Substance Abuse Is a Common Affliction Among

Substance abuse is a common affliction among the elderly population. Several factors may contribute to the prevalence of alcoholism and drug abuse among older adults, including loneliness, poor health, and depression. The most rapidly growing segment of the American population is the elderly, and whether or not alcohol can be considered beneficial or detrimental in this population depends on the doses being consumed (Ferreira and Weems, 2008). However, the population of older adults is increasing and so is the proportion of elderly individuals demonstrating alcohol abuse (Ferreira and Weems, 2008).

It is estimated that by 2030 the proportion of adults comprising the elderly population (65 years and older) will reach 20%, which marks double the current number (Duncan et al., 2010). Interestingly, substance abuse in general has shown increases in the elderly population, with a steady increase in primary substance abuse problems other than alcohol observed in the elderly population (Duncan et al., 2010). Alcohol abuse among elderly people, especially among men, is a public health concern that warrants attention, and it is predicted that problem drinking among elderly people will increase in future generations (Atkinson, 1990). Also, often times alcoholism among elderly people has a late onset and is not properly identified (Atkinson, 1990). This is due to lack of validation for the use of screening and diagnostic methods with the elderly population (Atkinson, 1990). Substance abuse and dependence is a problem across all age categories, but there are key similarities and differences in problem drinking behavior between younger and older adults, and substance abuse in young adulthood may be a risk factor for alcoholism later in life. The following investigation explores how much alcoholism in young adulthood affects alcohol abuse in the elderly.

Literature review

There are important differences in early-onset and late-onset alcoholism. Shahpesandy et al. (2006) hypothesized that alcoholism in these two age cohorts could be differentiated by substance related issues that could be classified as more severe, a more frequent family history of alcohol abuse, a higher rate of mortality, as well as increased antisocial behavior. These researchers compared results of the Geriatric Scale of Depression, the Standardized Mini-Mental State Examination and the Munich Alkoholism Test between groups of young alcoholics, elderly alcoholics, and elderly non-alcoholics (Shahpesandy et al., 2006).

Results of the study indicated that family history was more associated with alcoholism in younger adults than in older adults. Education level and marital status were found to be significantly different between young alcoholics and elderly alcoholics. It was found that significantly more elderly alcoholics were married compared with young alcoholics, and elderly alcoholics had significantly less education than young alcoholics (Shahpesandy et al., 2006). Abstinence level differed between the two groups as well, with the elderly alcoholic group abstaining more frequently than young alcoholics (Shahpesandy et al., 2006). Overall, the young alcoholic group was found to have significantly more family history of alcoholism, drink larger amounts of alcohol, have a greater forensic history, and more personality disorders in comparison with elderly alcoholics (Shahpesandy et al., 2006). Conversely, the elderly alcoholic group was exhibited more somatic complications as a result of alcohol abuse, drink less and abstain from drinking more, and demonstrated significantly less psychopathic traits (Shahpesandy et al., 2006). Also, elderly alcoholics were significantly more likely to be married, have less aducation, and belong to a lower social class than younger alcoholics (Shahpesandy et al., 2006).

An important question to postulate involves the level of alcohol consumption that can be considered as hazardous for elderly people. Lang et al. (2007) sought to examine risks involving disability and mortality as they relate to the level of alcohol consumtion among the elderly. These researchers conducted their investigation through two cohort studies that were population based, and the participants were 13,333 elderly individuals that were followed in the study for between 4 to 5 years. The results indicated that a substantial amount of men and women and men in the U.S. And England drank more alcohol than the recommended levels put forth by the U.S. National Institute on Alcohol Abuse and Alcoholism for individuals over the age of 65 years (Lang et al., 2007). The study also determined a significant relationship between increased alcohol consumption and increased risk of disability for elderly men and women in the study (Lang et al., 2007). However, overall the mortality and functioning outcomes in elderly people that consume alcohol at higher than recommended levels were found to not be poor (Lang et al., 2007).

