— You are examining alcoholism problems in the elderly. Is it possible to highlight any features here?
— Late-life alcoholism is the most common type of chemical dependency in this age group, we are talking about people over 50 years old. However, addiction here manifests itself, although it is not as intense as in young people. Age factors and “late age psychology” play a restrictive role: health fears, painful hangovers, decreased tolerance to alcohol. As a result, alcoholism develops and progresses more slowly.
In addition, older people with alcoholism are less dependent on the influence of alcoholic relatives than younger people. We are talking about psychopathological induction, that is, the main mechanism of active “involvement” in pathology: young people more easily fall under the mental influence of another alcoholic (inductor) and then begin to reproduce their own addictive disease scenario.
Older people are also more likely than younger people to have physical problems caused by alcoholism, but they are less likely to have problems with the law, employers, and incidents of violence. Against the background of the deterioration in the patient’s personality, there is also a decrease in physical tolerance to alcohol, so the elderly person cannot drink too much.
All “old” alcoholics are generally divided into two main groups. The first are patients in whom alcoholism has an early onset and the abuse continues in the second half of life. This is “late life alcoholism”. The second is patients with “advanced alcoholism”. That is, those who get sick after 50 years.
Late-onset alcoholism is relatively less malignant. In order for an alcoholic to live to old age, he must have either very good physical health or a relatively weakly expressed “addiction” component (addiction).
We compared these two groups of alcoholics observed from 2009 to 2017 to determine the characteristics of the course of the disease.
— What results did you get?
—The psyche of alcoholics who fell ill in their youth is less resistant to external influences of various factors; They have two to three times more problems with social adaptation. And those who start drinking after 50 have a more harmonious psyche, but their cognitive impairment increases faster after the onset of addiction.
If alcoholism began after 50 years, they are characterized by syntonia as a premorbid state (a condition that precedes and contributes to the development of the disease). Syntoni is the combination of inner balance with emotional sensitivity and sociability.
Also noted during the anamnestic study: In patients with early-onset alcoholism, the reason for relapse is mostly “bad mood”, in their own words, and in the second group, alcohol consumption is mostly “irrational”.
— Are there common characteristics between those who have been drinking since youth and “late alcoholics”?
— Yes, everyone drinks strong alcohol regularly. It acts “as it should” in elderly patients, causing post-toxic distress disorder. Therefore, they seek help more quickly due to its seriousness. Their intoxication is characterized by the predominance of psychomotor inhibition rather than excitation. This also explains why they are less likely to get into trouble with the law than younger addicts. Alcohol acts as a sedative and quickly causes depression of consciousness (stunner). Sleep disorders are also more common here.
Another difference: late-life alcoholism shows the general dynamics of the disease with a relatively positive course, which allows you to live “in the disease” until old age.
—Which of these two types of old-age alcoholism is more common?
— About a third start drinking after 50-60 years. The remaining two-thirds are addicted from a younger age and have a higher risk of the disease having a hereditary origin.
— If you know that your parent has been addicted to alcohol since the age of 20, is there a higher risk of hereditary predisposition to alcoholism?
– Yes, sometimes they say so, but this does not mean that you will be 100% an alcoholic. The “hereditary” factor of alcoholism is the unconditional influence of genetic predisposition, but there are many other factors: social, psychological, adverse family conditions, etc. The most important are clinical and pathogenetic. This is the “law” of the origin and formation of addiction pathology. However, all of this requires very serious research.
— Are there any special reasons why a person starts drinking after the age of 50?
– Yes. The emergence of late-onset alcoholism is largely associated with social and psychological factors rather than hereditary predisposition. Well, Here alcoholism can be attributed to some important event, stress, perhaps social discredit, a small pension, etc. It is a kind of “reaction” against.
Alcoholism in later life is called “problem” alcoholism. Because often anger is triggered by age-related phenomena such as social isolation, disappointment, dissatisfaction with the past and present, which cause physical and mental discomfort.
If we are talking about alcoholism that begins at an earlier age, the cessation of active professional activity, loss of friends and loved ones, loneliness negatively affect the prognosis of the disease.
— How does the disease progress if alcoholism begins after the age of 50?
— The stages of alcoholism develop rapidly in old age. A young person needs 5-10 years to develop a clinically visible pathological addiction; In older people, this period decreases to three to four years. During this time, hangover syndrome develops, their tolerance decreases, and their personalities change.
— Are there gender differences, or does age-related alcoholism occur in the same way in men and women?
– No, there is a distinct difference here. Gender differences in late-onset alcoholism are associated with a more pronounced factor in the occurrence of psychotrauma and loneliness in women.
What is it expressed in? The demographic situation in Russia is such that men die earlier. Women cannot cope with the loss of a spouse and the feeling of loneliness and boredom and develop the condition called “widow’s” alcoholism. Lifestyle and contacts are changing. “Drinking buddies” emerge, where topical topics are discussed during a “relaxing” drink. An inductive component is required; There is always a mutually inductive feed factor. Sometimes there is “drinking alone” of course, but there is still a “partner” most of the time.
But the “widow’s” alcoholism is a formal sign or a psychological explanation. In clinical practice, the specialist doctor treats only alcoholism.
— So, female alcoholism does not differ from male alcoholism in terms of clinical symptoms?
– There are still differences. Addiction in men occurs after an average of 7-10 years of regular drinking; It takes less time for alcoholism to develop in women.
Liver enzymes in women use ethanol worse than in men. Features of female physiology are important here. All this causes accelerated damage not only to the liver, but also to all other organs and systems in female alcoholism.
The protective function of the blood-brain barrier, which protects the brain from toxins, is also relatively lower in women than in men, so alcohol and its breakdown products penetrate the brain in large quantities, quickly damaging brain cells and destroying nerve connections. This causes rapid mental deterioration, impaired thinking function, decreased intelligence, and other “alcohol-like” changes in healthy physiology.
– Is it generally accepted that female alcoholism cannot therefore be cured?
— Often, imitating all kinds of psychological and somatic “masks”, female alcoholism secretly progresses to the second, and sometimes the third stage of addiction. And at these stages of pathology development, unfortunately little can be done to help.
The fact that the disease was detected so late can be explained by many reasons. Some women do their best to hide the fact of excessive alcohol consumption for fear of social condemnation. This results in late diagnosis of female alcoholism and reduces the chances of treatment. Here, clinicians need to have a more systematic and calibrated approach to early diagnosis of serious disease.
— How are elderly alcoholics treated?
— Treatment here is complicated by the presence of comorbidities, as well as “addictive” psychiatry. The relatively “simple” approach of “avoiding” alcohol is unlikely to be effective here. As always, a systemic clinical solution is needed. Active use of pharmacotherapy and psychotherapy. All this requires dynamic observation, personification and banal “medical” stimulation in order not to cause a deterioration in the patient’s health.
Psychological help is often needed in such situations. The help of loved ones is extremely important. But on one condition. All this must occur in full compliance with all standards of medical ethics and under the direct strict supervision of the attending physician.
Many patients and their families believe that alcohol is a last resort for “fun” in old age. This is a big problem. In daily life, many people view “moderate alcohol consumption” as an inevitable component of aging. Such judgments are wrong.