Abstract

You’re not alone ! There are millions of people who are addicted to alcohol and drugs the world over. Be courageous enough to accept the situation and get the help needed to deal with your problem, advises Dr Sameer Chaukkar, MD.

Alcohol abuse among the elderly is a more serious problem than what most of us take it to be. In later life it often remains hidden and consequently, overlooked. For example, many older adults drink in the privacy of their homes and are less likely to be disruptive in public or arrested for driving while intoxicated. Further, even when family, friends and professionals recognise the problem, they’re reluctant to confront the elder. This may be due to the fear of the person, lack of knowledge about alcohol problems in later life, or the older person's outright denial of any such habit, altogether.

“Alcohol abuse is a serious issue,” says Dr Sameer Chaukkar. “Alcoholism is a disease. It can never go off completely, like diabetes; there’s no cure, we can only arrest its progress.” Alcoholism is not a habit—it’s an inborn trait, say counsellors. Alcohol does not bring in the bad traits in one’s character—eg, stealing or bluffing. On the contrary, alcohol comes in because of these already existing traits in the alcoholic’s personality. It’s just a matter of time before it manifests itself, but the seeds are in your genes.

A Slow Death

Alcohol slows down the activities of the brain. It impairs mental alertness, judgement, physical coordination and reaction time -- increasing the risk of falls and accidents. Over a time, heavy drinking can cause permanently damage your brain and central nervous system, as well as the liver, heart, kidneys and stomach. Alcohol can affect the body in unusual ways, making certain medical problems difficult to diagnose. For eg, the effects of alcohol on the cardiovascular system (the heart and blood vessels) can mask pain, which may otherwise serve as a warning sign of heart attack. Alcoholism can also produce symptoms similar to dementia -- forgetfulness, reduced attention, and confusion.

Alcohol itself is a drug and mixes unfavourably with several other drugs, both prescription and over-the-counter. This means, the use of prescription drugs may intensify the older person’s reaction to alcohol, leading to rapid intoxication. Alcohol can dangerously slow down daily-life performance skills like driving, walking, and impair judgement and reduce alertness when taken with drugs like tranquilisers.

Use of alcohol can also cause some drugs to be metabolised more rapidly, producing exaggerated responses. In some people, aspirin can cause bleeding in the stomach and intestines, if they’ve been excessive drinkers. Alcohol irritates the stomach and can also aggravate this bleeding. A combination of alcohol and diuretics can reduce blood pressure in some, producing dizziness. Even moderate drinks can affect the way drugs react inside the body.

Contributing Factors

The circumstances leading to the problem are unique for each person. However, excessive use of alcohol in later life is often triggered by changes in work status, family relationships and health. “Typically the condition is called HALT (hungry, angry, lonely, tired)”, says Dr Chaukkar. Out of these ‘lonely’ is called the ‘empty nest syndrome’, categorised by children migrating abroad for studies and work, death of spouse etc. In short, when the nest is empty, loneliness sets in, followed by alcohol. People of all ages experience losses, but for older people losses are often irretrievable and tend to ‘pile up’.

1. Retirement: For those who have no developed interests and relationships, retirement can usher in many losses like an undisciplined life, loss of peer/co-workers/friends, sharp decrease in the number of daily activities, loss of income and feeling of being non-productive. Some older people drink in reaction to the loss in self-worth, responsibility and income that follows retirement. Others can't adjust to the lack of structured activity and drink out of boredom. Still others may find themselves in new leisure situations where ‘social’ drinking is expected.
2. Loss of relationships: When children leave home and spouse dies, friends move away or die, the circle of relationships grow smaller. Physical problems may limit mobility, confining the elderly to the house, barring a few visits off and on. Soon, a feeling of isolation and loneliness sets in and may become unbearable. Then, alcohol may become ‘the only friend’.
3. Poor health: Loss of physical health can be very stressful. It can limit physical mobility and also lead to a negative self-image. Alcohol may be used to block the emotional pain, or as a sedative to lessen chronic pain.

Recognise the Problem

Signs of an alcoholic problem may show up as changes in drinking patterns, behaviour or physical conditions. Get help if you:

• Drink to calm your nerves, forget your worries, or reduce depression.
• Lose interest in food.
• Gulp down your drinks.
• Lie or try to hide your drinking habits.
• Drink alone more often.
• Hurt yourself, or someone else, while drinking.
• Need more alcohol to get "high".
• Feel irritable, resentful, or unreasonable when you’re not drinking.
• Have medical, social, or financial problems caused by drinking.

