How To Treat Alcoholism in Older Adults

“Alcoholism” or alcohol use disorder (AUD) is commonly associated with young or middle-aged adults. Following a stint of college partying, the stress of adulthood and major life changes can contribute to excessive drinking in these age groups. However, contrary to the belief that the elderly are wise, older adults don’t always have it figured out either.

Although less frequent than in younger adults, excessive drinking and AUD in seniors are common occurrences. While we often hear of younger people attending rehab and getting their life back on track, AUD in the elderly is not discussed as frequently — adding to its unique challenges. To help us or a loved one overcome these specific hurdles, let’s first come to a better understanding of how excessive drinking and AUD affect the older population. 

Why Alcohol Use Is Common Among the Older Adult Population

As with other age groups, alcohol consumption has increased among the older adult population. According to the National Survery on Drug Use 
and Health (NSDUH), 20% of adults in 
the U.S. aged 60-64 and 10% aged 65 
and over report current binge drinking. 
We often attribute excessive drinking to the stressors of adulthood and the partying behavior of younger adults, but many factors can also drive seniors to drink:

• Life transitions. Older adults experience major transitions later in life just like their younger counterparts. Changes may include retirement, menopause, and loss of loved ones. Consciously or unconsciously, many of us may turn to drinking as a coping mechanism through these major life transitions.
• Physical health issues. Older age often comes with greater health issues. Health conditions can make us physically uncomfortable and many of us may turn to alcohol to self-medicate. Poor health may also trigger black-and-white thinking. This can make us believe that since we’re already in poor health, we may as well drink alcohol (more on why this can be extremely detrimental later).
• Mental health conditions. Stressors of adult life and major life changes can elicit poor mental health and lead to mental health conditions if not addressed. Mental health conditions are heavily associated with alcohol consumption, which can explain increased consumption in older adults. 
• Social isolation. Seniors often feel socially isolated when adult children start their own families, when their social circles change after retiring, or when they no longer participate in certain activities. These changes may drive older adults to use alcohol as a distraction.

While many of us often view retirement as the light at the end of the tunnel, older adult life comes with its unique challenges. Excessive drinking is harmful at any age, but how do the dangers differ between older and younger adults?

The Dangers of Excessive Drinking for Older Adults vs. Younger Adults

Aging comes with unique challenges that make excessive drinking in the older adult population more dangerous than in younger adults. Several factors make alcohol affect seniors differently.

• Sensitivity to alcohol. As we age, our sensitivity to alcohol increases. This means that the same amount of alcohol may have greater effects on an older adult than a younger one.
• Overall health. Older age comes with the risk of more health issues. Since we may be in less optimal health in comparison to younger adults, the harmful health effects of drinking can disproportionately affect the health of seniors — leading to even more health issues. 
• Co-occurring diseases. Since older adults may experience heightened health effects from drinking, our risk of developing co-occurring conditions may also increase. 
• Access to treatment. Seniors often have less access to treatment due to many factors such as mobility barriers and stigma. This can be harmful, as excessive drinking can lead to alcohol-related health issues and mortality. 

Excessive drinking can lead to dependence and AUD. How can we better identify signs of AUD in the older adult population?

Screening and Assessment for Alcoholism in Seniors

Alcohol use disorder, commonly referred to as “alcoholism,” is sometimes more difficult to diagnose in older adults for a number of reasons.

• Mistaken for aging-related issues. Symptoms of aging and excessive drinking can overlap. Experiences such as memory loss or decreased mobility can make it difficult for practitioners to make a proper diagnosis, as they may be written off as normal symptoms of aging. To combat this, it’s important to be forthcoming about our drinking habits with our health providers.
• Underreporting and stigma. Aging also comes with the notion that our lives become more stable and that we have everything figured out. However, older adults also have challenges to work through. This misconception that seniors should have everything in their lives worked out can lead to stigma — leading to underreporting and not accessing treatment.
• Co-occurring medical conditions. As with symptoms of aging, co-occurring conditions can complicate the diagnosis of AUD.

