Alcohol abuse and the elderly: the hidden population
As a society, we share a complicated history with alcohol. During the latter part of the 19th century, politicians, women’s groups, and churches banded together to convince lawmakers to ban alcohol. In 1919, the US Congress passed the 18th Amendment, making the sale and distribution of alcohol illegal. Alcohol consumption decreased but did not prevent illegal use and distribution. Prohibition ended in 1933, and as a result, millions of Americans have made alcohol an important part of their social activity. In the 1960s, the researcher EM Jellinek reported that excessive and abusive consumption of alcohol was a disease. Within 10 years, a public effort was launched in the United States to educate people that alcoholism was a disease.
In 1980, the American Psychiatric Association’s Diagnostic and Statistical Manual 3 refined the definition of alcoholism by differentiating between alcohol abuse and alcohol dependence. Yet people continue to use the term “alcoholism” when talking about all forms of “problem drinking,” when in reality alcoholism and abuse have specific clinical definitions. Alcoholism, also known as alcohol dependence, is a chronic, progressive, and life-threatening disease. Symptoms include frequent excessive drinking, inability to control alcohol intake despite medical, psychological, or social complications, increased tolerance for alcohol, and severe withdrawal symptoms when the person stops drinking.
On the other hand, alcohol abuse is a chronic disease in which the individual refuses to stop drinking despite the fact that this causes the person to neglect important family and work obligations. However, abuse, if left untreated, can turn into a dependency. The symptoms are: drinking when it is dangerous (drinking and driving), frequent binge drinking, interpersonal difficulties with family, friends, and co-workers caused by alcohol, and alcohol-related legal problems.
The National Institutes of Health (NIH) estimates that in 1998, alcoholism cost society $184.6 billion in lost productivity, medical care, legal services, and costs from traffic accidents. However, these statistics do 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 want 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 face it head on. Health care providers tend not to ask older patients about alcohol use if it was not a problem in their lives in previous years. This may explain why so many alcohol-related treatment admissions among older adults are for the first time.
Recent studies indicated that between 1.1 and 2.3 million seniors consume alcohol to alleviate grief and loneliness. What has been called the “invisible population” is now being discovered and measured. Most people tend to restrict their alcohol consumption as they get older, mainly due to health problems or reduced social activities. However, society has begun to recognize that the incidence of alcoholism among the elderly is on the rise. Despite the numerous studies being done on this subject, it is hard to find reliable statistics on today’s older alcoholics. However, some research suggests that 10-15% of health problems in this population may be related to alcohol and substance abuse.
One fact is clear: alcohol-related problems among the elderly are far greater than was perceived even a decade ago. It is also clear that the response of the average individual remains dedicated to treating their symptoms briefly and directly, rather than getting to the core of the drinking behavior and treating alcoholism. The general practitioner is undoubtedly the person who has the best opportunity to identify alcoholism in an elderly patient, whose social and family isolation is relatively common. However, the physician is often faced with denial of the problem by the patient and especially the family. One reason may be that the effects of alcoholism can mimic those of aging. Make it difficult to diagnose alcoholism because many symptoms, including aches and pains, insomnia, loss of sexual desire, depression, anxiety, memory loss, and other mental problems, are often mistaken for normal signs of aging or side effects of medications.
Another concern is that all too often when families or professionals try to get help for their loved one, identifying a drinking problem can be difficult. For example, many of the criteria necessary to make the correct diagnosis of alcoholism are more appropriate for younger abusers. These traditional criteria may not be appropriate for older people who may be more isolated or lonely, less likely to drive, and more likely to be retired. In fact, some researchers suggest that the diagnosis of alcoholism, for the elderly, focus on biomedical, psychological, or social consequences.
Although the prevalence of alcohol consumption and abuse decreases with age, alcoholism in the elderly remains a major public health problem. It is an increasingly important concern because the elderly are the fastest growing population today and this trend is expected to continue well into the next decade. There are two forms of alcoholism that can be distinguished in the elderly: alcoholism that begins before age 65 and continues, and alcoholism that begins after age 65. As noted above, alcoholism in the elderly is often difficult to diagnose, especially since health problems due to alcohol can be attributed to old age. Furthermore, in the case of alcoholism, elderly patients, who are taking multiple medications, are at increased risk of drug/alcohol interactions, especially with tranquilizers and sedatives.
At the beginning of this article I suggested that Americans have a complicated relationship with alcohol. Well, to some extent, the same can be said for society’s relationship with its senior citizens. In America we often don’t value our seniors, we send a double message, some may call it a love hate relationship with our senior population. As a result, some people tend to ignore or avoid older people who have a drinking problem. For example, to ease our own internal conflicts, we say things like, “After all, they’re not hurting anyone. Let them enjoy the time they have left… who cares?” Often the therapist may be reluctant to work with older alcoholics due to unconscious countertransference issues. For example, the elderly client triggers the therapist’s own fears about aging. Older clients are often accused of being rigid and not wanting or being able to change. In which case, therapists may feel that they are wasting their time working with these individuals. However, researchers studying the science of aging understand that these myths, assumptions, and stereotypes are unproven and often harmful to older people who may benefit from appropriate treatment or intervention.
One’s later years do not have to be a time of loneliness, depression, or a lifetime of alcoholism. Many people find happiness and even adventure in their later years. Those who age successfully tend to have a strong sense of accomplishment in life, high self-esteem, and a positive attitude. Older people who achieve a sense of ego integrity can look back on their past history with a sense of satisfaction. While older people who look back with regret and believe that it is too late to make significant changes may experience a sense of hopelessness and depression.
Those who age successfully can adjust to the loss of a spouse and other important relationships, adjust to retirement and reduced income, accept and deal appropriately with declining health, and participate in establishing satisfying living arrangements.
Unfortunately, not everyone ages successfully. Some people cannot accept the physical changes that come with advancing age. Others can’t handle the loss of a spouse or friends, or find it difficult to adjust to retirement. And all too often, many of these people turn to alcohol.
Many of these people had never had a drinking problem before this point in their lives. This is called late-onset alcoholism. The bad news is that this type of alcoholism can go unnoticed. The good news is that people with late-onset alcoholism have a much better chance of recovery. This is mainly because these people have a track record of successfully handling problems.
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 a harder time recovering from health complications from years of excessive alcohol abuse.
Finally, older alcoholics have a wide range of treatment options. After detoxification, when necessary, the elderly client may receive additional treatment from inpatient programs, day treatment, outpatient therapy, or community groups. Completion rates appear to be modestly better for senior-specific alcohol treatment programs compared to mixed-age programs. Some older people find that Alcoholics Anonymous (AA) meetings offer them strength and support in overcoming drinking problems. While other seniors feel these groups are stigmatizing and find it more comfortable to seek support from their peers in senior programs. What is important to know is that the most effective programs treat the “whole person,” making sure their health, housing, financial, and social needs are met. This is a major concern because late-onset alcoholism is often associated with stress, isolation, loss, and loneliness. Therefore, effective substance abuse treatment for the elderly must address these underlying problems.
