Drinking in mid to later life

Nine of 15 participants still drinking alcohol described themselves as currently drinking sensibly, having reduced their alcohol consumption from previously higher levels. However some individuals had not reduced their drinking. The heaviest drinker reported consuming nine pints and a bottle of wine most days. Most women who reported drinking little nevertheless felt they had increased their consumption as they entered mid to later life.

Going out to drink was a feature of the accounts of younger interviewees (50–69 years), with special occasions associated with heavier drinking:

I’ve had the nights out with the girls, where we’ve got all of our troubles over in the last half hour and then concentrated on having a few good drinks and all that. I’ve had that, done that, been there, thoroughly enjoyed it, liked the feeling that it gave me. (22; female, 59yrs)

Choice of where to drink was limited for interviewees aged 70+ by their mobility or other circumstances, for instance if in a care home. Two of the older interviewees described being influenced to drink more by people living close to them. One older woman found she started to drink more when she became less mobile and received frequent visits at home from a neighbour who drank heavily.

Interviewees who reported dependence described their drinking in mid to later life as increasingly taking place alone and at home. For female dependent drinkers this was a consequence of being at home much of the time; male dependent drinkers associated starting to drink at home with a shift to using alcohol as a coping strategy, or finding that drinking with other people inhibited their drinking. However, some dependent drinkers of both sexes valued social drinking as being less boring than drinking in the house alone. Some problem drinkers described drinking as a continuous process through the day, saving something at the end of an evening for an ‘eye-opener’ the next morning:

I’ll come down on a morning after I’ve taken a bath upstairs. I hardly ever touch the drink upstairs, I’ll bring it down. I take my tablets with the whisky…and then I might have some breakfast. (8, male, 74yrs)

Since drinking had become a solitary activity for some, getting out of the house could be seen as an important measure in reducing or avoiding consumption. One woman who no longer allowed drink in her house explained:

I used to go out to begin with, that was when I started drinking, and then I started staying in. That was when I started on the vodka because I thought well I’m in the house, if I get drunk nobody can see me. I can get as drunk as I want. I can make as big a fool of myself as I want. I’ve only got to get upstairs to bed, I haven’t got to walk up any banks or owt [anything] like that, and it just went downhill. (16; female, 52yrs)

In contrast to the individual interviews which were personalized, focus group participants tended to present themselves as responsible drinkers but described ‘other’ middle aged or older people they knew or knew of whose drinking was excessive or dependent.

M: I knew a bloke who used to go in the [name] club, and he was, when he used to go in he’d say “I stand here, seven nights a week”, thinking he’s clever. Do you know where he is now? He’s got a leg off [amputated], aye he’s in a home, and he doesn’t know anybody, and it’s all down to drink. (Focus group 2)

Some participants in particular described quite strict drinking habits or routines, for instance meeting particular groups of friends in pubs or clubs on specific nights, to help minimize the chance of heavy drinking. Those still working or volunteering during the week described drinking only on weekend nights when they would not be working the next day, or spoke of ‘waiting till the sun passes the yardarm’:

F: If it was after six in the evening I'd probably offer a drink before I would offer a tea or a coffee. (Focus group 3)

Routines included a drink out with a meal at lunchtime in the afternoon or merely a ‘nightcap’. For some participants, special occasions were the only times they reported having a drink. There were also suggestions that when away from home or on holiday, participants might drink greater amounts or more frequently:

F1: It's relaxing, a glass of wine, it's what you do abroad isn't it?

F2: It is.

GW: Is it? Do things change once you're on holiday?

F3: Oh yes. Totally different on holiday.

F2: Oh I think everybody changes when they're on holiday.

F4: I drink more on holiday, well I do, I drink a lot when I go on holiday. (Focus group 3)

Deciding to change

Interviewees described consumption in pints, bottles, or cans rather than units and while some were aware of the UK government’s recommended guidelines they tended to be skeptical regarding their helpfulness. It was frequently argued that guidelines would not be relevant to everyone because they did not take account of individual differences in tolerance:

I mean nobody goes out for a drink and says ‘I wonder how many units is in this? I better not drink that’ you know–nobody’s going to say that. (11; female, 55yrs)

Interviewees described themselves as aware of health campaigns targeting drinking, indeed some complained of their ubiquity. For some, public health messages were perceived as class-based ‘preaching’:

