Senior Adults and Binge Drinking: A Serious Problem

A study published in 2019 in the Journal of the American Geriatrics Society indicates that approximately one in ten senior adults (age 65 +) reported binge drinking in the month prior to completing a questionnaire for the National Survey of Drug Use and Health. Study authors pooled data from the years 2015-2017 to ensure they reported on a legitimate trend in the drinking habits of seniors, rather than a single year with unusually high results.

Researchers recognize the actual numbers might be higher, as seniors may be hesitant to admit the extent of their drinking. They also report the possibility that, due to various cognitive issues associated with aging, senior respondents may not offer an accurate account of their past drinking habits.

The study shows that binge drinkers in the senior population are more likely to be male. However, the rate of binge drinking among men remained stable compared to previous years, while rates among women increased. Men are also more likely to use tobacco and cannabis and are more likely to have visited an emergency room during the 12 months before completing the survey.

In addition, research from the National Institute on Aging Care indicates that widowers (men who have lost their spouse) over age 75 have the highest rate of alcohol use disorder in the nation. Nearly half of all nursing home residents have a problem with alcohol, which may or may not include binge drinking.

What is Binge Drinking?

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as five drinks or more on the same occasion for men, or four drinks for women. However, it’s important to note that as we age, we become less tolerant of alcohol, and the effects of alcohol appear more rapidly than earlier in life.

The NIAAA recommends that seniors should consume no more than three drinks per day. Experts from Harvard University suggest that older people should stop at one or two drinks, and should drink only occasionally, not every day.

Why Senior Adults Turn to Alcohol

Senior citizens may be long-term drinkers who started using alcohol many years ago. However, researchers estimate that at least 10 to 15 percent of older drinkers didn’t drink heavily until later in life.

Senior drinkers may experience a number of life challenges, such as grief and loss of loved ones, concern about reduced income, illness, chronic pain, depression, anxiety, loneliness, lack of social support, or boredom.

Why Binge Drinking and Excess Alcohol Use are Dangerous for Senior Adults

The National Council for Aging Care explains that muscle tissue absorbs alcohol rapidly, but as we age, fat gradually replaces muscle. As a result, more alcohol enters the bloodstream, and it takes longer for the body to process.

Binge drinking and excess alcohol intake are dangerous for anybody at any age, but the risks are compounded as we grow older. Potential dangers include:

• Increased risk of falling resulting in broken bones or other injuries
• Higher incidence of car accidents
• Negative interactions with prescribed medications, including sleeping pills, pain relievers, and anti-depressants
• Negative interactions with over-the-counter medications, including aspirin, acetaminophen, cold and allergy medicines, and cough syrup
• Nutritional deficiencies
• Worsened existing health conditions
• Problems with muscle coordination
• Increased risk of serious illness, including diabetes, heart disease, and dementia
• Osteoporosis and gradual weakening of the bones
• Compounded memory loss and confusion
• Higher risk of heart attacks, strokes, and kidney failure
• Decreases libido, increased impotence, and erectile dysfunction
• Increases risk of alcoholic fatty liver disease and cirrhosis of the liver
• Mood disorders
• Severe dehydration

Does Your Elderly Loved One Have a Drinking Problem?

It can be challenging to determine if an older person has a drinking problem. Confusion, forgetfulness, unsteady gait, social isolation, irritability, or other symptoms of excess drinking may resemble typical issues associated with aging.

Friends and younger family members often hesitate to discuss an elderly loved one’s drinking habits. They may be embarrassed, or they may think senior citizens should be able to enjoy their later years.

However, without the input of friends, caregivers, and younger family members, binge drinking and excess drinking among the elderly would likely go unnoticed.

Physicians tend to focus on the drinking habits of their younger patients more than their older patients. They may be reluctant to broach the issue for a variety of reasons, and many physicians lack adequate training to identify the signs of excess alcohol use among seniors.

However, anyone can recognize the red flags that may indicate your elderly loved one drinks too much:

• Depression
• Anxiety
• Memory lapses
• Changes in appearance
• Poor hygiene or grooming
• Unsteady gate
• Occasionally slurring words
• Insomnia
• Irritability and anger
• Mood swings
• Fatigue
• Blackouts

Talking About Treatment: Finding Treatment for Senior Adults

It’s not easy to talk to an older person about their drinking problem, but it’s necessary. Here’s an approach we advise.

Five Tips for Talking to An Older Loved One About Drinking

1. Choose a quiet time to discuss your concerns. Choose another time if you think your loved one is under the influence or isn’t feeling well.
2. Express your concern in a direct, straightforward manner. Be patient and supportive. Don’t lecture, and don’t be critical or judgmental.
3. Keep in mind that seniors benefit from treatment as much as any other age group. Treatment for alcohol use disorder can ensure those later years are healthy and fulfilling lives.
4. Offer to help your loved one find the best treatment possible. Twelve-Step community support programs like Alcoholics Anonymous (AA) are invaluable, but many people require professional treatment from a provider that understands the unique needs of older people. Outpatient treatment may be good enough for some seniors, but a person with a serious drinking problem may need inpatient treatment.
5. Seniors with a severe or long-term drinking problem benefit from medical or supervised detox. Medical detox programs offer around the clock monitoring and support, which makes withdrawal as safe and comfortable as possible.

Addiction treatment programs for the elderly should be age-specific, since what works for a younger person may not be the best solution for an older adult. Treatment for seniors should move at a steady, comfortable pace. Counselors should be compassionate and well-trained regarding the issues of the elderly. They should understand how to cope with hearing loss, memory loss, or other cognitive changes.

Suitable treatment for older folks should also address issues such as stress management, loneliness, lack of social support, anxiety, depression, and grief. Finally, a good treatment program should include a thorough aftercare plan. An aftercare plan or program is an organized approach to sustaining sobriety when official inpatient or outpatient treatment ends. Aftercare programs are critical to prevent relapse, as the risk is higher for seniors who live alone.

