Understanding Alcohol Addiction in Older Adults

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Alcohol addiction in elderly individuals is more common than many people may realize. Over the past 20 years, high-risk drinking and alcohol use disorder diagnoses have significantly increased among those aged 65 and older. At the same time, treatments for this population can be very effective.

How Significant is Alcohol Addiction in Elderly and Older Populations?

Alcohol is the most misused substance among the older population just like it is for younger adults. About 65% of older adults report engaging in high-risk drinking.¹ Experts define risky drinking for this population as having more than seven drinks per week or more than three drinks per day.²

Further, high-risk drinking among older adults increased by 65% from 2001 to 2013. Over this same period, diagnoses of alcohol use disorder for this population increased by 106%.³

One explanation for these statistics is that the Baby Boomer cohort (births from 1946 to 1964) is a large group with an increased life expectancy. Also, compared to cohorts before them, they had greater exposure to drugs and alcohol during a time when substance use was more commonly accepted.⁴

A 2019 survey found that about 5.6 million adults 65 and older engaged in binge drinking in the month prior. Binge drinking is consuming five or more drinks on the same occasion for men and four or more drinks per occasion for women.⁵

In 2011, 105,982 emergency room visits by older adults involved either illicit drug use, use of alcohol in combination with other substances, or nonmedical use of medications.⁶ Additionally, alcohol-related death rates in the United Kingdom are highest among those between the ages of 55 and 74.⁷

Because of the increased prevalence of alcohol-related concerns for those aged 65 and older, there is now a greater awareness of it among health providers. As a result, providers may screen patients in this population for alcohol misuse and provide recommendations.⁵

Levels of Alcohol Use for Older Adults

The Substance Abuse and Mental Health Services Administration has established four main levels of alcohol use for older adults:²

• Low-risk use: Those who do not binge drink. Their drinking also does not cause problems because they limit their use and do not drink when operating machinery or taking medications that are contraindicated with alcohol.
• At-risk use: Those who have more than 7-10 drinks per week or drink in risky situations. Though they do not have health problems because of drinking, problems can result if their drinking pattern continues.
• Problem use: Those for whom drinking has caused medical, psychological, or social consequences.
• Alcohol dependence: Those who cannot control their drinking. They also have a preoccupation and continued use of alcohol despite negative consequences, including tolerance and withdrawal.

One study found that when health status is considered, about 53% of older adults drink in a manner that is harmful to their health.⁸

Why is it Hard to Recognize Alcohol Addiction in Older Populations?

Though the statistics may seem surprising, various symptoms can mask an underlying alcohol use disorder (AUD) among older individuals.

For instance, a lack of balance and coordination can be easily attributed to old age. Or impaired cognitive abilities can be attributed to dementia or depression. However, alcohol use may cause or exacerbate these conditions. In addition, certain medications that older individuals are commonly prescribed can cover up the signs of addiction.⁹

Older individuals are also less likely to seek help for their alcohol use compared to younger populations. This is probably because they grew up with more stigma related to alcohol addiction and seeking mental health services.⁹

What Are Some Signs and Symptoms of Alcohol Addiction in the Older Population?

Various cognitive, behavioral, and physical signs may indicate that an older adult is engaging in problematic drinking. These include:⁹

• Changes in eating and sleeping habits
• Irritability or depression
• Desire to be alone for a significant amount of time
• Lack of interest in usual activities
• Difficulty staying in touch with loved ones
• Unsteady gait or frequent falls
• Bruises that cannot be explained
• Unexplained chronic pain
• Poor hygiene
• Problems with memory or concentration

Some older adults deal with AUD throughout their lives. Other older individuals develop it later in life.⁹

Why Does Alcohol Addiction Continue into Later Adulthood?

Certain circumstances can lead to alcohol use disorder (AUD) relapse in older adulthood, such as:¹⁰

• Anxiety and depression
• Loneliness
• Interpersonal conflict
• Significant loss

Furthermore, receiving mental health services in adolescence can lower the chances of substance use in adulthood.¹¹ However, for this population, greater stigma with substance use treatment could have kept individuals from seeking help early. This, in turn, increases the chance for continued use or relapse.

Why Does Alcohol Addiction Happen Later in Life?