I think the random, the average adult doesn’t drink too much in this country, but I don’t know, because I’ve got no figures and I think figures are done, are; they are created, put together by middle class people who haven’t worked at the coal mine or had a fishing boat or in the shipyards and they don’t see the socialisation, the outcomes of it, they only see the bad side of it. (21; male, 56yrs)

It was acknowledged that pressure from family or friends could build the impetus to change drinking behaviour. Older interviewees living in sheltered accommodation described censure from family members if they were thought to have been drinking too much, even though these relatives gave them bottles of alcohol as presents. Interviewees younger than 60 described realising that reducing their drinking might alleviate conflict in their family; for instance having received ultimatums from partners and children:

Then one night he took the kids away from me and I pulled myself together overnight. I just got up one morning and said ‘enough’s enough–I want my kids back’ because my kids were my life. (2; female, 59yrs)

Some younger interviewees had sought help when their partner pointed out the impact of their drinking on the family. One interviewee described his carer as ‘bossy’, but was going to attend counselling because she had persisted in suggesting he do so. Family pressure was not always in the direction of reducing alcohol consumption; if other family members drank dependently, they could be seen as likely to increase the interviewee’s own alcohol consumption. Some interviewees recalled that their family had left them to their drinking, or that it had not been discussed when they came to visit. Some interviewees described themselves as disinclined to drink to excess because of anxiety around alcohol dependency. They recounted that acquaintances or family members had become dependent on alcohol or died from it, and this had made them cautious about drinking.

Concern about the impact of alcohol on older bodies was voiced as likely to make older people reduce their drinking. Amongst those aged under 70 years, hangovers and the time ‘lost’ to them were seen as getting worse with age, and the desire to avoid them strengthened. Other strong incentives to limit consumption for this age group included ambitions for foreign travel and a desire to live more healthily, particularly to ensure a longer relationship with grandchildren or great-grandchildren. For interviewees aged 70+, fear of falling and the desire to avoid gaining weight were influential concerns. These incentives to reduce drinking were raised by both male and female interviewees.

However, when interviewees talked about giving up alcohol, they also recalled varied concerns about the consequences of not drinking, such as the loss of an enjoyable part of their lives, possibly the only one left to them:

I’d like to cut it down altogether, but even the last time–I cannot be going away and just sitting on my own. I don’t smoke, I don’t have nowt else and that’s the only pleasure I’ve got–drinking. (4; male, 61yrs)

Dependent drinkers were concerned about severe withdrawals or that they might be unable to cope with a return or worsening of their mental health problems. One interviewee with chronic obstructive pulmonary disease was concerned that cutting down had led her to smoke more. Others thought it would be difficult to spend time with friends or family if they did not drink:

I couldn’t understand how you can have fun just going out and having a cup of coffee. You think how boring. I felt as though I could open up a lot more, you know, when you’ve had a few drinks. (11; female, 55yrs)

Those who had been dependent but had reduced their drinking cited severe medical events, or a warning from a doctor that this was imminent, as powerful incentives to change; for instance, bringing up blood, a diagnosis of pancreatitis or identification of an enlarged liver. Some interviewees felt it was ‘too late’ for them to attempt to change their dependent drinking:

If you’re an alcoholic or an addict and say you’re 25 you have basically maybe 45 years to go, you know, of life. A person who is say 55 and drinking a lot says to himself ‘ah well I'm 55 now what’s there to look forward to now? Doesn’t matter if I stop drinking’ (6; male, 59yrs)

A number of reasons emerged why middle aged and older dependent drinkers might have delayed seeking help with their problem. For example, some perceived it as something to be dealt with by themselves, they felt able to function while drinking and perceived a strong stigma attached to being a dependent drinker, and they had been unaware or uncertain of what help was available.

Only a few participants from the focus groups correctly specified what the recommended guidelines for alcohol consumption were, and most agreed that calculating units was confusing:

M: I’ve seen it on the TV, so many units; I watched a programme about it on the TV, but I can’t remember the units…but they reckon is more, in theory, what women drink, there’s more in the wine, than what it is for beer. (Focus group 2)

At two of the focus groups, participants suggested that many middle aged and older people would regard advertising campaigns against excessive drinking as targeting those who got themselves drunk or lost self-control when drinking, and therefore not relevant to themselves. Participants were also critical of mixed messages from research reports in the media over whether red wine was beneficial or not.

