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from the brink - Diane talks about her on-going struggle with,
and recovery from alcoholism
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to recovery: Michael talks about this journey to recovery from a
serious alcohol problem
This leaflet is for:
- older people who are worried about their drinking;
- carers, friends or health professionals who are worried about
an older person’s drinking;
- anyone who wants to know more about the problems of drinking in
older people.
As we get older, our bodies change. On the outside we notice
lines, wrinkles, extra weight. Our skin is perhaps not quite as
strong or flexible as it used to be. On the inside we:
- lose muscle
- gain fat
- break down alcohol more slowly.
This means that we become more sensitive to the effects of
alcohol. We also react more slowly and tend to lose our sense of
balance. So, even if we drink the same amount of alcohol, as we get
older it is likely to affect us more than younger people.
How much is it safe to drink?
The more you drink, the more likely it is that alcohol will harm
your health; BUT there are “sensible” levels of
drinking which, for most people, are unlikely to be harmful. These
are roughly:
- 14 units of alcohol a week for women
- 21 units for men
However, the changes mentioned above mean that safe drinking
levels for older people are probably less than this.
Many drinks now show the number of units they contain on the
bottle. But to give you some idea:
- a pint of light beer (3.5%) or a double
whisky both contain two units
- a bottle of wine contains 9 - 10 units
so a glass of wine might contain anything from 1 ¼ to 3 units
depending on its size.
Weekly limits can be misleading. If just a quarter of the
recommended weekly amount is drunk over a matter of hours, this is
more likely to be harmful.
How many people drink too much?
Older people tend to drink less alcohol than younger people, but
even so 1 in 6 older men and 1 in 15 older women are drinking
enough to harm themselves.
Are there any risks to 'sensible' drinking?
Just because we drink within the limits does not mean that it is
safe. Very little research has been done on older people so we may
be mistaken in thinking that these limits apply to everyone. There
are also some particular problems:
- health problems can make us more susceptible to alcohol
- balance gets worse with age - even a small amount of alcohol
can make you more unsteady and more likely to fall.
Alcohol can:
- add to the effect of some medications, e.g. painkillers or
sleeping tablets
- reduce the effect of others, e.g. medication to thin the blood
(warfarin) – this can increase the risk of bleeding or
developing a clot or blockage in your bloodstream.
Check with your doctor about whether you can drinkk with your
particular health problems or medication.
What are the risks of drinking too much?
Alcohol can damage nearly every part of the body:
- the stomach lining → ulcers or bleeding
- the liver → cirrhosis and liver failure
- heart muscle → heart failure produces a build-up of fluid in
the lungs which makes you breathless
- cancer → of the mouth, stomach and liver
- malnutrition→ alcohol has lots of calories for energy, but none
of the protein, fats or vitamins you need to keep your body in good
repair
- sense of balance → falls and accidents (even with 'sensible'
drinking)
- blackouts or fits
- stroke
- poor sleep → day-time tiredness.
Not everyone who drinks too much will develop health problems
but, the more you drink for, the more likely you are to
get such problems.
Isn't drinking good for the heart?
If you drink about 1 unit a day, you are slightly less likely to
have a heart attack. This finding came from studies in men in their
40s and 50s - so it may not apply to everyone. It makes more
difference to control your weight, take exercise and make sure that
you get proper treatment for any high blood pressure, high
cholesterol or diabetes.
How can alcohol affect mental health?
Too much alcohol can cause:
- Anxiety: This may
be because you start to feel anxious as the alcohol wears off –
like a mild withdrawal symptom. So you have a drink to feel better
– but as the effect of that wears off, you start feeling anxious
again.
- Depression: You
feel less hungry, have difficulty sleeping and get tired more
easily. You start to feel that you have lost interest in things you
used to enjoy, are slower to take things in when reading or
watching television and feel less positive about the future - or
even feel that life is not worth living.
- Hearing voices: This is less common but can
happen if you have been drinking heavily for a long time. It starts
with vague noises, like leaves rustling, and gradually becomes
distinct voices. These can be unpleasant and are usually
distracting.
- Confusion: If you have been drinking but not
eating, the lack of Thiamine, an important vitamin, can make you
confused and unsteady on your feet. If this is not treated
urgently, you can get permanent damage to your short-term memory –
this is called Korsakoff’s syndrome.
