U N D E R T H E I N F L U E N C E
THE INTIMATE ENEMY
Will that friendly drink betray you?
by Nan Robertson
My 50th birthday was one of the happiest I ever knew. Yet I was alone and a widow. I had lost my beloved husband five years before; I had been demoted from a prestigious job as a foreign correspondent in Paris to reporter on my newspaper’s woman’s page; my closest friend of recent years was gone.
My friend was the bottle. My employer had summoned me home to New York in 1975 because I seemed to be on the verge of a nervous breakdown. The truth was, my heavy drinking was finally beginning to damage my life and my work. But as I turned 50 the following year, I was thankful for a magnificent gift. It was nothing less than a renewed capacity for hope and joy. I had been treated for alcoholism and sober for eight months. After a long period of self-destructive drinking, dramatically accelerated by my husband’s death, I had finally decided to be present and accountable for my own life.
Now I am 65. I am retired. I am still living alone. I am still sober. And I can look back on the 15 years since I marked my own half-century and say honestly-despite struggle and seriously illness and vanished friends-that these have been my quality years.
To be alcoholic at any age is a torment. Every one of us who escaped that misery remembers how isolated we were, how duplicitous, how secretly full of shame and guilt. And so I get angry when I hear, “It’s the only pleasure Mom/Dad has left. Why deprive her/him of a little nip?”
I am not speaking of social drinking here. I am speaking of alcoholism: problem drinking that distorts the lives of an estimated two-and-a-half million to three-and-a-half million older Americans, estranging them from family and friends and trapping them in a fog of blurred reactions. Cantankerousness, confusion, memory gaps, depression, anxiety-all too often, both doctors and kin dismiss these afflictions as a “natural part of growing old.” It is just as likely that alcohol is to blame, or, at the very least, has made the conditions worse.
To the “Why deprive them” question adult children of older alcoholics often ask, Daniel J. Anderson, Ph.D., president emeritus of Minnesota’s Hazelden Foundation-the granddaddy of all alcoholism rehabilitation centers-answers: “You’re an enabler by making up excuses for the drinking. You’ve given up on them; you’ve already got them in a casket. Take a chance on treatment. If you love your parents, you owe them that.”
“The rationale is that they haven’t got long to live,” says Edith Lisansky Gomberg, Ph.D., a University of Michigan psychologist who has been studying alcoholics for more than 40 years and is a nationally known authority on drinking in old age. “But alcoholism is not a pleasure-it’s weird to think it is. The consequences both medically and in interpersonal relationships are terrible.”
Studies have estimated that 10 to 15 percent of all Americans over age 60 suffer from alcoholism-about the same percentage as the general population. This is true even though many older people drink less or abstain altogether, usually because drinking complicates their medical problems or simply makes them feel bad.
How do you tell who is alcoholic? One of the best answers comes from Alcoholics Anonymous-the oldest, most famous and arguably the most successful program devised to arrest the disease. AA gives this definition of alcoholism in Time to Start Living, a pamphlet for older people:
“Whether or not you are an alcoholic is not determined by where you drink, when you started drinking, how long you’ve been drinking…what, or even how much. The true test is the answer to this question: What has alcohol done to you? If it has affected your relationships; if it has influenced the way you schedule your days; if it has affected your health,…if you are in any way preoccupied with alcohol-then the likelihood is that you have a problem.”
And remember, tolerance decreases with age because older bodies detoxify alcohol more slowly. What could be moderate drinking in a younger person-say, two drinks a day-can be dangerous in an older one.
Older alcoholics are divided into two groups. About two-thirds are “early-onset” drinkers who have abused alcohol much of their lives and have survived into an unhealthy, unhappy old age. The second group-about one-third of all drinkers over age 60-is unlike the general alcoholic population. This is the "late onset" group, which has an excellent chance for recovery.
“They are not as impaired physically, emotionally or cognitively as the early-onset drinkers,” says Renee Zito, treatment director of the respected Smithers Alcoholism Rehabilitation Center in New York City. “With abstinence, proper diet and time, recovery can be complete.”
Heavy drinking in the late-onset groups is usually triggered by traumatic loss. The deterioration is very rapid, covering in a year or two the progression in alcoholics who have been drinking for 20 to 40 years. They hit the bottle because their spouses have died, their children have moved far away, they have retired from their jobs, their health is not as robust as it once was. They are bored, lonely, invariably depressed. Alcohol takes the edge off those negative feelings-for a little while. But there is always the morning after, with remorse adding its sting to every bad emotion.
Le Clair Bissell, M.D., the founding director of Smithers and a recovered alcoholic who has been sober for 40 years, says it best: “There are no long-term chemical answers to life.”
For many years alcoholism experts believed that isolated older adults were usually the problem drinkers. Then came a 1988 study of alcohol use in three retirement communities in the West. The study found that drinking was part of the communities’ lifestyle, with 45 percent of the residents drinking on a regular basis and 27 percent of the heavy drinkers having increased their intake after moving there. While drinking was primarily social, the study found that those who drank socially also drank more when alone.
