Adults of any age can have problems with alcohol. In general, older adults don't drink as much as younger people, but they can still have trouble with drinking. As people get older, their bodies change. They can develop health problems or chronic diseases. They may take more medications than they used to. All of these changes can make alcohol use a problem for older adults.
What Is Alcohol?
Alcohol, also known as ethanol, is a chemical found in beverages like beer, wine, and distilled spirits such as whiskey, vodka, and rum. Through a process called fermentation, yeast converts the sugars naturally found in grains and grapes into the alcohol that is in beer and wine. Another process, called distillation, concentrates alcohol in the drink making it stronger, producing what are known as distilled spirits.
The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC III) found that 55.2 percent of adults age 65 and over drink alcohol. Most of them don’t have a drinking problem, but some of them drink above the recommended daily limits. Sometimes people don’t know they have a drinking problem. Men are more likely than women to have problems with alcohol.
Older Adults Are Sensitive to Alcohol's Effects
Limited research suggests that sensitivity to alcohol's health effects may increase with age. As people age, there is a decrease in the amount of water in the body, so when older adults drink, there is less water in their bodies to dilute the alcohol that is consumed. This causes older adults to have a higher blood alcohol concentration (BAC) than younger people after consuming an equal amount of alcohol.
This means that older adults may experience the effects of alcohol, such as slurred speech and lack of coordination, more readily than when they were younger. An older person can develop problems with alcohol even though his or her drinking habits have not changed.
Excessive Drinking Can Cause or Worsen Health Problems
Drinking too much alcohol can cause health problems. Heavy drinking over time can damage the liver, the heart, and the brain. It can increase the risk of developing certain cancers and immune system disorders as well as damage muscles and bones.
Drinking too much alcohol can make some health conditions worse. These conditions include diabetes, high blood pressure, congestive heart failure, liver problems, and memory problems. Other health issues include mood disorders such as depression and anxiety. Adults with major depression are more likely than adults without major depression to have alcohol problems.
Alcohol and Medicines
Many older adults take medicines, including prescription drugs, over-the-counter (non-prescription) drugs, and herbal remedies. Drinking alcohol can cause certain medicines not to work properly and other medicines to become more dangerous or even deadly. Mixing alcohol and some medicines, particularly sedative-hypnotics, can cause sleepiness, confusion, or lack of coordination, which may lead to accidents and injuries. Mixing medicines also may cause nausea, vomiting, headaches, and other more serious health problems.
Some Medicines and Alcohol Don't Mix
Dozens of medicines interact with alcohol and those interactions can be harmful. Here are some examples.
Taking aspirin or arthritis medications and drinking alcohol can increase the risk of bleeding in the stomach.
Taking the painkiller acetaminophen and drinking alcohol can increase the chances of liver damage.
Taking cold and allergy medicines that contain antihistamines often causes drowsiness. Drinking alcohol can make this drowsiness worse and impair coordination.
Drinking alcohol and taking some medicines that aid sleep, reduce pain, or relieve anxiety or depression can cause a range of problems, including sleepiness and poor coordination as well as difficulty breathing, rapid heartbeat and memory problems.
Drinking alcohol and taking medications for high blood pressure, diabetes, ulcers, gout, and heart failure can make those conditions worse.
Medications stay in the body for at least several hours. So, you can still experience a problem if you drink alcohol hours after taking a pill. Read the labels on all medications and follow the directions. Some medication labels warn people not to drink alcohol when taking the medicine. Ask a doctor, pharmacist, or other health care provider whether it's okay to drink alcohol while taking a certain medicine.
If You Drink
Drinking Too Much Can Be Harmful
Millions of older adults drink alcoholic beverages. Some of them drink too much, which can harm their health and lead to safety problems. Sometimes it’s hard to tell if someone has a drinking problem. Some signs of drinking, such as falls and depression, can be mistaken for other physical or mental conditions. Some people don’t recognize or admit that they have a problem. Drinking problems are serious and should be treated by a doctor or other health care professional.
How Much Is Safe To Drink?