Fortunately, there are some ways we can overcome these challenges and better assess for alcohol misuse and AUD in seniors:

• Early detection. Signs of alcohol dependence include the inability to stop drinking, dismissal of negative effects, and prioritizing drinking over other responsibilities. Early detection can help us and our support team better differentiate between symptoms of aging and the negative effects of excessive drinking. 
• Screening tools. Specific screening assessments such as the AUDIT-C and SASQ can be beneficial in identifying unhealthy alcohol use. Other general tools such as yes/no questions, leading questions, and the CAGE questionnaire do not identify all patients who might benefit from interventio; these tools also can miss prevention opportunities.
• Comprehensive assessment of physical, mental, and social factors. Alcohol consumption is influenced by many factors. Getting a clearer picture of different aspects of our life helps our physician better identify alcohol dependence of AUD if present.
• Involvement of family and caregivers. An unhealthy relationship with alcohol isn’t always easy to self-identify. Even if it is, factors such as stigma or shame may prevent us from accessing support. This is where the involvement of family and caregivers can be beneficial in helping to identify the need for change or help with accessing treatment.

Once alcohol dependence or AUD is identified in older adults, is it treated in the same way as the younger population?

How To Treat Alcoholism in Older Adults

AUD is treated through four main approaches for any age group. Treating AUD in seniors may require additional considerations (we’ll discuss specifics in the next section), but the methods remain the same. 

1. Medication management. Medication is used throughout various stages of treatment such as detox to address neurological dependence, and with managing co-occurring medical conditions. Medication adherence is often crucial to the success of treatment — making management crucial to recovery when medications are needed.‍

2. Psychotherapy. Psychotherapy is often used in conjunction with medication-assisted treatment and supportive interventions. Different types of therapies can help us develop positive coping strategies and create healthier habits: 

• Cognitive behavioral therapy (CBT). CBT focuses on working through negative thoughts, feelings, and behaviors.
• Dialectical behavioral therapy (DBT). DBT is based on CBT but focuses on the idea that two different things can be true at the same time. It helps us change negative thinking patterns but also teaches us to accept that these thoughts are valid.
• Motivational interviewing. This counseling approach focuses on the ambivalence to change. It helps us strengthen our motivation to facilitate change.
• Family therapy. Different types of family therapy utilize the complex system of the family to enact change. Since AUD can affect those around us, family therapy addresses the extensive impact of AUD to motivate us.

3. Supportive interventions. Supportive services can further aid our recovery through social support and accountability. There are many great options for supportive interventions:

• Peer support groups. Peer groups can help us develop a social network of individuals who understand our struggles. This can be beneficial in helping us learn positive practices and increase our social engagement. 
• Counseling services for specific niches. Specific counseling services can address unique challenges that may come up for certain individuals. For example, sports performance therapists may understand the challenges of an athlete better than a general practitioner and offer more individualized support. 
• Rehab programs focused on functional recovery. Functional recovery helps us explore a life without alcohol. Oftentimes, we may feel lost after quitting alcohol, and functional recovery programs can help us navigate this.

4. Holistic approaches. Some of us may opt for a more holistic approach to treatment or use it as a supporting treatment. It is beneficial for those of us who may not have access to traditional treatments. Some holistic practices to aid recovery include the following:

• Mindfulness-based practices. Practices such as meditation and deep breathing can help calm our mind — addressing potential root causes of our drinking.
• Exercise and nutrition. Taking care of our overall health can encourage us to be more mindful of consuming harmful substances such as alcohol. 
• Alternative practices. Other methods such as acupuncture and yoga can assist with unpleasant symptoms of withdrawal. 

These approaches can help treat AUD in all age groups, but what specific considerations are there when treating the elderly?

Addressing the Specific Needs of the Older Alcoholic

It’s important to tailor any treatment plan to meet the needs of an individual, but treating AUD in older adults may require specific considerations. Common experiences of older individuals warrant the need for additional modifications. 

