When does drinking become addiction?

Margaret was 58 years old when she negotiated an early retirement from her high-pressure job in advertising. Topped up by her investments and the sale of her house in Toronto, the generous settlement enabled her to fulfil a longtime dream: spending summers at her cottage in Ontario and winters in Florida.

But only a few weeks after pulling up stakes, Margaret knew she was in trouble. With no structure to her days, her once casual drinking habits started getting out of hand.

At first, it was “very pleasant,” she says. She’d have a dash of Kahlua in her coffee in the morning, a couple of glasses of wine at lunch, a few more sips of wine in the afternoon as she curled up with a good book, more wine with dinner. “But then it started to backfire,” Margaret says. “I’d take a break from drinking now and then but discovered to my horror that if I didn’t keep on drinking, I’d get sick! I’d be retching into the sink several times a day. I couldn’t eat. I guess I was going through the classic symptoms of alcohol withdrawal.”

At one point, Margaret decided to stop drinking completely. “It w a rough few days, but I got through it.” Since then, Margaret has resumed drinking but has been able to keep her consumption in check, limiting herself to a couple of glasses of wine a night. “I’m not ready to give up drinking altogether,” she says. “Behaviour modification seems to be working for me. Besides, a little wine every day is good for your health.”

Margaret’s situation underscores a quandary that a lot of retirees face. The health and social benefits of moderate alcohol consumption, especially for older people, have been well documented. Among other things, moderate alcohol consumption (one to two drinks a day) may reduce stress and your risk of heart disease.

But with a newfound chunk of leisure time on their hands, it’s tempting for many retirees to overindulge. And, like Margaret, their tolerance levels are probably not as high as they used to be because as we age, we don’t metabolize alcohol as efficiently.

Exacerbating the problem are the dangers of mixing alcohol with certain medications, not to mention the risk of cross-addiction. Some ballpark estimates say that as many as 15 to 20 per cent of people over 60 abuse alcohol. And while there are no reliable statistics about the number of alcoholic seniors, a British Columbia study suggests that six to 10 per cent of seniors have addiction problems, including alcohol.

When should you worry?
So how much is too much? It’s important to note that excessive drinking doesn’t mean drinking to intoxication. In other words, if having one or two drinks a day impairs your abilities, that’s one too many. To be on the safe side, most experts recommend that people over 60 should have no more than one to two alcoholic drinks a day.

But for many people, it’s hard to stop at one – especially if you’re a longtime drinker. In fact, research suggests that drinking to excess when you’re younger presents a major risk factor for alcohol abuse later in life.

Margaret was no exception. “All my adult life,” she says, “I drank too much. In my 20s, I went to bars because that’s where you met guys, and I drank. At work, I drank with fellow co-workers after hours. In the evenings, I’d drink while watching TV. Most mornings, I had a hangover although it rarely interfered with my job.”

Other older people with drinking problems may have started out as moderate social drinkers but gradually drank more as they aged. Many simply get bored with retirement and are filling in time; others abuse alcohol in an attempt to cope with depression.

Next page: The line between abuse and addiction

The bottom line: addiction specialists say they are seeing an increasing number of retirees in treatment centres. There are two reasons for this change. First, the number of older people in our society is growing exponentially as the baby boomers reach 55 and face the problems presented by a long retirement in a society where most people are defined by their work.

Second, alcoholism is no longer stigmatized the way it used to be, as a moral failing rather than a disease, so there is more openness about it. The result is that there is more willingness to go for treatment or be urged into treatment by families and friends.

“We have a steady influx of people 50 and over,” says Dr. Gerald Cooney of Bellwood Health Services Inc., a residential addiction treatment centre in Toronto. “There are a number of patients who, as they reach retirement, lose their purpose in life. We all have to have a reason for getting out of bed in the morning. Often, the problem is that you’ve had a very successful life and you’re at home with the big-screen TV and the rocking chair, and you need something to pass the time. That’s when people stop using drink socially and start using it to self-medicate.”

What’s normal anyway?
This may not always signal addiction, he emphasizes, but it’s a start down a slippery slope. “When you begin to see alcohol as a need in your life, then the need becomes a compulsion. If that compulsion isn’t curbed and you can’t stop, that’s when alcoholism becomes a disease. Once you cross the line from abuse to addiction, your brain says, This is what I need to feel normal.”

Nor is it only longtime drinkers who are at risk. Eileen McKee, a social worker and gerontology specialist at COPA (Community Older Persons Alcohol Program), an outreach program in Toronto, says, “We have people starting cold, who started to drink heavily from the pressures that come with age. The loss of mobility and physical health, the loss of a job and the loss of finances that goes along with it can all be factors.” She sees people in their 70s who are late-developing alcoholics.

