At Any Age, It Does Matter:
Substance Abuse and Older Adults
(for Professionals)
Supplements
Signs and Symptoms Related to Stages of Drinking
Early Onset
History
- Significant alcohol-related problems for many years; often has a family history of alcohol problems
- Generally began drinking sometime between the early teens and late 20s
- Began drinking for relief with gradual increasing tolerance
- Often dies by middle age; survivors bring their problems with them into late life
- May have numerous short-lived periods of sobriety
- May have had prior treatment or AA experience and believes "I failed"
- In later life, tolerance to alcohol decreases and the person cannot drink as much as before; family members may be deceived because "he drinks half of what he used to"
Medical Problems
- Alcohol-related health problems are usually advanced:
- Liver problems
- High blood pressure
- Gastrointestinal problems
- Increasingly severe withdrawal symptoms
- Possible alcohol-related dementia
- May have been hospitalized for alcohol-related problems, which may not have been identified as alcohol related
- In some cases, alcohol problems may have been recognized by health and social service providers long ago; they have given up on the person.
Social problems
- History of marital and family problems:
- May have divorced as a result of drinking
- May have had multiple marriages
- Adult children may have given up on the parent; the children also may have alcohol problems
- Alienated from family, often for a long time
- Social network may be limited to drinking friends
- May be living in isolation and solitary drinking
- May be homeless or living in a single room occupancy hotel
- History of occupational, financial, and legal problems
Psychological Problems
- Significantly higher levels of depression and psychological problems
- Is most likely to increase drinking in response to stress
- Has more social upheaval
- About 10 to 15 percent have antisocial personalities
- May lack emotional development and display personality characteristics similar to those of much younger adults
Prognosis
- Potential for treatment should not be written off; early-onset drinkers do about as well in treatment as late-onset drinkers
- Treatment for this group of older drinkers may be more complex because:
- Denial system is long term, well practiced, and ingrained.
- Alcohol has been associated with every aspect of adult living; the person does not know how not to drink.
- Person has no frame of reference for sober adult living skills.
- Support system, which is important during treatment and aftercare, is usually absent.
- Alcohol-related health problems are usually advanced.
Some older adults may have a long history of heavy alcohol use while remaining functional. This heavy use can be particularly problematic due to physical and metabolic changes that occur with aging.
Late Onset
History
- Less likely to have a family history of alcoholism
- Onset begins around age 50-60, often in response to losses, stresses, or difficult life events (e.g., retirement, declining health, death of family and friends)
- Loneliness, isolation, bereavement, and depression often precede the development of a drinking problem
- Drinking often starts to ease the pain and anxiety of life changes or to "take the edge off" of difficult feelings
- Alcohol/drug problem is more difficult to detect because of a lack of drinking/drug history and related health problems
- Often these were moderate to heavy social drinkers
Medical Problems
- Because contact with health care professionals has been routine, they are more likely to overlook signs of an alcohol problem and to prescribe medication to help the person get through a difficult time
- No previous long-term alcohol-related medical problems
Social Problems
- More likely to conceal the truth about the amount of alcohol consumed
- If family live at a distance, they may not be aware that drinking is a problem until a crisis
- Focus is often on the precipitating event as the problem; the need to stop the abusive drinking is overlooked
- Family members are frequently reluctant to consider drinking as a problem because it has not been a problem in the past
Psychological Problems
- Person more likely to feel shame/guilt and to keep drinking hidden
Prognosis
- Prognosis is more promising for this group
- Person often has a lifetime of relatively good coping skills to draw on and is more likely to have a history of dealing with problems in a healthy way prior to the onset of the alcohol problem
- Long-term denial system is absent
- Is not as impaired physically, cognitively, or emotionally as early-onset drinkers
- Family/support system is generally intact; family members, once they realize there is an alcohol problem, will generally provide support during treatment and aftercare
There is evidence that sometimes the drinking problem resolves spontaneously without professional assistance.
Intermittent
History
- May have a history of episodes of heavy drinking—binge or weekend drinking. Some may drink daily for years at a time and are abstinent for years at a time.
- Began drinking between the ages of 20 and 30
- Has had episodes of alcoholic drinking followed by periods of abstinence, which may have lasted from weeks to years
- Stress and loss brought on by the aging process will often trigger relapses
Medical Problems
- Often has some physical deterioration
- Medical problems are in proportion to the number and duration of alcoholic episodes and the length of periods of abstinence
- May not have severe medical consequences from the drinking but symptoms of hangovers have intensified
Social Problems
- May have experienced occupational, legal, and financial consequences from the drinking
- Family relationships are usually strained
- Family tends to focus on triggering event and waits for the episode to pass
- Person and family may have sought help during times of drinking but lacked follow-through, falling back on the knowledge that the episodes don’t last
Psychological Problems
- Has long-term well-practiced denial system
- Episodic psychiatric disorder (e.g., bipolar affective disorder) may be related to intermittent alcohol abuse pattern
Prognosis
- Prognosis is better than for early onset but not as good as for late onset
- Although long-term denial exists, the person may be able to gain insight into the relationship between periods of heavy drinking and negative consequences
- May have some family and social support
- When previous long abstinent periods were initiated by alcoholism treatment or AA involvement, prognosis for positive response to new treatment plan may be excellent
Focal Problem
- Focal problem drinkers have a specific health, legal, or social problem related to alcohol use.
- Focal alcohol problems become very important with increasing age.
Medical Problems
- Examples of health problems are hypertension and diabetes mellitus that are made more difficult to manage by excessive alcohol use that increases blood pressure, interferes with glucose metabolism, and alters the effects of prescribed medications.
Social Problems
- Irritability or coarse humor may be exaggerated by alcohol use and cause social friction.
- Arrests for driving while intoxicated represent a common focal legal problem.
Psychological Problems
- Some individuals with focal problems may be drinking on a regular, heavy basis and thus have at least mild alcohol dependence.
- Some may qualify for a diagnosis of alcohol abuse.
- Still others, however, manifest problems of such specificity that they do not meet all the DSM-IV criteria for an alcohol use disorder.
Prognosis
- Prognosis is good if focal problems are addressed in a timely manner.
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Last Updated: 07-03-2002
SAMHSA is an Agency of the U.S. Department of Health & Human Services
