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Treating Substance Use Disorder in Older Adults: Updated 2020 [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2020. (Treatment Improvement Protocol (TIP) Series, No. 26.)
As you age, alcohol can affect you more because:
Your body does not process alcohol as well as it used to.
You're more likely to be taking medications that interact negatively with alcohol.
You're more likely to have health conditions that will get worse if you drink alcohol.
If you drink too much, reducing or cutting back on your alcohol consumption can improve your health and well-being.
Family members, caregivers, friends, and other people in your life can help you quit or cut back on drinking.
If you need treatment for a drinking problem, a range of effective options are available to you.
Have hope! Many older adults are able to change their drinking habits to improve health and well-being.
Chapter 8 of this Treatment Improvement Protocol (TIP) benefits older adults, caregivers, and family members. It discusses the effects of alcohol and recommended guidelines for drinking in older adults. It will help older adults figure out whether they might have a drinking problem and how they can reduce or stop using alcohol. It will help families and friends recognize when an older adult in their lives is misusing alcohol and what they can do to support healthy changes in the older adult's drinking habits while also taking care of their own needs.
Older adults use alcohol more than any other substance.1229 Drinking carries more risks for older adults, and they are at risk even when they drink less than younger adults. Physical changes that come with age increase sensitivity to alcohol. Other common changes in later life—like the death of a spouse or close friend, retirement, or a move to a different neighborhood or living situation—can lead to unhealthy drinking. But don't be discouraged! Older adults in treatment can do as well as or even better than younger adults do.1230,1231,1232 That said, many older adults cut back on or quit drinking without specialized treatment.1233,1234,1235
Chapter 8 is for older adults who drink (including those who have questions about how much they should drink), their families, and their caregivers. It provides information about how alcohol can affect older adults' changing bodies, health, and life circumstances.
The first section of Chapter 8 discusses drinking guidelines specific to older adults. It also lists reasons why some older adults misuse alcohol and lists some effects and warning signs of misuse.
The second section describes alcohol's health effects and the ways alcohol and medication interact.
The third section gives tips and cautions for addressing your drinking on your own.
The fourth section describes treatment options.
The fifth section educates older adults' families and caregivers about alcohol misuse.
The final section lists some helpful resources. A more detailed resource guide is in Chapter 9 of this TIP. Exhibit 8.1 defines some key terms you'll see as you read further.
EXHIBIT 8.1 Key Terms.
The Dietary Guidelines define moderate drinking as up to one drink a day for women and up to two drinks a day for men. Importantly, these numbers apply to any given day and are not meant to be interpreted as averages over numerous days.1248,1249,1250
To make sure that your drinking is not high risk, avoid binge drinking. Binge drinking means drinking more than three drinks (if you're a woman) or four drinks (if you're a man) per day. However, given the body's decreased ability to absorb alcohol with age, you may need to limit yourself to fewer drinks to avoid binge drinking.1251
Don't drink when you will be driving a car or boat or doing other activities that require you to be coordinated and alert.
Heavy or binge drinking at any age harms the brain.1252 These patterns of drinking slow down communication among brain cells. Over time, heavy or binge drinking also shrinks the brain and changes it in other ways that negatively affect how it works. These changes can affect behavior; cause dementia; and worsen memory, coordination, and the ability to plan and learn.1253,1254
For some older adults, any amount of alcohol is risky.1255 Don't drink if you:1256,1257
Have a chronic medical condition that alcohol can worsen, like diabetes or heart disease.1258,1259
Are recovering from AUD.1260
Take medications to help you worry less or sleep. People often take a type of prescription medication called benzodiazepines to treat anxiety or sleeplessness.1261
Take opioid pain relievers, which healthcare providers may prescribe for severe or chronic pain.1262
Take other prescription or over-the-counter (OTC) medications that interact negatively with alcohol—that is, they may cause serious harmful effects if you take them and also drink alcohol.
For more information about how various medications interact with alcohol, see the “What Medications Interact With Alcohol?” section.
The two main reasons for lower drinking limits are:
You're more likely than younger adults to experience harmful alcohol-medication interactions.
As you age, your body responds differently to alcohol.
You may have already noticed that you feel the effects of alcohol sooner than you used to, even if you don't take any medications. That's because age-related changes affect how your body handles alcohol.1263,1264,1265 Exhibit 8.2 shows some of these age-related changes.
