Aging and Alcohol Abuse: Increasing Counselor Awareness.

Alcohol abuse in older adulthood is a rapidly growing but often hidden problem. The authors provide an overview of the issues related to older adult alcohol abuse through a discussion of physiological, psychological, and social risk factors; an examination of appropriate assessment procedures; and an overview of factors related to treatment. ********** Alcohol abuse in later adulthood is a rapidly growing problem. Recent estimates of the prevalence of alcoholism among older adults range from 6% to 16% (Menninger, 2002), and these statistics are likely conservative given the furtive nature of alcoholism. The U.S. Census Bureau (2001) has projected that by 2030, 1 in 5 individuals will be over 65, and, as the number of older adults increases, the diagnosis and treatment of alcohol problems are likely to become increasingly important (National Institute on Alcohol Abuse and Alcoholism, 1998). According to the National Institute on Alcohol Abuse and Alcoholism (1998), alcohol problems among older adults are often undiagnosed, untreated, or treated inappropriately because the problems may be mistaken for other conditions related to aging. The stereotypical characteristics of older adults--such as being frail, helpless, and in poor health--may, in fact, be symptoms of alcohol problems. In addition, alcohol abuse in later adulthood is often not recognized because older adults tend to drink more at home than in public and to drink smaller amounts at a time (Barry, Oslin, & Blow, 2001). Although other disciplines (e.g., nursing, social work, psychology, medicine) are addressing the issue of alcohol abuse in later adulthood in professional literature, a search revealed only one article (Myers, Dice, & Dew, 2000) in a counseling journal in the past decade. As a result, older individuals with alcohol problems remain largely a hidden population, and counselors are likely to be ill prepared to work with this population. In addition, a recent study by Schultz, Arndt, and Liesveld (2003) highlighted the lack of treatment programs for older substance abusing clients. Thus, the purpose of this article is to (a) discuss the risk factors associated with alcohol abuse in later adulthood, (b) provide an overview of issues related to assessment of alcohol problems in older adults, and (c) examine treatment implications for older individuals. RISK FACTORS FOR ALCOHOL PROBLEMS Many of the risk factors that may precipitate or exacerbate alcohol problems among older adults are different from those experienced by younger individuals. This section provides an overview of the various physiological, psychological, and socioemotional factors that are related to alcohol abuse in later adulthood. Physiological Factors Older adults are more vulnerable to the negative effects of alcohol abuse due to the physiological changes related to aging (Benshoff & Janikowski, 2000). Alcohol is a water soluble drug; therefore, as total body water and lean body mass decrease with age, the blood-alcohol levels will increase when alcohol is consumed. In the older adult, this property of alcohol creates a greater sensitivity, causing him or her to experience negative consequences from the consumption of lesser amounts of alcohol compared with that of previous years. Also, slower rates of metabolism and slower excretion rates account for higher blood-alcohol levels among older adults (Benshoff & Janikowski, 2000). Older adults may not recognize these physiological changes and continue to drink at levels considered safe when they were younger. In a comprehensive literature review, Stoddard and Thompson (1996) outlined several physiological complications that could be the result of alcohol abuse among older adults: (a) neurological disorders (e.g., cognitive impairments, memory deficits, poor motor functioning, and cerebral and cerebellar degeneration); (b) compromised immune and digestive systems; (c) heart muscle damage, including an increased risk for high blood pressure; (d) sexuality issues (e. …