Dependence – alcohol
Updated July 2006
While alcohol and other drug use generally declines as people grow older, problems with alcohol and other drugs among older adults is a source of risk to health and safety for many, and often a serious concern to their families and GPs.
Alcohol has direct effects on the body and may cause many diseases. Long-term alcohol dependence is the most common cause of severe liver disease and may damage the digestive system causing peptic ulcers. If excessive drinking continues for a prolonged period of time, damage to vital organs may be life-threatening.
Drinking patterns across the life span of an individual remain relatively stable. The changing metabolism that goes with ageing can make older people more susceptible to the effects of alcohol. Those who consider themselves moderate drinkers in earlier years may find that consuming the same amount of alcohol leads to trouble as they grow older.
It is therefore quite possible for an older person to experience the onset of alcohol problems, although his or her alcohol consumption has not increased. In England in 2004, 19 per cent of men and 5 per cent of women aged 65 and over were drinking above the daily recommendations.[see reference 1]
While moderate alcohol consumption has protective effects against coronary heart disease in older people, excessive consumption is associated with medical complications and personality changes. Anyone at any age can have a drinking problem.
Signs of possible alcohol abuse include:
- changes in sleeping and eating patterns
- confusion or disorientation
- malnutrition
- poor hygiene
- neglecting one's appearance
- slurred speech
- incontinence
- difficulty urinating
- tremors, and shakiness
- because alcohol affects alertness, judgement, coordination, and reaction time, drinking also increases the risk of falls, accidents and bruising
Consequences of long-term alcohol consumption among older people often go unrecognised, as they may be mistaken for medical or psychiatric conditions. Alcohol's effects can make some medical problems hard to diagnose. For example, alcohol causes changes in the heart and blood vessels that can dull pain that might be a warning sign of a heart attack. It also can cause forgetfulness and confusion, which can seem like Alzheimer’s disease. Older people who abuse alcohol are also more likely to be malnourished.
Of course, alcohol problems can be compounded by the use of other drugs. Mixing alcohol, itself a drug, with over-the-counter or prescription drugs is a common trap for the older person, and one that can be fatal. The potential for drug interactions increases with greater reliance on prescription drugs, multiple prescriptions, difficulty in correct self-administration, and age-related changes in physiology. Anyone who drinks should check with a doctor or pharmacist about possible problems with drug and alcohol interactions.
A person who is dependent on alcohol has an irresistible compulsion to drink, which takes priority over almost everything else in life. This craving for drink, coupled with withdrawal symptoms when drinking stops, is what separates alcohol dependence from alcohol abuse, a term used to describe regular drinking to excess. In addition to causing damage to the liver and brain, the need to drink to excess regularly is damaging to mental health and may destroy a person's family, social life, and career.
Alcohol dependence is often the result of a combination of factors. Sometimes it runs in families, partly as a result of children growing up in an environment of heavy drinking and partly because of an inherited predisposition. People who are shy, anxious, or have a social phobia or depression, may rely heavily on alcohol. Working in an occupation that is associated with social drinking increases the risk of dependence. Stressful events may turn a moderate drinker into a heavy one.
Alcohol dependence is most common between the ages of 20 and 40 and males are most often affected.
Symptoms may include:
- a compulsion to drink and loss of control over the amount consumed
- increased tolerance to the effects of alcohol, leading to greater consumption to achieve the desired effects
- withdrawal symptoms, such as nausea, sweating, and tremors that start a few hours after the last drink
Gradual reduction of alcohol intake or limiting alcohol consumption to social drinking is rarely possible. Instead, the person will be asked to stop drinking completely. Accepting that there is a problem and receiving emotional support during the effort to give up drinking greatly improves a person’s chance of recovery. Attending a self-help group reduces the risk of relapse. However, after a long period of dependence, several attempts at detoxification may be needed before a person abstains from alcohol altogether.
References:
[1] NHS Information Centre (2006) Statistics on alcohol: England, 2006. London: The Information Centre.
[2] Prime Minister's Strategy Unit (2004) Alcohol harm reduction strategy for England. London: Cabinet Office.
Further information:
- Action on addiction is a medical research charity
- Addaction, UK charity working in the field of drug and alcohol treatment
- Addiction Recovery Foundation (charity), publishers of ‘Addiction Today’
- Addiction Recovery Agency (incorporating Advice and Counselling on Alcohol and Drugs), addiction treatment and support services
- Alcohol Concern
- Alcohol Education and Research Council
- Alcoholics Anonymous Great Britain
- Alcoholics Anonymous World Services Inc
- Clouds is a charitable organisation offering comprehensive alcohol and/or drug related services
- European Association for the Treatment of Addiction (UK)
- Medical Council on Alcohol
- MedlinePlus – Alcohol consumption
- National Addiction Centre, King's College London
- NHS Direct Online – Alcohol misuse
- Portman Group is a pan-industry organisation whose purpose is to help prevent misuse of alcohol and to promote sensible drinking
- Institute of Alcohol Studies