DOES ALCOHOL USE OR MISUSE AFFECT OLDER WOMEN DIFFERENTLY THAN IT AFFECTS OLDER MEN?
To help you stay within the recommended limits, you need to know what counts as one drink.1280 It may be less than you think. In the United States, a standard drink contains 14 grams of pure alcohol, or about 0.6 fluid ounces. Exhibit 8.3 shows standard drink amounts by beverage type.
EXHIBIT 8.3 What Is a Standard Drink?
Alcohol content can vary by type of drink. Read container labels to see how much alcohol is in a serving.
What if you have a cocktail or mixed drink that combines a few different kinds of alcohol? You can figure out about how many standard drinks you're really consuming by using the Cocktail Content Calculator (www.rethinkingdrinking.niaaa_nih.gov/Tools/Calculators/Cocktail-Calculator.aspx) on the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) Rethinking Drinking website. The calculator gives the alcohol content and standard drink equivalent for several common mixed drinks.
To keep track of your drinking, it helps to know the number of standard drinks in a bottle of wine or other type of alcohol container. NIAAA's Drink Size Calculator tells you how many standard servings are in many common kinds of beverage containers. It shows this information by type and strength of beverage (www.rethinkingdrinking.niaaa.nih.gov/Tools/Calculators/Drink-Size-Calculator.aspx).
ACTIVITY: HOW MUCH ARE YOU REALLY DRINKING?
Alcohol misuse can begin or resume at any age. People who misuse alcohol may not always realize they are doing so. Stressful life changes that may lead to alcohol misuse in older adults include:1282,1283,1284,1285,1286,1287
The death of a spouse, partner, child, or close friend.
Increasing isolation.
Increasing disability or a chronic illness.
Forced or unplanned retirement.1288
A change of residence.
Increased financial strain.1289
Boredom; lack of meaningful activity.
Physical separation from adult children.
Spending time with people who drink is linked with alcohol misuse. For example, older adults may begin drinking too much after moving to a retirement community where drinking is a big part of socializing.1290
If your drinking patterns worsen in response to a change in your life, take action. The sections “How Can I Quit or Cut Back on My Own?” and “How Do I Talk to My Healthcare Provider About Alcohol Use?” can help you.
Some older adults use alcohol to cope with physical or emotional problems.1291 This is called self-medicating. Drinking to self-medicate can lead to alcohol misuse1292 and can actually worsen the problem instead of helping. For example, drinking to cope with depression can make symptoms of depression worse.1293 Similarly, drinking to cope with sleep problems can worsen sleep by reducing time spent in deep sleep and by causing snoring and other problems that interfere with sleep.1294,1295
Also, what was low-risk drinking when you were a younger adult can become alcohol misuse as you age, simply because your body does not handle alcohol as well as it used to. Refer back to Exhibit 8.2.
EXHIBIT 8.2 How Aging Affects the Body's Response to Alcohol1266,1267,1268,1269,1270,1271.
Healthcare providers sometimes mistake AUD for other conditions that are common in older adults. Some providers wrongly believe that older adults are not likely to develop AUD. These are good reasons for you to educate yourself about alcohol misuse in older adults.
Ask yourself whether any of these possible signs and symptoms of alcohol misuse apply to you:
Cognitive symptoms:
Physical and mental symptoms:
Social symptoms:
Behavioral symptoms:
If you have experienced or are experiencing any of these warning signs, consider speaking with your healthcare provider or an addiction specialist about your drinking. Also see “What Should I Expect During My Medical Appointment?” and “What Are My Options for Specialized AUD Treatment?”
Contact your healthcare provider if you:
Drink despite taking one or more medications that have severe interactions with alcohol.
Have had symptoms of alcohol withdrawal. See the text box titled “Warning Signs of Alcohol Withdrawal” for more information.
Alcohol misuse causes or increases your risk of developing more than 200 health conditions.1311 Drinking also worsens many health conditions common among older adults, including diabetes, high blood pressure, osteoporosis, pain, sleep problems, stroke, and urinary incontinence.1312,1313,1314,1315,1316
Alcohol misuse can also make it harder for you to manage any chronic medical conditions you already have. For example, you may skip meals, forget to exercise, or mix up medications.
