Elderly Alcoholic Parents & Spouses

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Caring for an Elderly Alcoholic Parent or Spouse

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Let’s face it — there’s no use kidding anyone. Helping an elderly alcoholic parent or spouse to stop drinking will be one of the most challenging tasks you have ever faced. But, with patience and persistence, it can often be done.

Three Steps to Help Your Elderly Parent Overcome Their Drinking Problem

• Help them understand and accept the fact that they have a drinking problem⁽¹⁾
• Help them find meaningful reasons to want to quit
• Help them get and stay sober

#1 – Help them understand and accept the fact that they have a drinking problem

The Eleven Symptoms of Alcohol Use Disorder⁽²⁾

In the past year, has your parent or spouse:

1. Had times when they ended up drinking more, or longer, than they intended?
2. More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
3. Spent a lot of time drinking? Or being sick or getting over other aftereffects?
4. Wanted a drink so badly they couldn’t think of anything else?
5. Found that drinking – or being sick from drinking – often interfered with taking care of their home or family? Or caused job troubles? Or school problems?
6. Continued to drink even though it was causing trouble with their family or friends?
7. Given up or cut back on activities that were important or interesting to them, or gave them pleasure, in order to drink?
8. More than once gotten into situations while or after drinking that increased their chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
9. Continued to drink even though it was making them feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
10. Had to drink much more than they once did to get the effect they wanted? Or found that their usual number of drinks had much less effect than before?
11. Found that when the effects of alcohol were wearing off, they had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

The presence of at least 2 of these symptoms indicates an alcohol use disorder.

How much is too much?

• More than 1 drink per day for women and 2 drinks per day for men. You should not begin drinking or drink more frequently on the basis of potential health benefits because moderate alcohol intake also is associated with increased risk of breast cancer, violence, drowning, and injuries from falls and motor vehicle crashes.

Is it safe to drink alcohol and drive?

• Absolutely Not. Even one drink slows reaction time and impairs judgment and coordination, which are all skills needed to drive a car safely. The more alcohol consumed, the greater the impairment.

A standard drink contains 0.6 ounces of pure alcohol, the amount found in:

• 12-ounces of beer (5% alcohol content).
• 8-ounces of malt liquor (7% alcohol content).
• 5-ounces of wine (12% alcohol content).
• 1.5-ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).

Beer or wine is safer to drink than liquor.

• No, it isn’t. One 12-ounce beer has about the same amount of alcohol as one 5-ounce glass of wine, or 1.5-ounce shot of liquor. It is the amount of alcohol consumed that affects a person most, not the type of alcoholic drink.

I take several prescription drugs that have a warning printed on the label, “Alcohol may intensify the effect.” Is it OK to have a few drinks if I’m careful.

• I wouldn’t if I were you, even if you are careful, and especially not if you’re taking two or more medications with that warning. In fact, hundreds of commonly used prescription and over-the-counter drugs can adversely interact with alcohol. For more information, visit WebMD’s list and PsychCentral’s informative article Combining Medication with Alcohol.

I’m bigger than most people. That means I can drink more. Right?

• Wrong. Your liver processes the alcohol you drink. Most people who are bigger than other people are overweight, but your liver is about the same size as people who are not overweight.

I’m an experienced drinker. That means I can drink more than people who drink only occasionally because I don’t get drunk like they do.

• Wrong. Bottom line, it means only that you may be a functional alcoholic.

I’ve been drinking for a long time. So I can handle my alcohol better than other people.

• Once again, wrong. Your body’s sensitivity to alcohol’s effects increases with age. As you age, the amount of water in your body decreases, leaving less water in your body to dilute the alcohol you consume. This causes you to have a higher blood alcohol concentration than younger people after consuming an equal amount of alcohol.

What is the difference between alcoholism and alcohol abuse?