In general, to be at low risk for alcohol use disorder (AUD), healthy men and women over age 65 should not drink more than three drinks a day or a total of seven drinks a week. Drinking more than these amounts puts people at risk of serious alcohol problems. However, people can still have problems within these limits. Depending on their health and how alcohol affects them, older adults may need to drink less than these limits or not at all. Do not drink if you plan to drive a vehicle or operate machinery, take medicines that interact with alcohol, or have a medical condition that can be made worse by drinking.
What Is a "Standard" Drink?
How much is one alcoholic drink? A "standard" drink contains about 0.6 fluid ounces of pure alcohol. A single drink can be
one 12-ounce can or bottle of regular beer, ale, or wine cooler
one 8- or 9-ounce can or bottle of malt liquor
one 5-ounce glass of wine
one 1.5-ounce shot glass of distilled spirits such as whiskey, gin, vodka, or rum. The label on the bottle will say "80 proof."
Not all drinks are served in standard sizes. For example, a mixed drink can contain as many as three or even more standard drinks, depending on the type of liquor and the recipe. Even popular brands of beer advertised as “light” may have almost as much alcohol as regular beer. "Light” typically refers to less calories, not less alcohol.
Risks and Benefits of Drinking
Many people think that a little drinking can be good for you. Studies have shown that people who drink at light to moderate levels—men who have one or two drinks a day and women who have one-half or one drink a day—are less likely to develop or die of heart disease than people who drink more or not at all. But it is not clear that red wine or any other alcoholic drink accounts for better health in people who drink moderately because they may be healthier than others to begin with.
The risks of drinking must be considered along with the potential benefits. For example, as little as one drink a day can slightly raise the risk of breast cancer in some women, especially those who are past menopause or who have a family history of breast cancer. Doctors do NOT recommend that people who don’t drink start drinking to improve their heart health.
Signs of Problem Drinking
It’s not always obvious that someone drinks too much. For older adults, clues to a possible alcohol use disorder include memory loss, depression, anxiety, poor appetite, unexplained bruises, falls, sleeping problems, and inattention to cleanliness or appearance. Answering “yes” to at least one of the following questions is also a sign of a possible drinking problem.
Have you ever felt you should cut down on your drinking?
Have people annoyed you by criticizing your drinking?
Have you ever felt bad or guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
If you answered "yes" to any of these questions, talk with your health care provider. Also seek help if you feel you are having drinking-related problems with your health, relationships, or work.
Reasons Older Adults May Drink
Older adults drink for different reasons than do younger adults. Some have been drinking for many years and are physically dependent on alcohol. Others start drinking later in life because of health problems, boredom after retirement, or loneliness after the death of a spouse or close friend. This is called "late-onset drinking." Feeling tense or depressed can also trigger drinking.
Alcohol Use Disorder
If a person drinks too much or too often he or she may develop an alcohol use disorder (AUD). An AUD can range in severity from mild to severe. On one end of this spectrum, drinking might cause sickness, depression, or sleeping problems. More severe symptoms include drinking more than intended or craving alcohol once you’ve stopped drinking.
AUD can be a lifelong disease in which people have a strong need to drink, cannot control their drinking once they start, and over time need to drink greater and greater amounts of alcohol to get “high.” Older adults who develop a severe AUD become physically dependent on alcohol. When they stop drinking, they can get nauseated, sweaty, shaky, and restless. These withdrawal symptoms can cause them to start drinking again to feel better, even though doing so can lead to physical or psychological problems.
Do Problems With Alcohol Run in the Family?
Many factors can influence a person’s risk of an alcohol use disorder. Some people inherit genes from a parent that increase the likelihood of an alcohol use disorder. People who drink heavily for a long time are more likely than people who start drinking later in life to have a family history of alcohol use disorder. High levels of stress, having friends and family members who drink, and ready access to alcoholic drinks also increase the chance of developing a problem with alcohol. But having an alcoholic parent does not always mean that a child will develop alcohol use disorder. Some people develop an alcohol use disorder even though no one in their family has a drinking problem.
