Alcohol and the elderly

alcohol and the elderly

Age-specific treatment

Alcohol presents more complications as people age: there are more falls and injuries; alcohol’s effects on memory are often mistaken for Alzheimer; older people take medications that interact poorly with alcohol; alcohol worsens the physical problems of old age; because the liver is usually damaged from years of drinking, it doesn’t take near as much alcohol to get an older person intoxicated.

In treatment we’ll often hear from an older person that they have cut down on their drinking, so they don’t know why the family is so concerned. The older drinker hasn’t really cut down, it’s just that it doesn’t take as much alcohol to get the same effect.

Most older alcoholics don’t seek treatment, although there will soon be millions of baby boomers who need treatment for alcoholism. The problem will likely be alcohol plus other mood-altering, addictive medicine. This is another reason older people have a hard time realizing they have a problem — the mood-altering medicine they take reduces their alcohol intake even more, but the combination can still be debilitating. Often alcohol enhances the effects of mood-altering medicine.

I’m not sure what it will take to get older people into treatment. It won’t be so easy to write off all the complications as old age problems when people start living longer into their 90s and beyond. There’s a lot of time living with an alcohol problem from 60 to 90, that is if alcohol doesn’t cause a premature death. The main issue, though, is quality of life. Knowing what we know about alcoholism, it’s not as if the older person is having a party every day in retirement. Alcoholism is a painful and debilitating disease that strips a person of dignity and self-esteem — it creates broken relationships and puts enormous strain on families. Dying from alcoholism in old age is one of the worst endings to life I can imagine. Life doesn’t have to end like this.

The treatment field might have to respond by creating senior-specific treatment facilities. Older people don’t relate to younger people in group therapy as well as they relate to people their age.

The problem of alcohol and the elderly will also become very costly as physical complications from alcohol use fester for years. Healthcare professionals will have to identify alcohol problems earlier and deal with the problems in much more solution-oriented ways. There’s been a tendency to let older people have their vices, but as we all live longer and longer, I don’t think the problems caused by alcohol in the later years can be ignored.

Alcohol and other drug addictions

alcoholbrainFor a long time now alcoholism has been treated as a chronic, progressive disease by properly trained  professionals. There is really no legitimate debate over alcoholism as a disease, and there is no longer a debate regarding the similarities between alcoholism and other drug addictions. Science is learning more and more about the neurobiological changes in the brain caused by long term use of various drugs, including alcohol. Because most people can drink normally and don’t take mind-altering drugs, they have little need to understand addiction. However, addiction affects a great number of people, and their addiction problem affects those close to them, so it’s a good thing to gain more knowledge regarding addiction. It’s amazing that many people still perceive addiction as a moral failing or a lack of will power, character or fortitude. Here is an excerpt from William L. White’s book, Recovery Management and Recovery-oriented Systems of Care: Scientific Rationale and Promising Practices:

Severe alcohol and other drug dependencies share many characteristics with such chronic diseases, particularly with 2 diabetes mellitus, hypertension, and asthma. All of these conditions, including alcohol and drug dependence:

• are influenced by genetic heritability and other personal, family, and environmental risk factors;

• can be identified and diagnosed using well validated screening questionnaires and diagnostic

   checklists

• are influenced by behaviors that begin as voluntary choices but evolve into deeply ingrained

   patterns of behavior that, in the case of addiction, are further exacerbated by neurobiological

   changes in the brain that weaken volitional control over these contributing behaviors;

• are marked by patterns of onset that may be sudden or gradual;

• have a prolonged or permanent course that varies from person to person in intensity (mild to

   severe) and pattern (from constant to recurrent);

• are accompanied by risks of profound pathophysiology, disability, and premature death;

• have effective treatments, self-management protocols, peer support frameworks, and similar

   remission rates, but no known definitive cure;

• often generate psychological responses that include hopelessness, low self-esteem, anxiety,

   and depression; and

  • Generate excessive demands for adaptation by Families and intimate social networks,

Care must be taken in conceptualizing addiction as a chronic disorder, so that this does not
constitute a professional euphemism for “Once a junkie, always a junkie.” Communications about addiction as a chronic disorder need to contain the following key elements.

• NOT all AOD problems are chronic—most do NOT have a prolonged and progressive course—

   but some do, and research is needed to identify early signs of chronic progression.

• NOT all persons with AOD problems need specialized, professional, long-term monitoring and

   support—many recover on their own and/or with family or peer support; again, research is

   needed to identify who is most likely to need intensive, professional care.

• Among those who do need treatment, relapse is NOT inevitable, and NOT all persons suffering

   from substance dependence require multiple treatments before they achieve stable, long-term

   recovery.

• Even with those who do relapse following treatment, families, friends, and employers should

  NOT abandon hope for recovery. (Community studies of recovery from alcohol dependence

   report long-term recovery rates approaching or exceeding 50%).30

• Having the serious chronic illness of addiction DOES NOT reduce personal responsibility for

  continuous efforts to manage that illness—just as those with serious diabetes or hypertensive

   disease must also manage their illnesses.

• Appropriate treatment for chronic addiction is NOT simply a succession of short-term detoxifications

   or treatment stays. Appropriate continuing care requires personal commitment to

   long-term change, dedication to self-management, and community and family support and

   monitoring.

Understanding the level of severity of the addiction problem is critical in treatment. When addiction is present, the chronic and progressive nature of the disease demands a long term recovery management approach. Addiction can’t be effectively treated with short-term, symptomatic strategies.