Alcoholism

Sixteen to Seventy: How Drinking Too Much Affects the Young and the Old

Most people agree that drinking too much is bad for every person. But there’s enough evidence to suggest that certain age groups may be at greater risk of developing problems due to overconsumption of alcohol. Whether you’re sixteen or seventy, there are some sobering facts to consider about how drinking too much affects the young and the old.

Before going any further, it’s important to point out that use of the word “old” is not meant to be pejorative or demeaning. It’s simply a quick way to refer to elderly persons – those who may also have many co-existing medical problems that are age-related. And as for use of the word “young,” this encompasses all teens from the age of 13 to 19.

Impacts of Alcohol on the Teen Brain

New research shows that alcohol affects the developing brain of a teenager differently than that of an adult. The American Medical Association (2003) says that “The brain goes through dynamic changes during adolescence, and alcohol can seriously damage long- and short-term growth processes.” The brain is still developing during the adolescent and young adult years (age 10 to 21).

The brain’s hippocampus, which is responsible for memory and learning, can be up to 10 percent smaller in underage drinkers. Alcohol use may impair memory, learning, decision-making, impulse control, and it greatly increases the risk of addiction. Research studies have shown that the younger a person begins to drink, the more likely he or she is to have significant problems with alcohol in adulthood. Specifically, children who begin drinking at age 13 have a 45 percent chance of becoming alcohol dependent. Compare this to the fact that a person who starts drinking at the legal age of 21 has only a 7 percent chance of becoming addicted.

The pre-frontal area (responsible for good judgment, thinking, planning, decision-making, and impulse control) is another key area of the brain that undergoes the most change during adolescence. Researchers have found that teenage drinking can cause severe changes in this area and drastically alter their development of adult personality and behavior. Alcohol-induced damage done during the teen years may prove to be irreversible.

Dopamine, a “feel-good” brain chemical or neurotransmitter, connects the feeling of pleasure to the things we enjoy. When the brain rewards us with feelings of pleasure, we want to repeat the action or thing that brought about the pleasure. Alcohol affects the brain’s pleasure-reward system by masking as a neurotransmitter. In that way, alcohol tricks the brain into generating pleasure-reward feelings from a harmful chemical instead of a real experience.

Because the teen brain produces an abundance of dopamine, continued drinking by teens results in an often quick trip from liking to wanting to needing alcohol – and becoming alcohol dependent. Here’s how it works. The teen’s brain adapts to the presence of alcohol. Pretty soon, more and more alcohol is required to achieve the same level of pleasure. Continued drinking results in cravings or urges for more, as well as an uncomfortable feeling or extreme discomfort without it. When consumption of alcohol reaches the addictive stage, the pursuit of and consumption of alcohol becomes more important than anything else – including family, sports, grades, or friends.

Alcohol use and abuse by teens can also result in a damaged ability to derive pleasure from normal, healthy experiences and leave them feeling “flat” about activities previously enjoyed.

Other Risks of Alcohol Use by Teens

But there are other dangers to too much alcohol use by teens. These include having problems in school, having poor judgment, having social difficulties, getting into trouble, and experiencing failure to achieve lifelong goals.

• Violence – Children who start drinking before age 15 are 12 times more likely to be injured while under alcohol’s influence and 10 times more likely to be in a fight after drinking – compared with those who wait until they’re 21 to start drinking.

• Traffic fatalities – Motor vehicle crashes are the number one killer of teens, and more than one-third of all teen auto crash deaths are alcohol-related.

• Sexual activity – Alcohol use by teens is a strong predictor of risky sexual behavior, unprotected sex, unwanted pregnancies, and promiscuity.

• School difficulties – Alcohol use among teens results in higher rates of alcohol problems and poor school performance than among non-drinkers. Truancy rates are also higher among eighth graders who drink greater amounts of alcohol.

• Binge drinking and alcohol poisoning – Teens don’t have a so-called alcohol switch that can cause them to go to sleep or pass out before consuming dangerous amounts of alcohol. If they drink too much, they can suffer alcohol poisning – before they even know it’s too late. Alcohol poisoning can cause difficulty breathing, unconsciousness, and death. Binge drinking – consumption of five or more drinks at a single setting – is dangerous and can kill. In fact, binge drinking is responsible for the death of more young people than all other drugs combined.

How Alcohol Affects the Brain of Senior Citizens

Persons age 65 and older constitute the fastest growing segment of the American population. Elderly individuals, typically defined as those who are over the age of 65, usually consume less alcohol and have fewer alcohol-related problems than younger persons. And although the extent of alcoholism among the elderly can be debated, diagnosis and treatment of alcohol problems are likely to become increasingly important as the elderly population grows.

Aging and alcohol both affect the brain of elderly individuals. Limited research suggests an increased sensitivity to alcohol’s health effects as people age. One of the reasons why this may be so is the fact that the elderly achieve a higher blood alcohol concentration (BAC) than younger people after consumption of an equal amount of alcohol. Why the higher BAC in the elderly? It’s because of an age-related decrease in the amount of water in the body in which to dilute the alcohol. Despite the reality that the elderly can metabolize and eliminate alcohol as efficiently as younger people, older persons are at increased risk for intoxication and adverse effects.

In addition, aging interferes with the body’s ability to adapt to the presence of alcohol (known as tolerance). Because of this decreased ability to develop tolerance, older people continue to exhibit certain effects of alcohol, such as lack of coordination, at lower doses than younger drinkers whose tolerance increases with greater alcohol consumption. As a result, seniors can experience the onset of alcohol problems even though their drinking patterns have remained constant.