Alcohol abuse is a pattern of drinking that results in harm to your health, interpersonal relationships, or ability to work. Signs and symptoms of alcohol abuse include the following:

• Failure to fulfill major responsibilities at work, school, or home.
• Drinking in dangerous situations, such as drinking while driving or operating machinery.
• Legal problems related to alcohol, such as being arrested for drinking while driving or for physically hurting someone while drunk.
• Continued drinking despite ongoing relationship problems that are caused or worsened by drinking.
• Long-term alcohol abuse can turn into alcohol dependence.

Dependency on alcohol, also known as alcohol addiction or alcoholism, is a chronic disease. The signs and symptoms of alcohol dependence include:

• A strong craving for alcohol.
• Continued use despite repeated physical, psychological, or interpersonal problems.
• The inability to limit drinking.

#2 – Help them find meaningful reasons to want to quit

Drinking too much can lead to:

• Loss of their career/job
• Loss of their marriage
• Loss of their family, including their children — and, if they have any, their grandchildren
• Loss of their home
• Loss of their friends — no one likes to hang out with an obnoxious drunk!
• Loss of control of their bodily functions (pee and poop themselves in public)!

Despite their denials – “It will never happen to me! I’m in control when I drink!” – they could easily become a nameless, homeless street bum who hangs out in parking lots at Walmart, the grocery store, Home Depot – desperately hoping that passing drivers will give them some spare change or – even worse – they’ll become a dumpster diver in search of scraps of food.

IMPORTANT: Even though they may not care what happens to themselves, you, their friends and family do.

Drinking too much can also severely damage their liver and their brain

Most of us know that excessive drinking can cause cirrhosis of the liver. Cirrhosis is scarring of the liver. Scar tissue forms because of injury or long-term disease. Scar tissue cannot do what healthy liver tissue does – make protein, help fight infections, clean the blood, help digest food and store energy. Cirrhosis can lead to:

• Easy bruising or bleeding, or nosebleeds
• Swelling of the abdomen or legs
• Extra sensitivity to medicines
• High blood pressure in the vein entering the liver
• Enlarged veins called varices in the esophagus and stomach. Varices can bleed suddenly
• Kidney failure
• Jaundice
• Severe itching
• Gallstones
• Liver cancer

Not only does alcoholic liver disease affect liver function itself, it also damages the brain. The liver breaks down alcohol and the toxins it releases. During this process, alcohol’s byproducts damage liver cells. These damaged liver cells stop functioning as well as they should and allow too much of these toxic substances, ammonia and manganese in particular, to travel to the brain. These substances proceed to damage brain cells, causing a serious and potentially fatal brain disorder known as hepatic encephalopathy.

Finally, let’s not forget that Wernicke-Korsakoff Syndrome – Alcoholic Dementia – is caused by a severe deficiency of thiamine (vitamin B-1), most commonly the result of alcohol abuse.

#3 – Help them get and stay sober

When the pain of depression or mental illness becomes too much to bear, people often cope by finding something powerful to replace the pain. Something that feels really, really good to them. So good that they want it again and again – until it turns into an addiction.

The pull is so strong, and the pain continues to drive them to seek refuge, even when their actions become harmful, dangerous, or debilitating. Even when their very lives are turned upside down and losing everything is a real threat or reality.

Offering support to someone suffering from a mental illness or depression is a delicate thing. So, how do you help a loved one that refuses your help? What do you do when they refuse treatment?

While you may disagree with the choices your loved one makes, try to stay positive and be supportive. Alienating them may create a combative situation. It’s most effective to actually offer your support. To help you do this:

• Be informed about the help your loved one needs
• Talk with your personal health care provider
• Call the National Drug and Alcohol Treatment Referral Routing Service at 1-800-662-HELP (1-800-662-4357). They can provide you with information about treatment programs in your local community, where you can speak with someone about alcohol problems.
• Be available to truly listen to your loved one when they need it
• Set boundaries on the things you can and cannot do – and stick to them regardless of whatever it takes
• Take care of yourself first! You may wish to investigate Al-Anon, where friends and families of problem drinkers find understanding and support at Al-Anon meetings.

How to Offer Help

If the person you are trying to help denies that they need help and resists you, consider trying the following approaches.

