D573 Task 1 Substance Use Disorder Analysis Example

The Glass That Replaced the Workday: Alcohol Use Disorder in Adults Over 60, Its Signs, Its Reach Into Families and Communities, and the Factors That Start and Sustain It

Student Name

Leavitt School of Health, Western Governors University

D573: Understanding Substance Abuse and Addiction, Task 1

Course Instructor

Month Day, Year

The Glass That Replaced the Workday: Alcohol Use Disorder in Adults Over 60, Its Signs, Its Reach Into Families and Communities, and the Factors That Start and Sustain It

Introduction

When people picture alcohol use disorder, they rarely picture a retired school secretary with a book club and three grandchildren. Yet alcohol problems among older adults are common, often missed and rising. This paper describes alcohol use disorder as it appears in adults over 60, its signs and symptoms, and its impact on individuals, families and communities. It then analyzes the biological, psychological and social factors that can start and reinforce heavy drinking in later life. A composite case is used throughout to show how these factors combine in one person.

A Composite Case

Linda, 66, retired two years ago after 31 years as a middle school secretary in suburban Cleveland. Her husband died of cancer eighteen months later. She had always enjoyed a glass of wine with dinner, but now she pours her first glass at four in the afternoon and finishes a bottle most evenings. She has fallen twice at home, once cutting her forehead on a counter, and blamed a loose rug. Her daughter noticed that Linda repeats stories in phone calls and has stopped attending her book club. Linda takes medication for high blood pressure and a sleep aid her doctor prescribed after her husband's death. She says wine is the only thing that helps her relax.

Alcohol Use Disorder and Its Signs in Older Adults

Alcohol use disorder is a problematic pattern of alcohol use leading to significant impairment or distress, identified by two or more of eleven criteria within a year. The criteria include drinking more or longer than intended, unsuccessful efforts to cut down, much time spent drinking or recovering, craving, failure to meet obligations, continued use despite social or health problems, giving up important activities, use in hazardous situations, tolerance and withdrawal (American Psychiatric Association [APA], 2022). Linda meets at least four: she drinks more than she intends, craves wine in the afternoon, has given up her book club and continues to drink despite falls.

In older adults the signs are easy to miss or mistake for aging. Falls, memory lapses, poor sleep, mood changes and withdrawal from social activities may be attributed to age or grief rather than drinking. Older adults also have fewer of the obligations, such as work, whose failure often exposes drinking in younger people. Reviews of substance use in later life note that screening in primary care is often skipped for older patients and that standard criteria may miss problems because older adults feel the effects of alcohol at lower amounts (Kuerbis et al., 2014).

How Common It Is

An analysis of the National Survey on Drug Use and Health found that among adults 50 and older, the prevalence of alcohol use disorder rose by a relative 23.3% and past-month binge drinking by 19.2% between 2005 and 2014, with significant increases among women (Han et al., 2017). As the baby boom generation ages, the number of older adults with alcohol problems is growing along with it.

Impact on Individuals, Families and Communities

Individual effects. Aging changes how the body handles alcohol. Older adults have less body water, so the same drink produces a higher blood alcohol level, and alcohol interacts with many common medications. For Linda, alcohol combined with a sleep aid increases sedation and fall risk, and alcohol can blunt the effect of her blood pressure medication. Heavy drinking also worsens memory problems, depression and sleep, the very problems that may have led her to drink.

Family effects. Adult children often become worried caregivers at a distance. Linda's daughter now calls every evening, cannot tell whether memory lapses are dementia or drinking and feels guilty for not visiting more. Grandchildren may lose time with a grandparent, and family members may disagree about whether to raise the subject at all.

Community effects. Falls and alcohol-related injuries among older adults increase emergency department visits and hospital stays. Isolation deepens as people withdraw from churches, clubs and volunteer roles, which weakens community networks that depend on older volunteers. Driving after drinking puts others at risk.

Factors That Start Heavy Drinking in Later Life

Biological factors. Chronic pain, sleep problems and medical conditions common in later life can lead people to use alcohol as self-medication. Family history and genetics influence vulnerability across the life span.

Psychological factors. Loss and loneliness are central in later-onset drinking. Bereavement, retirement and loss of purpose can bring depression and anxiety, and alcohol offers temporary relief. For Linda, the combination of retirement and widowhood removed both her daily structure and her closest relationship within two years.

Social factors. Retirement removes the schedule and social accountability that once limited drinking. Social drinking norms among some older adults, a lifetime habit of drinking with dinner and easy access to alcohol at home also contribute.

Factors That Reinforce It

Once heavy drinking begins, several processes keep it going. Negative reinforcement is powerful: wine relieves Linda's afternoon loneliness and anxiety, so the relief makes drinking more likely the next day. Neuroscience research describes addiction as a repeating cycle of binge and intoxication, withdrawal and negative affect, and preoccupation and anticipation, in which drinking increasingly serves to relieve the distress that heavy use itself produces (Koob & Volkow, 2016). Tolerance means she needs more wine for the same effect. Isolation reinforces drinking as well, since fewer people see her in the evenings and notice changes. Finally, stigma and shame about drinking in later life can keep older adults from raising the subject with a doctor.

Conclusion

Alcohol use disorder in older adults is common, rising and easily mistaken for aging or grief. It harms health through medication interactions, falls and memory problems, and it reaches families and communities through caregiving strain, injuries and isolation. Loss, loneliness and the loss of daily structure often start heavy drinking in later life, while negative reinforcement, tolerance and isolation keep it going. Recognizing that pattern is the first step toward screening and help.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Han, B. H., Moore, A. A., Sherman, S., Keyes, K. M., & Palamar, J. J. (2017). Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005-2014. Drug and Alcohol Dependence, 170, 198-207. https://doi.org/10.1016/j.drugalcdep.2016.11.003

Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773. https://doi.org/10.1016/S2215-0366(16)00104-8

Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance abuse among older adults. Clinics in Geriatric Medicine, 30(3), 629-654. https://doi.org/10.1016/j.cger.2014.04.008