with Kristianna Hall
Alcohol—just a particular combination of carbon, hydrogen, and oxygen molecules—can have complicated effects on our bodies as we age. Many of the traditions and customs men adopt and pass along to the next generation, including the continuing emphasis on our invulnerability, have been closely associated with alcohol. Bar hopping, beer festivals, bachelor parties, retirement celebrations, and numerous other well-established traditions surrounding the consumption of alcohol remain widespread. The consumption of alcohol is almost always an expected activity at major sporting events, and the 5 o’clock whistle continues to produce almost a knee-jerk reaction for both blue- and white-collar men alike to meet the boys at a local watering hole and hoist a few.
It is likely that many people reading this chapter may catch sight of its title and think “Well, that doesn’t apply to me,” or “Yeah, I have a few drinks, but I know I’m not a ‘substance abuser.’ ” For most of you, you’re exactly right. Although this chapter does address some of the signs, symptoms, and possible consequences of substance abuse, it is not intended to demonize the use of alcohol; nor is the intention to convince everyone who has a drink or two that they have a pending problem. Instead, it is important for middle-aged and older men to know how the process of aging changes the way our bodies respond to different substances and adds new risks associated with alcohol and medication use. On a more general level, this chapter will speak to the challenges and changing needs associated with becoming older while being on medications and/or using alcohol. Of course, many men can maintain a normal and healthy lifestyle that includes the consumption of reasonable amounts of alcohol as we age. Some men, however, might want to consider reducing their level of consumption in order to improve their physical and mental health and maximize their overall quality of life.
It is estimated that fewer than 10 percent of men age 60 and older are “at-risk” drinkers.1 Low-risk drinking for men has been defined by the National Institutes of Health as no more than 14 drinks per week and no more than four drinks on any day within the week.2 Drinking is not always physically or medically harmful, even among older men. There has been medical evidence to tell us that light alcohol consumption (e.g., an average of one or two drinks per day) among healthy older adults may have health benefits, especially in terms of men’s heart health and longevity. There also has been criticism of this heartening finding, since most existing alcohol-use studies are based on averages and include many men who had previously decreased their alcohol consumption because of their older age and medication use.3 While social drinking in light to moderate amounts can be relaxing and heart healthy, drinking that third drink daily is associated with numerous negative health effects—it can cause serious illness, worsen other medical conditions, interfere with needed medications, and greatly decrease overall quality of life.
Terms like moderate and heavy (or excessive) drinking can mean different things to different people. For men age 60 and older, the recommended (“moderate”) amount of alcohol is one drink per day, with the allowance of two drinks on occasions. Clinicians and researchers agree that a “standard drink” is best viewed as a 12-ounce can of beer, a 5-ounce glass of wine, or a 1.5-ounce shot of liquor (see figure 10.1). You should compare this “standard” with what you actually pour as a serving. Heavy drinking has been defined by the Centers for Disease Control and Prevention as more than two drinks a day, on average.
Figure 10.1. Standard sizes of alcoholic drinks
Given that half of men over age 50 drink “socially,” which means occasionally and no more than moderately,4 the safe use of alcohol versus its unsafe use needs to be addressed, along with the potential health benefits and risks of drinking in various amounts. Medical studies regularly show that consuming a safe amount of alcohol may be protective of our health.5 Moderate alcohol consumption can improve appetite. As you’ve probably heard, alcohol can be beneficial for cardiovascular health, and research indicates that moderate consumption by older adults has also been shown to be protective against type 2 diabetes6 and is associated with better cognition and well-being when compared with older adults who abstain from alcohol use.7
However, one key risk associated with alcohol use is our aging. As we get older, we are more sensitive to and less tolerant of even lower amounts of alcohol than we were able to consume in our forties and fifties. Frederic Blow, an expert on the topic of the use and misuse of alcohol in older adults, warns us that we may be at risk for severe consequences even from what we’ve always considered moderate drinking.