Jennifer, 79, a former arts publicist and recovering alcoholic, thinks she knows why: “It is part and parcel of trying to grapple with the fear and loneliness of old age. If your life is defined by your job and you no longer have the job, you’ve lost your identity, and then you start to lose your social life.”

Pinpointing drinking problems among older people can be difficult since some signs, such as memory loss and clumsiness, can be mistaken for changes associated with aging. More cogent indicators include slovenly habits, mood changes, lack of appetite, guilt about drinking, concealing drinking and the need for eye-openers in the morning.

Exploring treatment options
Approaches to treatment are more open to debate. For Lorne Hildebrand, the director of community relations at Edgewood, a Vancouver Island treatment centre that uses the 12-step approach, behaviour modification is not an option for older people.

The heavy-drinking retiree is usually an addict without knowing it, Hildebrand says. “Most people become alcoholics between the ages of 12 and 40. By 45, you’re hooked.” The devilish thing, he adds, is that addiction is 80 per cent psychological, and this allows addicts to deny the damage being done to their bodies. “By the time alcoholics are in their 50s, they are deteriorating physically, but their sense of denial is so powerful they can’t stop.”

Toronto’s Centre for Addiction and Mental Health, which runs a program called OPUS 55 (Older Persons’ Unique Solutions), takes a more moderate approach. “If a 30-year drinker comes to us with liver damage, sure, we’ll advise abstinence,” says therapist Helen McIlroy. But the emphasis at OPUS, which was started in 2001 (the year the first boomers turned 55), is on harm reduction – a behaviour-modification strategy. McIlroy concentrates on refocusing patients.

“It’s not really about what you’re not going to do (that is, stop drinking) but what you’re going to do instead. That’s what I ask. I see it as a creative process. What are you going to do with the rest of your life?” Depending on their health and other circumstances, there are all kinds of things a retiree can do. “If people are invested and defined by work and the self-esteem that’s tied into it, I recommend volunteer work. We look at skills they had in the job and how transferable they are to the volunteer sector.”

Retirees who fly in the face of the defined-by-work syndrome do seem to have a better handle on dealing with alcohol. Don, 75, a retired lawyer from Winnipeg, says he actually drank more when he was working: “It was the classic three-martini lunch with clients, cocktails after work.” Now, he says, he sometimes drinks a glass of red wine with dinner, but he has no interest in bumping up his consumption.

“It really helps to have something that engages your attention,” he says. “In my case, it’s music.” Don, who played tenor sax and clarinet and toured in bands when he was younger, revived his old love and now enjoys jam sessions with a few buddies and the occasional gig around town.

Having avid interests is the key to her coping with retirement, says Suzanne, 60, a retired teacher from Montreal. “I’ve always been very active physically, and retiring simply liberated more time to pursue my passions: tennis, ice skating and ballroom dancing.” Interestingly, she adds, “My drinking habits haven’t changed one iota.  I still average a bottle of wine a day, spread out over several hours. I suppose by a lot of definitions I’m an alcoholic. I’m certainly alcohol-dependent. But drinking doesn’t interfere with my life; it simply makes it more enjoyable.”

Frank, 61, a heavy-duty drinker when he was a newspaperman (“It went with the territory,” he says), sips his homemade wine and has the occasional scotch, but nothing, absolutely nothing – including booze – is allowed to interfere with his golf game.

Drinking: what’s good about it?
For the majority of seniors, most of whom are not alcoholics, a drink a day can be a good thing. Alcohol may protect against heart disease by changing the blood’s chemistry and reducing the risk of blood clots in the arteries. Red wine decreases the formation of fatty deposits on artery walls and, because it’s rich in antioxidants, is thought to have cancer-fighting properties.

In 1997, the New England Journal of Medicine carried a report of research done by the American Cancer Society with half a million elderly Americans. The researchers found death rates from all cardiovascular diseases were 30 to 40 per cent lower among the elderly who reported at least one drink daily. Danish researchers found a striking reduction in the risk of Alzheimer’s disease and dementia among elderly moderate drinkers compared to the non-drinking elderly.

But heavy drinking can increase the risk of heart failure, stroke, breast cancer and high blood pressure, as well as other medical problems such as cirrhosis of the liver.

George, newly retired from his job as a factory supervisor in Burlington, Ont., and a heavy drinker all his life, was told by his doctor that his liver was shot and that he would have to give up liquor. He was told he could have “a little wine.” So George drank a 1-1/2-litre bottle every day, starting in the morning. He was dead within a year.

Stories like this make Margaret more determined than ever to put the brakes on her own drinking habits. So far, it seems to be working. “Those bouts of illness were a wake-up call,” she says. “Since I cut back on my drinking, I feel better and look better, and I’m deriving more enjoyment from life’s little pleasures. Don’t get me wrong – I still look forward to those two glasses of wine at night.”

“But now I view drinking as something that enhances my life, not something that controls it.”