If your parents or neighbors were ill or needed help, you'd do everything you could to help, wouldn't you? But when that same older person shows signs of having a problem with alcohol or prescription drugs, it's hard for most people to know what to do or say. Alcoholism and the misuse of prescription drugs are becoming a life-threatening epidemic in older people. It is estimated that 70% of all hospitalized older persons and up to 50% of nursing home residents have alcohol-related problems. Among older people there is reason for concern about mixing alcohol and drugs. Of people over 65, 83% take some prescription. Over half of all prescriptions for older persons have some sedative. Combining prescriptions with alcohol can be deadly at any age, and especially so among the older age groups. Yet the symptoms may be difficult to recognize. For example, shaky hands and forgetfulness could be normal symptoms of aging—or a sign of alcohol or prescription abuse. It may be difficult to know how to talk to an older relative, friend or neighbor about this issue. When deciding whether to talk to them, you may think: "My father has been drinking all his life. He's too old to change." This is not necessarily so. Older people have the highest recovery rate of all age groups. In fact, research has shown that a key factor in the recovery of older people is the concern and involvement of family and friends. And as people get older, their tolerance to alcohol and others drugs decreases dramatically. What older persons thought they could "handle" at an earlier age may affect them in confusing and alarming ways now—making them more receptive to help than ever before. "Drinking is the only pleasure mom has left. Why deprive her of the one thing that makes her happy?" Alcohol is a depressant. Chances are that drinking is not making your mother happy at all, but instead, causing her misery, depression, remorse, and shame. Since people in their seventies can live another 5, 10, or even 25 years, helping to remove alcohol and unnecessary drugs could improve both their physical and emotional health. The misuse of alcohol and prescription drugs can worsen diseases normally associated with aging, including heart and liver disease, arthritis, diabetes, glaucoma, cataracts, hearing loss, pancreatis, colitis, ulcers, gastritis, and Alzheimers disease. And the thousands of older adults who do recover physically and emotionally from alcohol and drug dependency echo hope and joy when they talk of their newly sober lives. Invariably, they say, "These are the best years of my life"—whether they stopped drinking at 65, 75, or even 85. "The doctor says a glass of wine in the evening is good for Aunt Mary's heart." Many doctors suggest small amounts of alcohol to help older patients sleep better, improve their appetites or calm their nerves. However, a physician may not realize that an older person predisposed to alcoholism can't stop at one drink. And because of changes in metabolism, drinking two or three beers at age 65 can have the same effect as ten or twelve beers at age 20. In addition, an older patient may be taking medications prescribed by a specialist that a general internist may not know about. Keep in mind that 83% of people over 65 take at least one prescription drug, and that over half of all drugs prescribed to older persons have some form of sedative. Many older adults have two or more doctors, each prescribing certain medications. Drinking on top of taking prescription drugs can be extremely dangerous, since the alcohol can quadruple the effect of a drug. "I'm only a neighbor. I'm sure his family would do something if it were that bad." If your neighbor lives alone and has been drinking or taking prescription drugs, his family may not have noticed that the problem has gotten worse—or they have learned to ignore it. He may have also cut down on his drinking—or hidden prescription pill bottles—when his family visits. Also, he may have only recently started drinking heavily, for example, since retirement or in response to the death of his wife or close friend. As a neighbor, you may be the only one to see how many empty liquor bottles end up in the trash or how unsteadily he walks. And, you may be the one that he really listens to and allows to help him. "I live too far away to be of any help." Even if you live on the other side of the country from an elderly relative or friend, you can still help. You can learn about the special symptoms of alcoholism and drug misuse that older people experience, treatment options that are available and how to start a conversation on the subject either by telephone, in person, or in writing. The professional counselors at Hazelden Betty Ford Foundation have developed Recovery@50+, one of the few treatment programs for older adults. By learning the best way to reach out, you may save a person's life and make it worth living again. Signs of alcoholism and drug abuse in older people Alcoholism There are two types of alcoholism that are found in older people. Early-onset alcoholics have been drinking for much of their adult life and account for two-thirds of older alcoholics. The remaining third are late-onset alcoholics who