Alcohol misuse may put you and others at risk of injuries and other harms, like HIV. Harms linked with alcohol misuse by older adults commonly result from falls, motor vehicle crashes, and suicide attempts.1317,1318,1319 Alcohol misuse can also lead to risky sexual behavior (such as having unprotected sex with a new partner), which can spread HIV or other sexually transmitted diseases.1320,1321,1322,1323
Don't base decisions about drinking on news reports of alcohol's benefits. News stories don't always clarify whether a study found that alcohol causes or is simply associated with a health benefit. If a study shows that alcohol is only associated with a health benefit, other factors like genetics or income level may have also played a role.1324 The report may ignore a study's limitations.1325 For example, the results of a study with only younger participants may not apply to older adults.
You and your healthcare provider should weigh the possible benefits of light or moderate drinking with the known negative effects of alcohol use, especially if you:
Take medication that interacts badly with alcohol.
Have a history of alcohol misuse.
Have, or are at risk for, a medical condition worsened by alcohol.
Exhibit 8.4 presents just some of the health conditions linked to alcohol misuse.
EXHIBIT 8.4 Some Health Risks of Alcohol Misuse1326,1327,1328,1329,1330,1331,1332,1333,1334,1335.
Many older adults who drink regularly take prescription medications that interact harmfully with alcohol.1336,1337 Drinking makes some medications less effective and can make others more potent. The results can be unpleasant, dangerous, and even deadly.1338
Alcohol and medication can make a dangerous mix, even if you do not consume them at the same time.1339
If you drink, ask your healthcare provider whether alcohol can interact harmfully with any of your medications. Negative interactions may occur even if you don't see signs or symptoms like vomiting or dizziness right away. Serious effects of alcohol-medication interactions, like liver damage, can develop “silently” over time.1340
Dietary supplements (e.g., vitamins, herbal products) and OTC medications (like aspirin) can interact harmfully with alcohol. Talk to your healthcare provider if you take any of these products and drink.1341
ACTIVITY: CHECK YOUR MEDICATIONS FOR ALCOHOL INTERACTIONS.
Exhibit 8.5 lists 12 medications that interact badly with alcohol. Many older adults take these and similar medications. This list is provided for illustration only. Other medications for the same condition may have different interactions, and many conditions are not included. For more comprehensive lists, see the entries under “Alcohol and Medication Interactions” in the “Resources” section at the end of this Chapter.
EXHIBIT 8.5. Common Prescription Medication-Alcohol Interactions1343,1344.
BENZODIAZEPINE ALERT: CAUTIONS FOR OLDER ADULTS WHO DRINK.
Here are some more tips on avoiding negative interactions between alcohol and your medications:
Ask your healthcare provider or pharmacist whether a newly prescribed medication interacts harmfully with alcohol, even if you don't drink often.
Never take prescription medication offered to you by a family member or a friend, especially if you drink. The medication was prescribed with someone else's medical situation in mind, not yours. Taking it could harm you. In some cases, sharing prescription medications is illegal.
Check the ingredients of cough and cold medications and laxatives, which may contain alcohol.
OPIOID ALERT: CAUTIONS FOR OLDER ADULTS WHO DRINK.
If you drink more than is recommended for older adults—especially if you drink heavily or have been drinking regularly for a long time—don't sharply cut back on your drinking or suddenly quit on your own. Get medical advice first. Your body may be dependent on alcohol, so you could experience withdrawal if you go without drinking for longer than usual.1357 Severe alcohol withdrawal can be deadly if not treated right away in a hospital.1358,1359
WARNING SIGNS OF ALCOHOL WITHDRAWAL.
Think about how drinking conflicts with your top values—values you want your life to reflect, like independence, generosity, health, and honesty. Try these value-identifying exercises available online:
www
https://harvard
Feel free to add any of your own top values that you don't see listed in these exercises. Here are just a few possibilities: alertness, dependability, and empathy. The activity below will help you understand the relationship between drinking and your top values.
ACTIVITY: DOES YOUR DRINKING CONFLICT WITH YOUR TOP VALUES?
Writing a plan for change (Exhibit 8.6) will help you set and keep goals for cutting back or quitting drinking. Before making a plan, look at your answers to the “Does Your Drinking Conflict With Your Top Values?” activity. Consider first reading the “How Can I Get Support From Family and Friends?” section.
EXHIBIT 8.6 Writing a Change Plan.
Your main goal is to cut back and slow down your alcohol consumption when you drink.