People Can Be Treated Successfully
Most people with alcohol problems can be treated successfully. People with an alcohol use disorder and those who misuse alcohol and cannot stay within healthy drinking limits should stop drinking altogether. Others can cut back until their drinking is under control. Changing drinking habits isn’t easy. Often it takes more than one try to succeed. But people don’t have to “go it alone.” There are plenty of sources of help.
Treatment for Alcohol Problems
A doctor can help decide the best treatment for people with alcohol problems. Many people need more than one kind of treatment. Medicines can help people with an alcohol use disorder quit drinking. Meeting with a therapist or substance-abuse counselor or with a support group may also help. Support from family and friends is important, too. A doctor can help a person decide on the best treatment. Making a change sooner rather than later makes treatment more likely to succeed.
Older people with alcohol problems respond to treatment as well as younger people. Some studies suggest that older adults do better when they are treated with other people the same age instead of mixed in with younger adults. Some communities have treatment programs and support groups specifically for older adults.
Medicines for Alcohol Use Disorder
Prescription medicines can help people with an alcohol use disorder reduce their drinking, avoid going back to heavy drinking, and get sober. Because alcohol affects people differently, these medications may not work for everyone. It may be necessary to try more than one or to use them in combination with other therapies.
There are three medications approved by the U.S. Food and Drug Administration for the treatment of alcohol use disorder.
Naltrexone (Depade®, ReVia®, Vivitrol®) acts in the brain to reduce craving for alcohol
Acamprosate (Campral®) helps manage withdrawal symptoms such as anxiety, nausea, and sweating that may lead to a drinking relapse
Disulfiram (Antabuse®) makes a person feel sick after drinking alcohol.
Talking about alcohol use with a professional is beneficial to many people. Counseling—either one on one or in groups--can help develop skills to stop or reduce drinking, develop reachable goals, manage the “triggers” that lead to alcohol misuse and build a strong social support system that supports healthy habits. There are many kinds of counseling approaches Cognitive Behavior Therapy; Motivational Enhancement Therapy; Marital and Family Counseling; and Brief Interventions. Counseling can be provided by primary care doctors; psychiatrists; psychologists; social workers; and certified alcohol counselors.
Support Groups Can Help
Many people with alcohol problems find it helpful to talk with others who have faced similar problems. Mutual help groups, such as Alcoholics Anonymous (AA). AA’s “12-step” program helps people recover from alcohol use disorder. AA meetings are open to anyone who wants to stop drinking. Attending self-help groups is beneficial for many people who want to stop drinking. Many people continue to go to support groups even after medical treatment for their alcohol problems ends. There are other mutual help groups available such as Smart Recovery, Life Ring, and Moderation Management.
To find help in your area, ask your doctor, local health department, or a local social service agency.
Some people with an alcohol use disorder are treated in a facility, such as a hospital, mental health center, or substance abuse clinic. Treatment may last as long as several weeks. This type of treatment typically involves detoxification (when a person is weaned from alcohol), medicine, and counseling.
Steps to Quit or Cut Back on Drinking
People with alcohol problems can take several steps on their own to help themselves. They can write down their reasons for cutting back or quitting, such as to avoid hangovers or improve relationships. They can write down a goal -- a limit on how many drinks they will have each day -- and put it somewhere easy to see. Then, they can keep track of drinking habits for a week to see if the goal was achieved. Other steps are to plan alcohol-free days each week and to drink water, juice, or soda instead of liquor.
There are some other actions that you can take to help change drinking habits:
Remove alcohol from the home.
Sip slowly and eat food when drinking.
Say "no thanks" or "I'll have a soda instead" when offered a drink. If tempted to drink, think about the reasons for changing, talk to someone, or get involved with a non-drinking activity.
Avoid drinking when angry, upset or having a bad day.
Stay away from people who drink a lot and the places where drinking happens.
Use the time and money spent on drinking to do something fun.
Sticking With It
When treatment is successful, people have longer and longer periods without drinking alcohol. Finally, they are able to stop drinking or stick to healthy drinking limits. But treatment does not always work. Also, many people with alcohol problems do not even seek treatment. People with alcohol problems cannot be forced to get help, but family members and friends can support them when they are ready.