(These steps are recommended by inpatient and outpatient behavioral health facilities)

• If it’s an emergency in which you or someone you know is suicidal, call the National Suicide Prevention Lifeline immediately at 1-800-273-8255, call 911 or go to a hospital emergency room.
• If the person you are trying to help is a threat or danger to others, such as physical violence with a weapon or not, call 911 and seek shelter for yourself and children.
• If no danger is detected, try to remain courteous and non-threatening, but be honest and direct.
• Listen to the person in a non-judgmental way.
• Avoid confrontation; be prepared to “agree to differ” with the person’s perspective.
• While staying calm, discuss with them your reason for concern.

Helping Someone Who Refuses Help

If the person does not want help today, ask if they would like to go another time.

• Offer to go with them for the initial assessment or ask if they would like you to be there during the assessment.
• If the person you are trying to help is not interested in the services you have in mind, maybe there is another environment where they would feel more comfortable initially.
• If none of the above is an option at this time, consider joining a local support group of family members such as Al-Anon who work to support the loved ones struggling with mental health challenges.

When to Try Intervention

An intervention is a professionally directed, face-to-face meeting between a substance abuser and people who have been affected by that person’s abuse – generally family, friends and sometimes employers and coworkers. The goal of an intervention is to motivate a substance abuser to seek help with their drug and/or alcohol problem.

Informal interventions can be useful for less severe cases of substance use. But a formal intervention may be a more successful option for people who resist help. A professional who has experience with treating substance abuse directs it. Important: Have treatment lined up in advance, before the intervention, and be ready to go to the inpatient treatment center right then and there.

How to help the person stay sober

• Remove all alcohol from your loved one’s home, including: liquor, beer, wine, cooking wines, wine coolers, malt liquors, liqueurs, hard cider, etc. and other liquids – such as mouthwashes – that contain alcohol.
• Encourage their participation in support groups such as Alcoholics Anonymous (AA)
• Whenever you go out with your loved one, don’t drink yourself; in fact, it’s best that you stop drinking as well. Your loved one may been able to smell a drink on your breath and become irrationally jealous when you drink and they can’t. It’s enough for them to fall off the wagon.

Why do many people drink more when they get older?

Retirement / Reduced Income

Retiring or being downsized cuts many, if not most, social ties with fellow co-workers. It can also leave you with an identity crisis – your job is a major part of your personal identity. So, when their job disappears, most people feel lost. That can lead to depression which, in turn, may lead to self-medicating with alcohol.

Retirement or being downsized may also reduce the income that’s available to pay expenses. In fact, many retirees often take part-time jobs just to pay their bills. And, people who have been downsized must often try to find a full-time job (at a time when employers want to hire younger, lower paid employees) or use the monies they set aside for retirement just to pay today’s expenses. All-in-all, reduced income is often a cause of depression that can lead to alcohol abuse.

Death of a Spouse

For many people, loss of their spouse means loss of their soul mate. That’s especially true for couples who have been married for a long time. While not all long-term marriages are wonderful, most do provide at least some companionship.

The loneliness that follows a spouse’s death can seem impossible to overcome. Going out with friends is encouraged, but if they are still married, this can cause more pain, making it more difficult to escape the cycle of mourning. Then, the one glass of comforting wine, beer or mixed drink slowly escalates until heavy drinking erases the pain of loss rather than helping the person heal in a healthy manner.

Diagnosis of a Major Illness

Logically, a diagnosis of cancer, diabetes, Alzheimer’s or another major disease would motivate people to become more health conscious. But, that isn’t always the case. As strange as it may seem, the diagnosis of an illness is cited by the U.S. National Institutes of Health as one reason some seniors turn to alcohol use and eventual abuse.

Naturally, there are people who have abused alcohol most of their adult lives and these life events simply increase their level of use. However, for others, major life events can flip the switch from being an occasional social drinker into an alcohol abuser.

Stress – “No, you cannot do it all!”

A major cause of stress is the inability to say, “No.” People with this “affliction” often turn to alcohol – just one drink – to calm their nerves, to relieve their anxieties before climbing back into ‘life’s hamster wheel” to do everything that “just has to be done.” Unfortunately, that one drink can easily escalate until heavy drinking erases their stress rather than helping the person learn how to “de-stress” in a healthy manner.

