Executive Summary
This paper primarily delves into the issue of alcohol abuse among the elderly, its potential short and long-term implications, understanding the origin of the problem as well as what are the current methods that are being utilized to resolve the issue. Based on the information that has been analyzed, it was determined that alcohol abuse among the elderly was often due to its use as a coping mechanism or due to long-term ingrained habits. The result is that the excess consumption of alcohol creates a very real threat of creating medical complications due to its interaction with the various medications that the elderly have been prescribed. Another factor that should be noted is the fact that a body’s capacity to process alcohol efficiently deteriorates with age and, as such, the older a person is the longer alcohol remains in their system.
This prolonged state of inebriation can manifest in the form of a variety of social, psychological, and physical problems which can lead to increased isolation, depression, and even death in some cases. It is based on these issues that this paper examined the various methods that could be utilized to help the elderly population that has been identified as having an alcohol abuse problem. However, after examining the aforementioned methods, it was determined that there is significant room for improvement. One of the reasons behind this is connected to the low success rates related to the strategies for helping elderly patients who have been consuming alcohol for decades. This paper assumes that a combination of psychotherapy (group sessions), new policy initiatives in taxation, patient education as well as addressing the underlying causes behind alcohol addiction would lead to far more effective treatment regimes.
Identification of Need for the Synthesis
Understanding the Importance of the Issue
The importance of this study is directly connected to the potential negative effects of alcohol on the long term health and well being of the elderly. When an elderly individual consumes large amounts of alcohol, Marshall (2000) states that their body may not be able to eliminate the alcohol content within an adequate period. This assertion is supported by Ham (2007) who explained that abuse of alcohol by elderly individuals may pose serious health problems to the victims because of the reduced ability of the body system to manage alcoholic substances resulting in higher levels of alcohol exposure to vital organs. Due to the increased exposure to alcohol, these organs have a greater likelihood of being affected by a series of medical complications which can result in their slow deterioration (which results in the need for dialysis) or even outright organ failure resulting in their death (Nuevo, Chatterji, Verdes, Naidoo, Ayuso-Mateos & Miret 2015).
Effect of Excessive Alcohol Consumption on Medication
The first aspect of the identified issue is the impact of alcohol on medication and the resulting adverse consequences it may have. The study of Sinclair, Chick, Sørensen, Kiefer, Batel & Gual (2014) which examined the result of alcohol consumption and medication on numerous cases within hospitals showed that alcohol can either reduce the effectiveness of medication or bring about unintentional side effects. Sinclair et al. (2014) specifically focused on drugs related to epilepsy and diabetes and noted that they lost their effectiveness when consumed at the same time as alcohol. The result is that the conditions that these drugs were supposed to address get worse over time due to the lack of effectiveness of the medication that they are taking (Sinclair et al. 2014).
This makes an elderly patient worse off as compared to when they were taking the medication without alcohol. Other issues about medication and alcohol consumption come in the form of the synergistic effects that alcohol tends to have with sedatives such as Valium or even various types of antidepressant drugs such as Prozac (Forlani, Morri, Belvederi, Bernabei, Moretti, Attili, Biondini, De Ronchi & Atti 2014). Consuming alcohol and the aforementioned medications can cause issues such as an erratic heartbeat, brain dysfunctions, or even death in cases where the alcohol and medications interact in such a way that it causes the person to develop a stroke or stop breathing altogether (Forlani et al. 2014).
Another factor to take into consideration is the fact that due to the advanced age of the elderly, their capacity to process alcohol takes far longer as compared to their younger counterparts (Geels, Vink, Van Beek, Bartels, M, Willemsen, G, & Boomsma 2013). As a result, even if they believe that the alcohol they drank has been expelled from their system, it continues to remain for a significant portion of time (i.e. 12 hours or 1 day longer depending on the age of the individual in question) (Vrdoljak, Marković, Puljak, Lalić, Kranjčević & Vučak 2014). The result is that the period in which it unsafe to take medication increases with the elderly being unaware that they are mixing their medication with significant quantities of alcohol in their system (Vrdoljak et al. 2014). Forlani et al. (2014) explained that situations such as these are all too common and can be attributed as one of the leading causes behind medication-related deaths for the elderly.
Long Term Health Risks of Excessive Alcohol Consumption
Aside from the negative impact of alcohol on medication, there are also the long term implications of excessive alcohol consumption and its effect on the health of an elderly individual. Excessive drinking can damage the liver (i.e. fatty liver syndrome) to the extent that this can impact the capacity of the organ to properly filter out waste materials in the body (Hogenkamp, Benedict, Sjögren, Kilander, Lind & Schiöth 2014). Aside from this, alcohol dependence can result in impaired cognitive functions which, when combined with the deteriorating mental faculties inherent in all elderly individuals, exacerbates the potential development of psychological issues such as depression, excessive anger, or even suicidal tendencies (Hogenkamp et al 2014). Lastly, it was noted by Geels, Vink, Van Beek, Bartels, Willemsen & Boomsma (2013) that excessive alcohol consumption can also contribute towards an individual gaining weight resulting in the potential for obesity. While this is a serious issue for a young individual, it is deadly for an elderly individual given their body’s declining capacity to work off the excess weight through exercise (Geels et al. 2014). After considering all these factors, it can be seen that sufficient efforts must be undertaken to address the issue of alcohol abuse among the elderly.
Social Implications
It is important to note that the abuse of alcohol by the elderly also affects people around them both socially and economically. When such an individual becomes physically or verbally abusive to the members of the society, the effect of the alcohol abuse will be felt by many people (Buja, Scafato, Sergi, Maggi, Suhad, Rausa, Coin, Baldi, Manzato, Galluzzo, Enzi & Perissinotto 2010). Sometimes members of the family are forced to clean the soiled clothes of those who abuse alcohol, something that many consider demeaning (Buga et al. 2010). For this reason, it is important to treat this problem before it can bring a series of negative effects on the victims or their families. In this research, the focus will be to identify some of the best ways through which alcohol abuse among the elderly can be treated.