began drinking excessively later in life, sometimes as a response to the loss of a spouse or to the uncertainty of retirement. Abuse of prescription drugs Physicians routinely write prescriptions for tranquilizers for older patients—more than 16.9 million prescriptions each year. And about half of all drugs prescribed for older persons include some form of sedative. Older people often take higher doses than prescribed because they forgot that they already took a pill or because "if one is good, two is better." It is not unusual for older persons to take a drug prescribed to a friend or spouse—even when the prescription is old—if the drug fits a self-diagnosed ailment. An older person may become dependent on alcohol or drugs after a major operation or a lengthy hospital stay. This dependency can be life-threatening, yet is treatable. Some signs you should look for As you might guess, the signs of alcoholism and drug abuse are different in older adults than in younger people. For example, the majority of older people drink at home to avoid high bar prices and driving at night. Therefore, often their drinking is hidden. If they live alone, no one may notice when they pass out in front of the TV. And, if someone comes to visit unexpectedly, they may use the excuse of ill-health to avoid answering the door when they have been drinking. Also, since they're often retired, they don't have the work problems that often reveal substance abuse. They don't get arrested for drunk driving often, because they don't drive as much. However, here are some signs you may notice: Prefers attending a lot of events where drinking is accepted, such as luncheons, "happy hours" and parties Drinks in a solitary, hidden way Makes a ritual of having drinks before, with, or after dinner, and becomes annoyed when this ritual is disturbed Loses interest in activities and hobbies that used to bring pleasure Drinks in spite of warning labels on prescription drugs Always has bottles of tranquilizers on hand and takes them at the slightest sign of disturbance Is often intoxicated or slightly tipsy, and sometimes has slurred speech Disposes of large volumes of empty beer and liquor bottles and seems secretive about it Often has the smell of liquor on his/her breath or mouthwash to disguise it Is neglecting personal appearance and gaining or losing weight Complains of constant sleeplessness, loss of appetite or chronic health complaints that seem to have no physical cause Has unexplained burns or bruises and tries to hide them Seems more depressed or hostile than usual Can't handle routine chores and paperwork without making mistakes Has irrational or undefined fears, delusions or seems under unusual stress Seems to be losing his or her memory Many of the symptoms listed above are often attributed to other diseases or are accepted by relatives, friends, or older persons as part of the aging process. However, many older people find that once they stop drinking and have their prescription drug doses adjusted by a physician, these symptoms disappear. The first step to getting help for an older person Before speaking up, you may wish to consult a professional who is knowledgeable on the needs of older adults. This could be an alcoholism counselor, psychologist, doctor, minister or social worker. They will help you look at the situation more objectively and evaluate your options. Before your meetings, gather as much of the following information as you can: A list of prescribed and over-the-counter drugs the person is taking. A list of doctors the person is seeing. For example, they may have a general practitioner and a specialist. A brief life history of the adult including religious and cultural background and important life events. An idea of the person's present condition. Is he/she able to live alone and take care of himself/herself? How is drinking or the misuse of medicines affecting the person's health, family and social life, attitudes, etc.? A list of family members and friends who are concerned and would be willing to help, if necessary. Together, you and the professional should be able to make an informal assessment as to what type of help the older person needs and how the person should be approached. You may decide, for example, that it would be better for your friend's physician to bring up the problem, since many older people trust their doctors implicitly. Or perhaps you can ask a minister or an old acquaintance of your friend to sit down for a good heart-to-heart talk, if you feel you wouldn't be taken as seriously as someone known longer. Here are some general guidelines to keep in mind as you prepare what you want to say: Don't talk to the older person when he/she is drinking. If evening is the usual drinking time, talk earlier in the day. Be gentle and loving. Avoid a confrontational style. Bring up the person's good qualities and the happy memories you have together. Avoid the words "alcoholic" or "drug addict" since they carry a heavy stigma. If they feel they are "bad," they may retreat into resignation and even more solitary drinking. Don't bother pouring alcohol down the sink or throwing away tranquilizers. If older persons are not ready to get help, they