A diverse array of therapeutic options exist for the treatment of alcohol and substance use disorders.

One option is dialectical behavior therapy (DBT), a type of therapy developed by psychologist Marsha Linehan in the 1980s. Linehan initially devised DBT to help treat people with borderline personality disorder (BPD), but over the past three decades, therapists have adapted and used DBT to effectively treat a number of behavioral and emotional disorders, including alcohol use disorder (alcoholism) and substance use disorder (drug addiction).

This article offers a basic definition of DBT and explains how it benefits people in treatment, detox and recovery.

Understanding Dialectical Behavior Therapy

Behavioral therapies involve one-on-one and/or group counseling that focuses on teaching people how to identify and correct problems in their thoughts and actions. DBT is a specific subtype of cognitive behavioral therapy (CBT).

To learn about CBT and addiction treatment, click here.

During CBT, a trained therapist helps a person in recovery learn how their specific thoughts influence their emotions and behavior. By identifying and changing negative thought patterns, a person in recovery can change their non-productive, life-interrupting feelings and actions.

DBT takes this principle – changes in thought lead to changes in behavior – and adds specialized components that focus on emotional regulation, stress tolerance, and mindfulness. The core idea behind DBT lies in the word dialectical, which has two meanings that are relevant to understanding how DBT works.

Dialectical means:

1. Of or relating to the logical discussion of ideas and opinions
2. Concerned with or acting through opposing forces.

During DBT, therapists engage in an open and honest dialogue with individuals in treatment – that’s how DBT relates to the first part of this definition. The primary distinguishing feature of DBT, however, lies in the second definition. DBT therapists help people in recovery understand that two opposing ideas or concepts can coexist and that this interplay of fundamental opposites is a defining aspect of reality. Dynamic opposites are a feature of reality – not a bug.

The dialectic at the core of the disordered use of substances is the oppositional relationship of acceptance and change. A person in recovery must accept the reality that they have a behavioral disorder while simultaneously realizing they have the power to change that reality by taking steps to manage their behavioral disorder.

What Are the Benefits Of DBT?

The benefits of DBT are best explained by understanding the core skills DBT therapists teach patients in recovery. These include:

1. 
   

   Emotional Regulation

   
   

People with alcohol and substance use disorder often experience erratic behavior and extreme mood swings. DBT therapists use mindfulness to help people in recovery identify their emotional states without judging them. Once they accept their internal reality as-is, they can then step back and learn to process their disruptive emotions or patterns of thought in ways that help them, rather than hurt them.

2. 
   

   Distress Tolerance

   
   

Painful emotions related to past trauma or present challenges often play a large role in addiction. People turn to alcohol and drugs to soothe their emotions and live with difficult circumstances. A DBT therapist teaches people in recovery the skills needed to accept their emotional states and life circumstances without judgment – as mentioned above – then teaches them specific practical skills to handle stressful situations without resorting to non-productive behaviors, such as drinking or using drugs.

3. 
   

   Improved Self-Esteem

   
   

DBT teaches real skills that people in recovery can apply immediately – even before they leave treatment. With practice, over time, the emotional regulation and distress tolerance skills learned during DBT becomes new default coping skills. People in treatment learn they have the power to navigate life without using alcohol and drugs. This improves their feelings of self-worth and ultimately improves their confidence, self-image, and self-esteem.

4. 
   

   Setting and Achieving Goals.

   
   

Active addiction can cause an individual to give up on both short-term and long-term goals. Improved emotional regulation combined with enhanced distress tolerance and elevated self-esteem can lead a person in recovery back to goals they may have forgotten, or lead them to a place where they can create new goals – and use their DBT skills every day to achieve those goals.

5. 
   

   Improved Relationships.

   
   

Addiction often impairs the ability to maintain healthy and positive personal relationships. It can damage friendships, romances, workplace dynamics, and family interactions. This is not always because the person in active addiction engages in problematic behavior while they’re under the influence of intoxicants. It’s often because they lose the ability to create and maintain healthy boundaries. They forget how advocate for their basic emotional and psychological needs. They lose the ability to communicate effectively in difficult situations.

DBT skills give people in treatment the tools they need to do all of the above: create positive boundaries, seek and find emotional and psychological safety, and discuss their emotions without precipitating a crisis. The net effect of these skills on relationships is that they become enriching and fulfilling – or they have the potential to, when DBT skills are applied appropriately

The full suite of DBT skills enables an individual in recovery from alcohol or substance use disorder to create sustainable behavioral change. Once they begin to create the change they want to see in their lives, DBT skills give them the ability to review and revise their behavior as needed. This dynamic element is critical. As people grow in recovery, they change. As they change, they need the skills to create new coping skills that match their development. DBT creates that template, which evidence shows is durable, adaptable, and capable of supporting both small and large behavioral changes over time.

Treatment Helps You Take Control of Your Life

If you’re seeking treatment for an alcohol or substance use disorder, look for one that offers elements of DBT, like mindfulness. That’s not the only thing to look for, though. The most effective treatment centers use an integrated, holistic approach to treatment. DBT is one piece of the puzzle. It’s important, but it’s not the be-all, end-all therapy that solves everything. That doesn’t exist.

At treatment centers that use up-to-date, evidence-based therapeutic practices, individual counseling approaches like DBT are included alongside other treatment approaches, such as:

• Group therapy
• Family therapy
• Experiential therapy
• Dual diagnosis treatment
• Cognitive behavioral therapy

Recovery is a lifelong journey that you do not have to take on your own. Compassionate, evidence-based treatment provided by caring, experienced practitioners can help you change your life for the better. Inpatient and other treatment programs can give you the practical tools you need to learn, grow, and thrive. The life you create in recovery is a life you live on your own terms, free from the painful cycles of alcohol and drug addiction.

