nutrients needed to maintain health.
Alcohol also interferes with the digestive process.
Myth: Alcohol helps a person
sleep.
Fact: Alcohol is a sedative;
however, the effects are short-lived and are followed by periods
of irritability and agitation. Alcohol leads to increased sleep
disturbances.
Myth: A person has to want
to stop drinking or must "hit bottom" before he or
she can be helped.
Fact: One of the symptoms of
the disease is the inability of the addicted to recognize its
severity. Many people with an alcohol problem can be persuaded
to seek treatment through a process called intervention and the
support of others. Recovery is more likely with early intervention.
Early intervention can also prevent severe physical and psychological
complications.
Myth: Treatment is just stopping
drinking.
Fact: As is true with all chronic
illnesses, the person who suffers from alcoholism has to work
all the time at being well. Treatment and stopping drinking are
just very important first steps. Although sober, the person still
has the same illness. Recovery also involves learning alternate
ways of behaving in relation to feelings and situations.
Unfortunately, ignoring the problem doesn't make it go
away. The problem will continue and probably become worse.
It's particularly easy to deny an alcohol problem if
there are times when the person seems to have control over his
or her drinking. Denial also stems from embarrassment or shame
because of the associated social stigma. This approach is especially
prevalent when the person with a suspected problem is an older
women.
Denial is often strongest on the part of the older person.
Many older people are very proud. They expect to be able to handle
personal problems without seeking help. It's painful to admit
they have lost control. Drinking is a much stronger moral issue
for older adults, with a profound stigma attached to it. Denial
is a defense mechanism used to protect self-esteem and self-confidence.
Denying the problem has the same effect on the problem
as ignoring it.
Sometimes family members feel responsible for a relative's
alcohol problem. Perhaps you have felt "If I had loved him
more... If I had been a better child... If I had visited more,
he wouldn't have turned to the bottle." The resulting guilt
frequently prevents seeking help. Or sometimes, elaborate steps
are taken to control the person's drinking--dumping out bottles
or filling them partially with water to dilute the alcohol content.
It's important to realize you are no more responsible for a person's
alcohol problem than you would be if he or she suffered from
diabetes or cancer.
Stop enabling or protecting. Enabling
has a special meaning in relation to alcohol problems. It means
actions by people in the alcoholic's life that enable or allow
the person to continue drinking. It's the things we do that inadvertently
reinforce the person in his or her drinking. Actions that enable
and perpetuate the problem include providing alcohol, assuming
responsibility, covering up and making excuses, playing the role
of victim, and waiting until the older person is "ready."
Is anyone in the family providing alcohol to the older
person? Sometimes this is done out of the misguided belief that
"drinking is the only pleasure left," or "Grandma
needs a glass a day to keep her heart healthy."
More alcohol is never the way to help an older person
with a drinking problem. All family members must agree to stop
providing alcohol or money for alcohol to the person with a suspected
problem.
Children of an older person with an alcohol problem may
assume responsibility for household chores or financial management--any
number of tasks the person is neglecting. Such protection does
two things, both harmful. First, it allows the person to escape
responsibility for the consequences of his or her drinking. Second,
it can further reduce the person's self-esteem. And, because
of the psychological nature of the disease, this may lead to
more drinking to cover the emotional pain.
More subtle, yet still enabling behaviors include covering
up, making excuses, or shielding the person from the consequences
of his or her drinking. Calling to say "Mother was ill"
when she missed an appointment because she had been drinking
is an example of such behavior. Anytime you step in and protect
the person from the consequences of his or her drinking, you
are really allowing the drinking to continue.
Often, overwhelmed by the disease and by the changes
in the older person's behavior and personality, family members
react with resignation, disgust, hopelessness, anger, or blame.
They may yell and scream, "How could you do this to us?"
"If you loved us, you'd stop drinking." Faced with
such powerful emotions, the older person often feels alienated,
lost, and alone, and drinks more. A person with a long-standing
alcohol problem may have so alienated the family that he or she
has little support left.