One way of understanding alcohol abuse treatment among the elderly is from the perspective of Geels et al. (2013) who explained that ingrained habits get harder to treat the longer a person has been exposed to them. Aside from this, there are also issues related to psychological dependence and the fact that at advanced ages people seemingly stop caring about the long-term ramifications of their drinking habit since they have already aged considerably (Forlani et al. 2014). McInnes & Powell (1994) explained that the effectiveness of medical treatments should be between 75 to 85 percent effective to be classified as being medically viable. This takes into consideration complications associated with the various types of treatment methods out there. Suffice it to say, based on the assertion of Forlani et al. (2014), the current 40% intervention success rate is far from viable and is indicative that the current methods utilized are not effective enough to handle the issue. It is based on this that this paper has developed the assumption that current methods of alcohol abuse are simply not effective enough and, as such, new methods need to be implemented. This paper assumes that a combination of psychotherapy (group sessions), new policy initiatives in taxation, patient education as well as addressing the underlying causes behind alcohol addiction would lead to far more effective treatment regimes.
The Aim of the review
This research will specifically focus on finding the best treatment for the problem of alcohol abuse among the elderly. The research will not involve a collection of primary sources of data from the individuals who have been victims of the problem, or the experts who have been trying to address the problem from various perspectives. The research will only rely on secondary sources of data to find a solution to this problem. The researcher believes that by the end of this research, there will be clear information on how to deal with the problem. The following are some of the specific objectives that the researcher seeks to achieve from this review.
- To identify any conflicting information in the current literature on how to deal with the problem of alcohol abuse among the elderly.
- To determine why these conflicts in the existing literature are arising when experts try to explain how to address the problem.
- To identify any misconception that any of the previous researchers could have had in their study that could have led to differing opinions.
- To identify the level of validity in different pieces of research that will be used to determine the reliability of their conclusions.
- To come up with a comprehensive plan, based on the reviewed literature, on how to address the problem of alcohol abuse among the elderly.
- To identify some of the specific roles that can be done by the society and family members of the elderly to help address the problem of alcohol abuse among the elderly.
- Propose a clear approach that should be taken by future researchers who will be interested in advancing knowledge in this field.
Upon completion of this research, it is expected that all of the above objectives shall be achieved. This will not only help in addressing the current problem but also play a pivotal role in guiding future scholars. It will play an important role in guiding the policymakers and families caring for elderly alcoholics.
Significance of the Study
Based on an assessment of current methods of preventing excessive alcohol consumption among the elderly in the form of support groups, family interventions, limiting alcohol consumption, and a variety of other methods that will be discussed, it was determined that based on the success rates attached to these strategies (less than 50%), new methods need to be devised to address the problem. As medical knowledge and science continue to evolve, new methods of dealing with age-old problems have come about. It is based on this that this paper will endeavor in taking the first few steps in devising new strategies that can help address the issue of alcohol abuse among the elderly.
The significance of this paper lies in its potential to develop new methods of intervention that would help to either support the older methods utilized or supplant them as the primary method of alcohol consumption prevention. To accomplish this, some possible alternatives to current treatment methods will be assessed. This can include but is not limited to, the use of new medications to simulate the consumption of alcohol but without the ill effects, the use of new psychological techniques involving positive reinforcement to encourage lower alcohol consumption as well as a combination of the older strategies that may hold the key towards long term alcohol withdrawal. While this study cannot guarantee that the results of the investigation will yield a revolutionary new method of addressing alcohol abuse among the elderly, it could still prove to be a sufficient enough stepping stone for further research on the subject by future researchers which would result in an effective solution.
Research questions and hypothesis
Conducting research is a complex process that involves collecting relevant data, analyzing it, and drawing conclusions from the analysis. According to Fink (2010), when a researcher gets into the field to collect data, he or she will be encountered by massive sources of information, most of which may not be focusing on the research topic. Sometimes researchers would be swayed from the topic to other irrelevant information that may affect the quality of data collected from the field. Research questions play an important role in narrowly defining the data that should be collected from the field. This helps in avoiding the possibility that the researcher may get into the process of collecting irrelevant data from the field. In this study, the researcher developed the following research questions to help in guiding the process of data collection.
The first research question was developed based on the findings of Lowinson (2005) which revealed that many adults continue to lose their lives because of the abuse of alcohol.
To what extent are the elderly affected socially and economically by their abuse of alcohol?
This question was formulated to help in determining the social and economic harm that the elderly expose themselves when they engage in alcohol abuse.
This information that was taken from CDC data clearly shows a consistent rise in the rate of fatalities among the elderly in cases that is related to alcohol abuse. However, it is important to note that this data shows the trend from 1979 to 1993. This question will help in collecting more recent data. It will help in determining the current trend to determine if the relevant stakeholders are making positive progress to reverse this negative trend.
The second research question is based on the study of Nuevo et al. (2015) which analyzed the prevalence of alcohol consumption among the elderly. This question was based on how the study of Nuevo et al. focused on the long-term consequences of excessive alcohol consumption in correlation with its prevalence in various regions within Europe.
What are some of the health consequences of alcohol abuse among the elderly?
The third research question focused on the effect that alcohol abuse among the elderly has on society. According to Goldberg (2010, p. 45), the elderly rely on able-bodied adults for various needs. Some of them are always too weak to undertake some chores on their own. When they engage in alcohol abuse, managing them becomes even more stressful for their family members.
How is society affected by the abuse of alcohol among the elderly?
The table below shows the relationship between violence, drug, and alcohol abuse among the elderly.
The third question seeks to identify conflicting information about the approach to be taken when addressing alcohol abuse among the elderly. Through this question, the researcher will be able to identify some of the common misconceptions about the issue and come up with a valid approach that can be utilized
What are some of the conflicting information about the approach to be taken when addressing the problem of alcohol abuse among the elderly?
After identifying the misconceptions and conflicting information that is available on how to address alcohol abuse among the elderly, the next important stage would be to identify the valid approach that can be used. Addressing the 4th question involves a detailed justification of why the approach suggested is considered superior to other existing strategies, and the stakeholders who should be involved in the process.