It may seem surprising, but about one-third of older adults who engage in problematic drinking first develop the problem after the age of 60.¹⁰

Alcohol addiction can occur for the first time later in life because people may begin to use alcohol to cope. Numerous stressors first present in older adulthood. Coping with stressors is the largest reason for alcohol use among older adults. Teenagers or younger adults, on the other hand, tend to use alcohol or drugs specifically for the effects on the brain.⁹

Stressors that can present for the first time in later adulthood include:^4,9,12

• Involuntary retirement
• Reduced income
• Isolation
• Anxiety
• Health problems
• Grief and loss related to loss of loved ones or independence and abilities

In addition, addiction to other substances has remained high among older adults as they have aged.⁴ One study estimates that about 11% of those older than 50 have another substance use disorder.¹³ These individuals have a higher chance of also having alcohol use disorder that may first occur in late adulthood.¹⁴

What Are the Unique Risks of Alcohol Addiction Elderly Individuals Face?

For those over 65, there are greater physical and mental health consequences of drinking even small amounts of alcohol. These consequences can also be due to harmful alcohol-medication interactions.

Physical Health Risks

Older individuals are more susceptible to the effects of alcohol because their metabolism of alcohol slows down. This means their brains are more sensitive to the effects of alcohol. This is also why older adults are at higher risk for accidents and injuries even if they do not increase the amount of alcohol they consume.⁹

Due to lower metabolism, even small amounts of alcohol can exacerbate chronic illnesses in older adults. They are also more likely to be admitted to the hospital due to alcohol-related problems.⁷ A study of over 99,000 adults ranging from 55 to 74 years old found that those who consumed alcohol throughout their lives were more likely to be diagnosed with, and die from, cancer.¹⁵

Older adults also have a greater risk of getting fractures when they fall due to brittle and fragile bones. Therefore, alcohol addiction can further increase the risk of fractures because of a lack of motor control during intoxication.¹⁶

Mental Health Risks

Mental health conditions such as depression very often co-occur with alcohol use disorder (AUD). Twenty percent of older adults who have clinical depression also have AUD, and alcohol use can exacerbate depression.²

In addition, though you may expect decreased cognitive functioning in older adults, one study found that those who drank heavily were likely to have even worse cognitive functioning and memory.¹⁷ Moreover, an older adult with alcohol addiction is almost five times more likely to have dementia compared to one without alcohol addiction.¹⁸

Alcohol and Medication Interactions

Those who are 65 or older also tend to need more medications to treat health conditions. These include both prescription and over-the-counter medications. Most older adults take at least one prescription, and many take more than one.¹⁷

Therefore, another risk associated with drinking is harmful alcohol interactions with medications. These medications can include:¹⁹

• Antidepressants and antianxiety medications
• Diabetes medications
• Antihistamines
• Pain medications
• Seizure medications
• Water pills or diuretics
• Medications for problems like arrhythmia or high blood pressure

How is Alcohol Addiction Treatment for Older Populations Different?

More research is needed to identify specific treatment strategies for alcohol misuse among the older adult population.¹However, research has found that most older adults do not need specialized treatment, and brief interventions, such as education, are effective for reducing drinking.⁵

Ideally, providers should be knowledgeable about aging issues when treating alcohol use disorder (AUD) in older adults. This includes knowing that there is a lot of diversity in the population regarding race and ethnicity, socio-economic status, health status, age, values, and attitudes toward drinking.²⁰

For instance, Baby Boomers grew up in a time when substance use, in general, was more common and accepted. However, those born before World War II are likely to be shaped by Prohibition. Therefore, they might feel more shame about alcohol use.²⁰ With this group, experts recommend the use of a supportive and non-confrontational style. Using age-appropriate pace and content when providing education is also important.²¹

In addition, some researchers think that family therapy and self-help groups could be particularly beneficial for older adults because of the social support they provide.¹⁰

Medications for AUD are limited for the older population. Some scientists think that naltrexone and acamprosate are good medications for relapse prevention because they have very few adverse effects.¹⁰

It is never too late to get treatment for AUD, and various types of treatment can be very effective for older individuals.¹More than 20% of older adults remain abstinent after four years post-treatment, giving hope for recovery and a healthier future.¹⁸

For assistance with locating treatment providers, please call 800-948-8417 Who Answers? 24/7 for help from one of our treatment specialists.