It's hard to see the changes in a person; it's also hard
to accept that these changes mean a loved one has a problem with
alcohol. Keep reminding yourself that your loved one is ill and
can't control his or her drinking without help, just like he
or she couldn't control an illness like diabetes without the
help of insulin.
For a long time, it was believed a person with an alcohol
problem had to "hit bottom" before being ready for
help. Professionals now know that early intervention can be successful
and, especially for the elderly, can arrest the adverse physical
consequences of alcohol abuse.
Again, learning about the disease and talking to people
who have successfully coped will give you strength and hope for
the future.
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Take action
The right time to do something is when you suspect that
alcohol is a problem. It may take time to confirm this, to convince
other family members, and to convince the older person that a
problem exists and to accept treatment. But the sooner treatment
starts, the sooner life can begin to get better.
It's not easy to approach a person about an alcohol problem.
You will likely feel uncomfortable. You may fear the person will
become angry and hostile and will reject you. It may help to
know that the person who gets help usually does not turn against
the person who led him or her into treatment.
Try an intervention. One effective
method for helping someone see his or her drinking is a serious
problem is a process called intervention. In an intervention,
the person is confronted with the objective evidence of his or
her drinking and its effects in a caring, nonjudgmental, yet
firm manner. Support and a treatment plan are presented.
The goal is not to convince the person he or she is an
alcoholic. Rather, it is to convince the person that he or she
has a disease--one that is highly treatable. For many older adults,
the motivation to accept help comes from knowing that others
recognize something is wrong and are willing to help. They help
rather than blame or excuse their behavior.
There are both informal and formal interventions.
Informal interventions may simply be
an objective statement, presented in a kind and caring manner,
after drinking behavior has been noticed and when the person
is sober.
"Mom, I'm really concerned. The last several
months, every time I've come over after dinner, you've been sitting
in the front room with a glass of wine. Last night, you staggered
and fell when you got up. I'd like to talk about this with you.
I've talked with a treatment specialist and I would like you
to talk to him, too, about alcohol use and its effects."
The nature of the disease, however, makes it likely that
the person will minimize the amount of drinking and will deny
a problem exists. In such instances, a formal intervention may
be necessary.
A formal intervention is a carefully planned and
staged meeting in which the person who has an alcohol problem
is confronted with the effects of his or her drinking. Prior
to the intervention, meetings are held with the family to prepare
them for the process, deal with any negative personal feelings,
and discuss how to handle potential roadblocks to treatment.
It's best if an alcohol intervention specialist leads
the intervention process. A professional can ensure the intervention
is positive and that family members remain factually honest in
presenting information and don't become overly emotional, attack
the person, or back down. The professional can also validate
the feelings of everyone, for example, "your daughter must
love you a lot to risk offending you."
An intervention can be either a full-scale or
a mini-intervention. In a full-scale intervention,
many people significant in the person's life (family, close
friends, neighbors, clergy, and/or employer) gather together
and meet with an alcohol intervention specialist. Each person
is coached and rehearses what he or she will say to the drinker.
The group also agrees on what action they will ask the person
to take. At the appropriate time, the group meets with the drinker.
The person is asked to listen until everyone has spoken. Each
family member, in a caring way, expresses concern about the person's
well-being and describes specific situations he or she has observed
while the person was drinking. Then they ask the person to seek
treatment.
Some alcohol intervention specialists recommend first
trying a mini-intervention with older people. It is similar
to the full-scale intervention except it involves only one, or
at most two, close family members, plus the counselor. The family
member expresses his or her concerns and some facts about the
drinking situation to the older person. The counselor then suggests
the older person enter a program to gain additional information
about alcohol use in order to make a more informed decision about
whether there is a problem and the best course of action to take.
An intervention can also be conducted by the counselor without
the family.
The mini-intervention tends to be less threatening to
an older person's sense of self-worth and avoids potential damage
to family relations which the full-scale intervention risks.
Although all family members can benefit from learning that alcoholism
is no one's fault and that it is truly a disease, one or two
family members are often enough to carry out a successful intervention.
This method prevents embarrassing the older drinker in front
of everyone.