What is the best approach to addressing the problem of alcohol abuse among the elderly?
This last question is related to the question above. In this section, the researcher will investigate the role of various stakeholders in addressing the problem of alcohol abuse among the elderly. It will involve identifying these stakeholders, and explaining their role in the fight against this social problem.
What are some of the specific roles that should be played by different stakeholders when addressing the problem of alcohol abuse among the elderly?
Each of the questions above is expected to direct the researcher into looking for specific information from the sources available to obtain specific answers to them. Any information that does not directly respond to the above questions will be considered irrelevant. Based on the above questions, the researcher developed some research hypotheses below.
H1. The best way of addressing the problem of alcohol abuse by the elderly should involve both medical and psychological strategies.
The researcher will use secondary sources of data to determine if the above hypotheses are true or not.
Review of Strategy
According to Basit (2010), conducting a review requires a proper strategy that would help to identify the right sources of data, determining the validity of the sources, and compiling a comprehensive and reliable report based on these sources. Given that this research will purely involve data collected from secondary sources, it was important to develop a proper strategy that would help to identify the relevant sources of data. The search strategy will be defined from two approaches. The first approach will involve the identification of published sources of information on the topic that can be found in their print form. The following search terms were utilized to research the topic: treatment of alcohol; abuse among the elderly, alcohol consumption among the elderly, long term impact of alcohol consumption, and issues with alcohol consumption and advanced ages. The research strategy focused primarily on articles that specifically focused on the effect of alcohol consumption on elderly individuals. This consisted of a mix of medical and psychological data to better understand the potential negative effects. Articles about social factors were also examined but to a relatively minor degree. The strength of this research approach is that it enabled a far more precise means of examining the core of the topic rather than relying on general literature that focused on the effects of alcohol consumption on a broad population set.
The researcher will heavily rely on online sources of information when collecting data. Using online sources of information will be the second approach to collecting information for this research. Some of the relevant books for this research may be readily available through online sources. Most of the journal articles that will be used in this study are expected to come from online databases. Some of the databases that are reliable enough to provide relevant journal articles for this research include JSTOR, Oxford Journals, NCBI Databases, CINAHL, AMED, EMBASE, MDELINE, and EBSCO. These are reputable databases that have reliable peer-reviewed journals that may offer the researcher a good source of information for the research. The researcher has also developed a strategy for collecting grey literature. This will be collected from the school or public libraries by directly engaging the librarians and asking for their help in identifying such materials. The researcher will also make direct requests to some of the scholars who authored such materials within this institution.
It is very important to assess the quality of the literature before including it as part of the sources in the research. The validity of the literature will be determined using a validated checklist by analyzing the method used in concluding, the sample size used, the authority that the authors command in that field, and what other scholars say about the particular literature. The plan that will be used in the synthesis of the information from the identified studies will be defined by the objectives above. The plan must lead the researcher into achieving the above objectives. It means that it will start by identifying the relevant literature using the search term identified above, determining the validity of the literature, and then conducting a comprehensive review of the selected literature. Of interest will be to identify the strategies proposed by each, any conflicts, the reasons for the conflicts, and the way forward in addressing the issue. Although a meta-analysis may be necessary at this stage, it would not be included in this research.
Analysis and Synthesis of Data
The research will only rely on the data collected from books, journal articles, newspapers, and other relevant online sources. The analysis of this data will involve a careful analysis of the findings of these authors, identification of any conflict of the information they present, the validity of their research process, and the ethical procedures they followed. When synthesizing the information from these sources, this research will be keen to base the conclusion on the study’s validity and reliability.
Resources required
According to Fink (2010), it is always necessary to define all resources that may be required before starting the implementation process to determine the feasibility of the project. It is always common for such projects to fail along the way because the project’s needs were not clearly defined. The research will need some specific resources that will need to be used to achieve the desired result from this project. The first resource that will be needed for this research will be time to conduct the research. Some stages will be involved in collecting data, and at each stage, it will be important to define the time needed to complete all the activities. This is defined in the Gantt chart below. Books, journal articles, and magazines found in the university library will be among other resources that will be needed in this study. Stable internet connectivity and a personal computer, most preferably a laptop, will be necessary for data collection and compilation of the report. The researcher may also need an amount of money not exceeding £450 to subscribe to some of the databases mentioned above and to complete some of the tasks that may need some form of payment. This will include printing and binding services once the document has been finalized. The researcher will also obtain the necessary permission from relevant authorities at different stages of this research. This is not only meant to maintain ethics in the research, but also to ensure that the researcher gets relevant guidance from the authorities whenever it may be necessary.
Work plan
It is important to understand the work plan that will be used in this research process to help in defining its feasibility. The research will involve a series of activities, which will be conducted systematically. The Gantt chart below shows the specific activities that will be carried out in this research process. Each of the planned activities will have a specific timeframe within which it has to be accomplished. This will help in determining the total time that will be needed to complete the project.
The first activity will be proposal development. The researcher will develop a research proposal that will define all the activities that will take place in this research process. Given the nature of this research, the development of the proposal may take one month because it will also involve identifying all the resources that will be used in the research. Approval of the proposal is expected to be completed within 14 days, after which the researcher will start collecting the needed data. The next activity will be reviewing the literature which will then be followed by compiling the report. Typing and proof-reading of the report will take approximately 30 days and a week long.
Ethics
According to Dening (2013, p. 54), it is important to maintain ethics when conducting a piece of research. The research will be used by various people for different purposes. This informative report will be valuable to the policymakers in understanding some of the pertinent issues concerning alcohol abuse among the elderly. The report will identify the stakeholders and their roles in addressing alcohol abuse among the elderly. For this reason, the information presented in this document must be credible. It must be founded on factual information from authoritative sources. This will ensure that the information does not mislead people who may rely on it to take various actions. It means that the researcher will need to maintain ethics at every stage of this research. This section will critically evaluate how this research upheld ethics in various stages.