will simply replenish the supply. Do not dig up painful events from the past. Focus on the effects alcohol and prescriptions are having now. Keep in mind the person's age and ability to understand. Instead of talking things out in one session, you may have to bring up the subject a little bit at a time. He may try to use old age as an excuse not to address the problem. Keep talking consistently and patiently without undue pressure. Be direct. Sometimes we coddle an older person like a child. Treat the person as an adult. Be specific. Present the facts in a straightforward manner, such as, "I've noticed that you drink almost a full bottle of wine over the course of an evening," instead of "You're always drunk." Use "I" phrases, such as "I noticed," or "I'm worried," since the older person can't argue with your feelings. Talk about the effect of the alcohol or drug use on whatever the older person cares about most: what other people are saying, health or memory loss. For example, they may have given up on themselves, but still care very deeply about their grandchildren. Don't worry if you don't say things perfectly. The suggestions that follow are just guidelines. The most important thing is that you express your concern with love, gentleness, and respect. Getting the conversation started Here are some "opening lines" to help you approach an older person in the most appropriate way based on your relationship: Situation #1: a parent or grandparent who lives nearby "Dad, I'm concerned about the amount you've been drinking since mom died. I know you miss her very much, as I do, but drinking isn't going to bring her back. The other night when you came over to dinner, you drank a lot of beer in a short time and looked pretty unsteady when you left. And, you seem to get more depressed when you drink. I'm worried about you and I'd like you to see the doctor to find out if there's anything physically wrong." Situation #2: a parent or grandparent who lives far away "Mom, I wanted to call this morning because I'm worried about our phone conversation Tuesday night. You were crying and slurred your words. You kept repeating the same thing over and over again. This has happened before. I know you used to like a glass of wine with dinner, but the last time I was in town, it seemed that you were drinking more than that. I talked to my doctor about it, and he mentioned that as people get older, their metabolism changes, and they may not tolerate drinking as much as they used to. Please call Dr. Williams today and make an appointment to talk about it." Situation #3: a husband or wife "Honey, when we were planning our retirement, we both looked forward to relaxing and socializing more. But now it seems that when we go out to dinner and visit with friends, you're drinking more than you used to. And you seem to get more argumentative after a few drinks. The other night at the Philips, I was embarrassed when you got into that heated discussion over dinner. You're never like that when you're not drinking, so I was wondering if, perhaps, the gin is interacting with your heart medication. I think we should talk to the doctor about it." Situation #4: a good friend "Eleanor, you're my oldest friend, and I love you like a sister. So I hope you won't think I'm interfering when I tell you that I'm worried about you. I know your doctor prescribed tranquilizers after your operation last year, but I noticed that you're still taking them. You seem a little hazy and unfocused when we play cards, and I wonder if you still need that medication. I'm going over to the medical center tomorrow. Why don't you come with me, and we'll ask the doctor about it?" Situation #5: a neighbor "Hi, Mr. McCabe. How are you feeling? I noticed that you haven't been out as much lately, and I was wondering if you're okay. Last night, I got home late and saw that all the lights were still on, so I came over and knocked, but there was no answer. I was worried, so I looked through the window and saw that you were asleep in front of the TV with a burnt-out cigarette in your hand. Since the cigarette was out, I didn't bother to wake you up then. But I thought I'd come over today, and see if there's anything I can do. After my father got out of the hospital, he found that even one beer on top of his medication was more than he could handle. I'd be happy to drive you to the doctor, or call one of your kids to come over." Possible reactions and what to say in response "It's just a phase. I'm only drinking more now because I'm depressed over (a death, retirement, or illness)." Remind them that alcohol is a depressant—it only makes things worse. "Leave me alone. It's none of your business." Gently say that the reason you're bringing it up is because you care. If the older person gets angry, close the conversation and try bringing it up another time. "My doctor says it's OK." As if the doctor knows exactly how much the older person drinks and how many prescriptions they are taking. Offer to talk to the doctor yourself. "I'm nervous these days and I need the tranquilizers to calm me." Tell the person that there are other more healthy ways to deal with stress and that the drugs may be affecting his/her