Putting your drink down between sips.
Holding something in your hand besides your drink between sips.
Following an alcoholic drink with a nonalcoholic one.
Eating something while you drink—but avoid foods that make you thirsty.
Using a drinking tracker card (Exhibit 8.7), write down how many drinks you have each day. This will help you keep better track of your drinking as you work to cut back or quit.1372
EXHIBIT 8.7 Four-Week Drinking Tracker Card.
You may drink out of habit, boredom, or loneliness, or when you're with friends who drink. Try to find other activities that appeal to you and fit your abilities and budget. Here are some ideas:
Participate in recreation programs at your local community recreation center or senior center. (Be sure to consult with your healthcare provider before increasing your physical activity.)
Put your experience and gifts to use by volunteering at a nonprofit organization or a school.
Join a book discussion group hosted by a local library or bookstore.
Think about what your interests are and how you can make them a bigger part of your life.
Some occasions, like holiday parties or anniversaries of losses, may tempt you to drink or to drink too much. So may being around people or places that remind you of drinking. You can fight temptation better if you have a plan for handling such situations.1374 For example, you could plan to spend the evening of a difficult anniversary with an understanding friend. A written plan (Exhibit 8.6) can help you remember what steps to take to avoid temptation.
Another action you can take is to join a mutual-help group. Members of these groups support each other in their recovery from the misuse of alcohol and other substances. Mutual-help groups meet regularly, are free, and usually take place in community spaces, such as houses of worship and schools.
Some groups follow the 12-Step approach, which has abstinence as its goal.1375 Alcoholics Anonymous (AA) was the first 12-Step group. To find a meeting, go to www.aa.org/pages/enUS/find-aa-resources or look in your local newspaper or community newsletter. Some communities have meetings designated as senior friendly.1376 If you have difficulty getting around, you can check out AA's online and telephone meetings (https://aa-intergroup.org/directory.php).
For older adults-only meetings, look into Seniors In Sobriety (SIS), which is part of AA. The SIS website (www.seniorsinsobriety.com) provides a list of meetings.
Alternatives to traditional 12-Step organizations include:
SMART (Self-Management and Recovery Training) Recovery (www
Women for Sobriety (https:
Secular Organizations for Sobriety (www
Moderation Management (www
You can find faith-based mutual-help organizations at www.recoverymonth.gov/resource-category/faith-based.
Consider dropping by a mutual-help group meeting to see whether it's a good fit for you. Call the local office or contact person first to make sure that the meeting is open to the public. If you want to attend a meeting but feel a little uncomfortable with the idea, think about going with a friend.
MOBILE APPS.
If you have questions about your alcohol use or think you need help addressing it, you may need to raise the subject with your healthcare provider yourself. That's because some healthcare providers:
Here are some ideas for starting the conversation:
“I'm on several medications, so is it a problem that I have a couple of drinks in the evening?”
“It takes me awhile to fall asleep, so I have a nightcap. Is that okay, given my medical conditions?”
“My wife says I drink too much at parties. I'd like to know what you think.”
Whether you raise the subject of alcohol use or your healthcare provider does, be honest about how much and how often you drink. Your health and even your life may depend on it.
If you bring up alcohol concerns with your healthcare provider, he or she will likely ask you to answer a screening instrument or questionnaire. The most common alcohol screening instruments have just 1 to 10 questions. Your healthcare provider may ask you the questions directly, or you may answer them on paper or on a computer or tablet. Examples of alcohol screening questions are “Have you ever felt you should cut down on your drinking?” and “Do you usually take a drink to calm your nerves?”1383,1384
Screening helps your healthcare provider decide whether to look further into your alcohol use. It will also help you and your healthcare provider decide whether you may need specialized treatment to address alcohol misuse.
If screening suggests that you misuse alcohol, your healthcare provider will probably do an “assessment” or refer you to a specialist who can do it. Whoever does the assessment will ask you more questions about how much and how often you drink. The assessment will help your healthcare provider understand any negative effects of your drinking, your drinking history, and any previous treatment you may have had for misuse of alcohol or other substances. Other assessment questions may focus on your living situation and degree of support from family and friends.1385 You will likely have a physical exam, and you may also have lab tests to check for alcohol use and any resulting damage to your liver or other organs.