One way of maintaining ethics will be to avoid bias when collecting information. According to Goldberg (2010, p. 34), some scholars always ignore literature that seems to go contrary to their values. This is unethical behavior because it ignores the importance of such contrary opinions. In this study, the researcher was keen to analyze conflicting views to have a holistic view of this issue. This way, it was possible to explain where the scholars with conflicting views went wrong in coming up with their conclusion. This also helps in addressing some of the controversies that may confuse policymakers and other stakeholders.
According to Dening (2013, p. 78), it is always ethical to identify some of the weaknesses of research to help the users of the report to understand the extent to which they can apply to the document. There are cases where the consumers of such information require a high level of accuracy because of the consequences associated with their decision. They need to know the level of accuracy of a report, and the sources of data that led to the conclusion made in the report. In this study, most of the data will be collected from relevant literature and other secondary sources found online. For this reason, the researcher identifies the main weakness of this report to be the fear that some information in the report may not reflect the exact events happening today. However, the researcher tried to address this problem by collecting data from current newspapers and journal articles to capture the most recent information available in online sources.
Understanding the Origin of the Problem
When examining the case of alcohol abuse among the elderly, it is important to determine the origin of the problem to devise an appropriate solution. It is based on this that the work of Barrick & Connors (2002) is essential since it delves into the attitudes that lead to alcohol abuse among the elderly and how it initially comes about. Barrick & Connors explains that one of the first reasons behind alcohol abuse in the demographic being examined in this paper is connected to the concept of alcohol acting as a coping mechanism. Senior citizens, by their advanced ages, are often subject to a variety of stressful situations that people from younger demographics are not impacted by (at least until they reach the same age) (Barrick & Connors 2002). These stressors can be categorized under the following:
Feelings of Loneliness
People of advanced ages are often not included in the same social activities that they once were a part of when they were younger (Breitling, Müller, Raum, Rothenbacher & Brenner 2010). This is in part due to health concerns, the inability to be as physically active as well as current social predilections regarding interactions with the elderly (Millard & McAuley 2008). Senior citizens often feel left out and, as a result, they turn towards alcohol as a means of coping with the loneliness that they feel. This is often one of the most common reasons behind alcohol abuse among the elderly since, in one form or another; most elderly individuals encounter such a situation (Millard & McAuley 2008).
Death of a Spouse
Another of the reasons behind alcohol abuse can be connected to the subsequent death of a spouse (Breitling et al. 2010). This is another common reason behind the use of alcohol as a coping mechanism since spouses of advanced ages have often developed a very deep emotional connection with one another (Livingston & King 1993). Experiencing the death of their significant other, especially in cases where it is drawn out due to a debilitating illness, can often result in a considerable level of emotional turmoil which can drive an elderly individual to, using alcohol as a means to “dull the pain” so to speak (Breitling et al. 2010). It should be noted though that such behavior is understandable to a certain extent since coping with the death of a loved one, especially one that has been with you for a prolonged period, is a harrowing experience, however, the problem with utilizing alcohol as a means of coping with death is that it becomes habit-forming over time (Livingston & King 1993).
Fear and Anxiety
Aside from loneliness and the death of a spouse, another of the issues that cause elderly individuals to turn to alcohol as a coping mechanism are feelings of fear and anxiety (Bellavia, Bottai, Wolk & Orsini 2014). Simply put, the elderly are often subject to a variety of treatments, medications, and life-sustaining procedures that places a considerable level of stress on their mind (Bellavia et al. 2014). This is due to the fear of their impending death as well as the anxiety that develops as a direct result of such thoughts (Menon, Katz, Mukamal, Kestenbaum, De Boer, Siscovick, Sarnak & Shlipak 2010). The result is that they turn towards the use of alcohol as a means of “deadening” the fear and apprehension that they are dealing with (Menon et al. 2010).
Aside from the use of alcohol as a coping mechanism, other factors that cause the elderly to turn towards alcohol abuse consist of the following:
Long-term habits
While not necessarily applicable to all elderly individuals, some have been prolific drinkers for decades (Menon et al. 2010). These ingrained habits result in alcohol abuse later on in life as they succumb to alcoholism. The inherent problem when it comes to dealing with alcohol as a lifelong habit is that drinking has become such an ingrained aspect of their lives that treatment for alcohol abuse among such individuals is often incredibly difficult given the decades in which their system has grown dependent on alcohol (Menon et al. 2010). It should also be noted that despite various means of treatment, ranging from interventions, support groups, psychological counseling, etc. the success rate has been relatively low for elderly individuals that have such an ingrained habit (Wang, Liu & Wang 2014).
One of the reasons behind this can be seen in the work of Livingston & King who explained that while standard methods of alcohol intervention can have a modicum level of success on younger individuals, elderly alcohol abusers have a sense of “finality” in that they believe that since they are going to die anyway then it would be fine to imbibe alcohol in the manner in which they choose since they have already lived a long and fulfilling life (Livingston & King 1993). Of course, the inherent problem with this way of thinking is that it causes havoc on their health and can react negatively with the various prescription drugs that they already take resulting in them dying several years or even a decade earlier than they should due to kidney problems and damage to their liver (Wang, Liu & Wang 2014).
Admitting that they have a problem
Through the work of Blondell (1999), it was seen that the elderly are less likely to seek professional help early on which makes the problems associated with alcohol abuse even worse. Blondel explains that the social stigma associated with alcohol abuse is just as prevalent among elderly communities as it is in younger ones. As a result, people are often reluctant to admit that they have a problem and seek professional help. It should also be noted that Cummings, Bride & Rawlins-Shaw (2006) discovered that the elderly develop their own biases regarding their “problem” which is similar to that of many alcoholics. This effectively creates the idea that their problem “is not so bad” and that it is relatively minor as compared to the assortment of issues that they have to deal with (i.e. the death of a friend, the expense of medications, their impending death, etc.) (Cummings et al. 2006).
When taking all the factors that have been mentioned into consideration, it can be seen that there are a plethora of reasons that can cause an elderly individual to develop an alcohol abuse problem. As such, it is only by addressing the root causes in the following section that they can truly be resolved in the long term.