What effect does moderate alcohol consumption have on the cognitive functioning of older individuals? This question was investigated by McGuire et al. (2007) who examined the association between moderate alcohol drinking and cognitive functioning and differences between sexes in the elderly over the course of four years. The researchers used multiple logistic regression models in order to predict cognitive functioning according to alcohol consumption (McGuire et al., 2007). Results of the study indicated that there were significant differences in the relation between alcohol consumption and cognitive functioning in the elderly (McGuire et al., 2007). Furthermore, alcohol consumption of one drink per day or less compared with abstinence was associated with lower odds of low cognitive functioning in women but not in men (McGuire et al., 2007). This indicated that for elderly people with normal cognitive functioning, moderate alcohol consumption had a protective effect on cognitive functioning for women but not for men (McGuire et al., 2007). This demonstrates that there is a level of alcohol consumption that may be considered acceptable or even protective for elderly individuals. However, consumption beyond moderate levels may result in alcoholism, which has detrimental physical, mental, and social effects.

Consumption of alcohol beyond moderate levels in the elderly can have greater effects in the elderly and may have adverse cognitive effects (Peters et al., 2008). Some studies have indicated that moderate alcohol consumption is associated with decreased risk of cognitive decline and dementia in the elderly, as well as decreased cardiovascular risk due to antioxidant properties in alcohol (Peters et al., 2008). However, excessive alcohol consumption among the elderly is related to significant decreases in memory function (Peters et al., 2008).

Peters et al. (2008) looked at ten years of published research literature and determined that low to moderate alcohol use was associated with a risk reduction of 38% for dementia. However, it is difficult to establish causality in this association. The above researchers suggested that the protective effects could have been over-estimated due to a lack of standardization in studies (Peters et al., 2008). Causality of protective effects may be due to the fact that individuals that drink moderately are able to moderate other aspects of their lives in regard to mental, dietary, and physical factors (Peters et al., 2008). Causality will continue to be difficult in regards to determining effects of alcohol consumption because conducting randomized placebo controlled trials are not ethically possible (Peters et al., 2008).

There is a key difference between moderate alcohol consumption and alcohol abuse. Alcohol abuse among the elderly often results in neurodegeneration, while moderate drinking has been found to have cardiological benefits, including a reduction in cerebral vascular burden and peripheral vascular pathology, as well as decreased atrophy of the hippocampus and amygdala (Chiu, 2008). Chiu (2008) recognized that there are several confounding variables that influence the perceived effect that alcohol consumption has on elderly people. These confounding variables include obesity, heavy smoking history, diabetes, and vascular diseases, and they make the interpretation of research results difficult (Chiu, 2008). The only way to successfully determine the effects of alcohol consumption on the elderly is to utilize methodology that is both stringent and vigorous (Chiu, 2008). Furthermore, it is suggested by other researchers that alcohol abuse disorders among the elderly are often ignored and hidden by scholars and clinicians (Atkinson, 1990).

Moreover, alcoholism characterized by alcohol abuse and dependence among the elderly population is a growing social and public health concern (Liberto et al., 1992). Research has consistently demonstrated that the frequency and quantity of alcohol consumption, as well as the amount of problems considered to be related to alcohol, are significantly higher among elderly men than among elderly women (Liberto et al., 1992). Interestingly, a study conducted by Liberto et al. (1992) determined that elderly individuals with lower incomes tended to consume less alcohol than elderly individuals with higher incomes, and that one-third to one-half of elderly individuals with alcohol abuse problems experienced the onset of alcoholism in middle life or later in life. Furthermore, treatments for elderly alcoholics that had late-onset problem drinking appeared to have better outcomes than alcoholics with earlier onset problem drinking (Liberto et al., 1992).

It is important that appropriate diagnostic criteria and instruments be researched and utilized to properly assess alcohol abuse among the elderly. There are key differences between alcoholics with a late onset in life compared with earlier onset alcoholics. Wetterling et al. (2003) aimed to determine exactly what these key differences were. The study indicated significant differences in alcohol dependence between early onset and late onset alcoholics, with dependence diagnosis criteria being met by 94% of early onset alcoholics and 62% of late onset alcoholics. Significant differences between late onset and early onset alcoholics were found in several criteria, including preoccupation with drinking, inability to control drinking behavior, strong desire to consume alcohol, and lower rates of psychiatric comorbidity (Wetterling et al., 2003). Later onset alcoholics had significantly fewer detoxifications in the past, lower alcohol consumption, and demonstrated a higher rate of abstinence (Wetterling et al., 2003).