During this or a follow-up visit, your healthcare provider should give you more information and feedback about your drinking. The feedback will help you understand the results of the assessment and lab tests. Any other information you receive may help explain the risks and health effects of your alcohol use. Your healthcare provider may diagnose you with AUD if you meet certain criteria.
CAN MEDICATION TREAT AUD?
You may also receive a referral to an addiction specialist or an addiction treatment facility, depending on your level of alcohol use and health status.1393 You should seek someone who specializes in addiction treatment with older adults who have been using alcohol for a long time or who have health conditions that could complicate treatment for alcohol misuse. Your healthcare provider may also refer you to a mutual-help group like AA.1394
If you receive specialized treatment for AUD, you may move from one setting to another as the treatment proceeds. Whatever the setting, you will usually get counseling and education about alcohol misuse. Personal preference, availability, and eligibility requirements can affect your decision on where to get treatment. Cost can also affect your decision. Check with your health insurer to see how much coverage it provides for the treatment option you seek.
RESOURCE ALERT: TREATMENT LOCATOR FOR VETERANS.
The following list describes the main specialized treatment options:
Regular outpatient treatment typically consists of individual therapy, group therapy, or both, provided by a trained therapist. Additional services, such as family therapy and connection to mutual-help groups, may be included.1395 Some outpatient treatment is provided by healthcare providers or addiction specialists. In addition to doing assessments and diagnosing AUD, these specialists may provide counseling and prescribe medications for AUD. Outpatient programs differ a lot in how long they last and how intensive they are.
Medically supervised withdrawal is a process during which healthcare providers monitor you as your body clears itself of alcohol. This process is sometimes called detoxification, or “detox.” In medically supervised withdrawal, medical staff monitor and treat withdrawal symptoms and manage other health conditions as needed.1396 Medically supervised withdrawal in an inpatient setting, such as a hospital, is normally recommended for older adults.1397 If you undergo medically supervised withdrawal, you may receive referrals from the medical staff to addiction counselors or other behavioral health service providers for continuing treatment of AUD. If no referral is offered, you can ask for one or explore other options for continuing treatment or recovery support, such as attending AA meetings or using a treatment locator like FindTreatment.gov or the Substance Abuse and Mental Health Services Administration's (SAMHSA) National Helpline (1-800-662-HELP).
Intensive outpatient programs typically provide services at least 3 days a week, for at least 2 or 3 hours each day (or evening).1398 These services can include group and individual counseling, family therapy, medical and mental health evaluations, medication, and education about addiction and coping skills.1399,1400 These programs may take place at hospitals, mental health clinics, or office-based private practices.
Partial hospitalization programs typically run 4 to 6 hours a day, 3 to 7 days a week. They are also called day treatment programs. As with intensive outpatient programs, you do not stay overnight for treatment. These programs often treat addiction and mental disorders at the same time.1401
Specialized residential treatment facilities usually offer group and individual therapy, recreational activities, and mutual-help group meetings. Consider this type of facility if you would have difficulty getting to and from outpatient treatment or if you need more counseling, medical services, or ongoing guidance than an outpatient program would offer.
WHAT ARE RESIDENTIAL TREATMENT FACILITIES?
NIAAA's Alcohol Treatment Navigator recommends 10 general questions to ask when looking for a quality alcohol treatment program. The Navigator is available online (https://alcoholtreatment.niaaa.nih.gov/how-to-find-alcohol-treatment/10-questions-for-alcohol-treatment-programs).
Think about the issues you most want help with in treatment. Ask the programs you're considering whether they address these issues. You may also want to ask:1403
Does the program focus just on older adults or have a special track or groups for older adults?
Does the program cover topics like grief, loss, and isolation?
Can an older adult who uses a wheelchair/walker/cane easily enter and move around the facility?
What modifications will the program make for older adults with vision/hearing problems?
Do I need my own transportation to get there?
If you can't find a program just for older adults even though that's what you want, consider one that mixes age groups. Research shows that older adults can also do well in these programs.1404,1405 If possible, take tours of the facilities that you are considering.
RESOURCE ALERT: SAMHSA'S FREE NATIONAL HELPLINE.
COMMON TYPES OF THERAPY.
Don't be embarrassed or shy about involving supportive family members and friends in your effort to quit or cut back on drinking. They will probably want to help, especially if they have already told you they are concerned about your drinking. Consider asking them to:1416,1417,1418
Avoid drinking in front of you.