The Relationship Between Isolation and Addiction Relapse

For decades, medical experts have called addiction a “disease of isolation.” Although we’ve changed the way we think about addiction in recent years – we now call alcoholism or alcohol addiction alcohol use disorder (AUD) and call substance abuse or drug addiction substance use disorder (SUD) – that hasn’t changed the fact that isolation and addiction are intimately related.

In fact, isolation is both a known risk factor for addiction and a symptom of addiction.

That means the last two years in the U.S. were a one-two punch for people in recovery from alcohol use disorder or substance use disorder.

The first punch: many people who develop an addiction identify isolation and loneliness as contributing factors. Other factors include genetics, family history, the presence of past trauma, or the presence of a co-occurring mental health disorder.

The second punch: stay-at-home mandates, social distancing guidelines, and prohibitions against group gatherings – which includes in-person social supports like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) – resulted in the very isolation that many cite as a contributing factor to their addiction.

National experts on addiction recognized the dual threat COVID-related isolation poses to people in recovery. In an interview in April 2021, Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), said:

“Whenever there’s been a catastrophe like this, there is an increase in drug consumption across the board. Our alcohol drinking goes up, smoking goes up, and people relapse. We do know that drug-taking is one of the ways that people try to cope, and unfortunately, this can have very adverse effects. Meanwhile, social isolation is one of the most important factors contributing to drug-taking behavior.”

Let’s explore why social isolation is recognized by addiction professionals like Dr. Volkow as a contributing factor to substance use and addiction.

The Relationship Between Isolation and Mental Health

We’ll connect the dots between isolation and the risk of relapse so there’s no doubt in your mind about the challenges people in recovery face. If you’re in recovery, we’ll connect the dots so you understand them, as well. It’s important to know the challenges you face during the coronavirus pandemic are not in your head. They’re very real, backed by evidence, supported by data, and agreed upon by almost any mental health professional you ask.

The first two dots to connect are between isolation and mental health. Dr. Volkow made the connection between isolation and addiction in the quote offered above, but now we’ll explain why isolation increases the risk of both addiction and relapse – because she did skip that step.

According to the American Psychological Association, loneliness and isolation have a wide range of negative consequences on emotional, physical, and cognitive health. Here are the adverse consequences of isolation and loneliness they identify:

• Emotional health:
  • Depression
  • Anxiety
  • Stress
  • Insomnia
• Physical Health:
  • Poor cardiovascular function
  • Increased risk of coronary heart disease
  • Increased risk of stroke
  • Impaired immunity
• Cognitive Health:
  • Impaired executive function
  • Increased risk of dementia
  • Accelerated cognitive decline

That evidence is clear. In addition to increasing stress, loneliness and isolation can increase the risk of mental health disorders like anxiety, depression, and insomnia. Now it’s time to connect the next two dots: mental health and addiction.

The Relationship Between Mental Health and Addiction

The National Institute on Drug Abuse (NIDA) website offers an abundance of information about the relationship between mental health – or mental illness – and substance use disorder. They lead their resource section on co-occurring disorders – the term clinicians use when one person has a mental health disorder and a substance use disorder – with the following simple statement:

“Multiple national surveys have that that about half of those who experience a mental illness during their lives will also experience a substance use disorder, and vice-versa.”

You can read two of those national surveys here and here.

NIDA goes on to list the mental health disorders that may co-occur with SUD:

• Anxiety disorders:
  • Generalized anxiety disorder
  • Panic disorder
  • Post-traumatic stress disorder
• Mood disorders:
  • Depression
  • Bipolar disorder
• Other disorders:
  • Attention-deficit hyperactivity disorder
  • Borderline personality disorder
  • Schizophrenia
  • Psychotic illness
  • Antisocial personality disorder

While all the disorders above may co-occur with substance use disorder (SUD), the most common mental health disorders that co-occur with SUD are anxiety and depression. Research shows that:

• People with depression are approximately twice as likely to have a SUD as people without depression
• About 20% of people with an anxiety disorder also have SUD

When we look back at the mental health disorders that are most often associated with isolation and loneliness, we find that depression and anxiety are at the top of the list. That means that the dots between isolation and addiction now connect in a clear and unmistakable way.

Isolation, Mental Health, COVID, and Relapse

Here’s the simplified version:

1. Isolation can lead to anxiety and depression.
2. Anxiety and depression commonly co-occur with – and are risk factors for – both addiction and relapse.
3. Therefore, isolation can increase the risk of substance use and relapse to substance use.

That’s the default situation many people in recovery faced during the height of the pandemic: they were isolated because of coronavirus, and this isolation increased and intensified many of the factors that may have led to their addiction in the first place. And we didn’t mention the additional factors at play that have caused significant stress, and increased risk of relapse:

• Fear of contracting COVID-19
• Fear of loved ones contracting COVID-19
• Uncertainty about everything related to COVID-19:
  • How it’s transmitted
  • Risk of serious illness or death
  • How long the pandemic will last
• Unemployment
• Income instability

When we said one-two punch at the beginning of this article, that may have seemed dramatic, or possibly hyperbolic. Now we can see that it’s the opposite: calling isolation during COVID a one-two punch understated the situation. In addition to the one-two of isolation, several additional factors increase the risk of relapse during COVID, such as general stress, worry about COVID, income instability, and unemployment.

What to do if You Still Feel the Effects of Isolation

If isolation and uncertainty threatened your sobriety over the past two years – and still are – there are two critically important things for you to do: stay on your program and stay connected to your support community.

Staying on your program means doing all the things you know support your sobriety. That includes eating healthy food, getting enough sleep, exercising regularly, and participating in activities or hobbies you know are safe, sober-friendly, and life-affirming. Staying connected to your support community means attending virtual AA or NA meetings (visit their websites here and here for virtual meeting information), talking on the phone to your recovery peers, and participating in teletherapy with your counselor or therapist.

If you need more intensive support than you can receive by doing all those things, then it’s important to know that most residential programs are open and ready to help.