- Dementia: You can
lose your short-term and, as time goes on, your long-term
memory.
How might an older person develop an alcohol problem?
About a third of older people with drinking problems develop
them for the first time in later life. Bereavement, physical
ill-health, difficulty getting around and social isolation can lead
to boredom and depression. Physical illness may be painful. It can
be tempting to use alcohol to make these difficulties more
bearable. It may then become part of our daily routine and
difficult to give up. There may be less pressure to give up
drinking than for a younger person, fewer family
responsibilities, and no pressure to go to work each day.
It is possible that health professionals don't spot heavy
drinking in older people as often as they should, because:-
- Older people tend not to talk about their drinking, perhaps
because of embarrassment.
- They mistake the effects of alcohol for a physical or mental
health problem.
- They forget that older people may have drink problems so they
don’t look so hard for it.
What help is available?
It is often easier to treat drink problems in older people than
it is in younger adults.
Treatments include:
- Detoxification or ‘detox’. This involves
giving medication to reduce withdrawal symptoms and then tailing
off and stopping it after a few days or weeks. In older people this
is usually best done in hospital.
- Support groups. Many people find that
self-help groups like AA (Alcoholics Anonymous) are the most
helpful way to overcome a serious drink problem. But they don't
suit everyone. They tend to work on stopping drinking completely
and many older people may just want to cut down. If you have
mobility problems, it can be hard to get to meetings.
- Psychological or ‘talking
treatments’. Treatment can be “one to one” or with a
group of other people, where you can share their experiences with
others. Therapists are trained to talk about your problems without
judging you. They can help you to stop drinking completely, or to
control your drinking better. This can take some time and there may
be setbacks. This is normal and one setback should not be seen as a
failure.
- You will also need to find ways to occupy yourself with
activities, so you can get out of the daily routine that revolves
around alcohol. Friends and family may be able to help with
this.
- Acamprosate and naltrexone are medications for alcohol if
you have stopped drinking. They are not often prescribed for
as it is not known how safe or effective they are for
older people.
- Helping the problem that made you start drinking in the first
place. This could be anxiety, depression or just not seeing
other people very much.
What do I do now?
If you think that you have an alcohol problem, talk to your
doctor. If necessary they can arrange for you to have tests, see a
counsellor, or refer you to an NHS alcohol team in your
local area.
There are also a number of organisations offering free advice
for alcohol problems.
References
Dar, K. (2006). Alcohol use disorders in elderly people: fact or
fiction? Advances in Psychiatric Treatment 12: 173-181
O'Connell, H., Chin, A., Cunningham, C., & Lawlor, B. (2003)
Alcohol use disorder in elderly people-redefining an age old
problem in old age. British Medical Journal 327: 664- 667
Support Organisations
Age Concern: www.ageconcern.co.uk
Astral House, 1268 London Road, London SW16 4ER. Tel:02087657200
(main switchboard) or 0800009966 (National Advice Line)
Alcoholics Anonymous: www.alcoholics-anonymous.org.uk
General Service Office, PO Box 1, 10 Toft Green, York YO1 7ND.
Tel: 0845 769 7555 (National Helpline) or 01904 644 026 (York)
Alcohol Concern: www.alcoholconcern.org.uk
1st Floor, 8 Shelton Street, London WC2H 9JR. Tel: 020 7395
4000
Alcohol Recovery Project: www.arp-uk.org
2nd Floor, 7 Holyrood Street, London SE1 2EL. Tel: 020 7234
9940
Turning Point
http://www.turning-point.co.uk/
Standon House, 21 Mansell Street, London E1 8AA. Tel: 020 7481
7600
Websites providing further information
Drink Aware: www.drinkaware.co.uk
Institute of Alcohol Studies www.ias.org.uk
Help the Aged www.helptheaged.org.uk
Produced by the Royal College of Psychiatrists’ Public Education
Editorial Board.
Series Editor: Dr Philip Timms
Expert review: Dr Tony Rao
Updated: March 2008
© March 2008 Royal College of Psychiatrists: You can link to,
download, print, photocopy and distribute this leaflet free of
charge. But you must not change it or repost it on a website.
Charity Registration number (England and Wales) 228636 and in
Scotland SC038369.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
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