Some incentives were mentioned by participants for moderating drinking, including diets, driving, the desire to see one’s grandchildren grow up, and the desire not to appear foolish:

M: I could go out and drink 7, 8 pints, but it would be making a fool of myself really, you know. (Focus group 2)

One group suggested that many middle aged and older people were motivated to avoid alcohol or minimise their intake because of fears they might become alcoholic.

Experiences of primary care

Interviewees who recounted problems with alcohol indicated that General Practitioners (GPs) were the first source of help encountered. Participants may have sought help either for their drinking, or for mental health problems with which the drinking was associated:

At the time I was suffering from depression as well and obviously if you want something, some medication, that’s [GP’s] where you’re going to go. (6; male, 59yrs)

However, asking a GP for help usually meant overcoming a reluctance to do so, or to admit to being ‘drunk all the time’ or having an alcohol problem, which could be uncomfortable or embarrassing. One woman had not managed to face asking her GP for help until a friend took her along. Such interviewees recalled trying to hide their drinking from their GP or play down its extent. Some saw GPs as not wanting to treat drinkers, or did not see drinking as a ‘legitimate’ illness to trouble a doctor with:

But you can’t imagine somebody going in [to the doctor] and saying ‘oh, I’ve got a problem, I’m drinking far too much, what help can I get?’ can you? (12; female, 51yrs)

While some participants felt they had been successful in hiding their drinking others recalled that their GP had asked about drinking because of the smell of alcohol:

He [GP] said ‘have you been drinking?’ and I just said ‘aye, 1 or 2’ he said ‘do you know what time it is?’ I said ‘I’m quite aware of the time’ he said ‘I think you’ve got a problem’. (10; male, 60yrs)

GPs were identified, by some, as a source of pressure for changing behaviour. When they had been encouraging about a reduction in consumption, this was seen as positive. However, GPs could also be viewed as having high expectations of abstinence or drastic reductions that participants might have felt unable to meet. They had usually directed participants seeking help to contact a support service or group, or made a referral for detoxification or a psychiatric nurse rather than offering advice on how to cut down themselves:

But Dr [name] is the type of doctor where he’s so laid back, he didn’t specifically say to me ‘that can happen with your liver–that can happen with your brain–that can happen…’ I didn’t get that information. It was just ‘you’ve got a problem–here’s a card now go and deal with it’. (10; male, 60yrs)

One participant thought that many GPs did not understand problems that middle aged and older people faced with drink, but simply referred them on without necessarily knowing the most appropriate service. Some participants felt that their GPs had tried to prescribe them medication in relation to their alcohol problem or associated mental health problems without listening to them or considering alternatives to medication.

No clear differences emerged in experiences of primary care between men and women. Among the oldest group of interviewees (aged 70+), all but one said their GP no longer asked about alcohol; one explained this was “because they know I don’t drink”. The one man who said his GP still asked him about alcohol attributed this to his having had a stroke.

At all three focus groups, participants thought that it was important for doctors to be able to ask about all areas of health, but one group agreed that doctors were overly prone to look to alcohol consumption to explain the symptoms they visited about. Older women in sheltered accommodation on the other hand said that they were never asked, or felt that their doctors knew them well enough personally to know that they had no problems with alcohol. As one woman put it ‘they [doctors] have never had to pick me off the ground’.

Experience of detoxification and rehabilitation

Most interviewees who reported a serious alcohol problem had been through a detoxification programme at least once, in many cases several times, usually inpatient programmes or emergency responses to a hospitalisation. One interviewee who did not view himself as having any alcohol problems had been outraged to find that he received detox medication when hospitalised for a stroke:

I says ‘get the forms, I’ll sign myself out’. I says ‘all you are thinking about is me being an alcoholic’… They were injecting something into my stomach. (24; male, 72yrs)

Some interviewees had been unable to arrange for a home detox because they lived in temporary accommodation or did not have 24 hour support. Others found it had been difficult to secure a referral for detox because they were not drinking enough at the time, including one woman who said she had been told to reduce her drinking to one bottle of cider a day, but was then told she drank too little to qualify.