But why is this? As a man ages, his total volume of body water decreases. Alcohol is distributed in a person’s body water, and older adults have less room to work with, so to speak. Older men also have less of an enzyme responsible for metabolizing alcohol in the stomach, which leads to more work for the liver and results in slower alcohol processing. These effects of normal aging cause the alcohol consumed to have a heightened impact as we get older; we will likely have a greater blood alcohol concentration (BAC), even when we drink the same amount of alcohol as a younger man. BAC refers to the amount of alcohol in a man’s blood measured in terms of weight and volume and is routinely expressed as a percentage. Because alcohol in the blood travels directly to the brain, and because middle-aged and older men routinely experience greater sensitivity to the same amount of alcohol a younger man consumes, their higher BAC more severely affects reaction time, vision, hand-eye coordination, and brain function.
Figure 10.2. Blood Alcohol Content (BAC) scale. Courtesy of Campus Alcohol Abuse Prevention Center, Virginia Tech.
There are many other factors that affect your BAC when you drink. Some of these include your size and physical condition, what you have had to eat, how much sleep you have had, what medications you are taking, and, importantly, the actual alcohol content of the chosen “drink.” The effects of body weight on BAC are reflected in the BAC Chart for Men. The chart is intended as a guide for men, but it does not recognize how getting older increases the blood alcohol percentage.
BAC CHART FOR MEN
The dictum “Warning: Alcohol can be dangerous to your health” isn’t to be taken lightly. Consuming too much alcohol has severe adverse effects on our mental and physical health. Unlike the protective effect of moderate alcohol use against the development of many cardiovascular disorders, heavy alcohol consumption is associated with an increased risk of erectile dysfunction, dementia, hypertension, and nonischemic cardiomyopathy.8 For example, it is thought that between 5 and 10 percent of all cases of dementia are causally related to alcohol abuse, while still other men diagnosed with conditions such as Alzheimer’s disease may in fact be suffering from alcohol-related symptoms.
As already mentioned, a single drink can produce higher blood alcohol levels in older men than middle-aged men because of the increase in body fat relative to muscle as we get older. The percentage of total body weight consisting of fat for a typical male generally doubles from age 25 to age 60. Because alcohol does not dissolve in fat, the same alcohol dose results in higher blood alcohol levels in the older man.9 In addition, as we get older, sensitivity to alcohol may increase because we do not metabolize or break it down as quickly. Also, because the amount of water in our body declines as we get older, the same amount of alcohol will result in a higher percentage in an older man’s blood compared to a younger man. For all these reasons, older men cannot drink the same amount as they did when younger without noticeable effects.
We know the stereotype: men are more likely than women to take risks associated with drinking, such as driving after drinking. Say you and your wife go out for a nice dinner and share a bottle of wine. Quite likely, you drank more of it than she did; because of gender traditions, you will nevertheless be the one driving home. You think you are okay, but, as detailed above, our bodies do not “process” that wine as rapidly as when we were younger. Our driving capabilities are diminished as a result of the BAC.
Perhaps one of the greatest risks involved with social drinking is the potential to drink while taking over-the-counter drugs, prescription medications, or both. In one study of people using five or more medications, nearly half unwittingly misused medications and alcohol over a 6-month period.10 Even some herbal remedies are harmful when mixed with alcohol, and alcohol can cancel out the effects of many different medications or cause them to be toxic to the body (see the section in chapter 11 on herbal remedies).11 For example, alcohol in conjunction with acetaminophen (a common, over-the-counter headache medication) may lead to liver damage, and when alcohol is used with depressant-type medications such as sleeping or pain pills, it can have fatal repercussions. It is very easy to unknowingly misuse substances and encounter serious troubles.
Beyond the range of cardiovascular maladies related to consuming too much alcohol, heavy drinking causes many existing physical conditions to worsen, directly contributes to mental health concerns, and is the toxic substance related to more than 60 different disorders.12
Probably most of us understand on some level what substance abuse looks like—perhaps we know someone who identifies himself as an alcoholic, or maybe we’ve seen someone take a few too many pain medications a few too many times. But when does it go from “a few too many” to a worrisome problem, and how does that happen?
