Alcohol and aging: Understanding and recognizing at-risk drinking

Did you know that at-risk drinking is more prevalent among older adults than any other age group and likely plays a significant role in harms such as falls and motor vehicle accidents? In Canada, rates of hospitalization entirely due to alcohol are the highest in the 50-75 age group.¹

In this 2-minute video, Dr. James MacKillop discusses the risks of hazardous drinking and the diagnosis of alcohol use disorder, highlighting the health consequences and public health guidelines. He explains that while not all hazardous drinkers develop alcohol use disorder (AUD), those with AUD typically drink at hazardous levels.

Download a transcript of this video.

⏱ 4 min read

What is at-risk or hazardous drinking?

When drinking exceeds certain thresholds, a person is at risk for adverse health outcomes, and that’s considered hazardous or at-risk drinking. These risks include both acute harms, like car accidents or injuries, and chronic harms, like cancer and liver disease. Not all people drinking at hazardous levels will experience those outcomes, but the risk is meaningfully elevated. 

In contrast, alcohol use disorder is the diagnosis of a medical condition in which a person’s drinking is actively leading to important levels of harm or distress. Alcohol use disorder is one of the potential harmful outcomes of hazardous drinking. Most of the people who engage in hazardous drinking do not have alcohol use disorder, but the vast majority of individuals with alcohol use disorder drink at hazardous levels. 

The exact definitions of hazardous drinking vary by public health organization. For example, Canadian guidance is the most conservative globally and recommends no more than two standard drinks per week. American guidance recommends no more than 14 drinks per week for men and seven for women. So, recommendations vary, and the precise place to draw the line changes as the science evolves.

What happens as we age?

Older adults are more susceptible to the effects of alcohol and there are several reasons why. As we age, our bodies accumulate more fat and lose muscle mass and water.  These changes cause the body to process alcohol more slowly, making us more sensitive to its effects. The result is that the amount of alcohol in your blood after one drink is higher now than it was when you were younger.

Alcohol is a depressant, meaning it can slow down your brain and body, affecting your thinking and behaviour. While this can feel relaxing, excessive or frequent drinking can impact you differently as you age. Alcohol can: 

• Impair your balance, coordination, and reaction time, increasing your risk of falls and other injuries
• Interact negatively with medications you may be taking
• Heighten your risk of developing health conditions or mental health problems or exacerbating existing ones

How is alcohol use disorder diagnosed?

The diagnosis of alcohol use disorder is given by a physician or psychologist. It represents a problematic pattern of alcohol use leading to significant impairment or distress. There is no one single indicator for the condition, and alcohol use disorder is a syndrome with at least two of the following eleven symptoms², including: 

• Unsuccessfully trying to control drinking, including drinking more or for a longer time than you planned to 
• Wanting to cut down on drinking, or tried to, but couldn’t
• Spending a lot of time obtaining alcohol, using alcohol or recovering from drinking
• Experiencing intense cravings for alcohol
• Failing to meet your obligations at home or work due to alcohol use
• Continuing to drink despite it causing trouble with family or friends
• Giving up or reducing activities you once enjoyed because of alcohol use
• Using alcohol in dangerous or physically hazardous situations, such as driving
• Continuing to use alcohol despite knowing it is resulting in or exacerbating physical or mental health problems
• Having to drink more to feel the effects of alcohol (i.e., tolerance)
• Experiencing withdrawal symptoms when the effects of alcohol wear off, including trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, sweating, and, in severe cases, fever, seizures, or hallucinations. In some cases, alcohol or another substance is taken to relieve or avoid withdrawal symptoms.

Depending on the number of symptoms, a diagnosis of mild (presence of 2-3 symptoms), moderate (4-5 symptoms) or severe alcohol use disorder (6 or more symptoms) is given.

What about alcoholism?

Alcoholism is a colloquial term that is generally understood to reflect severe alcohol use disorder. The term alcoholism is widely recognized in everyday language and within support groups like Alcoholics Anonymous. However, it is not a medical diagnosis.

What is a standard drink?

Learn more about what a standard drink is, how alcohol can increase your risk for dementia, and tips on how to reduce your alcohol consumption.

Download the handout ‘Alcohol and Aging: Rethink How You Drink’ from the Canadian Coalition for Seniors’ Mental Health.

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