Detox programmes had enabled problem drinkers to stop drinking and, for instance, start eating again, but this had almost always been a temporary change. For one interviewee, the abstinence achieved had always been succeeded by complacency and relapse some months down the line. More often participants complained that after detoxification, they had returned to the settings or problems that had fueled their drinking with little or no follow-up to help them avoid alcohol:

Detox and then back to your normal life. I mean the nurses come out every day and they give you vitamin injections which last 6 month[s]. Then come the end of the week, that’s it: they’re gone and you’re back to just keeping away from the pub. You know what I’m saying? It’s hard. (16; f, 52yrs)

Some complained that no attempt was made to address mental health problems alongside a detox. Those referred for detox by counselling services did feel they had been supported through counselling before and after, and appreciated this. One man, for instance, felt that the programme he was about to undertake was more likely than his previous referral to make a difference because of the ten weeks of counselling to prepare him for it.

Rehabilitation programmes were viewed as more expensive, and referrals to them as harder to secure. This required one to demonstrate likelihood to achieve and sustain abstinence. One interviewee did not think that the rehabilitation facilities available were necessarily appropriate for middle aged or older people, describing one establishment as ‘scary’ as it accommodated ‘real winos’. Few participants mentioned having been through rehabilitation, but those who had, described it as an important part of their recovery. Views differed on the usefulness of the group work and activities that formed part of the programme, but the experience of sustained support and individual advice away from everyday routines was seen as a positive factor. They felt again that the support they required during the period after they left the programme had not always been available:

It’s when you come out and you’ve got nobody–that’s when you need them. I came out…I went in on the 30th November, and I was only away a week…I think it was the second week in January I got a letter to say ‘make an appointment to see me’. (11; f, 55yrs)

The lack of support to follow up rehabilitation made relapse likelier, and one woman estimated she had been through five programmes. Long waiting lists were also viewed as a problem, meaning that the impulse or readiness to make a change in behaviour might have passed by the time a place became available.

Due to the smaller numbers of participants experiencing detoxification and rehabilitation there were no differences that could be meaningfully attributed to age or gender.

Experience of counselling and therapy

Those who had given up drinking as a response to counselling were positive about the help they had received; those who were still drinking and had received counselling appreciated the chance to talk to someone in private but did not see it as having had a significant effect. Counselling was seen as helping to deal with underlying problems, preparing them for other interventions, or supporting abstinence and relapse prevention. One participant whose GP had referred her to a psychotherapist for her mental health problems described this help as ‘brilliant’, as it had helped her understand why she drank. However, the experience of turnover in counsellors, when one moved to a new job, was unsettling, making participants feel as if they had to start from scratch in developing a relationship with the new counsellor, and one participant was inclined not to try counselling again because of this.

Some participants expressed a preference for services that were not specifically dealing with alcohol problems, partly because they felt alcohol services brought them into contact with alcoholics who were likely to encourage relapse; for instance one interviewee said of Alcoholics Anonymous:

It’s just a load of sob stories. I think ‘well I’ve got enough of my own’ without listening to somebody else’s. It made me feel depressed and I wanted a drink when I came out. (11; f, 55yrs)

Groups tended to be appreciated more when they were not focused solely on drinking. Relaxation, alternative therapies and arts classes were popular, helping to fill the day and allowing interviewees to expand their social circle. Both activity groups and drop-in centres (Drop-in centres, generally run by voluntary organisations and local councils, offer emotional support, companionship and practical advice to vulnerable people who live independently in the community) were enthusiastically endorsed as forms of support that gave access to other people to talk with on an ad-hoc basis:

They know where you’re coming from and they're volunteers and they sit and they talk to you and you just chat and it's a way of putting in your time without going to the boozer or getting a drink. (6; m, 59yrs)

It was frequently emphasised that support was best coming from people at the same stage of struggling with alcohol as themselves, or from an ex-alcoholic, in part because they were seen as less likely to be judgmental about drinking and relapses. A voluntary organisation staffed by recovering drinkers was praised because volunteers understood the problems involved but presented the example of health and stability to aspire to. They were seen as a ‘little family’ with which interviewees could connect in the face of isolation experienced elsewhere:

My world is drink and people who drink. The people in the [shopping centre], they might as well–either I might as well not be there or they might as well not be there because I can’t equate with them. (15; m, 65yrs)

Doubts were often expressed about people who had not been through alcohol problems themselves offering help because they lacked first-hand knowledge. Some people were also critical of receiving help from people much younger than themselves who did not know what alcohol problems were like for middle aged or older people, though others thought the age of the person helping you made no difference.

Due to the smaller numbers of participants experiencing counselling and therapy there were no differences that could be reliably attributed to age or gender.