Resources

1. National Institutes of Health. (2020). Substance use in older adults DrugFacts.
2. United States Department of Health and Human Services. (2012). Older Americans behavioral health issue brief 2: Alcohol misuse and abuse prevention.
3. Grant, B.F., Chou, S.P., Saha, T.D., Pickering, R.P., Kerridge, B.T., Ruan, W.J., Huang, B., Jung, J., Zhang, H., Fan, A., & Hasin, D.S. (2017). Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013. JAMA Psychiatry, 74(9), 911-923.
4. Kuerbis, A., & Sacco, P. (2012). The impact of retirement on the drinking patterns of older adults: A review. Addictive Behaviors, 37(5), 587-595.
5. Joshi, P., Duong, K.T., Trevisan, L.A., & Wilkins, K.M. (2021). Evaluation and management of alcohol use disorder among older adults. Current Geriatrics Reports, 10, 82-90.
6. Substance Abuse and Mental Health Services Administration. (2017, May 11). A day in the life of older adults: Substance use facts.
7. Wadd, S., & Papadopoulos, C. (2014). Drinking behavior and alcohol-related harm amongst older adults: Analysis of existing UK datasets. BMC Research Notes, 7, 1-9.
8. Wilson, S.R., Knowles, S.B., Huang, Q., & Fink, A. (2014). The prevalence of harmful and hazardous alcohol consumption in older U.S. adults: Data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Journal of Geriatric Internal Medicine, 29, 312-319.
9. University at Buffalo Research Institute on Addictions. (2015). Substance abuse in older adults: A hidden problem.
10. Barrick, C., & Connors, G.J. (2012). Relapse prevention and maintaining abstinence in older adults with alcohol-use disorders. Drugs & Aging, 19, 583-594.
11. Nkansah-Amankra, S., & Minelli, M. (2016). “Gateway hypothesis” and early drug use: Additional finding from tracking a population-based sample of adolescents to adulthood. Preventive Medicine Reports, 4, 134-141.
12. Kelly, S., Olanrewaju, O., Cowan, A., Brayne, C., & Lafortune, L. (2018). Alcohol and older people: A systematic review of barriers, facilitators, and context of drinking in older people and implications for intervention design. PloS ONE, 13(1), 1-14.
13. Wu, L., & Blazer, D.G. (2013). Substance use disorders and psychiatric comorbidity in mid and later life: A review. International Journal of Epidemiology, 43(2), 304-317.
14. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
15. Kunzmann, A.T., Coleman, H.G., Huang, W., & Berndt, S.I. (2018). The association of lifetime alcohol use with mortality and cancer risk in older adults: A cohort study. PLoS Medicine, 15(6), 1-18.
16. National Institutes of Health. (n.d.). Older adults.
17. Woods, A.J., Porges, E.C., Bryant, V.E., Seider, T., Gongvatana, A., Kahler, C.W. de la Monte, S., Monti, P.M., & Cohen, R.A. (2016). Current heavy alcohol consumption is associated with greater cognitive impairment in older adults. Alcoholism Clinical & Experimental Research, 40(11), 2435-2444.
18. Caputo, F., Vignoli, T., Leggio, L., Addolorato, G., Zoli, G., & Bernardi, M. (2012). Alcohol use disorders in the elderly: A brief overview from epidemiology to treatment options. Experimental Gerontology, 47(6), 411-416.
19. Cousins, G., Galvin, R., Flood, M., Kennedy, M., Motterlini, N., Henman, M.C., Kenny, R., & Fahey, T. (2014). Potential for alcohol and drug interactions in older adults: evidence from the Irish longitudinal study on ageing. BMC Geriatrics, 14, 1-10.
20. Substance Abuse and Mental Health Services Administration. (2020). Treating substance use disorder in older adults: Treatment improvement protocol (TIP) 26.
21. Lal, R., & Pattanayak, R.D. (2017). Alcohol use among the elderly: Issues and considerations. Journal of Geriatric Mental Health, 4(1), 4-10.