Addressing the Issue
After going over everything that has been stated so far, the following strategies have been devised to address the issue of alcohol abuse among the elderly. Do note that in no way does this encompass all possible methods of addressing the problem, rather, it focuses on those most pertinent in resolving the problem based on origins that have been stated in this paper.
Alcohol as a Coping Mechanism
The concept of alcohol as a coping mechanism has its origins in two specific theoretical models that attempt to explain the origins of addiction, namely: the exposure orientation theory and the classical conditioning principles. Under the exposure orientation model, the introduction of substances with addictive qualities (in this case alcohol) results in the development of metabolic adjustments within the body to satisfy the cravings that have been developed and to stave off withdrawal symptoms (Immonen, Valvanne & Pitkälä 2011). This is commonly known as addicts getting their “fix” so to speak when it comes to addressing their addiction. Immonen, Valvanne & Pitkälä (2011) connects this to the current topic being investigated by explaining that the development of alcohol addiction among the elderly begins as a direct result of some form of underlying psychological turmoil that results in them utilizing alcohol as a type of crutch. It is due to their constant imbibing of the substance and the continued presence of the turmoil that caused it that manifests in the outcomes seen in the exposure orientation theory (Immonen, Valvanne & Pitkälä 2011). As the elderly continue to use alcohol to cope with their psychological issues, they require greater and greater amounts which results in progressively higher levels of addiction to the point that they drink simply because their bodies have become addicted to it (Immonen, Valvanne & Pitkälä 2011).
The inherent issue with alcohol as a coping mechanism is that it does not address the underlying psychological turmoil that comes about through feelings of loneliness, the death of a spouse, or the fear and anxiety that the elderly feel at times. This is where the principle of classic conditioning is applied wherein Lin, Kikuchi, Tamakoshi, Wakai, Kawamura, Iso, Ogimoto, Yagyu, Obata & Ishibashi (2005) state that the consumption of alcohol for elderly individuals afflicted with the aforementioned issues that have just been mentioned becomes a reinforcing action based on the “ritual” behind the addiction. Lin et al. (2005) simplify this statement by explaining that with alcohol acting as a coping mechanism, the mere act of drinking and its association with the “reward factor” behind the process results in the creation of conditional craving responses and the continued relapse of an individual into this type of behavior whenever they experience the psychological triggers associated with the event (Lin et al. 2005).
To resolve the issue, it would be necessary to address the underlying psychological triggers that cause a person to drink alcohol in the first place. It is based on this perspective that Caputo, Vignoli, Leggio, Addolorato, Zoli & Bernardi (2012) state that psychological counseling in the form of one on one therapy, group therapy or simply having an outlet for the problems an elderly person faces daily can do wonders in resolving the need for alcohol to cope with the problems they encounter. Psychological counseling, as explained by Krach (1998), involves addressing the underlying problem by bringing it to the surface which helps patients to slowly deal with their emotional issues resulting in the triggers that relate to their drinking habits slowly subside.
Such a strategy can often be done through the use of support groups in elderly communities or through the placement of an in-house therapist within a nursing home to talk to the patients through a schedule of meetings (McInnes & Powell 1994). What is important, as indicated by Saunders, Copeland, Dewey, Davidson, McWilliam, Sharma, Sullivan & Voruganti (1989), is that a sense of normalcy and regularity is implemented into their daily schedule through these counseling sessions. Trevisan (2014) delves deeper into this by explaining that “going through the motions” so to speak of having a scheduled existence that also has the benefit of addressing their underlying fear, anxiety, and depression would do wonders in terms of removing the root causes of their alcohol abuse problems.
Trevisan states that the addition of emotional turmoil via the root causes of alcohol abuse creates an unscheduled existence that enticed further disruptive behavior (i.e. depression) which results in even more alcohol abuse. It is only when people are properly “grounded” so to speak that they can get their emotional and psychological state to the extent that they no longer need to depend on alcohol as a means of coping with their problems (Trevisan 2014). This particular approach is effective in addressing the other problem with alcohol abuse wherein the elderly do not want to admit that they have a problem when it comes to their alcohol consumption (Onen, Onen, Mangeon, Abidi, Courpron & Schmidt 2005). Do note that the aforementioned strategy is not as effective when it comes to alcohol abusers that have been drinking heavily for decades since it has become more of an ingrained habit for them rather than a coping mechanism for something that they are only recently experiencing.
Addressing Alcohol as a Long Term Ingrained Habit
The learning theory of addiction states that addiction is a learned behavior wherein it manifests as a direct result of social learning (ex: seeing people drinking in public), classical conditioning (wherein the act is learned through repetition and the creation of a habit, and operant conditioning (which is a type of behavioral choice) (Lin et al. 2005). It is based on the concept of addiction as a learned behavior that Watts (2007) posits the claim that behaviors that are learned can be similarly unlearned resulting in the slow removal of the factors that contribute towards relapse. Through the work of Cummings et al. (2006), it was seen that addressing alcohol abuse in the elderly is made more difficult if it has been going on for decades.
Cummings et al. pointed to the fact that alcohol consumption within various regions such as the U.S., UK, and Russia has become such an ingrained aspect of the local culture that it is more surprising to find someone that does not drink alcohol than someone that does. Under the learning theory of the addiction model, there is an inherent connection between socio-cultural behavior and the development of addiction in individuals due to factors related to emulation (Goldberg 2010). Going even further, (Watts 2007) states that some individuals are more predisposed towards developing addictions as compared to others as per the medical model of addiction development which states that addiction is a form of the disease with some people merely being more susceptible to it. It is due to this that Cummings et al. (2006) explains that there is a social aspect connected to alcohol addiction wherein the act of drinking alcoholic beverages when a person is with their friends in a friendly setting (i.e. a bar) creates the potential for the development of addictive behavior.