Finally, if you’re worried a friend or loved one in recovery is in danger of relapse, you can take action. Reach out to them, remind them to stay on their program and stay connected to their recovery community – as described above – and remind them that if they need intensive support, they can seek professional detox treatment.

What COVID Revealed About Addiction

We’re ready for it to be over.

Completely over: as in no new variants, no new school closings, no new pandemic-related curveballs.

We’re tired of hearing phrases like “the new normal” and “COVID changed everything.”

Before we continue, let’s do a quick reality check.

Although we often hear phrases like “we’re all coping with similar issues” and “everyone is in the same boat” when discussing the impact of COVID in our lives, that’s not necessarily true. Subjective experiences of the coronavirus pandemic vary by – among other things – location, demographics, health status, attitudes toward COVID, and the public health response implemented by local officials.

That list is obviously incomplete.

Suffice it to say that the experience of an individual in Brooklyn, New York, may differ from the experience of an individual in a rural town like Kamiah, Idaho. And within those two examples, subjective experiences may differ. A divorced mom with two kids in Kamiah likely had different COVID stories than a retired fly-fishing guide living alone in a mountain cabin outside of town. A twenty-something lawyer living with roommates in a house in Queens likely has different COVID stories than a family of four living in a three-bedroom apartment in Bensonhurst.

We say all that, by way of preface, to let you know we understand that what we talk about in this article will not apply to everyone. We assume variation across populations. As mental health professionals working in an evidence-based discipline, we understand that any sample set will contain both predictable and unpredictable diversity.

However.

We notice recurring themes when we talk to our colleagues who also work in addiction recovery.

In this article, we’ll introduce two of those themes, and address one in-depth.

New Routines Uncover Unresolved Issues

You may have heard or read the term functional alcoholic.

While the addiction treatment community has moved away from using the word alcoholic – as well as the term addiction, for that matter – it’s cultural shorthand that means the following:

“An individual with an alcohol use disorder that does not have a noticeable impact on that individual’s ability to carry out day-to-day responsibilities and commitments related to work, school, family, and peers.”

You can see the new, preferred terminology in that definition. We now refer to a person once labeled an alcoholic as an individual with an alcohol use disorder (AUD). This aligns with two trends in addiction treatment.

First, it’s consonant with the disease model of addiction, which defines alcohol or substance misuse as a mental health condition or disorder that responds to evidence-based treatment.

Second, it emphasizes a person-first/patient-first/patient-centered approach to all medical practice, which recognizes that treatment for any medical condition – mental or physical – is most effective when that treatment moves past addressing symptoms only, and moves toward addressing the biological, psychological, and social issues present in the patient’s life.

Now that we have our terms defined, we’ll talk about two major themes we see happening in the treatment community. Here’s the first:

COVID revealed the functional as dysfunctional.

What this means is that in some families, serious drinking problems that went unnoticed or somehow flew under the radar are now plain to see and flashing red on everyone’s radar. We’ll discuss this in a moment. Here’s the second theme:

COVID revealed unresolved trauma.

We’ll discuss that theme in another article.

Let’s be clear: these are anecdotal observations. We don’t have evidence in the form of peer-reviewed journal articles with vetted and statistically analyzed data. What we have is our experience – which we’ll share now.

Why Did This Happen?

We’ll talk about functional drinking revealed as dysfunctional, disordered drinking first.

What appears to have happened is that many people whose daily routines – work, school, social life, hobbies – masked their problem drinking patterns no longer had daily routines in place that masked their problem drinking patterns.

Let’s take a relatively extreme – but not at all unusual – example. Say, for instance, a person with a 9-5 office job has a serious drinking problem, but before COVID, nobody knew it. They themselves didn’t know it.

What no one knew was the bottle of beer or glass of wine they drank every day at lunch stopped alcohol withdrawal symptoms from appearing.

Then, about five hours later, when withdrawal symptoms may have appeared again, a regular stop at the neighborhood pub for another beer or glass of wine stopped withdrawal symptoms from appearing – for the second time in a day.

Finally, when this person returned home at night around seven or eight o’clock – not drunk, not displaying any outward signs of a serious problem – a nightcap (or two) was enough to fall asleep and keep withdrawal symptoms at bay until lunch the next day.

When Enabling Routines Change

Then, with all the changes related to COVID, the daily structure – the enabling routine – that supported the problem drinking disappeared.

That means when lunchtime rolled around, two things might have happened:

1. The absence of beer or wine in the fridge might have caused withdrawal symptoms to appear – for the first time, ever.
2. If beer or wine were in the fridge, consuming a beer or a glass of wine every single day at lunch might have caused a spouse, roommate, or family member to ask, “Hey, do you really do that every day?”

You can guess how the person drinking might have responded to that. You can also predict how the rest of the day might have played out. We bet that most scenarios you come up with reveal the presence of a drinking problem. The person might have made a nonessential trip to the store to buy alcohol. Because for them, preventing withdrawal was essential. The person might have broken social distancing guidelines to have drinks at a bar that was open in defiance of local guidelines for bars and restaurants. Because for them, having a drink out of sight of family was also essential.

In our informal conversations among our colleagues, we agree situations like what we described above probably played out all over the country.

How to Handle Problem Drinking Revealed by COVID

As professionals working in the field of alcohol and substance use disorder treatment, we have a disclaimer. Only a mental health professional or physician trained in addiction can determine a clinical diagnosis of alcohol use disorder.

Therefore, if what we write above resonates with you – or you saw the signs of disordered drinking in someone close to you – the first thing to do is make an appointment with a licensed and credentialed medical or mental health professional and ask for a full biopsychosocial assessment for the person you’re concerned about.

Tell the clinician what you saw. Tell them you’re concerned your friend or loved one has an alcohol use disorder.  Or tell them you, if you see yourself in the above discussion – might have an alcohol use disorder. Legitimate, effective assessments can be conducted via telehealth. It’s possible to make this happen in areas where a licensed professional is not nearby.