Physical Complications of Excessive Alcohol Use
• Liver disease (cirrhosis)
• Chronic obstructive lung disease
• Peptic ulcer
• Psoriasis
• Increased risk of falling
• Malnutrition
• Osteoporosis
• Anemia
• Coma
• Deterioration of brain and spinal cord
• Sleeping problems
• Worsening of high blood pressure
• Brain atrophy
• Potential for harmful medication interactions
• Potential for seizures; delirium tremens during withdrawal
• Esophagitis
• Alcoholic cardiomyopathy
• Increased risk of pneumonia, tuberculosis
• Enlarged liver; enlarged spleen
• Gastritis
• Atrophy of testes
• Peripheral neuropathy
• Decreased platelets
• Clumsiness
• Muscle problems
• Changes in the heart and blood vessels
• Worsened diabetes
• Potential for additional side effects if cigarettes are used with alcohol
• Potential risk of death from withdrawal
Mental Health Issues Related to Alcohol Consumption
• Depression
• Impulsivity
• Confusion
• Potential of hallucinations during withdrawal
• Delirium
• Anxiety
• Irritability
• Mood disorders
• Suicidality
• Forgetfulness
Source: Centers for Disease Control and Prevention (n.d.). Frequently asked questions.
The phrases substance abuse and substance dependence are frequently used interchangeably, but they refer to two separate (yet often interrelated) conditions. Substance dependence, in its simplest form, refers to the pervasive need to use a drug or alcohol and frequently involves a physiological component of tolerance and/or withdrawal. Substance abuse, however, refers to a pattern of excessive or harmful use of alcohol or drugs. The harm and negative life consequences involved in the abuse of alcohol or drugs include neglecting responsibilities, jeopardizing the health and well-being of others, legal problems due to drunk driving, and the inability to stop engaging in unlawful and/or dangerous behavior despite the consequences.13 Psychiatric texts make it clear that abuse and dependence are two different conditions, yet the people we commonly think of and refer to as “substance abusers” have become habitually dependent on a drug or on alcohol. So then, how does dependence develop? Let’s look at Ron’s story for clarification:
Ron, a man in his midforties, was recently laid off from the job he’d had for the past 20 years. Ron had always enjoyed a nip or two of Southern Comfort after getting home from work, but he never overdid it because he knew he would need to pick up his wife from her job later in the evening. After being laid off, Ron let his wife take the car to work every day while he stayed at home. Upset about losing his job, and having no need to drive, Ron started drinking a little more SoCo in the evenings before his wife got home. Eventually, Ron noticed that he did not feel much after three drinks, and still not much different after four. He needed to have almost five drinks to feel the alcohol’s effects, and when he woke up in the morning his hands often shook. After a few mornings of this, Ron started to have a glass of whiskey in the mornings to steady himself. Ron’s wife noticed his increased drinking and became concerned for her husband’s health.
Ron’s story illustrates the concept of substance dependence. When Ron upped his alcohol intake to three drinks per night, he felt a certain level of intoxication. However, after having three drinks per night for a while, Ron’s body started to develop a tolerance to the alcohol, meaning that he needed to have more and more drinks to feel the original effects that he once felt after one or two nips of whiskey. This type of physiological tolerance often goes hand in hand with withdrawal—in Ron’s case, his shaky hands in the morning indicated that his body was “suffering” from not having alcohol. For those who are dependent on a substance, physical withdrawal symptoms are unpleasant and often compel the user to seek more alcohol or drugs, simply to stave off withdrawal.
Figure 10.3 shows the beginning and end, respectively, of tolerance and dependence. The top shows a typical drinking experience: The user starts out feeling normal (baseline). After drinking, the user feels the “high” and then eventually sobers up and feels normal again. For people with alcohol dependence, however, like Ron, the bottom image is more applicable. If Ron does not drink, his hands shake and he experiences uncomfortable withdrawal symptoms. Thus, Ron starts at below baseline (he feels bad) and then must drink simply to get himself to feeling okay.