By combining the medical theory of addiction which biologically predisposes certain individuals towards the development of addictive behavior to the learning theory of addiction which states that people learn to develop an addiction, it can be seen that social and cultural settings help to create a predilection towards alcohol consumption (Hogenkamp et al. 2014). This results in certain individuals going for items that either have a higher alcoholic content (i.e. hard liquor such as tequila) or drinking alcohol in large volumes (i.e. consuming a six-pack of beer in a single day) which is under the exposure orientation model of addiction development (i.e. greater amounts of addictive substances are needed to obtain the necessary “fix”) (Goldberg 2010).
Based on the combined theoretical assumptions that have just been mentioned, it can be assumed that the development of alcohol into a long term habit comes as a direct result of observation, the creation of a set of triggers to cause a person to drink, potential biological predisposition and a predilection to increase the amount of liquor drunk due to exposure orientation (Onen et al. 2005). When examining the theoretical basis behind this issue, the solution is obvious: take away the social and cultural aspects that cause a person to drink to help them slowly remove their need to imbibe alcohol (Onen et al. 2005). Millard & McAuley (2008) help to justify this strategy by stating that social drinking is a common occurrence across a wide variety of different cultures and societies with different age groups participating in the act. However, when it comes to the elderly, Millard & McAuley (2008) state that the ill effects associated with alcohol consumption are far more exacerbated due to their advanced ages. It is due to this that before implementing any method of addressing long-term drinking habits, it is necessary to first acknowledge the withdrawal symptoms associated with lowering an elderly individual’s alcohol consumption and the various risks associated with them (Millard & McAuley 2008).
The withdrawal symptoms associated with stopping one’s long term consumption of alcohol begin to resemble those associated with drug addicts or smokers. This can manifest in “shakes” (i.e. the individual in question sometimes involuntarily twitches), becoming feverish, an increase in irritability, some form of physical pain that does not have a specific origin but it felt in some areas of the body, lack of energy as well as issues related to adverse psychological behavior (i.e. violence, depression, etc) (McInnes & Powell 1994). It is when considering these symptoms that weaning an elderly individual off of a long term habit becomes far more complex since, given their advanced ages, the aforementioned withdrawal symptoms can place a considerable amount of stress on their body to the point that it may cause strokes, cardiac dysrhythmia (i.e. the irregular beating of the heart), extreme depression leading to suicide and other such manifestations of long term alcohol withdrawal (Lowinson 2005).
On the other hand, Cummings et al. stated that simply allowing the habit to continue to avoid such symptoms from manifesting also causes issues in the form of liver and kidney damage as well as the fact that the various medications that help to sustain an elderly individual (i.e. keep them alive) do not react well when mixed with alcohol (Cummings et al. 2006). It is based on this that to address alcohol abuse as a long-term ingrained issue among the elderly, what is necessary is to focus on an equally long-term view regarding the treatment procedure (Onen et al. 2005). What is necessary is to simultaneously enroll the elderly individual in group sessions of other elderly alcohol abusers while slowly reducing their alcoholic consumption (Cummings et al. 2006). This type of treatment can take up to 3 years depending on the level of addiction, however, slowly reducing their dependence on alcohol over several years, helps to mitigate the symptoms associated with alcohol withdrawal while at the same time helps the elderly individual adjust to living a life without alcohol (Onen et al. 2005).
Addressing the Issue of the Elderly not admitting they have a Problem
Through the work of Millard & McAuley (2008), it was seen that the elderly are often in denial when it comes to admitting that they have a problem with their alcohol consumption. Under the cognitive theory of addiction, individuals choose their addictive behaviors over safer (i.e. healthier) behaviors based on their inherent expectations connected to the action (Sinclair et al. 2014). Millard & McAuley (2008) help to explain this reasoning by stating that individuals who are subject to alcohol addiction believe that the withdrawal symptoms are worse and would result in bodily harm.
The result of this method of justification is that despite truly having an alcohol dependency problem, people that have imbibed alcohol over a significant period continue to state that they do not have a problem or that they are perfectly fine (Sinclair et al. 2014). One of the reasons behind this is connected to their advanced ages wherein they assume that since they have already lived for so long; their consumption of alcohol should no longer matter (Sinclair et al. 2014). It is with this attitude in mind that a means of resolving alcoholism is needed: an intervention. This can often come in the form of friends and family members telling the elderly individual in question that he/she has a problem with their consumption of alcohol. While the method is not 100% effective, it has proven to create some form of self-introspection in the individuals involved resulting in some of them lessening their consumption of alcohol to some degree (Trevisan 2014).
Solutions
Chemical-based therapy
Chemical-based treatment for addiction has its basis on the medical model which states that addiction is a form of “brain disease” which manifests as a type of neurotransmitter imbalance (Fang et al. 2013). Under this theoretical framework, it is assumed that the best way of getting over an addiction is to resolve the chemical imbalance in the brain that is at the route of the addictive behavior (Fang et al. 2013). This ordinarily comes in the form of regression wherein a person is slowly weaned off of the addictive substances that they are used to until it reaches a point that their brain goes back to its original state (Fang et al. 2013). It is due to this that there have been a variety of developments that have focused on procedures that allow the brain to reach a form of equilibrium to cancel out the impact of addictive substances. One example of this comes in the form of the nicotine patches utilized by smokers to get over their habit (Menon et al. 2010). However, the research of Geels et al. (2013) points out that a similar strategy is unlikely to work in the case of elderly individuals that have a history of alcohol abuse.
This is based on their analysis which showcased higher rates of regression when attempting to slowly wean elderly individuals from consuming alcohol. It can be assumed that the reason behind this is connected to ingrained long term behavior which causes a lower rate of positive treatment using chemical-based therapy. Other studies such as those by Forlani et al. (2014) and Fang et al. (2013) help to verify such results and show that relying on this particular method as a primary method of treatment is unwise. What can be derived from this examination is that chemical-based methods of addressing alcohol abuse among the elderly do not have a high rate of success (Menon et al. 2010). It is due to this that the next section will focus on the temperance model of addiction and how it can be used to help resolve the issue. The problem with pharmacotherapy is that it merely addresses the symptoms of alcohol abuse and does not address the main issue behind the problem (Menon et al. 2010).