Recommendations for treatment should accompany assessment results. An addiction professional may recommend detox followed by residential treatment at an accredited rehab in Ohio. Once you get an assessment, you collaborate with everyone involved. You work with the doctor, the person with the diagnosis, your family. Together, you decide what course of treatment meets your specific needs and personal goals.

One thing we know a well-trained professional will tell you is fundamental. Evidence-based, integrated treatment tailored to the individual leads to the most favorable outcomes for people diagnosed with alcohol use disorder.

People can and do recover.

We see it happen every day at our rehab in Cincinnati, Ohio.

What is the link between trauma and addiction?

Trauma comes in many forms. It can affect an individual, a family, and an entire community. Many people who experience trauma don’t understand the significance or impact of trauma in their lives. They may not consider themselves trauma survivors. They may show all the clinical signs of having experienced damaging trauma, but do not believe they have post-traumatic stress disorder (PTSD), which often develops in response to trauma.

It’s not unusual for people to downplay their trauma. They may categorize their experience as a bad memory or simply a tough time they went through. In many cases, people think that because something difficult or negative happened a long time ago, and they don’t think about it every day, it has nothing to do with their lives in the present moment. They cope as best they can and soldier on without complaint – even when their friends, family, and therapist – if they have one – can see plainly how their history of trauma affects their current behavior.

This misunderstanding of trauma and PTSD can have serious consequences. The long-term effects of untreated PTSD include, but are not limited to:

• Depression
• Anxiety
• Alcohol use disorder (alcoholism)
• Substance use disorder (drug addiction)
• Eating disorder
• Insomnia
• Chronic pain
• Autoimmune disease
• Disrupted relationships
• Family problems
• Cardiovascular disease
• Self-harming behavior
• Suicidal ideation

These effects can begin early and last a lifetime. However, not all people who experience them understand they’re connected to trauma.

Why Do People Minimize Trauma?

Trauma survivors include people who’ve been bullied, physically assaulted, or emotionally abused and/or neglected. As we mentioned, many people who experience these things don’t consider themselves trauma survivors. Instead, they think they’ve just been through some tough times, which are now in the past.

An interesting fact about trauma is that it isn’t necessarily defined by the event itself. It’s more about how the individual perceives the experience. Think of it this way: one individual may experience bullying at work but doesn’t perceive the behavior of their boss or colleagues to be that disturbing. Another person may experience the same thing with a completely different take on the incidents and have an entirely different outcome in response. They may develop anxiety, have trouble sleeping, or quit their job. Their self-esteem may suffer. They may avoid places or people that remind them of the traumatic experience.

With all that in mind, let’s dig deeper into trauma, beginning with a clear definition.

Trauma: A Clinical Definition

We hint at the definition above, but it’s important to understand exactly what we’re talking about. Here’s a helpful definition provided by trauma experts at the Substance Abuse and Health Services Administration (SAMHSA):

“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that can have lasting adverse effects on the individual’s functioning and physical, social, emotional well-being.”

They go on to define events mental health professionals consider traumatic:

• Natural disasters
• Sexual abuse
• Physical abuse
• Domestic violence
• Witnessing domestic violence
• War, terrorism, political violence
• Medical injury, illness, or procedures
• Community violence
• Neglect or deprivation as a child, adult, or senior
• Kidnapping
• Accidents
• School violence
• Loss of a family member, loved one, or peer

Trauma experts define three distinct types of trauma. All three of these may involve the events or experiences listed above, in varying degrees:

1. Acute trauma. Acute trauma is the result of a single incident.
2. Chronic trauma. Chronic trauma is caused by repeated and prolonged exposure to traumatic experiences, such as domestic violence or childhood abuse.
3. Complex trauma. Complex trauma is caused by repeated exposure to multiple traumatic events of different types.

It’s important to understand that not every person who experiences trauma will go on to develop post-traumatic stress disorder (PTSD). Many will develop low-level anxiety, low self-esteem, and mild depression. In many cases, people who experience these symptoms turn to drugs and alcohol to alleviate the uncomfortable emotions and patterns of thinking associated with them.

It’s also important to understand that effective, evidence-based treatment for PTSD exist and can help people manage the effects disruptive effects of trauma in their lives. We’ll talk about treatment in a moment.

Before we do, we’ll share statistics on the prevalence of trauma worldwide and in the United States.

Prevalence of Trauma

Research on the prevalence of trauma shows surprising results. Here’s are some key points from a survey published by the World Health Organization (WHO) in 2017:

• 70.4% of respondents reported at least one traumatic event in their lifetime
• 31.4% reported experiencing the death of a loved one
• 23.7% reported witnessing or discovering a death or serious injury in another person
• 22.9% reported experiencing physical violence
• 14.0% reported intimate partner violence
• 13.1% reported war-related trauma

Here are the results of a study on trauma prevalence conducted in the U.S. in 2013:

• 89.7% reported at least one traumatic event in their lifetime
• 53.1% reported experiencing interpersonal violence (assault, rape, assault with intent to kill, assault with a weapon)
• 43.7% reported experiencing physical assault
  • 44.9% of women
  • 42.4% of men
• 29.7% reported experiencing sexual assault
  • 42.4% of women
  • 15.8% of men

In addition to these statistics about adults, it’s important to understand the prevalence of trauma experienced by children. In the United States, approximately two-thirds of children experience at least one traumatic event before the age of sixteen, twenty percent of high school students experience bullying, seventeen percent experience cyberbullying, and close to twenty percent of children who experience trauma have post-traumatic stress disorder. Research shows a direct relationship between experiencing childhood trauma and developing an alcohol or substance use disorder later in life.

We should point out that though the relationship between trauma and addiction is unmistakable, not everyone who experiences trauma or develops PTSD will develop an alcohol or substance use disorder. The most effective way for people to process trauma and avoid its negative long-term effects is professional mental health treatment.