• Cognitive decline or dementia. Psychotherapy is dependent on remembering and applying the practices. However, older individuals may be more susceptible to cognitive decline or dementia — affecting the success of treatment. It’s important to consider this factor to individualize the plan based on a patient’s needs to set them up for success.
• Medications and comorbidities. Adherence to medication can be crucial in severing neurological dependence and treating co-occurring conditions. Older adults may require support with managing medications and comorbidities more than younger adults. Implementing these supports within the treatment plan can support the success of our recovery.
• Mobility challenges. This can significantly affect access to treatment. An older individual may not be able to attend a treatment center physically. Creative planning involving family participation or virtual treatment may need to be explored.
• Accessibility and comfort in treatment settings. Accessibility isn’t always physical. For example, if a peer support group meets virtually every week but an older individual doesn’t know how to log in independently, their access to support is limited. Additionally, seniors have unique needs, and certain components may need to be added to their treatment setting to meet their comfort needs. This can range from matching them with an older therapist

In addition to general considerations when treating seniors with AUD, individual preferences and needs should also be taken into account. Treatment can require an all-around approach. 

How to Support a Senior in Recovery From AUD

Having a support system during recovery is highly beneficial. How can we support an older family member with AUD?

• Study up. Learning more about AUD and the specific challenges that seniors face helps us approach with greater compassion and understanding. 
• Provide a judgment-free space. As we’ve discussed, the stigma surrounding alcohol misuse in older adults is even greater than it is normally. Offering a judgment-free space helps us obtain support without fear of judgment. 
• Get involved in treatment planning and aftercare support. Staying involved in current and aftercare treatment helps our loved ones feel less alone and provides accountability. 
• Provide emotional support. Recovery can be challenging emotionally. Offering support in this area helps our loved ones avoid turning to alcohol to avoid uncomfortable emotions.
• Set boundaries. Taking care of ourselves is also important when supporting an older family member in recovery. This can avoid tension due to stress and help us sustain our support in the long run. 

Support isn’t necessary in acute recovery only but also in aftercare. This aftercare can help prevent relapses. Let’s get a better idea of what aftercare can consist of for seniors recovering from AUD.

Aftercare and Alcohol Relapse Prevention in Seniors

Aftercare in recovery is important, as the physical and neurological dependence associated with AUD can lead to relapses. Some important aspects of aftercare for seniors in recovery include the following:

• A personalized plan. A personalized plan can consist of realistic goals and actions that help us adhere to healthy habits. They can also include individual support such as medication management and accessing ongoing treatment to aid in the success of recovery.
• Ongoing monitoring and follow-up. Continued follow-up can help support us through different stages of our recovery. It’s a great way to check in for accountability and to ensure we stay on track. 
• Strategies for relapse prevention. By developing positive coping strategies and identifying triggers, we can better navigate them when we stop receiving direct treatment. 
• Reintegration into the community. Participating in community activities helps us explore interests and redevelop social support networks. This participation can help us find purpose and help us feel less alone during our recovery. 

Treatment for AUD in the elderly requires comprehensive care and support. To set ourselves up for success, what specific challenges should we be aware of?

Challenges and Considerations in Treating Alcoholism in Older Adults

Knowing what barriers are present helps us better navigate treatment for AUD in the older adult population. Some specific challenges include the following: 

• Limited research and awareness. AUD in the elderly is less common than in young to middle-aged adults. Since it’s less common, research and awareness may be limited. This can negatively impact the detection and treatment of AUD in seniors.
• Age-related barriers to treatment. Because AUD is most frequently occurring between the ages of 18 and 25, treatment may not always be accessible to seniors. Thess barriers may include challenges with accessing technology or limited senior-specific treatment.
• Interactions between alcohol and medications. Older adults are more likely to have co-occurring conditions, which may increase the risk of interactions between medications and alcohol. This can cause additional health issues that may need to be considered. 
• Long-term support and care for chronic conditions. Seniors with AUD may experience greater health effects and have chronic conditions alcohol- or nonalcohol-related. These conditions may require long-term support even after acute treatment, which may not always be needed for other age groups. 
• The stigma surrounding AUD in older adults. Stigma can lead to shame and other negative emotions, impact our motivation to reach out for support or treatment. 

Although treatment for AUD in older adults requires additional consideration and comes with unique challenges, recovery is worth it and possible.

It’s Not Too Late

AUD in the older adult population often goes untreated, contributing to greater alcohol-related harm and mortality. Understanding the challenges in detecting and treating AUD in seniors can help decrease the chances of missed prevention opportunities. While a support system is beneficial for any one of us who may be recovering from AUD, family and caregiver involvement is even more crucial for seniors. No need to gauge if it’s worth it — recovery is beneficial at any age!