There may be significant differences between men and women in regards to elderly alcohol abuse. Among the elderly, there are fewer women than men that consume alcohol, and fewer women that exhibit problem drinking behavior (Gomberg, 1995). Some of the key differences between older men and women with alcohol abuse problems, it has been discovered that older women are significantly less likely to be married, divorced or separated, and demonstrate a higher likelihood of being widowed than older alcoholic men (Gomberg, 1995). Also, older alcoholic women have later onset of problem drinking than older men, and it is significantly more likely that older women alcoholics have problematic use of prescription psychoactive drugs (Gomberg, 1995). Another study conducted by Bobo et al. (2010) indicated that the majority of women do not demonstrated changed alcohol consumption after the age of 50. However, some women exhibit substantial increases in alcohol use and exceed recommended alcohol consumption levels (Bobo et al., 2010).

Since there is a projected dramatic increase in elderly individuals experiencing alcohol abuse problems, it is necessary that effective treatment interventions be determined and utilized (Gfroerer et al., 2003). Gfroerer et al. (2003) projected the need for alcoholism treatment interventions among the elderly in the year 2020 using regression models based on data from the National Household Survey on Drug Abuse. Results of this study indicated that the number of elderly individuals that will be in need of treatment interventions for alcoholism will be approximately 4.4 million in the year 2020 (Gfroerer et al., 2003). This marks a projected 70% increase in the need for alcohol abuse treatment among the elderly population from 2001 to 2020 (Gfroerer et al., 2003). Therefore, there is a critical need for effective screening, diagnostic, and treatment tools for the elderly population.

Research questions

The present study will investigate two research questions. Based on the above discussed literature, two questions were formulated for investigation regarding alcohol abuse among the elderly. The first question is are older adults who abused alcohol previously in life at a younger age more or less likely to abuse alcohol than those who did not? The second research question posed for investigation in the present study is are older adults who have lost a spouse more or less likely to abuse alcohol than older adults who have a living partner or who have never been married? These two questions were created based on gaps in the available literature concerning alcoholism among the elderly.

The first research question examines the potential causative effect that early onset alcoholism has on the experience of alcoholism later in life. This is an important question to explore due to the potential for prevention strategies that could be implemented in order to prevent elderly alcohol abuse. There are several factors that contribute to alcohol abuse behaviors across the lifespan, and pinpointing these factors allows for the development of greater understanding of the process involved in the manifestation of alcoholic behavior in the elderly. This furthermore would lead to the development of effective interventions in both primary and secondary care. Effort toward the development of effective prevention initiatives is especially important given the dramatic increase in the elderly population in the United States over the next 20 years.

The second research question in the present study is to investigate whether older adults who have lost a spouse are more or less likely to abuse alcohol in comparison to older adults who have a living partner or are never married. Previous research has indicated that a greater proportion of alcoholic women compared to alcoholic men are widowed (Gomberg, 1995). However, this research did not expand to explore the association beyond widowhood and alcohol abuse any further. The present study will investigate the specific prevalence of alcohol abuse problems among elderly people as they specifically relate to whether or not the individuals have lost a spouse, are married, or never married. Answering this research question will allow for greater clarity regarding important factors that must be included as important components for screening interventions for older adults more at risk for developing late-onset alcoholism. This is important due to the upcoming increase in the elderly population and the resulting increase in need for prevention and treatment of alcoholism among the elderly.

Hypotheses

The hypothesis for question one is that older adults who abused alcohol when they were younger are more likely to abuse alcohol after the age of 65 years. This hypothesis is formulated based in part on previous research indicating the association between age of onset regarding alcoholism and several factors, including marital status, education level, drink preference, forensic history, and increased alcohol consumption (Shahpesandy et al., 2006). This previous research looked at distinct differences between individuals with early onset vs. late onset alcoholism, but it did look at the prevalence of alcoholism later in life as a result of alcohol abuse earlier in life. This hypothesis that alcoholism early in life is likely to result in continued alcoholism in old age is based on assumptions that alcohol abuse often continues across the lifespan unless effective interventions are implemented that change or halt this behavior. The null hypothesis for this first research question is that older adults who abused alcohol as younger adults are neither more or less likely to abuse alcohol after the age of 65 years.

