Working with Family
Alcohol and drug dependency problems in later life not only affect the individual, they can strongly affect family members, particularly the person's spouse. Adult sons and daughters also often have conflicting emotions about a parent's or parents' uncontrolled drinking or drugs/medication dependency.
Family members may feel guilty and responsible, yet exasperated and helpless. As one writer notes: "Feelings become jumbled, and besides guilt, commonly include resentment, anger, fear, frustration, helplessness and hopelessness."
The results of the drinking or drug dependency may be more critical and can be life-threatening for older adults because of changes in their health, leaving families feeling more desperate. The family members may go to elaborate lengths in attempting to stop or control the drinking. Family relationships can be undermined in the process, and alienation among family members may eventually occur.
It is very hard to generalize about how families may react to an older adult's drinking problem. Some individual family members will be very close to their aging parent or relative; others may prefer to avoid contact and distance themselves from the person. Spouses and other family members who are age 55 and over are more likely than other age groups to be abstainers and some may be less tolerant of others' drinking.
Family's willingness to be involved in the older person's life can change over time in response to changes in the older adult (level of drinking, geographic proximity, changes in health. It can also change in response to changes in the family member's own lives. Family members, too, are growing older and maturing.
Some Common Family Responses
Family members' reactions may differ, depending on whether alcohol use is a recent problem or has been a recurring problem. Some of the more common family reactions include:
Denial: Alcohol problems continue to be very stigmatized and there are many stereotypes about who can develop an alcohol problem. So it is common to hear family members offer comments such as
"Mom couldn't have a possibly have an [alcohol/ drug] problem. She not a drunk. She's always been an upstanding person, she's always taking care of other people."
In reality, people with alcohol problems are very diverse. There is no one "typical" person with an alcohol problem. People who develop an alcohol or other substance use problem certainly are not confined to any specific social, economic, religious, ethnic, and cultural group. There certainly is no age limit on developing alcohol problems.
A second common response among family members is:
"Dad always worked hard all of his life. What's wrong if he's having a few drinks now. He deserves it after all."
In some cases, family may not be fully aware of the extent of the problem drinking, or the negative effects it is having on the older adult's life. Drinking may very well no longer be pleasurable, and it may mask serious problems in the person's life.
A third comment that tends to pop up is:
"But, Mom drinks less than I do [and I don't have a problem]".
Or, family member may note
"How can there be a problem, Dad's drinking much less than he was when he was younger."
There are two issues here:
A. Aging Effects: As people age, the absolute amount of alcohol that the person is current drinking does not necessarily identify whether or not an alcohol problem has developed. Levels of drinking that may not be high or risky younger adults can be risky for some older adults. This is particularly the case if older person's body weight changes (smaller bodies), as water ratio in the body changes (less water), and the types of medications the older adult uses.
B. Personal Risk: Some younger people who have parents experiencing alcohol problems may also have alcohol problems. Talking about a parent's drinking problem may feel scary to a family member because it means reflecting on his or her own drinking as well.
In focus groups, seniors with alcohol problems have mentioned having a sister or brother who was willing to say to them "You have a problem". However, the relative would not acknowledge that or consider whether their own drinking might be problematic too. About one in three seniors will have one or more family members with an alcohol problem.
Some family members may have significant fears about alcohol becoming a personal problem in their lives: "I've heard alcohol problems run in families, will this happen to me too?"
Hopelessness: When the older person has had a recurring alcohol problem, families may struggle with feeling the situation is hopeless. There is often a good reason for family to feel this way: the situation may have ebbed and flowed over the years. Family may feel "Here we go again."
Exhaustion or Exasperation: Long term alcohol problems greatly increase the likelihood of the older person having multiple health problems including depression, gastritis, falls or factures, mobility problems, peripheral neuropathy, cognitive impairment, and many other health conditions. There can be pressing health conditions even among people who have only recently developed the alcohol use problem.
Family members, particularly the spouse, provide 80% of the care, support and assistance to older adults. In many communities throughout Canada, formal services to seniors have been reduced. Family members are being expected to carry an even greater responsibility of providing assistance and support for the older adult, irrespective of whether they are emotionally and otherwise able to do so. For many working family, providing assistance is becoming increasingly difficult. Their children may still be at home, their own work days are increasing in length. As well, the "elder care" supports from the workplace to take time off work without penalty are often not there.
When a parent's problems are added on to these pre-existing family responsibilities, the lives of daughters, sons, or other relatives who are providing support and assistance to an older adult can easily feel "out of control". While health care providers may see it useful to suggest "self care strategies" such as attending support groups, the family member may easily feel "already up to his/her neck in alligators."
At the same time, it is important to recognize that some family members who are in close contact with a parent who has an alcohol problem should not be giving care without a lot of other support, This is especially the case if the caregiver has an alcohol problem. The potential for neglect or physical abuse of the spouse or parent in these circumstances is much higher than most caregiving relationships. Alcohol or other substance use problems are implicated in up to 35% of senior abuse cases coming to the attention of community agencies in Canada.
There are a number of important ways that counsellors and other service providers can help counter these common feelings and responses.
o Normalize the Issue: Let family know that alcohol problems in later life are more common than people may think. In Canada, over 2.4 million seniors drink. Of this group, up to a quarter million seniors experience alcohol problems.
o Help Them to Start the Conversation: Family members are often uncertain about how to talk with a spouse or parent about an alcohol problems. Giving the person some phrases and guidelines on how to raise the issue in a respectful, caring manner. [see the end of this sheet]
o Help Build Their Knowledge: It is also useful when working with family members to help them better understand
- the nature of alcohol problems (how problems develop in later life) and particularly what changes as people age;
- the connection between alcohol and depression among many older adults;
- how relapse can be a step on the way to positive change and is not a "failure"; and
- why people act the way they do (alcohol related behaviours).
