At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

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Patterns of Alcohol Use

Early Onset

Problems began early in life and a pattern of alcohol abuse has continued since. The earlier the age of onset, the more likely that familial or genetic factors come into play. But lifelong alcoholics are also at risk for drinking in response to stress. About two-thirds of older problem drinkers are early-onset or intermittent drinkers, as described below.

This group is defined as having an alcohol problem that began before age 50 or 60. People in this group have numerous chronic alcohol-related medical problems such as cirrhosis, organic brain syndrome, and psychiatric problems. These early-onset patients generally have a family history of alcoholism, are less well adjusted, and have had alcohol-related problems with the law.1

Late Onset or “Reactor”

Late-onset alcoholism develops after age 50 or 60 in someone with no previous history of alcohol abuse. They are thought to be using alcohol to cope with stress and change. About one-third of older problem drinkers fall into this category, and women outnumber men. These patients are thought to have a more favorable treatment response.

In this group the alcohol abuse may be secondary to the stresses and losses associated with aging. Because of the later onset of alcohol abuse, reactors show fewer physical consequences and fewer lifestyle disruptions than early-onset alcoholics.

Patients within this group frequently point to life events as a cause of their drinking more often than those with early onset of the problem. However, dysfunctional relationships, premature health problems, early retirement, and other life stresses could be secondary to alcohol abuse as well as contributing factors.

Both early- and late-onset problem drinkers appear to use alcohol almost daily, outside social settings, and at home alone. Both are more likely to use alcohol as a palliative, self-medicating measure in response to hurts, losses, and affective changes rather than as a socializing agent.

Intermittent

The intermittent alcoholic began drinking in early years and has had episodes of alcoholic drinking followed by periods of low use or abstinence. These periods may have lasted for weeks or years. Life stresses often trigger relapses.

Intermittent drinking problems are easy to overlook but crucial to identify. Even those problem drinkers who have been sober for many years are at risk for relapse as they age. Therefore, during routine health screenings, clinicians need to take a history that includes current and lifetime use of alcohol to identify prior episodes of alcohol abuse. With this information, health care providers can help their older patients anticipate situations that tend to provoke relapse and plan strategies for addressing them when they occur.

Intermittent drinking may involve binge drinking. A binge is usually defined as any drinking occasion in which an individual consumes five or more standard drinks. For older adults, a binge is four or more drinks per occasion. People who are alcohol free throughout the week and celebrate with Friday night or holiday “benders” would be considered binge drinkers.

Identifying older binge drinkers can be difficult. Many of the usual clues, including disciplinary job actions or arrests for driving while intoxicated, are infrequently seen among aging adults who no longer work or drive. Although research is needed on the natural history of binge drinkers as they age, anecdotal observations indicate that younger binge drinkers who survive to their later years often become continuous or near-daily drinkers.

Focal Problem Drinking

Focal problem drinkers are persons who have a specific health, legal, or social problem related to alcohol use. Focal alcohol problems become very important with increasing age.

References

  1. Standridge, J. Alcohol Abuse in the Elderly. Chattanooga, TN: Department of Family Medicine, University of Tennessee, College of Medicine, November 1998 (latest revision).
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