How to Address Substance Abuse in an Elderly Loved One

AiR member reachingout7 wrote with concerns about her elderly father's drinking:

"My father has been a functional alcoholic for much of his adult life. He is now almost 80, quite frail, and does little except sleep, and watch television/drink late into the night. Our family has done little over the years to address his alcoholism and the codependency of others that goes along with it. He is a very difficult man to speak to about personal/emotional issues. I would like to try talking with him about his failing health-physical and emotional- and his drinking. I have listened to some of the modules (4&8) on the site and have found these helpful. However I was wondering if you (others) had more specific advice on how to confront alcoholism in an elderly man and what treatment options would be wise should he be willing to accept help. My sister is in the mental health field and is suggesting intervention but I am wary of this route due to his personality and age. Thank you for your assistance and your site. It seems like a great resource."

The ability to apply CRAFT to your situation depends on the amount of contact you have with your father. I’m guessing that he doesn’t live with you or your sister, which limits the impact of your reactions. CRAFT is designed to clean up your part in the relationship. By doing this, you reduce how you may inadvertently enable your dad with his drinking. Follow the techniques in Video Modules 5 (My Loved One Isn't Using Right Now, Now What?) and Video Module 6 (My Loved One Is Using Right Now, Now What?) on how to improve your interactions with your dad – this is about what you can do in day-to-day life with him.

What the modules guide you to do

The modules set out the small things you can do, such as cutting short phone calls if your dad sounds like he’s been drinking. You use the word “codependency,” which suggests that there are some long-set patterns in your family that have probably normalized his drinking. Everyone close to your dad should look at those modules and make an effort to alter behavior that may be undermining your father from taking responsibility for his drinking. Easier said than done in some families, I recognize, but it starts with watching two modules and takes 40 minutes of your time.

Your sister suggests an intervention. I’m sure you are all worried about the degree of danger, especially given his age, and the fact that he is closed and probably quite defended about his drinking. Getting a professional interventionist may work and work quickly – or it will anger him and fail, and cause him to shut down even more.

Here are a few things to try as you debate the merits of an interventionist and attempt to apply the two modules I suggest everyone watch.

1. Healthcare provider as ally

Confidentiality in healthcare means that your father’s providers can’t talk to you about his medical care but nothing prevents you from talking to them. Everyone that treats your dad should be aware of how serious his drinking is, and the immediate danger you and your family believe your dad to be in. Call them, tell them you know they can’t talk, but that they can listen to what you have to say.

2. Start by getting him support for a less-touchy aspect of his life

Does your father worry about any aspect of his health? Does he complain of feeling sad or anxious, of having nobody in his life? Is there something that bothers him that he would be willing to have addressed that is less emotionally loaded than the alcoholism? Here again, you would prime the visit with the provider with a conversation about your father’s drinking.

If we imagine your family doing what is set out in Modules 5 and 6, to the best of everyone’s ability, then in 3 to 4 weeks your dad might be more ready to hear a case for treatment from a family member or friend.

Module 8 describes who should do the talking, the timing of the talk, and what to say. So, upon waking and before he starts to drink, if you are the designated person:

“Dad, I love you very much. I need you to listen to what I have to say. Your drinking is taking over your life. I’m having a hard time with it. I feel like I’ve lost my dad. I worry constantly about you. It keeps me up nights. I love you but I hate the drinking. Your drinking is not up to me. I wonder though if you’d be willing to come check out a group I’ve found – we’d go together. Please come to it with me just once to see what it’s about.”

This would be but a start. The idea is that your dad would need to drink less on that afternoon or evening and might even enjoy the outing with you and the group. It would put a wedge into his routine and would offer him something else to think about and to do.  It may not work at all. Your father has been drinking probably his whole life. This could start a process of cutting back though, or might bring to light for him his inability to cut back.

3. Let the first responders in when needed

Another thing to consider is calling in first responders if you have any concerns whatsoever about your father’s safety: so, if he is clearly intoxicated on the phone or you find him intoxicated and not fully responsive you call the police or an ambulance. If you have any concerns at all, in many jurisdictions, the police will do a wellness check. They’ll go look in on your father and call you. Like with the medical providers, let in the authorities.

Your dad is going to need medical detoxification, probably in a hospital setting, if he has other health conditions. Withdrawal from alcohol is life threatening, given how you’ve described the level of your father drinking.

A few things to keep in mind about treatment for older adults:

Most post-detox treatment in this country is not designed for people over 60 and is not particularly effective. That is changing. There is a growing subfield in substance abuse treatment for older adults, driven in part by aging baby boomers. Treatment for older adults needs to be tailored to their physical and psychosocial needs. It should be supportive, non-confrontational, and slower paced. Cognitive behavioral approaches have been found to work well. Look for services designed for older adults.

On the news blog you’ll find a piece that addresses substance abuse in the elderly. We’ve also posted a resource in the Supplement.