Late Onset Alcoholism – Causes, Consequences and Treatment Needs
How can a person abstain or drink sensibly through adulthood only to fall into problem drinking in their retirement years?
Why does this happen, and more importantly, what can you do about it?
Well, if you or someone you love is a late onset problem drinker, read on to learn more about your situation and to find out:
- How early and late onset drinking differs.
- About common causes of late onset problem drinking.
- The consequences of late onset drinking (these differ from the consequences of early onset drinking).
- The unique treatment needs of older adults.
What Is Late Onset Alcoholism?
Most older alcoholics begin problem-drinking in their teens or twenties, but a smaller cohort of drinkers avoid alcohol problems until retirement age and then succumb to problem drinking or alcoholism.
- Older adults who start drinking heavily at a young age and drink throughout adulthood are called early onset problem drinkers. Most older alcoholics, about 2 in 3, are of the early onset type.
- Older adults who start problem-drinking later in life are called late onset drinkers. About one in three older alcoholics are of the late onset type.
Differences between Late Onset and Early Onset
Although there are exceptions to every rule, on average:
- Early onset drinkers are more likely male and late onset drinkers are more likely female.
- Early onset drinkers tend to have lower socioeconomic status and late onset drinkers have higher socioeconomic status.
- Early onset problem drinkers often have a family history of alcoholism. Late onset alcoholics are less likely to have this direct familial history.
- Early onset problem drinkers are more likely to succumb to an alcohol-related disease at some point in life, such as cirrhosis or pancreatitis. Late onset drinkers are less likely to experience these types of diseases.
- Early onset alcoholics typically have physical dependence and
withdrawal issues. Late onset alcoholics may never become physically dependent.1
- By older age, early onset drinkers are likely to experience severe cognitive damage. Later onset drinkers experience less cognitive damage.
- Cognitive damage is less reversible in early onset problem drinkers. Though late onset problem drinkers do experience some cognitive declines, these are mostly reversible with abstinence.
- Late onset problem drinkers may be more treatment compliant than early onset drinkers.2
But though there are many differences, there are also similarities between early and late onset heavy drinking, for example:
- People from both groups drink more heavily in response to stressors.
- Heavy drinking exacerbates symptoms of other age-related medical conditions, like hypertension or diabetes.
What Causes Late Onset Alcoholism?
So what causes a person to fall into problem drinking or alcoholism after decades of responsible adult drinking?
Well, there’s no single answer, but major life-changes often precede changes to drinking habits; for example:
- The death of a spouse.
- A major change in health status.
- Other losses, such as income loss, mobility loss or social network losses.
Also, people who had substance abuse problems early in life are at higher risk to develop drinking problems later in life, even after decades of abstinence or controlled drinking.
Evaluate the Consequences, Not the Quantities
Is the drinking really a problem? What if we’re only talking about a few beers or glasses of wine a day? How much is too much?
When assessing for problem drinking and alcoholism you have to consider daily drinking habits, but consumption quantity doesn't tell you everything – focusing on the impact and consequences of the drinking tells you much more about the seriousness of the problem.
And this is doubly so for older adults who may experience serious consequences after seemingly quite moderate consumption. Alcohol tolerance can decline in older age because:
- Older adults have less lean muscle and increased bodily fat. This causes a decrease in blood water content and results in greater blood alcohol levels per unit consumed.
- Liver enzymes needed to process alcohol (dehydrogenase) are
less present in older age. It takes longer for an older person to metabolize a
single unit of alcohol.3
Warning Signs of an Alcohol Problem
So do you need alcohol treatment?
- Well, first you need to determine if alcohol causes you problems.
- If it does, you have to see whether you can stop on your own – and if you can’t, then you need help.
Since older adults can’t metabolize as much alcohol and since medication interactions can intensify alcohol’s effects, you can’t really look at the amount consumed as a reliable indicator of a problem; instead, look for signs that indicate that alcohol is causing you life-problems.
Unfortunately, it’s usually up to the individual and those that care about her to identify problem drinking, since many of the symptoms of alcohol disorders are easily misinterpreted as symptoms of other normal age-related conditions.
At retirement age, if you drink regularly – and especially if you also take prescription medications - be on the look-out for any of the following warning signs that may indicate a problem:
- Increased anxiety or irritability.
- Hiding your drinking or drinking alone.
- Drinking with medication even when medication warning labels advise against it.4
- Increased sadness or depression – or in extreme cases, suicidal thinking.
- Memory problems.
- Concentration problems or problems sustaining attention.
- Decreased interest in activities you used to enjoy.
- Less interest in personal grooming or personal hygiene.
- Episodes of incontinence.
- Chronic pain or problems with headaches or dizziness.
- Alcohol related financial or legal problems.
- Loss of appetite.
- Loss of interest in socializing with friends and/or family.