Intervention usually works. However, no one should attempt
an intervention without a thorough knowledge of the process.
Many treatment centers and alcohol counselors will teach families
about the process and will help them plan and rehearse an intervention.
If such services aren't available in your community,
read and learn all you can. Committed families can lead successful
interventions by themselves; however, it's still important to
consult a professional beforehand. An excellent resource is Intervention:
How to Help Someone Who Doesn't Want Help by Vernon E. Johnson,
the developer of the intervention process.
Involve other people. Involve others--family,
friends, clergy, doctors--who care about the older person, have
seen problems resulting from alcohol use, and are open to learning
about alcohol problems. They should also be willing to maintain
a caring, nonjudgmental, objective approach. Anyone who believes
alcohol problems are a moral weakness should not be included
in an intervention. The older person must sense and believe that
the people participating in the intervention really care.
Involving others is especially important if you live
at a distance. Locate a resource in your community for your own
education and understanding. Visit the older person at once and
develop a local support system. Consider nearby friends and relatives,
professionals, and social service providers. Remain in frequent
contact with the older person and the network of helpers.
The combined care and concern shown in a group effort
can have a powerful effect.
Gather information. To be most effective
in an intervention, you must gather beforehand specific information
about the older person's drinking behavior, negative changes
in behavior, and treatment options available. Look for specific
examples of times when drinking caused problems. You may want
to focus on the extent and frequency of drinking as well as the
consequences.
Talk to others who have observed the older person. Discuss
the problem with the person's physician and arrange for an overall
health assessment to determine physical and medical consequences
and to confirm that alcohol is the problem. The physician can
often get the person into treatment by sharing information about
the medical consequences of drinking.
Have treatment options available to discuss with the
older person. Check your telephone directory for local alcoholism
treatment centers; call your local mental health clinic or senior
center for referrals. Visit the treatment centers or programs
and gather brochures to give to the older person. You may even
want to make an appointment for him or her.
Remain caring, supportive, and objective. Focus
on the behavior, not the person. In a caring way, express your
concerns about the impact the person's drinking is having on
his or her health, behavior, and relationships. However, avoid
scare tactics.
It's important to keep comments current and not dredge
up instances from the past. When talking about incidents, acknowledge
how difficult it is to talk about them. Begin with positive statements.
Use "I" statements and be as specific as possible.
The following are some comments family members have used to express
their love and concern.
"The grandkids love to come over to visit. But
last week you had been drinking. When Billy asked why you smelled
'funny,' you yelled at him."
"Dad, I love you and I don't want to lose you.
The doctor says that if you continue drinking..."
"The neighbors called. They're worried, and I'm
worried, because you seem withdrawn and seldom go out anymore."
Instill a sense of hope. Remember the
person's strengths and build on them. Identify positive reasons
for the person to stop drinking. Let the person know that life
can be better without alcohol, that help is available, and that
you will provide support.
"Dad, the doctor says that your memory will get
better once you stop drinking, and you'll be able to finish the
family history. I love you and will help you."
Avoid moralizing or making judgmental, blaming, punitive
statements. They don't help and will likely only create defensiveness
or hostility.
No matter how well-prepared, supportive, or loving you
are, the older person may resist and resent any suggestions that
he or she is drinking too much. Expect anger. Anticipate denials
and excuses; you've probably heard them before. Be prepared to
respond to them courteously and firmly, without blaming, giving
up, or backing off.
Respect the older person. Loss of self-esteem
and self-confidence and feelings of self-hate, guilt, and remorse
are common among older persons with alcohol problems. You can
show your respect and enhance self-worth in subtle ways.
When approaching the person, emphasize the person's ultimate
freedom of choice and responsibility for his or her decisions
and actions. Generally, when the person feels respect rather
than blame, resistance and denial will decrease. Because of the
profound social stigma many older persons feel about alcoholism,
use terms such as "alcohol problems" or "problem
with drinking" rather than "alcoholism," "alcoholic,"
"drunk," or "lush." Rather than knocking
down the person's defenses, emphasize the disease/health concept.
