When we picture a typical night of binge-drinking, which, for the record, is five drinks for men and four for women, we’re inclined to picture college kids, frat parties and twentysomething debauchery at any bar, USA. Basically, anything but grandma or grandpa knocking back a troubling amount of alcohol over the course of the night.
But recent research shows that even as the number of worldwide drinkers has dropped by 5 percent in the last 20 years, older folks are catching up with the usual suspects, coming in third as the biggest binge-drinkers after college kids and adults between the ages of 24 and 26.
To figure out what gives — and get a better understanding as to why retirement is more vodka and soda than golf and world travel — I spoke to Brenda Iliff, the executive director of the Hazelden Betty Ford Clinic in Naples, Florida, a city where the median age of residents is 65.
This research from NYU shows that a higher number of older adults, maybe 10 percent of that age group, are binge-drinking now. Is that news to you, or is that something you’re already seeing?
I’m familiar with it. But as someone who works a lot with older adults struggling with chemical misuse and abuse, it would be more accurate if they defined binge-drinking as two drinks for women and three for men in one sitting.
What exactly does “in one sitting” mean — over the course of the day or evening?
The official definition is having that many drinks within two hours. Binge-drinking is based on what it takes for a normal person to get to a .08 blood alcohol level. Experts are really recommending we change the definition for older adults because of how they metabolize alcohol. The same body that could handle four or five before, now can’t. As we age, our liver slows down. Our metabolism slows down. Our kidneys slow down. So they don’t get rid of toxins well enough. For older women that can happen in two drinks, and for men, three.
So if anything, we’re underestimating the problem?
It’s a huge underestimation if we define it as only three or four drinks instead of two or three.
I read that of this binge-drinking group, you have people who always drank but are now drinking more, or as you said, having problems drinking the same amount. But 10 or 15 percent of this group actually starts binge-drinking at this age. What are you seeing more of?
We see a lot of people who are what we call late-stage addicts, or late-stage binge drinkers, meaning they really never had a problem their whole life with drinking. They may have played around with it in college and had a problem, but they got jobs or careers and something happened. But maybe now that they’re retired, they don’t have to get up in the morning anymore, so if they have a few extra drinks at night. It could be, “Hey, I’m free during the day now, so let’s get drinks.”
It can be losses. Grief can be a huge issue. The group that starts binge-drinking at this age is often due to loss. We all want to feel well, and the reality is that a drink comforts us. It can also be anxiety, that because I’m retiring, there’s loss of importance. Nobody’s asking their opinions as much anymore. It could be the way the body metabolizes alcohol. Some people actually drink less than they used to when they were younger, but their body still can’t handle it because the effects are greater.
It could be the one or two drinks they had their whole lives they could handle just fine, but they add a Xanax prescription to that, a sleeping pill and an anxiety pill. Maybe they had a knee replacement, and they’ve added an opiate. All of a sudden we’ve got this perfect storm for addiction for someone who never had a problem before. You know 42 percent of opiate overdoses are older adults. That’s significant. But the media treatment portrays it as if it’s younger people.
We picture retirement as such a positive thing — that you’re now finally relaxing after a long life of work to focus on family, hobbies and leisure, not troubled drinking.
People think, ‘I’m going to move to Florida and life will be wonderful.’ But what often happens is they’re in a new community where no one knows them, and now they’re just another person with a shopping cart. These are hard transitions for people to go through, especially if they were active in family before retirement.
Plus, we still want to belong, and when you move to a new place, how do you belong? You go to social events. Especially in retirement communities like here in Naples, the drinking is all day long. It’s, “Come over for drinks.” It’s socially accepted, and it’s a leisure activity. So it’s, “Why not have a drink?”
I saw something mentioned about this aging population of Boomers is also more comfortable with drug and alcohol use because they came of age during the 1960s and 1970s.
They grew up with sex, drugs and rock ‘n’ roll, so there’s the attitude of “If it’s illegal, so what?” We have people in treatment where cocaine is their drug of choice at 50-plus. An older lady in one of our groups said, “Meth was so addictive. I got addicted immediately!” A young guys immediately asked her, “You used meth?” I responded, “Why? Is she cool now that she tried meth?” He said absolutely.