Get Help

Older problem drinkers have better chances of recovery because once they decide to seek help, they usually stick to the treatment programmes and are consistent too. You can begin getting help by calling your family doctor, and seeking his advice on the matter. He can be your guide to the next step. <.p>

A number of agencies are involved in helping alcoholics quit their addiction, as well as treatment and rehabilitation. Kripa Foundation, has facilities such as counselling, detoxification and deaddiction, and Rehabilitation Centres. The Kripa programme covers an in-house comprehensive therapeutic living and learning along with Primary Care and After Care over a 90-day period. Some others in Maharashtra are Sevadaan, and Mukhangan (Pune).

A Family Disease

Alcoholism is known as a ‘family disease’ as it affects the entire family. It can be as damaging to the family as to the alcoholic. The members of a family depend on each other for mutual love, care, support and respect. An older person with an alcohol problem who exhibits forgetfulness, irritability or increased physical problems will disturb the normal, healthy, emotional relationships within a family. The general tendency has been that a person who neglects home or self will usually neglect relationships.

Behavioural changes are very sharp in alcoholics. Far from being pathetic and helpless, as we believe them to be, they are cunning, baffling, selfish and manipulative, says Dr Chaukkar. “A simple definition of an alcoholic is one who has the following four traits—Tolerance (today he needs one peg, tomorrow two and goes on increasing. The level of tolerance to alcohol increases by the day), Withdrawal (if he doesn’t get his drink, he’ll be irritable and difficult), Preoccupation with substance (thinking about alcohol most of the time and hiding it everywhere like under the bed, bathroom etc), Disturbance in lifestyle (which simply means he’s not able to perform normal routines and is under the influence of alcohol most of the day).

Seek Professional Help

The first thing that comes from an alcoholic is denial. “No one wants to admit he’s an alcoholic. They always make comparisons between themselves and someone else who drinks. Worse is when the family also refuse to acknowledge the problem,” says Dr Chaukkar. The problem multiplies with denial. The solution lie in acceptance and then seeking professional help. For rehabilitating an alcoholic, it’s important the family identifies and acknowledges the problem.

Attend support groups that’ll give an inside view of the problem and help you to sustain. Al-Anon (for relatives and friends of alcoholics) or Adult Children of Alcoholics can be a valuable source of educational information and emotional support. They can help you understand and deal better with problems related to drinking. Alcoholics Anonymous has open meetings that can be attended by the general public. (Closed meetings are limited to AA members.) Many communities also have programmes designed specifically for women, "Women for Sobriety."

• Long-term residential programmes - The person is admitted to a specially designed programme for three to nine months or sometimes longer.
• Short-term in-patient programmes - The person is admitted to a hospital or clinic for 10 to 30 days.
• Outpatient programmes - The person lives at home but attends scheduled activities, often on a daily basis.
• Support groups - The person attends meetings with others who have a similar problem, for mutual education, information and support. AA is the prime example of this approach.

Unfortunately, few treatment programmes deal specifically with older persons. More are being established, as professionals recognise how the physical, psychological and social needs of an older person may differ from younger drinkers.

First, detoxification for the first 10-15 days, then rehabilitation. It’s a programme where everything from knowledge about alcoholism to completely reinventing oneself is encouraged. It consists of yoga, meditation, walks, writing sessions, group discussions and fun time. “Alcoholics are egoistic and it is important to crush their ego. We make them do their own work, even if that means cleaning toilets. Only when they get rid of their ego can any programme benefit them”, says Dr Sameer Chaukkar.

Once the rehabilitation programme is complete, an alcoholic must totally reinvent his lifestyle. If he doesn’t follow the programme after being discharged, there’s a possibility of relapse.

Possibility of Relapse

Relapses occur sometimes even when a person is committed to recovery. A person may take a drink after being sober for several months, thinking he or she is cured or can now handle alcohol. Don't give up. The person needs more support and encouragement than before. Condemning the person or feeling responsible for a relapse will not help.

Although it's discouraging to see a person return to drinking, such relapses are not necessarily repeated. They often serve as a valuable lesson and frequently help a person to accept that abstinence is necessary because of their powerlessness over alcohol.

“As a result of society's age-apartheid system, the elderly are often alone, by no fault of their own,” says Dr Chaukkar. Older people feel left out because they can’t share their feelings with others out of shame or guilt. It’s important to give vent to your feelings even at this age. Don’t think your problems are unique, don’t be ashamed of them. There are others who’re in the same boat, and you can expect sympathy, definitely. There’s a need to build a strong support system to enable the elderly to avoid the grave problems of loneliness and subsequently, alcohol abuse.

(Dr Sameer Chaukkar, MD, with a PG Diploma in Addictions Treatment and Prevention (Canada), is a Senior Counsellor at Kripa Foundation, which offers healing programmes and supportive community living for those with alcohol and chemical dependency. He can be contacted on 09892166616, or at - This e-mail address is being protected from spambots. You need JavaScript enabled to view it .)