- Falling or injuring yourself.5
Recommended Drinking Quantities
Though you shouldn’t assess for a problem by looking at the amount you drink in isolation, if your consumption exceeds recommended safety guidelines, then you may want to cut down for health reasons. According to the National Institute on Alcohol Abuse and Alcoholism, for adults aged 65 and older safe drinking is:
- Not more than 1 standard drink per day or 7 in a week (a standard drink = 1 can of regular strength beer, 5 oz of regular strength wine or 1.5 oz of liquor,)
- Not more than 2 standard drinks per day on any special occasion day (birthday, wedding, etc.)
Why Don’t Older Adults Get Treatment?
Although research shows that older adults respond well to treatment and that reduced drinking leads to substantial quality of life gains, the majority of problem-drinking older adults never get appropriate addiction treatment. Some factors which explain this inadequate treatment participation include:6
- Problem drinkers often get mandated into treatment via employer programs or through interactions with the criminal justice system. Since older adults may no longer work outside of the house or drive a car as frequently, they can more easily hide their drinking.
- Doctors may confuse symptoms related to alcohol abuse for symptoms of common age-related disorders.
- Due to shame and embarrassment, older adults and their families are more likely to hide and minimize their drinking and less likely to initiate treatment.
Treatment for Older Drinkers
Late onset problem drinking or alcohol dependence can lead to severe cognitive, emotional and physical health problems and decreased quality of life, however:
- Older adults generally respond very well to treatment. They tend to have better outcomes than younger adults getting similar treatment.
- There is some evidence that late onset problem drinkers have better treatment compliance and better outcomes than early onset drinkers.2
Start with Less Intensive Treatment
According to a SAMHSA expert consensus panel, older people with alcohol problems should try less intensive forms of treatment first, before moving on to more disruptive and intensive forms of treatment. Examples of less intensive forms of treatment include:1
- Brief interventions (one or more sessions with a doctor or other counselor to explore drinking habits and drinking consequences).
- Motivational interviewing – a series of sessions with a counselor. These non-confrontational sessions help people overcome ambivalence to change and develop personally relevant reasons for behavior modification.
If less intensive forms of treatment do not result in decreased drinking, then you would move up to more intensive forms of treatment, such as intensive outpatient programs or residential rehab.
Treatment for Late Onset Problem Drinkers
There is some evidence that late onset problem drinkers respond better to less intensive treatment approaches than early onset problem drinkers. This is likely because late onset drinkers are more responsive to social pressure and because their alcohol problems tend to be less severe.1
The Benefits of Older Adult Addiction Treatment Programs
Though older adults can get adequate care in a mixed-age adult treatment environment, older-adult specific programs offer a more comfortable social environment and specially tailored treatment. According to SAMHSA, features of effective addiction treatment for older adults include:1
- Treatment is age-specific and supportive
- Treatment is not confrontational and bolsters self esteem
- Treatment content is appropriate to an older audience and delivered at a comfortable pace (this may be slower than in a standard adult group). Treatment is flexible and responds to your needs.
- Treatment respects gender differences.
- Treatment addresses bereavement and loss, loneliness and depression.
- Program staff members are experienced and interested in working with older adults. There is a culture of respect within the treatment program.
- There is an explicit effort to expand each person’s social network.
- There is increased case management and linkages to appropriate medical and social services agencies.
If alcohol may be an issue for you or someone you love, consider enhancing your life with activities that may protect you from overuse. If possible:
- Get involved in community activities.
- Maintain goals to work toward – keeping a sense of purpose provides direction.
- Cultivate social relationships and embrace familial and friendship relationships that offer emotional and practical support.
- Work on maintaining your independence.
- Keep learning.
Stop Putting Your Independence at Risk
Why try to change at such a late stage in life? Why take away small pleasures from your life? What’s the harm really...?
Well, if you’re asking yourself these types of questions you should think carefully about the likely consequences of your actions. Because beyond impaired physical and mental health, alcohol abusing older adults also risk their independence.
- Alcohol abuse can lead to falls and disability. This occurs through direct intoxication and through medication-interaction effects.
- Alcohol abuse increases your risks for a wide array of diseases. Health complications can limit your ability to care for yourself.
- Risky drinking can lead to financial problems. In extreme cases, financial issues may limit independent living options.
By older age, lifelong heavy drinkers tend to show obvious wear and tear. In contrast, late onset alcoholics may avoid notice simply because they look too healthy and seem too normal.
But though late starters avoid some of the obvious alcohol-related diseases, heavy drinking still comes with a heavy price tag, such as:
- It exacerbates other existing conditions, such as hypertension or diabetes.
- It increases the odds of depression.
- It increases the risks of cardiovascular disease and stroke.
- It decreases immune system functioning.
- It decreases bone density and increases risks for broken bones (it also increases fall-risks).
Take Home Message
- Late onset alcoholics may never develop physiological dependence. So just because a person never gets the shakes or other withdrawal symptoms, this does not exclude the possibility of a serious problem.
- Though late onset older adults can experience a wide range of serious health consequences, those who seek treatment can expect excellent outcomes. Though a lifetime of heavy drinking can cause irreversible cognitive damage, for those who started later in life, this damage is almost entirely reversible.
- Treatment doesn’t have to a ‘big deal’ to make a big difference. May late onset problem drinkers respond very well to brief counseling sessions or to motivational interviewing.
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