Urge the person to learn more about alcohol problems
and to make his or her own decision about whether or not he or
she has a drinking problem. Give him or her a choice about how
he or she might get help to stop drinking. If the person chooses
not to stop drinking, even after a formal intervention, you will
need to accept this decision unless he or she is clearly a danger
to self and others. Accepting this decision, however, doesn't
mean you have to like it.
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Explore treatment options
Alcohol treatment programs vary in their environment,
methods, and level of services. Treatment/recovery programs include
long-term residential centers, short-term inpatient programs,
out-patient programs, and support groups. Programs are run by
hospitals, including the Veterans' Administration, mental health
clinics, private rehabilitation centers, and self-help support
groups.
Long-term residential programs. The
person is admitted to a specially designed program for 3 to 9
months or sometimes longer.
Short-term in-patient programs. The
person is admitted to a hospital or clinic for 10 to 30 days.
Out-patient programs. The person lives
at home but attends regularly scheduled activities, often daily.
Support groups. The person attends
meetings with other people who have a similar problem for mutual
education, information, and support. Alcoholics Anonymous is
the prime example of this approach.
Unfortunately, few treatment programs deal specifically
with older persons. More are being established, however, as professionals
recognize how the physical, psychological, and social needs of
the older person may differ from younger drinkers.
You will need to assess existing programs within the
community to determine whether they are appropriate. Answers
to these four questions will help determine the most effective
approach.
- What is the physical condition of the older person?
Severe medical complications may indicate a need
for hospital-based detoxification prior to beginning a treatment
program.
- How long has the person had a drinking problem? If
the person has a long history of drinking problems, talking about
past educational/treatment experiences may help in making new
treatment plans that will work. If the alcohol problem developed
recently, medical problems may be less severe and social support
systems still strong.
- What support system is available to the person? The
person who does not have support from family and friends will
benefit most from a treatment program that provides support during
and after treatment.
- What financial resources are available? The
person's financial resources will determine treatment options.
Insurance may or may not cover treatment and if so, possibly
for only a limited time. Medicare coverage is limited to hospital-based
treatment.
Evaluate and select a treatment program. Visit
and talk with staff about their program and about the older person's
problems. Here are some suggested questions to help select a
program.
- Does the program recognize and respect the special
needs of older people? Many programs are not designed
specifically for the older person with alcohol problems. The
person with a life-long alcohol problem is likely to have no
family support and significant medical problems. With people
whose drinking problem started late in life, it's particularly
critical that treatment focuses on age-related losses and stresses.
Programs geared to the older person often modify educational
activities, considering the failing hearing and vision associated
with aging. - What are the staff 's attitudes? Does the program
use a supportive approach? Look for positive and
considerate staff. Unfortunately, ageism (negative attitudes
toward the elderly) is prevalent in our society, even among treatment
professionals. The staff must be optimistic and positive; they
must believe that older people can be successfully treated, and
they must be sensitive to the special needs of older adults.
Avoid programs that use an intense, confrontive, belittling approach.
- Does the program take into consideration that older
persons recover more slowly? Detoxification can
take longer for the older person. Withdrawal may need to be closely
monitored. Less intensive, longer-term follow-up programs are
recommended to help the person achieve and maintain recovery.
- Does the program emphasize social activities? Loneliness
and isolation mark the lives of many older persons. Rebuilding
social networks is a key to recovery, so treatment should emphasize
social therapy. Groups play a vital role in providing a new source
of social support and an avenue for building self-esteem. Involving
the family in treatment and therapy helps rebuild the social
support system.
- Does the program use peer groups of older persons? Sharing
experiences with others who have similar values and experiences
can lead to meaningful insights. The older person learns that
he or she is not alone and gains strength and support from others.
Group participation can be particularly important for the socially
isolated person.
Older people are often reluctant to talk about their feelings,
especially in a group of mixed ages. Many also have a distaste
for profanity, which may be used by younger people in treatment.
In general, older people need to work through age-related issues
such as loss and grief. These issues are often much more easily
dealt with in a peer group; however, same-age peer groups are
not always necessary or available. A particularly critical time
for group involvement appears to be in the out patient after-care
or follow-up component of treatment.