The hypothesis for the second research question is that adults over the age of 65 years who have lost a spouse or life partner are more likely to abuse alcohol than adults who have never lost a spouse or have never been married. This hypothesis is grounded in the presence of depression that often results from the loss of a spouse. Depression often leaves individuals with feelings of hopelessness and lacking, and alcohol is often used as a form of self-medication. The prevalence of widowhood among the elderly population is greater than that for younger adults, so it is predicted that the loss of a spouse is likely to significantly contribute to the development of alcohol abuse behaviors as a coping mechanism. Past research has related marital status to alcoholism, but it did not look at it specifically as an independent variable. The null hypothesis for this second research question is that adults who have lost a spouse or life partner are neither more or less likely to abuse alcohol than adults who never lost a spouse or never married.

Study variables

Regarding the first research question and investigation of the first hypothesis, the independent variable is a history of alcohol abuse earlier in life. The dependent variable for this hypothesis is the presence of alcoholism as defined according to diagnostic criteria outlined in the DSM-IV. It will be investigated whether the presence of alcohol abuse behavior earlier in life is significantly associated with the diagnosis of alcoholism later in life (after the age of 65 years). The operational definition for the level of measurement used for investigation of the first research question is nominal, and the operational definition for the dependent variable level of measurement is ordinal. Respondents will be asked through questionnaire regarding different behaviors involving alcohol consumption and abuse previously in life prior to the age of 65 years using guidelines for the diagnosis of alcoholism outlined in the DSM-IV through questions addressing self-report of alcohol abuse behavior. Through this questionnaire respondents will be asked questions regarding current behaviors as they relate to guidelines and diagnostic criteria for alcoholism.

The second research question and its resulting hypothesis will be investigated according to the independent variable of marital status, defined as widowed, widower, currently married, divorced, or never married. Similar to the first research question and hypothesis, the dependent variable for the investigation of the second hypothesis is the diagnosis of alcoholism according the diagnostic criteria outlined in the DSM-IV. The second hypothesis postulates that marital status will be significantly associated to the presence of diagnoses of alcoholism among elderly individuals. For the purposes of this investigation, single will be defined as individuals with no significant relationship, married will be defined as those who currently have a legally recognized union or are cohabiting with someone for more than five years and have significant emotional and economic ties to this other person.

Control variables for the present study are alcohol abuse experienced previously in life (nominal variable), the degree of alcohol used at a younger age (interval variable), treatment received for alcoholism (nominal variable), level of education (ordinal variable), past criminal behavior (ordinal variable), presence of a spouse or marriage (nominal variable), single (nominal variable), divorced (nominal variable), previous experience in a serious meaningful relationship (ordinal variable), or lack of previous experience in a serious meaningful relationship (ordinal variable).

Validity and reliability

The validity of the study is an important consideration, because it establishes whether our instruments and research methods are in fact truly measuring the variables intended for measurement. In the present study, concurrent validity can be proven through investigation of the effects resulting from factors involved in the independent variable, including verification of the presence of past alcohol abuse or proof of marital status. Reliability of the present study would imply that the results of the study could be generalized to the greater elderly population, and that in general alcoholism in early adulthood manifests a certain way in old age, or that in general marital status affects the prevalence of alcoholism in older adults. The presence of reliability can be tested by the consistency of results when the study is replicated using the same variables.

Study sample

The sample population for the current study will be a group of elderly individuals that frequent the Anchorage Senior Center. The overall population under investigation in the present study is represented by elderly individuals. The Senior Center provides access to a diverse and representative sample of the elderly population. However, one limitation to this sample is that the seniors that frequent the center may be more active than the average elderly population. The sampling frame for the present study is a list of all elderly individuals who have attended an activity at the Anchorage Senior Center over the past year, and thus, a list of all members of the population from which the sample is chosen.