Treatment for Trauma and PTSD

The Anxiety and Depression Association of America (ADAA) indicates that psychotherapy – in some cases accompanied by medication – is the best way to treat trauma and PTSD. One-on-one sessions with experienced therapists help trauma survivors develop skills to manage their symptoms and cope with them when they arise. Therapy sessions often focus on recognizing and changing patterns of thinking and behavior related to the original trauma. Therapists and patients work together to identify these life-interrupting patterns and replace them with patterns of thought and behavior that are non-disruptive and life-affirming.

The most common types of therapy used to treat PTSD and process trauma include:

• Cognitive Behavioral Therapy (CBT)
  • This solution-focused therapy stressed behavioral change. The talk component typically includes specific strategies that a patient can apply right away.
• Exposure Therapy
  • Exposure therapy involves a therapist carefully re-introducing a patient to traumatic stimuli – or directing a patient to the memory of traumatic stimuli – in such a way as to minimize its power.
• Eye Movement Desensitization and Reprocessing (EMDR)
  • EMDR blends exposure therapy with directed eye movements. This process helps patients change their reactions to traumatic memories and reduce the frequency and intensity of symptoms related to those memories.

Because each person is different, each course of treatment for trauma is different. Techniques that work for one person will not necessarily work for another. Therapists collaborate with patients to find what works for them, then move forward together to develop effective strategies to manage symptoms and mitigate the effect of trauma in daily life.

This is crucial for people in treatment for alcohol or substance use disorders, since they often develop their disordered use of alcohol or substances to alleviate the uncomfortable symptoms of PTSD or early trauma. Evidence shows that when treatment addresses PTSD/trauma and alcohol/substance use simultaneously, outcomes improve – and patients learn to live a life that’s not dominated by their past trauma or present mental health or substance use issues.

The Ridge in Cincinnati offers an inpatient facility to help people suffering from addicts to undergo a complete detox program.

In our recent article “Why Do People Fear Going to Rehab for Addiction?” we discussed several reasons people with alcohol and/or substance use disorder – a.k.a alcoholism and substance abuse – hesitate to participate in alcohol or drug rehab. We identified five main reasons people who need treatment are reluctant to seek treatment. Research shows that reluctance to seek treatment is often based on fear. When considering treatment, people fear:

1. The unknown
2. Living without alcohol or drugs
3. Stigma associated with treatment
4. Relapse
5. The treatment process

The goal of this article is to address items one and five on this list: fear of the unknown and fear of the treatment process. To do this, we’ll describe how residential rehab for substance abuse works. We’re confident knowledge of how treatment works will change many of the unknowns into knowns, which, in turn, may help people make the decision to enter treatment and start the path to long-term recovery.

First, to ensure we’re on the same page, we’ll make an assumption: when most people think of alcohol and/or drug rehab, what they think of is residential treatment. Residential treatment comes in two forms: short-term and long-term. Data from the Substance Abuse and Health Services Administration (SMHSA) indicates the median length of stay in a short-term residential treatment program is 21 days, while the median length of stay in a long-term residential treatment program is 56 days. Therefore, for the rest of this article, what we mean when we say rehab or treatment or residential treatment is an onsite stay in a live-in, full time addiction program that lasts anywhere from three weeks to three months.

For the record, The Ridge sees the most success when our clients stay for our 45 day program, while long-term treatment programs encourage a stay of 180 days or more.

Residential Treatment: The Assessment Process

Once a person decides to seek treatment for alcohol or substance use disorder (AUD/SUD), an assessment process begins. The assessment process typically occurs in three phases or steps. Please note that the following is a general outline for how the assessment process happens in high-quality treatment centers. To learn about our assessment process, click here.

• Step 1: Initial Screen.

  • An initial screen can happen over the phone with an admissions counselor, with a primary care physician in a typical wellness checkup, with a mental health therapist or counselor, or with physicians or other licensed and qualified personnel in a hospital/emergency room setting. If an initial screen indicates the possibility of a substance use disorder, then the screener recommends a brief assessment.

• Step 2: Brief Assessment.

  • The brief assessment determines the possible severity of the substance use disorder. It identifies additional health, legal, or social problems associated with substance abuse. In addition, it gathers initial information on health and psychiatric history, current medications, and current medical conditions. At this point, the person seeking treatment and treatment center staff determine what level of care may be appropriate. We’ll assume, for the purposes of this article, that treatment center medical staff recommend residential treatment. But it’s possible they’ll recommend intensive outpatient treatment or partial hospitalization treatment. Those are two less intensive, but equally valid types of treatment programs.

• Step 3: Full Biopsychosocial Assessment.

  • A comprehensive biopsychosocial assessment is exactly what it sounds like. Clinicians go in-depth. They develop a full picture of the biological, psychological, and social factors that may affect the alcohol/substance use disorder and its treatment. During this assessment, any co-occurring mental health disorders may be identified. In most cases, the full biopsychosocial assessment takes place at the treatment center after admission, within the first several hours of the treatment stay.

Once these steps are complete, clinical staff and the person seeking treatment create an individualized treatment plan. The plan reflects everything the clinicians learn during the assessment process and includes recommendations – based on their experience with the person seeking treatment – for a combination of therapeutic approaches that can lead to the greatest chance of long-term, sustained recovery.

With an individualized treatment plan in hand, the person seeking treatment begins treatment.

Residential Treatment: The Process

Detoxification

In some cases, an assessment indicates that medically supervised and/or medication-assisted detoxification is a necessary first step. Detoxification is the process of clearing alcohol and/or drugs of abuse and related toxins from the body so the person in treatment can begin with a clean slate. The length of the detox phase depends on the substance used, the amount and frequency of use, the age, and gender of the person seeking treatment, their current health status, and their medical history. Detox typically takes between two days and one week. The length of detox depends on the factors just mentioned.