This last point is especially important where there is evidence of frontal lobe damage and permanent impairment (in some cases family become more understanding of a parent where they know it is a form of brain injury from the alcohol use, rather than "This something Dad is doing to hurt me").
o Offer Encouragement: Helping family members also involves encouraging them, especially letting them know that change and "success" is possible for many people in later life. It is important to help get past the assumptions such as "It's too late. He can't change" or the mistaken belief "Older people are poor candidates for treatment." Older adults do as well, if not better than younger adults when they receive appropriate assistance and support.
Very importantly, working with family member(s) may involve helping them to
Some agencies have found useful is to
At the same time, it is very important for the counsellor to be careful to not over-identify with the older adult's children, and develop an alliance with them against the older drinker.
Understanding Older Adult Children
Considerable popular literature has been written about adult children of people who have alcohol problems. The focus is often on issues such as their help seeking behaviour, anger management, psychiatric risk, current family relationships and the potential for substance abuse in their lives. They are often described in negative ways as being "controlling", "dependent" or "deficient" in their relationships with others.
This is an oversimplification, and not necessarily the case for many. Many adult children of people with alcohol problems do quite well in their lives and relationships. Their growth and resiliency, for example often depends on the supports around them at important points of their lives.
"Mom, Dad, We Need to Talk"
Talking about alcohol or drug use problems is hard in any family and it is often hard to find just the right words. Here is how one daughter started her conversation:
"Mom, I'm really concerned. The last several months, when I've come over after dinner, you've been sitting in the living room with a glass of beer. You don't seem to care as much about things as you used to. I'm becoming worried about your health. Can I help you arrange to talk with someone about these changes?"
When a Spouse or Older Parent has an Alcohol or Other Substance Use Problem: How Families Can Help (*) Click here for PDF version of the handout.
Alcohol and medication use problems are much more common in older families than many people might think. Fortunately, many older adults are able to reduce the harm of the alcohol or medication use, with appropriate help in the community and the support of family members and others who are about them. Here are a few starting points you may find useful:
. Treat the person with dignity and respect.
. Offer a supportive relationship.
. Be gentle and caring. Bring up the person's good qualities and happy memories you share.
. Recognize the person's values and attitudes.
. Be positive and optimistic.
. Be direct. Sometimes we coddle an older person like a child. Treat the person as an adult.
. Be specific about your concerns, the things you have noticed.
. Present the facts in a straightforward manner. Use phrases such as "I've noticed" or "I'm worried" since a person cannot argue with your feelings.
. Focus on the effects that alcohol or prescription drugs are having on the person's life.
. Present the effects of alcohol or drug use in relation to whatever the older adult cares about most.
. Some older adults may care about their health or what others are saying about them. Some may have given up on themselves, but still care deeply for their grandchildren.
. Avoid words like "alcoholic" or "drug addict." These words are not helpful and carry a great deal of negative stigma.
. Do not bother pouring alcohol down the sink or throwing away tranquilizers. If the person is not ready to receive help at this point, he or she will replenish the supply.
Adapted from "Alcohol, Medications and Older Adults" (Module 6 Talking about Sensitive Issues) http://pathwayscourses.samhsa.gov/
Alcohol Concern. n.d. Not Born Yesterday. Aquarius Action Projects, United Kingdom.
Amodeo, M. (1990). Treating the late life alcoholic: Guidelines for working through denial, integrating individual, family, and group approaches. Journal of Geriatric Psychiatry, 23(2),91-105.
Beesley, D. & Stoltenberg, C. (October, 2002). Control, Attachment Style and Relationship Satisfaction of Adult Children of Alcoholics. Journal of Mental Health Counselling, 24 (4), 281-298.
CSAP's Prevention Pathways. "Alcohol, Medications and Older Adults" (Module 6 Talking about Sensitive Issues). Online at: http://pathwayscourses.samhsa.gov
Campbell-Reay, A. M. & Browne, R.D. (2001). Risk factor characteristics in carers who physically abuse or neglect their elderly dependants, Aging & Mental Health. 5(1): 56- 62.
Gallant, M. P. & Connell, C. M. (May. 1998).The stress process among dementia spouse caregivers. Research on Aging, 20 (3), 267-297
Martin, J. (February, 1995). Intimacy, loneliness, and openness to feelings in adult children of alcoholics. Health & Social Work, 20 (1), 52-60.
National Institute on Alcohol and Alcoholism. A Family History of Alcoholism. Online at . www.niaaa.nih.gov/publications/Family/Family%20Hist%20Final.pdf
Perkins, K. & Tice, C. (1999). Family treatment of older adults who misuse alcohol: A strengths perspective. Journal of Gerontological Social Work, 31(3/4), 169-185.
Pittaway, E. & Gallagher, E. (1995). A Guide to Enhancing Services for Abused Older Canadians. Victoria, B.C. Office for Seniors & Interministry Committee on Elder Abuse
San Jose, B., Bongers, I.M.B., & Garretsen, H.F.L. (1999). Drinking patterns and attitudes toward drinking in the late-middle-aged. Substance Use and Misuse, 34(8), 1085-1100.
VandeWeerd, C., Paveza, G.J., & McGeever, P. (2001). Correlation between alcohol use and conflict resolution style in Alzheimer's family caregivers. Gerontologist, 41(Special issue 1), 276-283.
Watt, T. T. (March, 2002). Marital and Cohabiting Relationships of Adult Children of Alcoholics: Evidence from the National Survey of Families and Households. Journal of Family Issues. 23 (2), 246-46.
Page last updated Tuesday January 23, 2007. Information sheet prepared by Charmaine Spencer, Gerontology Research Centre, Simon Fraser University, Vancouver, B.C.
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