Co-authored with Nicole MacFarland, Ph.D
Excessive drinking can be a problem for older adults. The most common estimate is that a bit over 15 percent of older adults drink more than is advisable. Unfortunately, the drinking problems of older adults often go unnoticed because usually they don't look like the drinking problems of younger people. Yes, there are older adults who are full blown alcoholics or who get drunk and behave badly in public. But older adults with drinking problems are more likely to live and drink in isolation. In addition, they do not tolerate alcohol as well as younger people. It does not take as many drinks for them to become dangerously intoxicated and at risk for automobile accidents and falls even when they appear not to have had that much to drink. In addition, the symptoms of excessive drinking may be indistinguishable from symptoms of depression or cognitive impairment. As a result, excessive drinking may be neglected as a significant cause of such problems as declining memory and decreased pleasure in life.
For example, Maude, who was widowed at 77, continued the custom she shared with her husband of having a cocktail or two every night. But now she was alone. One or two drinks became three or four. She often fell asleep without dinner, woke up and had another drink to help her sleep. One night she fell on her way to the bathroom and broke her hip. It was the beginning of the end for her.
Or, Edward, who retired from his position as a school custodian many years before his wife was ready to retire herself. Having no work and being home alone depressed him, and he began to drink earlier and earlier every day. He had two car accidents before he and his wife realized that he had become an alcoholic and needed help. He was fortunate and benefitted from a good rehabilitation program and from ongoing treatment when he returned home.
Or, Jennifer, who enjoyed the company of many friends, with whom she shared several glasses of wine when they got together. As she got older, she did not drink more, but it affected her more and she became argumentative and nasty. Over time, her friends avoided her. She drank alone more and more. It was a vicious cycle. The more she drank the more isolated she became. The more isolated she became, the more she drank.
These are just three examples of excessive drinking in old age, none of them easy to recognize.
What are the signs and symptoms of excessive drinking?
As with all mental and substance use disorders, the most important sign of a problem is a significant decline in basic functioning at work, within the family, or in social relationships. Specific signs include:
• Neglect of important tasks
• Decreased reliability
• Increasing procrastination and ineffectiveness at work and home
• Difficulty making decisions or becoming impulsive
• Increasingly forgetful
• Increasingly moody
• Increasingly irritable and unpleasant
• Slurred speech
• Slowed and impaired thinking
• Increased isolation
• Loss of interest in previously fulfilling activities
• Driving while intoxicated
• Unsteadiness walking
• Falls and accidents
• Unexplained injuries
• Declining health
• Declining personal hygiene
• Lack of attention to nutrition
If you see these signs and symptoms in yourself or in someone you care about or in a patient, take them seriously. Drinking problems can be very dangerous, even fatal.
Obviously, all of these signs and symptoms of excessive drinking can also be symptoms of other substance use disorders, depression, and early stage dementia. Distinguishing the primary cause of these symptoms and identifying co-occurring disorders can be difficult and may require professional help.
But there is one key step to take -- ASK ABOUT DRINKING. Often people with drinking problems are not ready to acknowledge that they may be drinking too much. They also may not be forthcoming about how much they drink. But asking is the first step.
There are also screening tools that doctors can use, and increasingly doctors are being trained in motivational interviewing, which helps them elicit honest answers from their patients so that the process of treatment can begin quickly.
How Can You Get Help For Yourself or Someone You Care About?
There are quite a number of interventions that can be helpful for people with drinking problems. Some are residential; some are outpatient. They include: detoxification, rehabilitation, counseling, and self-help groups such as Alcoholics Anonymous.
A primary care physician is a typical starting point, although often they do not have expertise in mental or substance use disorders. Emergency rooms may also be a useful starting point, especially if they have developed programs known as SBIRT (Screening, Brief Intervention, and Referral to Treatment). Some communities have programs that provide outpatient treatment and rehabilitation as well as private practitioners who specialize in substance use disorders, including alcohol abuse.
If you are lucky, there may be helpful information and a referral service in your community.
Or contact the national mental health and substance abuse helpline at 1-800-662-HELP (4357).
Drinking in old age can be a source of pleasure and is not necessarily a problem. But for those older adults for whom it is a problem, it is dangerous and needs to be faced head on. Easier said than done, of course. But it can be done, and the outcome can be very beneficial.
(Nicole MacFarland, Ph.D., is the Executive Director of Senior Hope Counseling, Inc., the only outpatient, non-intensive, free-standing, state licensed outpatient clinic in New York State catering exclusively to the 50+ population that struggles with addictions. For information call 518-489-7777 or visit www.Seniorhope.org)