Also, stopping the use of alcohol and some drugs sends the body into withdrawal. That’s why medically supervised or medication-assisted detox is necessary in some cases. Medical supervision ensures safety in the case of an emergency, and medication can help ease the uncomfortable physical symptoms of withdrawal.

Note: in some cases, alcohol withdrawal can be very dangerous. In some cases, it can lead to death. That’s not an exaggeration. We recommend anyone with a history of regular alcohol consumption consult with a medical professional before quitting. We’ll put that another way: in rare cases, quitting cold turkey can kill you. Therefore, the smartest thing to do – for someone with a history of regular and considerable alcohol consumption – is to talk to a doctor or addiction professional first.

Treatment Participation

After detox, the person in treatment joins the therapeutic community and begins participating in the treatment plan they created with clinicians during the assessment process. Residential treatment typically includes:

• Group therapy and counseling.
  • Group therapy and counseling during substance abuse treatment takes many forms. Some group sessions are highly structured, clinical experiences led by therapists or counselors. Other group sessions may be less formal, peer-led, and involve recovery peers sharing experiences and offering advice about the recovery process. Group sessions may also be educational, rather than explicitly therapeutic. Educational sessions may include:
    • The science of addiction
    • The science of recovery
    • How to identify and manage triggers (external cues that can lead to relapse)
    • Relationship management
    • Healthy eating
    • Anger management
    • Setting boundaries
    • Seeking Safety
• Individual therapy and counseling.
  • Like group therapy, individual therapy and counseling includes various approaches, which are determined by the clinical staff and included in the treatment plan. Individual therapy and counseling may include:
    • Cognitive behavioral therapy
    • Dialectical behavioral therapy
    • Motivational interviewing
    • Acceptance and Commitment therapy
    • Attachment therapy
• Family therapy.
  • Most rehab centers recognize the importance of family dynamics in addiction and addiction treatment. In a nutshell, the rationale behind including the family in rehab is that to understand the person in treatment, therapists and clinical staff need to understand where they came from and how they became the person they are. In almost every case, this means understanding the family. Family therapy may include therapeutic and/or educational workshops on:
    • Effective communication
    • Codependency
    • The science of addiction and recovery
    • Boundary setting
    • How to support a friend or loved one in recovery
• Experiential therapies.
  • Once in rehab, people realize that recovery is a lifelong process. They learn it will last long after their time on-site in a rehab center. Experiential therapies help people in recovery learn new skills, techniques, and lifestyle habits that support recovery. These therapies may be facilitated by licensed clinicians trained in things like music therapy or equine therapy (horses). Or, they may be facilitated by experts specific to that experiential approach. It’s important to understand experiential therapies augment, rather than replace, traditional therapies. Experiential therapies may include:
    • General exercise: calisthenics, walking, jogging, aerobics, weight training, kickboxing – any form of exercise may be included.
    • Mindfulness activities: meditation, yoga, tai chi, mindful eating, mindful walking.
    • Outdoor experiences: hiking, cycling, or anything that gets people in treatment outdoors and active
    • Sports: golf, tennis, volleyball, basketball – any activity that a treatment center has facilities to support or access to may be part of rehab
    • Expressive therapies: writing, music, dance, and drama activities may be part of the rehab process
• Community Support.
  • The support of a compassionate community of peers is an essential element of recovery. Evidence shows that adding just one sober peer to their social group increases the chances of long-term sobriety for a person in recovery. Community support groups may include:
    • Alcoholics Anonymous
    • Narcotics Anonymous
    • SMART Recovery

Aftercare Planning and Discharge

Aftercare, also known as continuing care, means everything recovery or treatment-related that happens after official recovery is complete, i.e. after discharge. In collaboration with the person in recovery, clinicians create an aftercare plan that’s designed to help the person in recovery maintain their sobriety independently. Staff at high-quality treatment centers begin crafting an aftercare plan early in the treatment process, based on observation of what works and what does not work for each person.

• A good aftercare plan includes:
  • Resources for ongoing treatment and regular doctor checkups. Ideally, these include names, times, and dates of individual therapy or other relevant addiction services, such as medication maintenance, if applicable.
  • A list of lifestyle or experiential therapies that worked well, enhanced the treatment process, and may contribute to a long-term, successful recovery. For instance, if yoga made an impact on the person in treatment, then resources for local yoga studios – up to and including class dates and times – may be included in the aftercare plan. The same is true for any other experiential approaches that helped, such as meditation, sports, general exercises, or expressive therapies.
  • Community support resources. Like the two components just mentioned, the best aftercare plans include specific dates and times for AA or NA meetings that are convenient for the person leaving treatment. In an ideal scenario, the person leaving treatment will already have an AA sponsor – in which case, the aftercare plan will include their phone number or relevant contact info.

It’s important to understand that in some cases, a person in treatment will not go directly back out into the world. They may step down to a less intensive level of care. For instance, a person may go from residential treatment to partial hospitalization treatment to intensive outpatient treatment to outpatient treatment over the course of six months or more. Decisions about what happens after residential treatment are made through a collaborative process that includes the person in treatment, their family members, treatment center staff and clinicians, and insurance providers.

How to Find a Residential Rehab Center

Since no two people are exactly alike, no two rehab experiences are exactly alike. The entire process is based on open, honest communication between the provider and the patient. This means that finding the best possible treatment center is similar to creating a treatment and implementing a treatment plan. It’s a collaborative process, based on factors specific to the individual. Location, type of program, insurance coverage, and treatment history all contribute to the final decision on which residential treatment program is the best fit.

Evidence shows that integrated, individualized programs that address biological, psychological, and social factors lead to the most successful outcomes. When seeking treatment for a loved one, a family member, or yourself, it’s crucial to research potential programs. Get on the phone, ask questions about everything we mention above – and when a potential match is found, make sure the treatment center is licensed, accredited, and has an experienced staff with specific training in addiction and recovery.