- Does the program involve the older person in treatment
planning? Listening to and respecting the older
person's wishes and ideas can help maintain pride and self-esteem.
It gives a measure of control and a sense of responsibility for
the future.
- Is the program accessible to the older person? Older
people often prefer daytime hours for out-patient classes and
follow-up programs. Ideally, a treatment program should be accessible
via public transportation and to people with physical limitations.
- Does the program look at the whole person? Effective
treatment programs consider the older person's health, nutrition,
social support, financial, legal, and spiritual situations. The
staff should recognize that the older person may need homemaker,
chore service, meal preparation, or other assistance during follow-up
or out-patient treatment.
- Does the program provide long-term after-care? What
happens after treatment is as important as treatment itself.
Programs that offer support and follow-up increase recovery success.
The symptoms of the disease don't stop just because the person
has stopped drinking. Relapse can occur with anyone who has an
alcohol problem, but is more likely for those who do not participate
in some type of structured follow-up program.
Recovery is ongoing and truly "one day at a time."
Recovery means learning to live again without alcohol.
After-care or follow-up may include referral to Alcoholics
Anonymous for the older person and Al-Anon for the family. Some
treatment programs include special family meetings to mend and
build relationships and to improve communication.
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Recognize the possibility of relapse
Sometimes relapses occur, even when a person is committed
to recovery. A person may take a drink after being sober for
several months thinking he has been cured or can now handle alcohol.
A relapse means only a temporary setback, not failure.
It doesn't mean the treatment or the person has failed. Don't
give up. More than ever, the person will need support and encouragement.
Condemning the person or feeling responsible for his or her relapse
will not help.
Although it's discouraging to see a person return to
drinking, such relapses are not necessarily repeated. And they
often serve as a valuable lesson for the person. A relapse frequently
helps a person to accept that abstinence is necessary because
of his or her powerlessness over alcohol. As one person said,
"I learned the problem was the first drink...not the last
drink."
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Provide continued support
Continued support is essential. It may be easy to provide
support if the older person recognizes the need for, and willingly
enters, a treatment program. You can attend group and family
meetings and enjoy your new life together as you all work together.
But if the person strongly denies that a problem exists
and resists seeking help or returns to previous drinking patterns,
do not give up and do not ignore the problem. Support is still
important. Continue to present facts in a caring, concerned way.
Tell the person how you think the situation is affecting him
or her and how it affects you. Let the person weigh the evidence.
Wait a while, then reapproach the person or have someone
else who has influence talk with him or her.
If the person continues to resist and persists in drinking,
you may have to threaten to withdraw support. Support can be
any benefits provided or controlled by the family. It can include
spending money, transportation, shelter, time, or attention.
You withdraw support to allow the person to experience the consequences
of his or her drinking. Sometimes it takes a crisis before help
is accepted. Become involved again at the moment of crisis.
If the drinking persists and causes danger to the person
or to others, you may consider obtaining guardianship or civil
commitment.
In these situations, it's important that the family get
help and support. You must accept that no one can force
anyone else to stop drinking. Sometimes when you've done all
you can, you need to walk away and take care of yourself.
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Conclusion
The older person who has a drinking problem can recover
and learn to live a life free of alcohol. However, it's unrealistic
to expect the person to get help on his or her own, although
a few do. Because the person usually cannot recognize his or
her need for help, it's up to family and friends to intervene.
The earlier treatment begins, the greater the chance for recovery.
Resources
Local services
Look in the telephone book under "Alcoholism Information
and Treatment Centers." In the section "Community Services
Numbers," look under "alcoholism."
Alcoholics Anonymous, Al-Anon, Al-Ateen, and Adult Children
of Alcoholics, self-help support groups for persons affected
by alcohol, often list meeting times and places in the local
newspaper.
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Prepared by Vicki L. Schmall,
Extension gerontology specialist emeritus; Corrine L. Gobeli,
graduate assistant; and Ruth E. Stiehl, professor of education;
Oregon State University.
Reprinted
November 1998.
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