Alcohol as a Response to Stress in Older Adults: A Counseling Perspective

The authors explore the relationship between stress and alcohol use in older adults. The importance for the counselor to determine the client-specific role of alcohol use, whether as a stress buffer or as a coping mechanism, is discussed. ********** As the U.S. population ages, concern about quality health-care delivery to older adults has risen among health-care providers, policy makers, and the public. Related to this concern is the use, and abuse, of alcohol by older individuals as well as the associated physical, psychological, and social implications of that use. The increase in the population of older adults, and our concern regarding their alcohol use, has occurred at the same time that many social service budgets have been reduced. Thus, available funds are decreasing while the population size and concern over alcohol abuse increases. This situation demands the careful targeting of resources as well as efficient and effective intervention programs. Alcohol use is a complex phenomenon. Common causal factors have their origins in the physiological, environmental, social, and psychological domains. Some causal factors have not yet been identified, and many known causes are not fully understood. Some researchers believe that causal factors for early- versus late-onset alcohol use differ (Rosin & Glatt, 1971; Schuckit, 1977; Dupree, Broskowski, & Schonfeld, 1984). Individuals who have early-onset alcohol use frequently have been found to have a family history of alcoholism and a history of treatment for alcoholism, and they display severe levels of depression and anxiety (Atkinson, Turner, Kofoed, & Tolson, 1985; Schonfeld & Dupree, 1991). Late-onset alcohol use is related to depression, loneliness, and boredom brought on by contemporaneous life events (Schonfeld & Dupree, 1991). In this article, we explore one of the causal factors in alcohol use: the interaction of stress and alcohol use by older adults. Stress is one of the better documented alcohol abuse causal factors; an understanding of the stress-alcohol relationship will help counselors to identify and target at-risk clients and to design intervention programs that focus on alcohol abuse. STRESS Stress Theory The structural context of stress theory was based on the interaction between social institutions, or structures, and an individual's roles (Pearlin, 1989). According to the theory, stressful events could be triggered by persistent problems, and the nature of a relationship prior to the event often determined how stress was perceived (Pearlin, 1989). Age, gender, education, and occupation also provided the background and context for the stress process, as did the kinds of stressors to which people were exposed and their resources for dealing with stress (Pearlin, Mullan, Semple, & Skaff, 1990). Stress theory assumed that "response to stress is legitimately of greater interest than the cause of stress" (Pearlin, 1989, p. 243). This theory recognized the influence of life events, or nonnormative changes, and chronic stressors that are often rooted in institutionalized social roles (Pearlin, 1989). According to Chiriboga, Weiler, and Nielsen, (1990) stress theory included three basic parts: (a) stressors, which are life events--personal status- or situational-related factors that provoke stress; (b) responses, or reactions to stressors such as depression; and (c) mediators that determine the level of response to the stressors. Pearlin et al. (1990) made a distinction between primary and secondary stressors. Primary stressors (e.g., decreasing cognitive status) were likely to last and intensify over time. Secondary stressors, according to Pearlin et al., included role strains and intrapsychic strains (e.g., family grievances, employment, economic strain, and loss of social life). There are a number of stress definitions and frameworks in the literature (Menaghan, 1990). …