Treatment works – and the sooner a person who needs detox treatment for a substance use disorder gets treatment in a specialized alcohol or substance abuse rehab center, the greater their chances of achieving sustained, lifelong recovery. The Ridge offers inpatient, outpatient and partial hospitalization facilities to help all such individuals.

How prevalent is alcohol use disorder in women? What are the consequences?

Alcohol use in the U.S. is common. People serve alcohol at parties, commemorative events, and at home. They include it as an option at occasions as diverse as backyard barbecues and executive business lunches. Adolescents experiment with alcohol, college students often make consuming alcohol a way of life, and adults use alcohol to relax, facilitate social interaction, and reward themselves after a hard day of work or play.

Its prevalence – while innocuous in many instances – can also lead to misuse. The 2020 National Survey on Drug Use and Health (2017 NSDUH) shows the following population-level data on alcohol use disorder (AUD) in the U.S.:

• Adolescents (12-17): 712,000 (2.8%)
• Young Adults (18-25): 5.2 million (15.6%)
• Adults (26+): 22.3 million (10.3%)

Quick math tells us that almost 30 million people in the U.S. meet the clinical criteria for AUD, or what most people think of as alcoholism. Further examination of the numbers shows the rate of AUD gradually decreased for all age groups between 2002 and 2017, then increased between 2017 and 2020. However, additional research reveals an increase in the prevalence of AUD in one group over the same time: women.

A study published by the American Psychological Association (APA) in 2014 explores the differences in the development and consequences of alcohol use disorder in women, and how they differ for women and men. This article summarizes that study and discusses its implication for the treatment of alcohol use disorder in women.

Prevalence of Alcohol Abuse in Women Compared to Men

In general, men experience higher rates of AUD than women. Here’s the data:

• AUD in men: 24.6%
• AUD in women: 11.5%

These numbers represent a distinct shift, not only over the past 15 years, as indicated above, but over the past 90 years. In the 1930s, data places the ratio of disordered alcohol use for men, compared to women, at seven to one (7:1). When we fast forward to 2017, we see that ratio close significantly: it now hovers around two to one (2:1). If you’re not used to reading or thinking in ratios, what this means is that about a hundred years ago, seven times more men than women experienced problem drinking. Now – or according to data from 2017 – only twice as many men than women experience problem drinking.

That’s a big change. The specific reasons behind the change are beyond the scope of this article, but it’s reasonable to suggest that the increased reporting of rates of AUD for women mirror their increased ability to participate in all aspects of society, from working, to owning property, to securing equal rights and access to a variety of social, political, and cultural activities that were previously denied them, as Supreme Court Justice Ruth Bader Ginsburg observed, “on the basis of sex.”

What is within the scope of this article, however, is identifying differences in the development and impact of AUD on women compared to men.

We’ll talk about those now.

Alcohol Use Disorder in Women: The Negative Effects

Disordered alcohol use causes severe, lasting, and negative impacts for anyone. Men, women, young people, old people – any person who develops disordered drinking patterns risk damage to their brain and body. The latest research tells us two important things: some of the negative impacts of AUD are more pronounced in women than in men, and AUD develops differently in women, as compared to men.

Research indicates the following short-term differences in the effect of alcohol consumption on women, compared to men. Women show:

• Higher blood alcohol levels when consuming the same amount of alcohol
• Increased cognitive impairment
• Increased sedation (sleepiness)
• Higher levels of impairment (drunkenness)
• Increased levels of acute, alcohol-related injury
• Increased risk of sexual assault (as a victim)

Long-term differences in the effect of alcohol use disorder on women, compared to men, include:

• Increased risk of brain damage and shrinkage
• Shorter time for brain damage and shrinkage to occur
• Increased memory impairment
• Increased cognitive impairment
• Elevated risk of alcohol-related liver disease
• Elevated risk of mouth, throat, esophageal, liver, breast, and colon cancer
• Greater risk of heart disease and cardiovascular complications
• Increased risk of depression and mood disorders

Pregnancy And Alcohol Use Disorder

Studies also show the negative impacts of alcohol consumption during pregnancy. Risks to newborns of mothers who consume alcohol excessively during pregnancy include:

• Birth defects
• Low birth weight
• Fetal Alcohol Syndrome (FAS), which can cause:
  • Physical deformations
  • Slow growth (before and after birth
  • Defects in major organs
  • Defects in the brain and nervous system
  • Cognitive impairment
  • Social impairment
  • Memory impairment
  • Disrupted emotional development
  • Impaired balance

These elevated risks mean, in a nutshell, that AUD – or simply excessive drinking – has the chance to cause more damage, more quickly, to women than men. The authors of the APA study cited above put it this way:

“AUD appears to be a more severe form of psychopathology in women.”

Alcohol Use Disorder Rehab For Women

There are two more pieces of information we left out – and both are relevant to our discussion. First, following initiation of alcohol use – i.e. their first drink – women develop patterns of disordered drinking more rapidly than men. Second, when women begin drinking during adolescence, the intensity and duration of alcohol use disorder are greater than that found in men who begin drinking around the same time.

Taken together, all this information is critical for primary care physicians, physicians who specialize in women’s health, therapists, psychiatrists, and social workers involved with women’s issues. In other words, anyone directly involved in the health and wellbeing of women should understand the increased physical, emotional, and psychological risks associated with AUD in women compared to men.

Putting this knowledge into action means that medical and mental health professionals can include questions regarding alcohol consumption in any screenings they conduct during regular office visits. These professional caregivers can then act quickly on the information they collect. If women show signs of AUD, doctors and therapists can recommend a drug and alcohol rehab for women and treatment plan sooner rather than later – which can help women with disordered drinking patterns live healthy lives and significantly mitigate the negative short- and long-term consequences of alcohol abuse.

Sources:

https://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NSDUHDetailedTabs2020/NSDUHDetailedTabs2020/NSDUHDetTabsSect5pe2020.htm