The story of Ron’s experience with alcohol dependence may not always hold true for the vast majority of adult men. Diagnostic criteria have generally been developed and tested on younger people, and while middle-aged and older adults may experience the same end results as their younger counterparts, the process of addiction can look quite different.14
Figure 10.3. Drinking experience baseline
It is important to realize that men over 50 may become physiologically dependent on substances without meeting the standard criteria for dependence. Granted, this sounds nonsensical, but clinical guidelines for tolerance and dependence generally fail to account for adults’ aging-related physical changes.15 Going back to Ron, even if he had not developed a problematic pattern of alcohol use, his two drinks a night would have, most likely, eventually become too much had he continued to drink in the same manner when he reached his midsixties.
Research in the area of older adult addiction has identified two distinct types of problematic users. As you might guess, some older men are alcoholics or drug addicts who survived into older age. They are referred to as “earlyonset” users or “survivors.” Men who fall under this category are at high risk for continued substance use later in life and have a much greater risk of health complications as a result of their years of drinking or drug use.16
However, men sometimes develop a problem with alcohol or other substances for the first time later in life. They are known as “late-onset” users or “reactors.”17 Among these late-onset users are men who develop substance use problems after the onset of other health problems or a very troubling later-life event.18 Experiences such as the death of a spouse or the postretirement loss of daily vocational rhythms can lead to severe distress and an increased use of a substance to cope. Older men who use substances to cope or “medicate” may have earlier used a drink to wind down, and now some of them turn to alcohol to try to cope with troubles and their depressive mood.19 Early-onset alcoholics account for approximately two-thirds of all problem drinkers among older men, late-onset problem drinkers the other third.20
According to the National Survey on Drug Use and Health, the evidence is that the use of illicit drugs and misuse of alcohol are increasing among older men.21 More older men now disclose “heavy” than “moderate” alcohol use, and more also report occasional binge drinking (which is defined as five or more drinks in a sitting). Most experts concur that the problem of misuse and abuse of legal and illegal drugs in older adults is grossly underreported and likely to become more of an issue as baby boomers reach retirement age, because they have had a higher substance use level than previous generations of older adults.22
Why does substance abuse in older adults go so unnoticed? For one thing, because diagnostic criteria and clinical screening tests tend to be geared toward a younger population, a problem among older men can get overlooked by health professionals. Moreover, many medical practitioners are not able to differentiate symptoms that may be associated with aging, such as tremors or confusion, from drug- or alcohol-related side effects, especially given the fact that a small amount of alcohol may seem inconsequential to a health professional but could have deleterious effects on an older man’s health.23 Furthermore, the substance abuse that tends to be associated with life events such as losing a job or going through a divorce may not readily apply to older men, whose “late-onset” drinking practices are less likely to be publically viewed. For example, while the excess drinking by a man in his twenties or thirties may cause him to lose his job or be slapped with a DUI, a retired man in his seventies who depends on a daughter for rides may still have an alcohol abuse problem, but one that will never manifest itself and affect his daily life.
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following in a 12-month period:
• recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home;
• recurrent substance use in situations in which it is physically hazardous;
• recurrent substance-related legal problems;
• continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effect of the substance.
Source: Diagnostic and Statistical Manual of Mental Disorders, 5th ed.
Men are not immune to the possibility of prescription drug misuse and abuse; in fact, it is much more common for middle-aged and older men to make unintentional mistakes with regard to their consumption of prescriptions than younger men. As we get older, we are commonly prescribed several different medications, often from more than one health care provider, and we are at an increased risk of experiencing medication interactions and other side effects that result from “polypharmacy,” which is the concurrent use of four or more different prescription drugs.
Older men sometimes do not understand that their physical symptoms may in fact be related to the misuse of medications and/or abuse of alcohol. Just like their doctors at times, older men may mistake physical and mental symptoms such as hand tremors, dizziness and instability, sadness, and confusion for normal aging—they assume that they are “just getting old,” when the real cause might be as simple as mixing alcohol with an over-the-counter medication, or mixing an over-the-counter medication with a prescription medication. As we get older, we need to be aware of our increased risk of “substance misuse,” even when it is absolutely unintentional. Not only are our older bodies less able to process the alcohol in a drink, but a single glass of wine along with our evening dose of a medication can cause instability, confusion, and many other physical and psychological symptoms. We can and should be our own best resource for monitoring substance use.
