JACS Library - Articles

JACS: Jewish Alcoholics, Chemically Dependent Persons, and Significant Others

JACS LIBRARY - ARTICLES

Jewish World Review July 22, 2002 / 13 Menachem-Av, 5762

Peter H. Gott, M.D.

Gramps is a lush

http://www.NewsAndOpinion.com DEAR DR. GOTT: My 70-year-old father has been retired for five years. He admits to me that he is lonely and bored. How also reluctantly admits that instead of his traditional two cocktails before dinner, he may have three -- plus a nightcap at bedtime. Sometimes, when I telephone him in the evening, he seems forgetful and vague. I'm worried that the alcohol may be to blame. How can I address this issue without precipitating a family crisis?

DEAR READER: This is a difficult question about a potentially serious disorder.

Drinking problems in senior citizens are, by all accounts, under-diagnosed. After retirement, many seniors begin to consume more alcohol -- as a function of depression, loneliness, boredom or a feeling of liberation -- at precisely the time in their lives when they are least able to handle it.

For example, alcohol has a much greater impact on older adults than it does on the younger, because of physiological changes. An enzyme in the stomach (gastric alcohol dehydrogenase) is reduced.

This enzyme begins the metabolic breakdown of alcohol; if it is deficient, more alcohol enters the bloodstream and will affect the nervous system. Also, the liver is less able to detoxify alcohol as we age. Finally, women at all ages are less tolerant of alcohol.

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) has defined moderate and acceptable drinking in adults over 65 as no more than one drink a day. One drink is equivalent to 1.5 ounces of spirits, a 12-oz beer, or a 5-oz glass of wine. While this guideline may be conservative, experts agree that the elderly should not exceed 14 drinks a week for men, seven for women, and no more than four drinks on one occasion for men (three for women). Finally, researchers have estimated that the prevalence of alcoholism is 10 percent to 14 percent in the general population. Alcohol abuse is up to six times more common in elderly men than in their female counterparts.

To a large extent, the effects of alcohol consumption depend on a person's health profile and the use of medications. A healthy 70-year-old man without hypertension, heart disease, liver disorders or prescription medicines can safely consume up to two standard drinks a day without adverse consequences. In contrast, a senior in poor health should markedly moderate his intake.

As a general screening test, many physicians use the CAGE questionnaire:

Have you ever thought you should CUT down on drinking? Have people ANNOYED you by complaining about your drinking?

Have you felt GUILTY about your drinking?

Have you ever had an EYE-OPENER to get going in the morning?

Two or more positive answers raise suspicion of alcohol abuse.

The issue is further complicated by the difficulty clarifying drinking patterns. One drink may lead to subjective interpretations. (I once had an alcoholic patient who admitted to "one" drink a day -- an 8-oz glass of vodka.) A pint of beer is more than 12 ounces and a "refreshed" glass of wine is closer to two glasses than one. Finally, many heavy (or "problem") drinkers are either in a state of denial or object to being questioned about their consumption, believing that this is a "personal matter" which is no one else's business.

All of this discussion, although interesting and (I hope) informative, is a long-winded way of answering your question. With respect to your father, I suggest a low-key initial approach. Talk to him (during the day) about your concerns. Emphasize that you love him but are concerned about the health consequences of his habit. Involve your siblings if necessary. Discuss the situation with your father's physician, who should be informed of the problem and will be able to offer immeasurable assistance. In addition, the doctor can perform liver tests, define moderate drinking and -- if necessary -- intervene in a treatment program, such as Alcoholics Anonymous.

If your father did not have a drinking problem before retirement, he may simply have slipped into an unhealthful habit that the doctor can correct by educating him. On the other hand, if alcoholism is to blame, a more structured rehab plan may be necessary.