While general physicians are normally aware that excessive alcohol consumption is the reason behind the need for extensive pharmacotherapy in some cases, this paper has shown that there is nothing doctors can do if a patient drinks alcohol outside of a hospital setting (Menon et al. 2010). It is with this in mind that when viewing pharmacotherapy as a means of addressing the problems related to alcoholism, it should be stated that it would be the same as putting a band-aid on top of a deep puncture wound (Bellavia et al. 2014). While on the surface it may appear to have resolved the problem, the fact remains that it is still far from actually resolving the issue. As such, other methods need to be implemented to either supplement or replace pharmacotherapy as a solution towards ensuring the health of the elderly when it comes to their alcohol abuse problems.
Taxation
The temperance model of addiction and recovery states that addiction is the direct result of exposure to substances that cause addiction in the first place (Caputo et al. 2012). Thus, under this theoretical framework, prevention comes in the form of restricted access to substances that cause a person to become an addict (Caputo et al. 2012). One potential avenue of approach that could help in reducing alcohol abuse among the elderly based on this is to focus on increasing the tax associated with alcoholic beverages (Caputo et al. 2012). The best method of resolving this issue is not to target the state of alcohol abuse directly since there is no way to prevent a person from drinking, instead, a more effective method would be to discourage the process of drinking large quantities of alcohol by making it prohibitively expensive (Basit 2010).
Taxes have always been a way in which governments have controlled the flow of imported goods into the country to give local producers a chance against cheap imports, an enacted policy that levels a specific type of tax on foods identified as being the cause of health problems among the elderly would raise their prices sufficiently to limit their consumption (Basit 2010). The advantages of this method are simple, the elderly have a limited amount of income which they can use to purchase particular products; having an alcoholic product that leads to health issues cost more and the elderly would only be able to drink a specific amount of that particular type of beverage due to limitations in income (Lin et al. 2005). Other policy initiatives have focused on dealing with the problem of alcohol abuse among the elderly when it has already occurred; this policy initiative specifically targets the cause of alcohol abuse and ensures that it has a limited impact on how it is consumed (Lin et al. 2005). The temperance model of addiction and the proposed changes can be seen to have a significant correlation with one another which helps to justify the implementation of the proposed method.
Patient education
Under the education model of addiction, it is the lack of sufficient education and inaccurate information that causes people to delve into substances that create addiction (Immonen et al. 2011). It is based on this that one potential method of preventive treatment for the elderly comes in the form of imparting relevant information to patients to help them better alter their behaviors and improve their overall mental health (Immonen et al. 2011). This process often involves helping patients understand their current condition, how it is negatively affecting their mental and physical well-being, and the various methods they can employ to get better (Immonen et al. 2011). The inherent problem though with utilizing patient education as a means of addressing alcohol dependency is that there is no guarantee that a person will go through with limiting their alcohol intake (Wang et al. 2014). Patient education can only go so far in convincing a person that they need to stop drinking alcohol excessively (Wang et al. 2014). It is with this in mind that this paper cautions future strategies that focus exclusively on patient education as the primary method of treatment for alcohol abuse among the elderly (Wang et al. 2014). The fact is that some form of reliability is needed and present-day studies have yet to show sufficient reliability with an information-oriented strategy that deals with alcohol abuse.
Psychotherapy
The general systems theory of addiction treatment focuses on the concept of groups and how they influence both addiction and treatment (Breitling et al. 2010). Under this theoretical framework, aspects related to peer pressure and group social influences have a significant impact on the likelihood of individuals developing an addiction (Breitling et al. 2010). However, it has also been noted by Vrdoljak et al. (2014) that the general systems theoretical framework can also be utilized as a means of helping people that have developed an addiction. It is based on this that this framework will be utilized as a part of the psychotherapy solution for the treatment of alcohol abuse among the elderly. This particular form of treatment involves group sessions between patients and trained psychotherapists (Vrdoljak et al. 2014).
These particular forms of treatment often involve an exploration of what triggers instances of re-experiencing and attempts to help resolve such issues through progressive methods of disassociation till the event no longer elicits the same amount of stress (i.e. the death of a loved one) (Watts 2007). This particular method of treatment also involves the implementation of a variety of coping mechanisms to lessen the degree of anxiety connected to the use of alcohol as a coping mechanism for the elderly when it comes to addressing their issues. (Watts 2007) Overall, I have determined that therapy sessions would be one of the most advisable methods of handling the issue of alcohol abuse among the elderly (Nuevo et al. 2015). There is an assortment of strategies that could be implemented to help a person slowly rely less and less on alcohol as a psychological crutch. This can range from joining group therapy sessions such as those in alcoholics anonymous as well as having private sessions with a therapist (Nuevo et al. 2015). Whatever method would be most appropriate can be determined by the general practitioner that the patient goes to. I believe that this particular method holds the most “promise” so to speak when it comes to creating a long-lasting means of ensuring an elderly individual does not abuse their consumption of alcohol.
Recommendation
When going over all the information that has been presented so far in this paper regarding alcohol abuse among the elderly, the one topic that was not focused on was strategies delving into early-onset alcohol abuse detection. Ranging from observing a patient’s behavior to blood testing, early-onset detection helps doctors and family members determine whether an elderly individual in their care has been imbibing alcohol to such an extent that it may cause considerable health problems down the line (Halme 2010). It should be noted that early-onset detection is a far better way of addressing the issue of alcohol abuse since it enables intervention at an early stage before the patient in question begins to manifest a psychological dependency on alcohol which would make a withdrawal that much worse (Halme 2010). However, while there are methods that have been developed to detect high levels of alcohol consumption in the body, there have yet to be strategies that have been devised to convince the children of elderly parents or retirements homes to submit the elderly people that they are caring for to undergo mandatory alcohol testing (Sinclair et al. 2014).