Offer you just nonalcoholic beverages.
Join you in alcohol-free activities.
Go along when you discuss your drinking with a healthcare professional, to help you take notes and to provide support.
Accompany or drive you to mutual-help group meetings.
Be available to talk to you if you get an urge to drink.
Another way that family members can help is by participating in family therapy or BCT with you, if you are in treatment and your provider recommends such therapy. For more information, refer family members to SAMHSA's Family Therapy Can Help booklet, which is available at no cost (https://store.samhsa.gov/product/Family-Therapy-Can-Help-For-People-in-Recovery-From-Mental-Illness-or-Addiction/SMA15-4784).1419
Also consider asking any family members that you live with to keep little or no alcohol at home.1420
WHAT IF MY FAMILY AND FRIENDS ARE NOT SUPPORTIVE?
First, give yourself credit for realizing that you may need to do something about your drinking.
Remember that many different treatment options are available for alcohol misuse. These options have enabled many older adults like you to stop or reduce their alcohol consumption.1423 Congratulate yourself on any action you take to limit how much you drink. In addition, remind yourself that, no matter what your age, overcoming alcohol misuse can help you feel better and live longer.
If you think a family member may be misusing alcohol, review the list of warning signs in the “How Can I Tell Whether I'm Misusing Alcohol?” section. Other signs to look for include:1424,1425
Hiding alcohol supplies.
Denying or justifying drinking.
Refusing to discuss drinking.
Becoming annoyed when asked about drinking.1426
Becoming aggressive or abusive.
Displaying excessive mood swings.
Having new problems with decision making.1427
Appearing sleepy during the day.
Falling behind on bills.
Having unexplained burns or bruises.1428
Having frequent car accidents.
Talking about or attempting suicide.
Suicide attempts and talk of suicide require immediate attention. Call 911 if your family member attempts or threatens suicide. Call your family member's healthcare professional or the National Suicide Prevention Lifeline (1-800-273-8255) if you worry that he or she is thinking about suicide. Note that by July 2022, you will also be able to reach this hotline by dialing 988.
CHALLENGES TO RECOGNIZING ALCOHOL MISUSE.
Know what prescription and OTC medications your relative takes. The same advice applies to dietary supplements, including vitamins and herbal products. Review the “Check Your Medications for Alcohol Interactions” text box for tips on finding out whether these products have harmful interactions with alcohol.
You may need written or verbal permission from your family member to discuss possible alcohol interactions with his or her healthcare provider or pharmacist.1429 Even without such permission, you can still inform these healthcare providers of any concerns you have about interactions.
See “What Are My Options for Specialized AUD Treatment?” for information on finding treatment facilities and providers in your area. Look at the section “Join a Mutual-Help Group” for tips on finding mutual-help group meetings, if this type of support would be appropriate for your family member.
Talking constructively with a family member about a drinking problem takes patience. But the payoff may be a greater willingness on his or her part to address the problem. Where you can, connect the conversation to your concerns about your family member's health. Here are some other tips:1430,1431,1432
Don't bring up the topic when your family member is intoxicated.
Use “I” messages that express your feelings and concern, not “You” messages that criticize or blame the older adult. For example, you can say, “I worry that you'll have another bad fall if you don't cut back on your drinking” instead of “You drink so much that you get falling-down drunk!”
Don't use guilt, threats, or bribes to try to get your family member to stop drinking.
Avoid using offensive terms like “an alcoholic” or “an addict” or “a drunk.”
Make positive comments about your family member's strengths and personality.
Adjust what you say and how much you say at one time to match his or her ability to understand.
Remind the person how drinking interferes with his or her values, relationships, or favorite activities.
Offer to drive or arrange transportation for treatment or a mutual-help group.
Participating in therapy with your family member can support his or her treatment. Your relationship with your family member could also benefit because of your participation. See “Family Therapy” and “Behavioral Couples Therapy” in the “Common Types of Therapy” section for brief descriptions of these approaches. You can read more about family therapy in SAMHSA's Family Therapy Can Help booklet at https://store.samhsa.gov/product/Family-Therapy-Can-Help-For-People-in-Recovery-From-Mental-Illness-or-Addiction/SMA15-4784.
Sometimes it may seem easier just to pretend that a family member's drinking is not a problem. But doing so can be unhealthy for both of you. Also, if your family member has dementia, don't use alcohol to help him or her sleep or calm down. Doing so is unsafe and can worsen symptoms.