health. "It doesn't matter. Nobody cares if I live or die anyway." State how much you care about the older person and that there's help available. "I don't want to go to the doctor. He'll just send me back to the hospital or to a nursing home." Many older people are surprised to find that treatment is provided in a cheerful, campus-like environment. If a hospital stay is necessary, it may be just short term. Getting treatment will make life better, not worse. "I just drink because I'm lonely. There's nothing to do once you get old." Remind your friend of the pleasurable things he/she used to do and still can do. The world will get bigger, not smaller, once he/she stops drinking. If the older person is ready for help The first thing to do is listen and be supportive. You may want to urge your friend to see a physician to get a professional assessment of the problem. Depending on the severity, the older person may need hospital care to treat the physical symptoms of alcohol and drug reactions. Many older persons can benefit from inpatient treatment for alcoholism or drug dependency. There are some treatment centers that specialize in older adult chemical dependency. Some offer daytime outpatient care, residential treatment or medical care along with continuing treatment for the older person. You may find that there is an outpatient or inpatient program nearby. You or a counselor, social worker or treatment center representative should contact the older person's health insurance company or Medicare to confirm coverage. Help make the older person comfortable about spending time away from home if that type of treatment is necessary. Promise to watch the house, water the plants, and handle the bills if he/she needs or desires inpatient care. If there is access to an outpatient program, you'll be nearby for support. Alcoholics Anonymous (AA) can be a good alternative—supplemented by one-on-one counseling with an alcoholism professional. Founded in 1935, AA has helped millions of people achieve sobriety. Find a local meeting by calling the AA number in the phone book. When you talk to the AA volunteer, ask for a meeting where an older person would be comfortable. A wide number of AA meetings exist, including groups for older people in recovery. Offer to drive the older person to a meeting yourself. Or better yet, if you know another older adult who is in one of these programs, find out if he/she would be willing to help and introduce them. What to do if the older person isn't ready for help Denying that there's a problem is one of the symptoms of the disease. When older persons have been drinking or using prescription drugs over the years, they may not notice how bad things have gotten or they may have some brain damage that prevents them for relating to what you're saying. On the other hand, they may be fully aware of the problem, but too scared to accept help. Unless the older person's physical or mental health is severely deteriorating, the best thing to do may be to drop the subject temporarily. However, you may wish to contact the person's doctor about the condition. Meanwhile, stay in touch and don't despair. You have planted a seed of recovery that may grow when you least expect it. You have taken a loving and courageous action that may save a life down the road, and there probably will be other opportunities to offer your assistance. In certain situations, a trained alcoholism counselor may suggest a "formal intervention." In this situation, you and other family members or friends, plus the counselor, will plan a meeting with the older person to specifically discuss the problem. What to expect as the older person recovers Although the recovery rate for older alcoholics is the highest for any age group, the recovery process may be slower. Since aging slows down the ability to process information, they may be overwhelmed by everything they're learning about their condition. They may have a more difficult time sharing their feelings, and may feel uncomfortable talking in a group. Therefore, if possible, try to make sure that the older person receives as much individual attention as possible from a professional who is sensitive to the special problems of older adults, such as grief and depression. When the older person returns home, stay in contact as much as possible. And continue to try to help where needed. Realize that you have given back a life and made it worth living again. If you live with someone who has a problem with alcohol or prescription drugs Living day in and day out with someone close who has a problem with alcohol or other drugs can be a difficult, heart-breaking experience. You shouldn't try to handle it yourself. Most importantly, please talk with a professional first. Don't bring up the drinking problem until you first get help for yourself. By becoming informed on alcoholism and drug dependency, you'll be in a better position to help your friend. You can also get the support and information you need at Al-Anon Family Groups. For information, call your local Al-Anon number in the phone book. In addition, many treatment centers and substance abuse professionals have special programs for friends and family members.