Substance Use in Aging Populations: Three Types of Drinkers

By Regina Walker 03/14/16

Recent surveys reveal dramatic increases in alcohol and drug abuse among older adults.

Drinking and Drugging As We Age

Aging once had a rather common face—an elderly woman, knitting or watching television in her rocking chair while her husband snoozed in the La-Z-Boy.

But in 2016, when you can join AARP at age 50 and the entire cast of St. Elmo’s Fire is eligible to be members, “aging” has a whole new face. 

The 2009 SAMHSA National Survey on Drug Use and Health revealed dramatic increases in illicit drug use in older adults, including non-medical use of prescription drugs among women aged 60 to 64. Overall, alcohol was the most frequently reported primary substance of abuse for persons aged 50 or older. Opiates were the second most commonly reported primary substance of abuse, reported most frequently by individuals aged 50 to 59. These individuals also had the highest proportions of inpatient admissions for cocaine, marijuana, and stimulant abuse. 

"Despite drinking comparatively little, older drinkers consume alcohol far more often than any other age group," the Institute of Alcohol Studies has reported. "The cumulative effect of regular drinking takes its toll on the body of an older person, which is less able to handle the same levels of alcohol as in previous years." The IAS theorized that "there is evidence that today's population of older people may be relatively heavier drinkers than previous generations. This could be the result of an effect whereby a generation which has had its formative years at a time of increasing affordability, availability, and social acceptability of alcohol may be more likely to retain the habit of drinking."  

The problem is not an exclusively American one, by the way. The Office for National Statistics, which is part of the UK Statistics Authority, reports in the January 2013 study titled “Alcohol-related deaths in the United Kingdom: 2011” that “alcohol related death rates amongst older people are higher than other age groups.” ONS figures show that the number of deaths from alcohol-related causes among people aged 75 and over in the UK increased by 58% in the last 20 years—an astonishing figure, and one that speaks to both an increasingly older population and one that is struggling with broad changes in alcohol consumption patterns as a whole.

The situation is not much better in the U.S. According to SAMSHA, alcohol abuse and misuse is the major substance abuse problem among older adults: "In the United States, it is estimated that 2.5 million older adults have problems related to alcohol, and 21% of hospitalized adults over age 40 ... have a diagnosis of alcoholism with related hospital costs as high as $60 billion per year." Alcohol, of course, is associated with many long-term negative health effects—and many of these are problems which tend to become greater with increasing age even in the absence of alcohol—such as hypertension (high blood pressure), heart problems, a greater risk of many cancers, stroke, and of course, damage to the liver.

So as we focus on alcohol and substance misuse in the younger population, we are missing the population undergoing the greatest increase in alcohol misuse and abuse—and one that, because of health risks associated with aging, is in much greater danger of irreversible negative consequences.

In all fairness, we have not been conditioned to view older people as potential substance misusers. Doctors might be less likely to consider an elderly patient’s fall as the result of alcohol or drug misuse or abuse. But as the baby boomers begin to reach their golden years, our societal view of the aging population needs a rehaul.

There are numerous reasons why the aging and elderly may turn to alcohol or substances. Grief and mourning are major areas of concern; the loss of sometimes decades-long relationships as friends and family members succumb to aging can make taking refuge in alcohol or drugs very attractive. Though, in general, as the population is living longer, the aging population has many unique issues that are not often recognized or discussed.

As we age, we experience the loss of loved ones. Additionally, aging brings with it health issues not experienced by those in their twenties and thirties. Retirement, divorce, loneliness and economic fears add to the burdens faced by older adults.

Researchers have identified three types of older drinkers. 

First are “Survivors” or early onset drinkers. These individuals are defined as having had long-term problems with alcohol misuse and abuse, and thus often experience significant health problems and are estimated to have a lifespan abbreviated by between 5 and 15 years due to the negative impact and damaging health effects of chronic alcohol overconsumption.

Next are the “Reactors” or late-onset drinkers. These individuals are thought to begin problematic drinking later in life, in response to specific traumatic events such as a death of a loved one, illness, or loneliness—sometimes secondary to retirement. The loss of professional identity as one moves into one’s retirement years may very well be an emotional trauma that, once again, makes a person who took pride in their emotional identity—and who mourns its loss—take refuge in alcohol.

Finally, we have the “Binge Drinkers” or intermittent users. These individuals may use alcohol only occasionally but to excess, which can cause health problems including falls, gastrointestinal problems, and negative interactions with prescribed medications. For these individuals who over-drink infrequently, the increased impact of alcohol as the body ages may come as an unwelcome and unexpected surprise.

Though moderate drinking is thought by some to improve health, as we age, our bodies become less able to process alcohol effectively. There is a decrease in the ratio of body water to fat, which means there is less water in the body overall for alcohol dilution. Additionally, decreased hepatic blood flow (decreased blood flow to the liver, where alcohol is broken down) is a common occurrence in aging, thus weakening the liver and increasing the amount of alcohol that enters the blood from the digestive system. Older brains are more quickly affected by alcohol than younger brains due to an altered responsiveness in the brain. Alcohol depresses the brain function to a greater extent in older people, thus impairing coordination and memory, and raising the likelihood of incontinence, hypothermia, injury by accident, and self-neglect.

The Royal College of Physicians once estimated that “perhaps up to 60% [of older people] who are admitted to hospital because of confusion, repeated falls at home, recurrent chest infections and heart failure, may have unrecognized alcohol problems. Some are long-standing drinkers who have become old, others started drinking in old age … elderly widowers are the most vulnerable group.”

Solitude, economic hardship, a loss of social support, a weakening of the body's ability to tolerate stress in general, and the effects of alcohol in particular—these are all reasons for the medical and recovery communities to take stock of the risks posed to older at-risk individuals, and consider how understanding their particular needs might head off much more serious, more expensive, and more physically and emotionally damaging problems.

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Regina Walker is a licensed psychotherapist in NYC. She has written for multiple publications and is an avid photographer. You can find her on Linkedin or follow her on Twitter.