Is the “importance” aspect of addiction bigger for men? They typically have such stronger identities around career.
Men? It can be loss of identity. For women, it could be loss of caretaker of kids or older parents. We had one guy who called himself a FIP — a “Formerly Important Person.” Retirement is really about creating a new identity, and asking, “How do I matter?” We all want to matter.
To that end, some research shows that older adults want other people to bring up the topic of irrelevance; they have trouble doing so on their own. When we bring up fear of irrelevancy, however, they want to talk about it. Sometimes we just have to put words to it and define it for them. It helps them go, “I get that.” Otherwise, it’s too shameful.
It’s a lot of, “How could I end up in a place like this? I ran four businesses. I was an office manager.” People can’t believe it. When their adult children bring them in, they say, “Not my mom. She never drank; she only had one or two drinks or day.” We have to say, “Yes, but now something is different, and her system is different.” Some people need a little intervention. For others, it’s an education in how their metabolism has changed, and to look at their drinking in a new way.
Is it easier to get older adults to see this, or are they more stubborn about it?
For most older adults, they’ve lived responsible lives, so they really show up. They go to classes. They take their meds. They’re a delightful, motivated population. It could be for their health. It could be for the independence. Another big motivator is the grandkids. When their family tells them, “Grandpa, you’re not going to see your grandkids, I can’t have my kids seeing you drunk like that,” it will get people’s attention faster than anything.
On the other hand, is it more complicated to detox with older adults?
We have to get people sober safely, and older adults’ detox needs are a little more complicated. It’s important we don’t tell them to just stop immediately because they will probably go into seizures. It can be dangerous, and they need medical care. Someone can come off meth and they’re not going to die, they’ll just crash. Same with cocaine. But with alcohol, you can die. If it’s a trifecta of addiction — booze with benzos or anxiety or sleeping pills and opiates, cocaine, meth or speed — it’s more dangerous. We can, though, use anti-craving meds and help with that.
How are you treating them differently than younger people with addiction issues?
With older people, they’ve had a life; we just need to get them back to a life. With younger people, you’re often teaching them how to live. With older people, we say, “Let’s get you back to purpose, to values and to life. It will be different than when you were working, but it can be really good.” It’s about getting them into community in any form — even if it’s just AA. Too many people are retired now without purpose. Sometimes the 12 steps are all it takes because a lot of older gentlemen will then be up at 7 a.m. to an AA meeting and then out for donuts, and about their day — they go golfing, take care of their partners, etc.
What about the groups that have been drinking heavily their whole lives — versus the one’s you’re describing who have a problem because they’ve crossed a line due to aging or circumstance?
Those are called early onset. Often, they’ve already died because the body couldn’t handle it that long. Many are in the criminal justice system. When you’ve been drinking that long, you already often have DUIs. There are more men in that group — about two-thirds of that group is men. They’re a huge medical concern. They have what we call “wet brains.” They wouldn’t benefit from treatment, because at that point, it’s more like custodial care. A lot don’t make it. But if they did survive and have good genes, let’s get them in recovery.
How would we determine if an older adult has a problem. Is there a checklist?
We tell people to ask themselves the CAGE to see if the drinking might be a problem. The C is, “Have you tried to cut down or control your drinking?” People who don’t have a problem don’t think about cutting back. The A is, “Are others annoyed or angry about your drinking?” The G is, “Do you feel guilty about your drinking? Did you hate yourself when you drink or because of your drinking?” The E is the eye-opener: “Do you sometimes drink earlier than you thought you would, or more than you thought you would?”
It’s asking yourself if you’re losing things in your life due to this — your health, your independence, your values and your friends.
What’s one last thing about this group that we might not see or understand?
There are lots of myths: They’re too old to change. They’re enjoying life, so you shouldn’t say anything; let ‘em stay that way. No, they’re not enjoying life. Before they cross the line, they may be. But after people cross it, let me tell you, they aren’t enjoying life anymore. The good news is that while addiction ages people, recovery helps them feel young.