Loneliness May Be Cause of Hidden Alcohol Use Disorder in Older Adults

Loneliness. It became my father's steadfast companion. The loss of his life partner of 48 years (my mother) triggered a cascade of alcohol indulgence exacerbating his diabetes. Alone at 71, the door of solitude opened wide while the outside world was shuttered from prying eyes. Dad numbed his grief with hidden alcohol use.

The U.S. Surgeon General stated in 2023 that loneliness has become a leading health concern. Life circumstances change for all of us. Retirement, scattered family, empty nests, a late-life divorce, a friend dies, a spouse passes, or a severe injury affects mobility; these losses sometimes lead to isolation. Indeed, the decline in satisfying social connections among retirees may lead to overeating, over medicating and alcohol use.

Loneliness has also been linked to poor health behaviors such as a diet of mostly processed foods, drug and alcohol use, smoking and inactivity. Dad was a capable cook and prepared homemade soups, baked vegetables and fish and ate fresh fruits. He didn't overeat or consume sweets, was vigilant with prescribed medications for his diabetes and high blood pressure. His healthy eating still didn't curtail his alcohol consumption because he was alone.

Dad's doctor knew he was a widower and recognized the signs of his alcohol use: out-of-control glucose levels, an unsteady gait from neuropathy and weight loss. The doctor warned him repeatedly to stop drinking — eventually releasing Dad from care. But no number of warnings could fill the void Dad experienced. Dad instead continued to self-medicate with scotch, beer or wine.

During the next 6 years, his alcohol indulgence took a toll on his health. Dad never disclosed to anyone how his doctor released him from medical care. He continued to live alone while my siblings and I resided within driving distance. We believed he was taking care of himself.

It wasn't until I was contacted by a local hospital that I first understood the gravity of Dad's circumstances. I peered past the emergency room examining curtain and caught a horrifying sight: Dad's feet were darkened black. Necrosis had set-in, a life-threatening condition. His hidden alcohol use was no longer a secret, and his life was saved with a leg amputation from the knee down. He then sustained a massive stroke and died two weeks later.

Twenty-six years since Dad's passing, there are better outcomes for older adults who face the same challenges he experienced. Anika Alvanzo, M.D., at Health Management Associates and secretary of the American Society of Addiction Medicine (ASAM) explains, "First, I have never released a patient from care who needed help, and the terms 'alcoholism' or 'alcoholic' are stigmatizing. ASAM encourages the use of non-stigmatizing, person-first language. Rather than using the term alcohol abuse, it is recommended to use 'unhealthy' or 'harmful alcohol use.' Since 2013 … alcohol use disorder (AUD) is the term used for the medical condition characterized by an impaired ability to stop or control alcohol use despite harmful consequences."

Myriad feelings surface after life-changing losses: guilt, anger and despair are just a few. Routine tasks may become burdens, and depending on the circumstances, navigating through these feelings can lead to taking the shortest route for relief: alcohol, a relatively inexpensive drug which doesn't require a visit to a doctor for a prescription. Well-stocked supermarket shelves with wine and wall-to-wall refrigerated beer make alcohol use all too convenient. A discreet purchase where a shopper doesn't need to go to a liquor store or bar.

AUD increases health risks such as heart attack, stroke, depression, liver disease and diabetes. There is also shame associated for falling into this abyss. The shame of drinking alone, staying away from family and friends, spirals to a tipping point where medical intervention is a necessity.

According to the National Institute of Alcohol Abuse Association (NIAAA), alcohol use among older adults has increased. Data from the National Survey on Drug Use and Health indicates that approximately 20% of adults ages 60-64 and 12% over age 65 report current binge drinking. Combining alcoholic beverages with prescribed medications and over-the-counter drugs can become a toxic cocktail for older adults because their tolerance for alcohol is decreased. This puts older adults at higher risks for falls, car accidents and other injuries.

Alvanzo says, "The strategy for treatment is not that different regardless of age. We educate patients about healthier coping mechanisms. If it is an issue of isolation, we identify resources in the community, such as senior centers, to get them engaged, if they are willing. We clinicians should be screening patients for alcohol use when we deal with their medical conditions. We ask how they use alcohol, what is it doing for them, what is the impact on their life, physical and mental health and social functioning. We want to educate our patients how continued use of alcohol is unhealthy and how we can help them meet their goals."

The NIAA outlines medications that can help those who are overusing alcohol. Three medications currently approved by the U.S. Food and Drug Administration to help people stop or reduce their drinking and prevent a return to drinking are: naltrexone (oral and long-acting injectable), acamprosate and disulfiram. All these medications are nonaddictive, and they may be used alone or combined with behavioral treatments or mutual support groups.

Bygone stereotypes persist about alcohol users as unkempt, constantly intoxicated, making public outbursts or physically abusive to family members. Current education initiatives are helping to dispel these negative images. Stay-at-home moms, retirees, widowers and widows, the neighbor who lives alone, all may begin overusing alcohol to relieve stress. The commonality is increased solitude and unstructured daily routines, and their lifeline of support vanishes.

The NIAAA defines at-risk drinking for adults over age 65 years as more than three drinks per day and seven drinks per week; these thresholds may be lower for older adults taking medications.

Are you or someone you know at risk for AUD? The first step is to bring your concerns to your doctor, be truthful with yourself. There is no shame to have AUD or any medical condition. Learn about better coping strategies, medications and agencies that can help. Go to the websites ASAM, NIAAA and AA. Take that first step away from the precipice of loneliness and hidden alcohol use.

Joan B. Reid is a freelance writer of education, health and humor topics. She formerly worked as public relations director for a northeast chapter of the American Red Cross and as a counselor at Nyack College. She has been published in 50 Plus Magazine, Art Times, Education Outlook-Journal News, and Life is a Bike. She also has a memoir, “Joyful Passage: A Woman’s Path to Retirement.” Read More