As a society, we share a complicated history with alcohol. During the latter part of the 19th century, politicians, women’s groups, and churches came together to convince legislators to ban alcohol. In 1919, the United States Congress passed the 18th Amendment, which made the sale and distribution of alcohol illegal. Alcohol consumption decreased, 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 EM Jellinek reported that the 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 a disease.
In 1980, the 3rd American Psychiatric Association’s Diagnostic and Statistical Manual refined the definition of alcoholism by differentiating between alcohol abuse and dependence. However, people continue to use the term “alcoholism” when talking about all forms of “drinking problems,” when in reality alcoholism and abuse have specific clinical definitions. Alcoholism, also known as alcohol dependence, is a chronic, progressive, and life-threatening disease. The symptoms are: frequent excessive drinking, inability to control drinking despite medical, psychological or social complications, increased tolerance to 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 even though it causes the person to neglect important family and work obligations. However, abuse, if left untreated, can turn into 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 legal problems related to alcohol use.
The National Institutes of Health (NIH) estimate that in 1998, alcoholism cost society $ 184.6 billion in lost productivity, medical care, legal services, and traffic accident costs. 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 that even fewer seek treatment for 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 many of the alcohol-related treatment admissions among older adults are for the first time.
Recent studies indicated that between 1.1 and 2.3 million elderly people consume alcohol to relieve pain 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 age, mainly due to poor health or reduced social activities. However, society has begun to recognize that the incidence of alcoholism among older people is on the rise. Despite the numerous studies that are being conducted on this topic, it is difficult to find reliable statistics on older alcoholics today. However, some research has suggested that between 10% and 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 they were even perceived a decade ago. It is also clear that the average individual’s response remains dedicated to treating their symptoms briefly and directly, rather than getting to the core of drinking and treating alcoholism. The family doctor is undoubtedly the person most likely to identify alcoholism in an elderly patient, whose social and family isolation is relatively common. However, the doctor is often faced with denial of the problem, by the patient and especially the family. One reason may be because the effects of alcoholism can mimic those of aging. Making the diagnosis of alcoholism difficult because many symptoms, including aches and pains, insomnia, loss of sex drive, depression, anxiety, memory loss, and other mental problems, are often mistaken for normal signs of aging or the side effects of medicines.
Another concern is that too often when families or professionals try to get help for their loved ones, identifying a drinking problem can be difficult. For example, many of the criteria necessary to make a proper 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, focuses on the biomedical, psychological or social consequences.
Although the prevalence of alcohol consumption and alcohol 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 over 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 mentioned above, alcoholism in the elderly is often difficult to diagnose, especially since health problems due to alcohol can be attributed to old age. In addition, in the case of alcoholism, elderly patients, who take 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 might call it a love-hate relationship with our senior population. As a result, some people tend to ignore or avoid older people with drinking problems. For example, to ease our own internal conflicts, we say things like “After all, you are not hurting anyone. Enjoy the time you have left … Who cares?” Often times, the therapist may be reluctant to work with older alcoholics due to unconscious countertransference problems. 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 like they are wasting time working with these people. However, researchers studying the science of aging understand that these myths, assumptions, and stereotypes are unproven and are often harmful to older people who may benefit from proper treatment or intervention.
The last few years do not have to be a time of loneliness, depression or a life of alcoholism. Many people find happiness and even adventure in their later years. Those who age successfully tend to have a strong sense of achievement in life, high self-esteem, and a positive attitude. Older people who achieve a sense of ego integrity can view their past history with a sense of satisfaction. While older people who look back regretfully and believe that it is too late to make significant changes may experience a sense of despair and depression.
Those who successfully age can adjust to the loss of a spouse and other important relationships, adjust to retirement and reduced income, accept and appropriately treat deteriorating health, and participate in establishing satisfactory living arrangements.
Unfortunately, not everyone ages successfully. Some people cannot accept the physical changes that come with old age. Others cannot handle the loss of their spouse or friends, or find it difficult to adjust to retirement. And too often, many of these people turn to alcohol.
Many of these people have never had a drinking problem before this time 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 history of successful problem management.
On the other hand, early-onset alcoholics are those individual drinkers who have been drinking heavily for many years. As a result, they may have a harder time recovering from health complications from years of heavy alcohol abuse.
Lastly, 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 give them strength and support in overcoming drinking problems. While other older people feel that these groups are stigmatizing and find it more comfortable to seek the support of their older peers in programs for older people. What is important to know is that the most effective programs treat the “whole person”, ensuring that 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.