Simply stating: “We are doing this to prevent alcohol abuse” would result in an onslaught of possible recriminatory accusations from the centers and the children of the patients. As such, new strategies need to be developed to convince people that elderly alcohol abuse is actually a prevalent issue and that it should be identified and addressed immediately to prevent the problem from worsening Buja et al. 2010). Aside from this, strategies also need to be developed to prevent identified individuals from consuming more alcohol than they should. While this paper has delved into various possible strategies, it cannot be stated that these are “absolutes” since there is always the potential that alternatives exist to what has been presented so far Buja et al. 2010). Another issue that should be focused on to a greater extent is the potential for information campaigns to change how people view the act of drinking (Ham 2007). It is assumed that the more people associate drinking as something that causes more harm than good; the more likely they are to not participate in such an activity in the first place (Ham 2007).
However, this is merely an assumption and few studies have delved into the long-term effectiveness of information campaigns on the drinking habits of people starting from a young age (i.e. the legal drinking age) until they retire (Ham 2007). While it is assumed that exposure to information campaigns would help to lessen the psychological dependence to drink when confronted with the possible health issues that a person would develop due to excessive alcohol consumption (Barrick et al. 2002). It is with this in mind that this study recommends that future researchers attempt to determine the overall effectiveness of information campaigns in preventing the early onset of alcohol abuse. This particular approach in examining such an issue can apply either to younger demographics or the elderly (Barrick et al. 2002). The main purpose of the study would be to determine if information campaigns would be effective and, if so, what method would be the most appropriate depending on the age group that is being targeted. It is expected that such a study would go a long way towards contributing towards present-day literature on the issue of alcohol abuse and should result in the development of new strategies that should reduce the number of people that turn towards alcohol consumption as a form of psychological support.
Early Onset Psychological Intervention
One of the earlier issues that were mentioned in this paper was related to the elderly utilizing alcohol as a “crutch” so to speak to deal with a variety of different emotional situations such as their friends or family members dying due to old age. It is based on this that to resolve the problem and “nip it in the bud” so to speak, one method that could be utilized is to implement early-onset psychological intervention (Geels et al. 2013). This method focuses on providing psychological care and assistance to elderly individuals after they have experienced the loss of a loved one. By doing so helps to considerably lessen the psychological burden that they have and should lessen their potential dependence on alcohol as a means of addressing their emotional issues (Geels et al. 2013).
Alternative Treatments
This failure to add some form of an effective preventive method for relapse when it comes to alcohol abuse among the elderly has been noted by various researchers as being because even an assortment of external preventive programs have very little in the way of a sufficiently effective preventive capacity when the origin of the problem is the internal decision-making process of a patient (Geels et al. 2013). It is often the case that patients need to develop their internal realization backed by psychological reasoning when it comes to abstaining from alcohol abuse. What is necessary is the development of a sufficiently strong internal reasoning mechanism and support system to ensure that the factors that caused a particular individual to turn to drugs in the first place do not manifest (Saunders et al. 1989).
Religious Spirituality as a Possible Solution
One possible alternative method that has been gaining a considerable degree of traction in a variety of alcohol abuse treatment programs has been the use of religious spirituality (Onen et al. 2005). It was determined in the article “Patients consider spirituality and self-help approach vital in TC” that religious spirituality can not only aid in the process of alcohol abuse rehabilitation but can even act as a preventive measure to ensure that relapses do not occur (Onen et al. 2005). The reason behind its effectiveness is quite simple, religious spirituality acts as a means of altering an individual’s perception in such a way that they view their life as not just their own but rather is connected to an almighty external creator (i.e. God) (Ham 2007). Not only that, spirituality in certain cases involving religious groups and organizations helps to instill a sense of belonging in patients with the religious community that they are involved in often acting as a support group to prevent drug-related relapses from occurring (Caputo et al. 2012).
What you have to understand is that a large percentage of current alcohol abuse cases are often related to individuals who feel depressed, worthless, and alone in life. Such behavioral symptoms are often correlated with a lack of sufficient support and social interaction which makes the use of alcohol seemingly more ideal since it acts as a form of escape from such situations (Ham 2007). By adding religious spirituality to alcohol abuse treatment programs creates the initial foundation by which addicts could find an alternative to using drugs by immersing themselves in the feeling of being in a community and belonging to a greater whole (Caputo et al. 2012). Such a solution would prevent the potential for patients to relapse since it addresses the internal psychological state that must be addressed to ensure that patients develop their realization regarding the ill effects of alcohol abuse (Caputo et al. 2012). As such, this paper has the assumption that adding the concept of religious spirituality to alcohol abuse treatment programs can help to decrease the number of relapses by elderly patients.
Conclusion
Based on what has been presented so far, it can be seen that a combination of psychotherapy (group sessions), new policy initiatives in taxation, patient education as well as addressing the underlying causes behind alcohol addiction would lead to far more effective treatment regimes. Overall, when taking everything that has been stated into consideration, it can be seen that addressing the issue of alcohol abuse among the elderly needs to go through several steps. The first is identifying why the consumption is occurring (i.e. is it due to dependence, a coping mechanism, or simply a long-term habit) and afterward choosing the appropriate means of addressing the identified cause. So far, these aspects have been detailed in this paper, however, they are in no way the only means by which alcohol abuse can be identified and prevented. Instead, what has been presented is a general overview regarding the process and what can be expected should it be used in a professional setting.
This study believes that “emotional numbing” which is a symptom that manifests itself as a distinct detachment from people, social situations, and activities that were previously thought of to be enjoyable, comes about through depression over some aspect of an elderly person’s life (usually the death of their spouse or the idea of their impending death) that causes them to turn towards the use of alcohol as a coping method. It also happens to manifest itself as a form of detachment or state of withdrawal where this individual is unresponsive to external stimuli. It is from this perspective that this paper recommends that to truly determine appropriate methods of treating alcohol abuse among the elderly, it would first be necessary to determine why they drink excessively in the first place. If they utilize alcohol as a means of covering up some form of emotional heartache or trauma, it would be necessary to address that issue first before getting them to stop drinking. Otherwise, it is unlikely that they would stop since the only thing that is being addressed is the external issue rather than the internal psychological issue that is at the heart of the problem.
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