Figure 10.4. Prescription Rx warning
Certain conditions put older men at greater risk for experiencing a substance use problem later in life. These include psychological conditions such as depression or anxiety, age-related health problems, and a previous history of substance abuse problems.24
A significant risk factor for substance abuse across all ages is a psychological problem. In fact, older adults with alcohol abuse or dependence are nearly three times more likely to have an underlying psychological disorder. Here we will briefly focus on depression, as it, much like substance abuse, is an underrecognized problem in older men.
Men’s depression too often goes unnoticed. Most of the time, the complaints we voice that are associated with depression tend to be physical—fatigue, sleep disturbances, unexplained aches and pains, loss of appetite (see chapter 4 for more details). For older men these symptoms are too readily thought to be evidence of normal aging—slower movement, forgetting (to take medications), worrying about being a burden. The depression we feel is not sadness, but rather a lack of energy or a worsening of existing physical issues such as arthritis or headaches.
It may be tempting to try to manage our losses, grief, physical pain, and boredom by using alcohol and prescription drugs, but research shows that this can actually complicate our symptoms of depression. With alcohol especially, short-term rewards are not worth the long-term ramifications. Alcohol is a depressant drug and actually worsens conditions such as anxiety and irritability, and it also has a negative impact on the quality of your sleep. Moreover, it can interact in harmful ways with antidepressants.
Statistically, adults are less likely to use illicit (illegal) drugs as they grow older. It is middle-aged adults, age 50–54, who are the most likely to use marijuana, to purposely misuse prescription drugs, and to use other types of illegal substances, but according to the National Survey on Drug Use and Health, these numbers “declined dramatically” as respondents’ ages increased. For men over 65, about 1 percent reported using prescription drugs for nonmedical purposes, and approximately 1 percent reported using marijuana.
Legal in an increasing number of states, medicinal marijuana is used by older adults who suffer from glaucoma or advanced macular degeneration and by cancer patients undergoing chemotherapy. It has also proven to be an effective therapy for a variety of other conditions, including inflammatory bowel disease, migraines, fibromyalgia, alcohol abuse, depression, hepatitis, digestive disease, bipolar disorder, and Parkinson’s disease. Medical marijuana has also proven helpful in stimulating appetite in AIDS and cancer patients. It is available for sale in an authorized dispensary in those states permitting its distribution if you have medical authorization. For those older men suffering from chronic pain that has not been treated effectively by other means, the use of medical marijuana may be a treatment to consider in consultation with your physician.
Although there is potential for the abuse of many prescription drugs, most men genuinely try to take their medications the “right” way and are often unaware that some side effects they experience may be as a result of mistakenly misusing their prescriptions. One scenario in which prescriptions can be misused is medication sharing. You might start to develop a new ache or find that falling asleep is becoming increasingly problematic, and a well-intentioned friend might offer one of his or her unused prescriptions—“Oh, well that happened to me, and this cleared it right up. I’ve got half a bottle left, and it’ll save you a trip to the doctor.” In these times of increasing medical costs, it might seem very tempting to save time and money by accepting a “donated” prescription. However, this practice can be highly dangerous—you will not be able to know if the new medication will interact with your other prescriptions, what side effects it may cause in you (versus in your friend), or whether it really is the best treatment for your condition.
Despite the fact that it is expensive to seek medical help and fill a prescription, it is really important that the medications you take come from a health care professional who is informed of your personal history and knows about all of your current prescriptions.
Perhaps the most common example of drug misuse involves the interactions of different prescriptions with themselves, or with over-the-counter medications or alcohol. At this point we have not done our job if you do not realize that alcohol and prescription medications are a harmful cocktail, so we will focus on the former two scenarios. Naturally, the number of different prescriptions and/or over-the-counter medications a man takes will increase his risk of misuse. This is especially pertinent to psychoactive drug consumers, as they are generally on more medications than are nonpsychoactive drug users. Also, the use of several prescriptions from one class of drugs, such as combining two types of bronchodilators, is a common example of misuse in older adults. Over-the-counter medications are also commonly misused when combined erroneously with prescriptions. For example, using aspirin in conjunction with anticoagulant drugs increases your risk of bleeding, and combining aspirin with Clinoril, an anti-inflammatory drug used to treat arthritis pain, puts you at increased risk of gastrointestinal upset.