Older alcoholics are often hard to spot. Detecting the problem is difficult because the signs by which society and the law identify younger drinkers are usually not there. These include arrests for drunk driving (many older people have stopped driving), warnings from employers about tardiness, waning productivity, etc.
How, then, can you tell when something is wrong?
“You can’t say the problem is definitely alcohol-related unless you have an eyewitness, the patient admits to it, or his or her physical condition has deteriorated noticeably,” says Larry W, Dupree, Ph.D., clinical psychologist and associate research professor in the Department of Aging and Mental Health at the Florida Mental Health Institute, University of South Florida at Tampa.
If you are a friend, helper or relative of an older person, you might suspect alcohol abuse if you notice any of the following signs. (With the exception of bottle stashes, these could also indicate prescription drug abuse; in any event, the person demonstrating such symptoms is in trouble.)
- Abrupt or significant changes in behavior: hostility, paranoia, disorientation, forgetfulness, unsteady gait, slurred speech or trembling hands.
- Previously controlled (via medication) conditions now out of control (e.g., diabetes, hypertension).
- Complaints of insomnia; frequent napping; an absence of restful sleep.
- Deterioration in grooming, housekeeping and eating habits.
- Falls, broken bones, bruises or burns.
- Bottles stashed in the home. (“Home health aids report many bottles in homes visited,” says Dupree.)
Once alcoholism is suspected, how do you get an older person to seek treatment? Alcoholics of all ages deny they have a drinking problem.
“There is a tremendous amount of guilt and embarrassment among older people about the ‘stigma’ of alcoholism,” says Jean Dunlop, R.N., M.A., and a certified chemical dependency counselor who runs an outpatient program for older alcoholics at St. Vincent Hospital in Portland, Oregon. “The disease concept of alcoholism was accepted by the American Medical Association back in 1956, but these people have never heard of it. When they were growing up, alcoholics were skid-row bums; immoral, weak people. You show them films and bring them to lectures and they say, ‘Well, it’s very interesting, but I still think I was at fault: I had no will power.’”
Dunlop and others feel the number one motivator that gets an older person into treatment is a doctor who points out the medical problems drinking is creating. Zito and still others think the family network can best bring the older alcoholic into recovery. It is highly unlikely that older alcoholics will reach out for help on their own.
“Most of them weren’t brought up to deal with their emotional problems, and they often view alcoholism as a sin,” says Zito. To overcome this, intervention becomes necessary.
“Intervention involves presenting the facts about the alcoholism to the drinker in a tone that is nonjudgmental and shows concern,” Zito explains. “ideally, all persons who are meaningful to the alcoholic, such as family, friends, neighbors, religious advisor, physician, should make clear and specific lists about events caused by drinking. The goal of intervention is to get the alcoholic to acknowledge the need for help, however reluctantly.”
The suggested approach is to be loving and gentle. The use of words like “drunk,” “drunkard” or “alcoholic” should be avoided. Those who treat older patients agree that the confrontational approach, though it often works well with younger patients, is absolutely wrong for older people. It is essential, says Zito, that the intervention be coordinated and conducted by a trained professional.
Once into treatment, the late-onset drinker usually responds well. But should the patient receive therapy in groups of only older people? Or are mixed-age groups better?
Those who vote for segregated age groups say that many older people are offended by and cannot identify with the younger people now pouring into treatment. The profanity, the talk about abuse of illegal street drugs that often accompanies alcoholism in the young, the horror stories told in gory detail-all of this turns off the older person, some experts say.
Dan Anderson of Hazelden is in the middle. “It depends on how dominate the young people are in the group,” he says. “It is the duty of older people to defend the traditional culture and the duty of the young to tear it down. On the other hand, a lot of folks just don’t want to be in a group where everybody else is also 70 years old.”
Zito believes that after the initial shock, older patients are stimulated by daily contact with young alcoholics. She spoke of Virginia, a woman who came into treatment in her mid-70s after an intervention by her 45-year-old son. Virginia had been drinking almost suicidally since the death of her husband three years before. She immediately complained that she was older than the other patients and no one could understand what she was going through. Soon, however, the person she became closest to was a 21-year-old male patient, with whom she spent many hours talking.
Virginia was strongly encouraged to attend Alcoholics Anonymous meetings regularly after her discharge from Smithers. The comment of John T. Schwarzlose, executive vice-president of the Betty Ford Center in Rancho Mirage, California, is typical; “Patients ask how important it is to go to AA after they’re through here. I say, ‘I can give you a guarantee: When you leave here, if you don’t go to AA, you won’t make it.”
Eleven years later, Virginia is still going to AA. She reconnected with her son and grandchildren; she made many new friends in AA and became a mentor to newcomers, particularly the young; she reached out to old friends from whom she had isolated herself after her husband’s death. She occasionally dropped by the Smithers rehab center to report her progress.
Says Zito, “As the years went by Virginia seemed to get younger and appeared to become a stronger and more vital person. She found a place for herself and contributed to the world.” At last, Virginia-now in her late 80s-was enjoying the “golden years” she’d been promised.
I know how Virginia feels. I’ve been there.
(Source: Modern Maturity, February/March 1992)