Academic journal article Adultspan Journal

Alcohol Abuse in Later Life: Issues and Interventions for Counselors

Academic journal article Adultspan Journal

Alcohol Abuse in Later Life: Issues and Interventions for Counselors

Article excerpt

The authors discuss risk factors for late life alcohol abuse and characteristics that differentiate early- and late-onset abusers. Problems in identification, diagnosis, assessment, and treatment of older abusers are reviewed. A case example illustrates the dynamics of effective treatment with this population.

"The substance abuse problem in older adults is a serious one ... [ranking] third among leading mental disorders in older Americans, accounting for 10 to 12 percent of those who receive services from mental health professionals" (Smyer & Qualls, 1999, p. 212). Prevalence estimates of alcohol-related problems among older adults range from 5% to 60% of older persons living independently (Marcus, 1993) and from 15% to 44% of older persons living in institutional settings. A conservative estimate is that 10% of the older adult population experiences substance abuse problems, which typically are undiagnosed and untreated because of the tendency for all substance abusers to deny usage (Segal, Van Hasselt, Hersen, & King, 1996). As the number of older Americans increases from the present 33 million to an estimated 70 million in 2030 (American Association of Retired Persons [AARP], 1996), it is likely that the number of older persons experiencing problems related to alcohol will also increase.

Although treatment success with older persons is comparable to that with younger substance-abusing populations (Blow, 1991), older adults with alcohol problems are far less likely to receive professional care (King, Van Hasselt, Segal, & Hersen, 1994). In fact, only 15% of older adults with alcohol problems receive adequate treatment (Parette, Hourcade, & Parette, 1990). Treatment is complicated by underdiagnosis or misdiagnosis of alcohol problems in older individuals, which may be either ignored by health care providers or hidden by older people and their families (Miller, Belkin, & Gold, 1991).

Effective intervention with older adult abusers requires different strategies for identification, diagnosis, assessment, and treatment than are commonly used with younger abusers (Dupree & Schonfeld, 1996; Schonfeld & Dupree, 1991). Counselors who work with older individuals ate likely to encounter older substance abusers, and thus may benefit from knowledge of these differences, as well as skill in effective intervention strategies to help older persons experiencing problems with abuse. In this article, we (a) provide a brief overview of the physiological effects of alcohol consumption in older persons; (b) discuss characteristics of older substance abusers; (c) examine problems that arise in accurately identifying and diagnosing alcohol abuse in the older population; (d) discuss assessment and treatment strategies that have been used with older people and the implications for counselors; and (e) present a case example from the third author's practice to demonstrate late-life substance abuse disorders.


Older persons experience changes and declines in every body system, making them more prone to infectious diseases and less able to tolerate stress (Saxon & Etten, 1994). Although acute and often curable medical conditions are common earlier in life, older persons frequently experience chronic disease states that require medical management and result in progressive disability (Ferrini & Ferrini, 1992). Both diagnosis and treatment are complicated because multiple problems often occur simultaneously, thus requiring many older adults to consume multiple medications (HHS Inspector General, 1989). Older individuals experience adverse effects from alcohol because of medication interactions as well as the aging process itself. It has been estimated that about half of all the drugs older people take can interact with alcohol (Schmall, Gobeli, & Stiehl, 1989), with adverse reactions ranging from temporary behavioral changes to life-threatening acute reactions (King et al. …

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