Studies have identified that accidental misuse is sometimes just that—an accident. Older adults may take either too much or too little of their prescriptions, which is often due to improper (or nonexistent) instructions that they receive from their pharmacists or health care providers. You may not know or remember the use for particular medications, or you may have trouble in appropriately following directions concerning proper dosage. Not only are older adults less likely than younger people to receive physician- or pharmacistinitiated counseling on proper usage of their medication, but older adults are unlikely to ask their health care providers questions about how to take their prescriptions. In one study it was found that older adults were more uninformed than younger adults about the potential risks of medications they were taking (in this case the drugs were potentially driver impairing).25 Do not hesitate to ask questions, and never be afraid to request clarification. Your health care provider and pharmacist will be able to tell you what you need to know about your prescriptions. Don’t let your physician assume that you already know everything you need to know about a new prescription; this is your health, and you have every right to stay as informed as possible.
Most of us probably have several old orange containers lurking in our medicine cabinets. For whatever reason, we seem reluctant to get rid of old prescription medications. Maybe we’re worried they will fall into the wrong hands if we simply put them out with the garbage, or maybe we’re environmentally conscious and prefer not to contaminate our water by flushing pills down the toilet, or maybe we just forget that we even have medicine left over from that annoying sinus infection that plagued us two years ago.
According to the U.S. Environmental Protection Agency, older adults are especially prone to the accumulation of expired or unused prescription medications; this is no great surprise, given that older people make up the largest prescription-using population. Medications pile up when health care providers switch patients’ prescriptions or encourage them to discontinue using certain drugs, or when family members pass away and leave unfinished medications, or when people stop using medications due to unpleasant reactions or just plain feeling better.26
Asking Questions about Your Medications: What You Need to Know
• Make sure you know the name and spelling of the drug you are being prescribed, as well as why your doctor wants you to take it.
• Ask your doctor to write down how often and for how long you should take it.
• Ask if you will need a refill, and if so, how to get one.
• Ask what changes you need to make when taking the medication: “Are there foods, drinks, other medications, or activities that I should avoid while taking this medication?”
• Ask what time of day you should take the medication.
• If a medicine says “take with food,” ask whether that means before, with, or after food. If it does not specify, ask, “Should I take my medicine at meals or between meals?” or “Do I need to take the medicine on an empty stomach or with food or a whole glass of water?”
• Ask what you should do if you forget and miss a dose.
• Ask when the medicine will begin to work, and ask about any possible side effects that it has, especially for older people.
• And always bring a list of all prescription and over-the-counter medications you are currently taking, as well as when you take them, and show it to your doctor.
Source: NIH News (2007, July 26). NIHSeniorHealth offers tips on how to talk with your doctor. Washington, DC: U.S. Department of Health and Human Services.
These excess medications, left unused in your home, can cause a host of problems. You may have grandchildren who could gain access to potentially lethal amounts of medications. At the very least, having too many prescription bottles can lead to mistakenly taking the wrong medicine or confusing expired pills with newer ones. But we hang on to them because the problem of disposal seems sometimes to be just as risky and/or problematic.
There are, however, many resources available for medication disposal. The U.S. Drug Enforcement Agency, recognizing that people often have unused or unwanted prescription medications in their homes, has organized “Drug Take-Back” days. These national events involve participating collection sites where people can drop off their old medications for proper, environmentally friendly disposal. Your community may also have other local collection programs for safe drug disposal, such as those operated by senior centers, law enforcement, or pharmacies.
The term psychotropic medications refers to drugs that are prescribed for a mental health condition. Also referred to as psychoactive medications, these types of drugs have the highest risk for abuse. They include benzodiazepines and opiates, which are arguably the most abused by older adults and merit their own discussion (see below).
Older men should take some comfort in the fact that, as a group, we are less likely than older women to abuse psychotropic (or other) prescription medications. Older men tend to be more likely, as mentioned earlier, to abuse alcohol and cannabis than they are to misuse or abuse prescription medications. However, risk factors for psychotropic medication misuse and abuse include having a large number of different prescriptions and other substance abuse problems (either previously or at the same time). Men are certainly not immune to unknowingly or purposively misusing medications.