If your family member requires emergency hospitalization for any reason, tell the hospital staff immediately if he or she misuses alcohol. Otherwise, he or she may experience alcohol withdrawal, which the medical team could miss or mistake for another condition. The medical team involved in a planned hospitalization for your family member also needs to know in advance if he or she misuses alcohol.1433 See the “Is Alcohol Withdrawal a Concern?” section for more information.
Sometimes you have to put yourself first to continue to care for your family member. Accept offers of help and make time to socialize with others. Try to get enough sleep and exercise. Look after yourself by keeping medical appointments and not using alcohol or other substances to cope with stress or other difficult emotions.
WHAT IF I'M OVERWHELMED?
Al-Anon is a mutual-help group for people concerned about or affected by someone with alcohol misuse. If you cannot attend an in-person meeting, look into meetings that take place online or by phone. To learn more, call 1-888-425-2666 (toll-free) or go to the Al-Anon website (https://al-anon.org).
If your family member is in addiction treatment, find out whether the facility or individual provider runs support groups or programs for family members and friends.1436 Other options are listed in the Resource Alert at the end of this section.
Your family member may refuse to discuss his or her drinking habits no matter what you say. Options for next steps include talking to and involving:1437
Your family member's healthcare provider.
An adult family member.
A close family friend.
A clergyperson.
Your family member's case manager or social worker, if applicable.
It may be easier for your family member to hear about his or her alcohol misuse from someone other than you. Getting another viewpoint may also help your family member see how serious the problem is.
Also consider taking a facility tour, if possible, so that you can better discuss the treatment experience.
RESOURCE ALERT: RESOURCES FOR CAREGIVERS.
National Institute on Aging (NIA)—Alcohol Use or Abuse (www.nia.nih.gov/health/topics/alcohol-use-or-abuse): This webpage provides tips on talking to a doctor about alcohol and reasons and resources for addressing alcohol use.
NIA—Older Adults and Alcohol: You Can Get Help (https://order.nia.nih.gov/sites/default/files/2018-01/older-adults-and-alcohol.pdf): This easy-to-read brochure lays out the issues and answers common questions that older adults have about drinking.
NIAAA—Rethinking Drinking (www.rethinkingdrinking.niaaa.nih.gov): This NIAAA website provides information about what a standard drink is; gives tips on how to refuse drinks and reduce or quit drinking; and offers interactive tools to help address alcohol misuse, such as an alcohol spending calculator. Note that the information provided is not specific to older adults.
VA—VetChange (https://mobile.va.gov/app/vetchange): VetChange is an app that, according to the VA, can be used by anyone interested in developing healthier drinking behaviors. Among the app's features are tools for cutting down or quitting drinking and tools for managing stress symptoms. The app is not meant to replace professional treatment.
NIAAA—Harmful Interactions (www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines): This consumer guide provides information about the dangers of harmful medication-medication interactions and medication-alcohol interactions.
FindTreatment.gov (https://findtreatment.gov): People seeking treatment for SUDs can use this federal locator maintained by SAMHSA to find treatment facilities based on location, availability of treatment for co-occurring mental disorders, availability of telemedicine care, payment option, age, languages spoken, and access to medication for OUD. The site also links to information on understanding addiction, understanding mental illness, and paying for treatment.
SAMHSA—Behavioral Health Treatment Services Locator (https://findtreatment.samhsa.gov/): This locator is another tool for finding facilities that offer treatment for substance use or mental disorders. The site includes a video tutorial on ways to filter search results by different criteria.
SAMHSA—Finding Quality Treatment for Substance Use Disorders (https://store.samhsa.gov/product/PEP18-TREATMENT-LOC): People seeking alcohol treatment can use this factsheet to learn about the necessary steps to complete before accessing a treatment center and the five signs of a quality treatment center.
MedicareInteractive.org—Treatment for Alcoholism and Substance Use Disorder (www.medicareinteractive.org/get-answers/medicare-covered-services/mental-health-services/treatment-for-alcoholism-and-substance-abuse): This webpage discusses Medicare coverage of treatment for SUDs.
NIAAA—Alcohol Treatment Navigator (https://alcoholtreatment.niaaa.nih.gov): This website helps people understand what alcohol use disorder is and how to locate high-quality treatment for it.
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