Both aging and alcoholism produce similar cognitive and behavioral deficits. In fact, alcoholism may accelerate normal aging or cause the brain to age prematurely. Studies using magnetic resonance imaging (MRI) techniques have found more brain tissue loss in subjects with alcoholism than those not suffering from the disease – even taking their ages into account. In another revealing finding, older alcoholic subjects had more brain tissue loss than younger study subjects with alcoholism, very often despite similar total lifetime alcohol consumption. Results of these studies indicate that aging may make a person more susceptible to alcohol’s effects.

Just as research has found to be the case with younger drinkers, the frontal lobes in the brains of the elderly are especially vulnerable to long-term heavy drinking. Considerable research shows shrinkage of the frontal lobes increases with alcohol consumption. The shrinkage is also associated with intellectual impairment in both young and old subjects with alcoholism.

The difference between the two – young and old – is startling in one respect, however. Older persons with alcoholism are less likely to recover from the cognitive deficits during abstinence than younger persons who quit drinking.

Other brain effects of alcoholism and aging include damage to the cerebellum, the part of the brain that is involved in regulating posture and balance. Age-related changes in volume already occur in the cerebellum, and long-term misuse of alcohol could result in acceleration of the development of age-related postural instability – leading to an increased risk of falls.

Alcohol and Aging: Combined Effects

Given that the elderly often have many medical and other problems that are associated with both aging and alcohol misuse, it’s hard to determine the extent to which both factors contribute to alcoholism. Still, there are some potential alcohol-aging interactions that researchers have identified:

• Alcohol-involved traffic fatalities – There’s no doubt that alcohol-related traffic crashes are an important cause of injury and death in all age groups. But the fact is that the elderly are the fastest-growing segment of the driving population. Research shows that a person’s crash risk per mile increases starting at age 55. By age 80, the crask risk per mile exceeds that of a young, beginning driver. Crashes of similar magnitude result in more serious injuries to the elderly than to younger drivers. Age and alcoholism increase driving risk. An elderly person with alcoholism is more impaired than an elderly person without alcoholism after consuming an equivalent amount of alcohol, and the risk of a crash is greater as well.

• Effect on prescription medications – Long-term alcohol consumption activates enzymes that break down toxic substances, including alcohol. But when activated, these enzymes can also break down prescription medications commonly used by the elderly. Since the average person older than 65 takes two to seven prescription medications daily, consumption of too much alcohol is dangerous. Alcohol-medication interactions are common among the elderly, resulting in increased risk of negative health effects and potentially reducing medication effectiveness.

• Increase in depressive disorders – Studies have shown that depressive disorders are more common among the elderly than amoung younger individuals and tend to co-occur with alcohol misuse. In a National Longitudinal Alcohol Epidemioligic Survey, data demonstrate that among persons older than 65, those with alcoholism were three times more likely to exhibit a major depressive disorder than those without alcoholism. One study of 5,600 elderly patients with alcoholism found 30 percent had concurrent psychiatric disorders. Among persons older than 65, moderate and heavy drinkers are 16 times more likely than nondrinkers to die of suicide, which is commonly associated with the presence of depressive disorders.

• Hip fractures increase – Among the elderly, the incidence of hip fractures increases with the amount of alcohol consumption. Falls while intoxicated, coupled with a more pronounced decrease in bone density of the elderly with alcoholism versus elderly without alcoholism can partially explain the increase in hip fractures in this population.

• Moderate drinking may offer heart disease protection – Much research on the benefits of moderate drinking in offering some protection from heart disease in the general population extends to the elderly drinker. Despite the fact that research on the elderly and drinking is limited, there is evidence that shows moderate drinking also has a protective effect on those older than 65. But, due to age-related body changes in both men and women, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that those over the age of 65 consume no more than a single drink per day.

Treatment Benefits Both Young and Old

It might be tempting to think that only younger persons benefit from treatment for alcoholism or alcohol-related problems – as compared with elderly drinkers. But such is not the case. Research studies show that elderly persons with alcohol problems are at least as likely to benefit from treatment for alcoholism as their younger counterparts. It is true, however, that treatment outcomes are more favorable for persons with shorter histories of problem drinking – or late-onset drinking.

While a number of other factors have to be considered in the selection of treatment settings, there is evidence from some studies that suggests treating the elderly individual with alcoholism in age-segregated settings may prove more beneficial in terms of treatment outcomes.

Use of medications in the treatment of elderly alcoholism has not been studied extensively. One study did find that naltrexone might be beneficial in helping to prevent relapse in patients aged 50 to 70. But animal studies suggest that age-related alterations in the brain’s specific chemical messenger systems may alter medications commonly used to treat alcoholism and mental disorders.

According to the NIAAA Alcohol Alert (http://pubs.niaaa.nih.gov/publications/aa40.htm), it is a mistake to believe that the elderly have little to benefit from treatment for alcoholism. “Each stage of life has its own rewards for sobriety, and they are all valuable.”

Bottom line: Sixteen to seventy, drinking too much affects both the young and the old with varying degrees of severity. But there is help, and both groups can recover from alcohol-related problems. Sobriety can improve the individual’s quality of life, whatever their age.

Know someone who needs treatment for alcoholism? Find treatment facilities by using the Treatment Facility Locator (http://dasis3.samhsa.gov/) maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA), or call their toll-free treatment referral helpline at 1-800-662-HELP.