One type of psychoactive drug, benzodiazepines, or “benzos,” as they are commonly called, is repeatedly mentioned in the medical literature as being a risk for both abuse and misuse by older men. Often prescribed to older adults for the treatment of anxiety and sleeping problems, benzodiazepine use can often result in physiological dependence after as little as 2 months. Benzos have largely replaced barbiturate-type drugs and other sedatives of the past as they are considered to be safer. But as a class of drugs they represent a significant threat. While this is not intended to scare anyone off their meds, it is important to realize that if you have been prescribed a benzodiazepine-type drug, you may experience withdrawal symptoms if you discontinue its use.
Benzodiazepines and Their Common Brand Names
Oxazepam: |
Serax, Murelaz, Alepam |
Lorazepam: |
Ativan |
Diazepam: |
Valium |
Temazepam: |
Restoril |
Triazolam: |
Halcion |
Alprazolam: |
Xanax |
Clonazepa: |
Klonopin, Rivotril |
Flurazepam: |
Dalmane |
Withdrawal from benzodiazepines is somewhat similar to withdrawal from alcohol in its symptoms and potential severity. This is because each of these substances has the same depressant effect on the body. Although withdrawal from any substance is uncomfortable and sometimes a painful process, those who are dependent on either alcohol or benzos (as opposed to most other substances) may actually run the risk of death when withdrawal is abrupt and not medically managed. Symptoms of withdrawal from benzos include increased pulse, hand tremors, insomnia, nausea, vomiting, and rebound anxiety. Grand mal seizures can occur. It is extremely important to seek medical advice before making the decision to stop a prescription; your doctor may only advise you to gradually step down your dose. Under no circumstances should you ever begin or discontinue taking a medication without first talking to your health care provider.
It cannot be stressed enough that the combination of benzodiazepines and alcohol can be deadly, with the possible result of a shutdown of the central nervous system. In one study conducted specifically on the misuse of prescription drugs by older adults, almost 15 percent of all misuse events involved alcohol, which suggests that many older men may unwittingly put themselves at risk by drinking in conjunction with their prescriptions.27
Many older men are also prescribed opiate-type medications, often for the management of chronic pain. However, when used inappropriately, they can produce a euphoric “high” that may open the door for some men to become dependent on their pain medications for more than just physical relief. While most authorities agree that older adults are far less likely to abuse their opiate-type prescriptions than their younger counterparts, taking these medications puts us at increased risk for harmful side effects. Drugs such as codeine, for example, can lead to poor motor coordination, whereas stronger medications such as oxycodone can impair your vision, diminish your ability to pay attention, and be even more detrimental to your coordination.28 While withdrawal should be medically monitored, the risks involved with ceasing the use of opiates are generally not as serious as they are with benzos and are confined to more uncomfortable side effects such as nausea, aches, insomnia, and diarrhea.
If you are concerned that you may have a problem, you are not alone. As many as one in five men over the age of 60 may face a serious health risk because of their alcohol abuse, and more older men may unknowingly misuse their prescription medications to the point where professional help is required. Fortunately, there is evidence that older adults respond to alcohol and/or drug abuse treatment as well as, if not better than, their younger counterparts. In addition, although withdrawal can be a longer process for older people than for younger individuals, older adults tend to experience less severe symptoms. On the other hand, treatment services may take somewhat longer to gain access to because you are older, and temporary hospitalization may be recommended if detoxification is necessary.
Tips for Cutting Back on Drinking
• Count how many ounces of alcohol you are getting in each drink.
• Keep track of the number of drinks you have each day.
• Decide how many days a week you want to drink. Plan some days that are free of alcohol.
• Pace yourself when you drink. Don’t have more than one alcoholic drink in an hour. In place of alcohol, drink water, juice, or soda.
• Make sure to eat when drinking. Alcohol will enter your system more slowly if you eat food.
• Develop interests that don’t involve alcohol.