Socializing

It starts innocently enough – getting together with the guys to watch “the game” or play a few hands of cards – getting together with the girls to play bridge or just to chat. But, we’re all retired now and don’t have any limits like having to get up early to go to work, or to get the kids off to school. So, we begin staying a little later – and a little later – and have a few more drinks than we used to – and then a few more. Maybe we’ll even have a little nightcap when we get home. Before you know it, your drinking turns into alcohol abuse.

Boredom / Loneliness

One of my grandfathers was a snowbird, traveling from Indiana to Florida for the winter and back again for the summer. During the summer, he spent most of his days sitting in his recliner watching TV with a bottle of beer in hand to pass the time. He spent most days during the winter alone in his fishing boat. (I don’t know if he drank beer while fishing, but I rather suspect that he did.) In other words, he was bored and probably lonely. After he retired, he rarely, if ever, got together with his fellow co-workers from the Post Office.

Depression

People who are sad or depressed for long periods of time often turn to alcohol as a way to relieve their mental discomfort. Sadly, alcohol is a natural depressant. So, when the more pleasant feelings induced by drinking alcoholic beverages wears off, their depression comes back, sometimes even worse than before.

Characteristics of Drinkers

In addition to the reasons why people drink, there are several different types of drinkers, each one of which can be helped by a harm reduction strategy. Most drinkers fall into one of the following groups:

• Experimental Users
• Social Users
• Solitary Users
• Social Users
• Misusers
• Problem Users
• Shadow Users
• Watchful Users
• Discontinued Users

Each of these groups and their related Harm Reduction Strategies is discussed in more detail in the excellent article, “Are the DSM-5 Addiction Revisions Still Confusing?“.

Signs of Alcohol Abuse

Unless they’re falling down drunk, passing out or slurring their speech, adult children often have a hard time even noticing their parent’s abuse of alcohol, especially when they think, “They have a job, they’re functional in a lot of ways …” And, of course, most alcoholic parents will vehemently deny they have a problem.

(This is called functional alcoholism. For example, I once had a boss whose secretary filled his water carafe with vodka every morning and which he finished by the end of the day. Then, if he wanted to bar hop with you, would end up drinking you under the table before you’d stagger to catch the last commuter train at midnight. And, yet, he could give his sales people one of the more inspiring sales presentations you’d ever heard at a 7am breakfast the next day.)

Other elderly alcoholic parents are much easier to spot: they fall and break their hips. In fact, in 2012, when nearly 2.5 million seniors battled alcohol abuse problems, nearly 800,000 hospital visits were related to alcohol. In other words, a senior citizen could have a drink with dinner, slip and fall, and go to the ER for a fractured hip. FYI: 1 in 5 seniors who fracture their hip never walk again.

Causes for Alarm

Many prescription drugs such as anti-depressants enhance/worsen the effects of alcohol and can cause serious, often life-threatening problems. Find out what medications your parent takes. Then use a drug interactions checker such as the two on our page, Prescription Drug Interactions and Side Effects, to see if you can find any likely interaction problems with alcoholic beverages. Include all the medications they take (prescription drugs, over-the-counter drugs such as aspirin, antacids, herbal remedies, nutritional supplements — even daily multi-vitamins).

Heavy drinking over time also can cause cancer, liver cirrhosis, immune system disorders, and brain damage. Alcohol can make some medical conditions hard for doctors to find and treat. For example, alcohol causes changes in the heart and blood vessels. These changes can dull pain that might be a warning sign of a heart attack. Drinking also can make older people forgetful and confused. Wernicke-Korsakoff Syndrome (Alcoholic Dementia) is caused by a severe deficiency of thiamine (vitamin B-1), most commonly the result of alcohol abuse. This could be mistaken for signs of Alzheimer’s disease. For people with diabetes, drinking affects blood sugar levels. [endsection]

⁽¹⁾ Fact Sheets – Alcohol Use and Your Health
⁽²⁾ Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5

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