• Avoid people, places, and times of day that may trigger your drinking.
• Plan what you will do if you have an urge to drink.
• Learn to say “no thanks” when you’re offered an alcoholic drink.
• Remember to stay healthy for the fun things in life—birth of a grandchild, a long-hoped-for trip, or a holiday party.
Source: National Institute on Aging (2012, Mar.). Alcohol use in older people. Washington, DC: U.S. Department of Health and Human Services.
Older men who suffer from alcoholism can benefit from being prescribed naltrexone, which decreases alcohol cravings. Naltrexone also blocks the effects of opiate drugs, making it useful for people addicted to pain medications. When used in conjunction with substance abuse treatment, naltrexone can also give those in recovery an extra layer of protection from relapse. Furthermore, 12-step meetings, such as those offered by Alcoholics Anonymous (AA), can be helpful in recovery; about a third of all members are over the age of 50. Men who are in recovery from drug (rather than alcohol) abuse may actually find themselves more comfortable in AA than its counterpart, Narcotics Anonymous (NA), as NA generally tends to have younger members.
Types of Substance Abuse Treatment for Older Adults
Brief interventions: |
One or more counseling sessions involving direct feedback on screening questions, patient education, approaches to motivational and behavioral changes, and use of written manuals and materials to reinforce message |
Interventions: |
Counseling sessions with patient in the presence of family or friends to confront drug-use problems |
Motivational counseling: |
Intensive meetings with counselor to understand patient’s perspective on the situation, assess readiness to change behaviors, help patient shift perspective, and consider alternative solutions |
Specialized treatment: |
Inpatient/outpatient detoxification, inpatient/outpatient rehabilitation, outpatient services |
Maintenance treatment: |
Psychotherapy, individual and/or group counseling, and self-help and 12-step programs |
Source: Simoni-Wastila, L., & Yang, H. (2006). Psychoactive drug abuse in older adults. American Journal of Geriatric Pharmacotherapy, 4, 380–394.
If you are questioning your alcohol use or that of a loved one, consider the following two examples of evidence-based screening tests used by physicians and mental health professionals to assess for alcohol abuse. An “evidence-based screening test” is one that has proven to be valid (i.e., effective) based on the results of rigorous scientific evaluation.
CAGE Test
The word CAGE is an acronym for the first letters of the key words in the following four questions. A response of “yes” to any two questions may indicate a risk of alcohol abuse:
1. Have you ever felt you should Cut down on your drinking?
2. Have you ever felt Annoyed by criticism about your drinking?
3. Have you ever felt Guilty or bad about drinking?
4. Have you ever felt the need for an “Eye-opener” in the morning to steady your nerves?
Source: Ewing, J. A. (1984). Detecting alcoholism: The CAGE questionnaire. Journal of the American Medical Association, 252, 1905–1907.
Short Michigan Alcoholism Screening Test (S-MAST)—Geriatric Version
Two or more “yes” responses may be indicative of an alcohol problem.
|
Yes (1) |
No (0) |
1. When talking with others, do you ever underestimate how much you actually drink? |
O |
O |
2. After a few drinks, have you sometimes not eaten or been able to skip a meal because you didn’t feel hungry? |
O |
O |
3. Does having a few drinks help decrease your shakiness or tremors? |
O |
O |
4. Does alcohol sometimes make it hard for you to remember parts of the day or night? |
O |
O |
5. Do you usually take a drink to relax or calm your nerves? |
O |
O |
6. Do you drink to take your mind off your problems? |
O |
O |
7. Have you ever increased your drinking after experiencing a loss in your life? |
O |
O |
8. Has a doctor or nurse ever said they were worried or concerned about your drinking? |
O |
O |
9. Have you ever made rules to manage your drinking? |
O |
O |
10. When you feel lonely, does having a drink help? |
O |
O |
Total S-MAST-G Score (0–10) |
___ |
___ |
Source: Blow, F. C., Brower, K. J., Schulenber, J. E., et al. (1992). The Michigan Alcoholism Screening Test—Geriatric Version (MAST-G): A new elderly-specific screen instrument. Alcoholism: Clinical and Experimental Research, 16, 372.