Dr. Andrew Duxbury

Dr. Duxbury has an extensive background in community based geriatric programs. While on the faculty at the University of California he developed courses in geriatric health and wellness and founded an educational house call program to teach physicians in training the disappearing art of health care in the home environment. In 1998 he joined the faculty of gerontology and geriatric medicine at the University of Alabama where he is medical director of UAB geriatrics.

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Dear Dr. Duxbury,
We need help. Mom, 87, is depressed and feeds her depression daily doses of alcohol. She insists on living by herself, but my wife and I are worried sick. Especially when we see this every time she comes to visit. We're trying to keep our cool and get her to come and live with us before she falls and really hurts herself. What can we do?

Alcohol and other substance abuse is a hidden but growing problem among many older Americans. It is often a dirty little secret, especially when the patient is female. It is not looked for by physicians, is often ignored or minimized by families, and is capable of causing devastating medical and social consequences. The first step to dealing with the problem is to admit that it is a problem.

You seem to have accomplished this but Mom has not. You may be correct in your thoughts that Mom is using alcohol as self-medication for depression. This is a common pattern. Unfortunately, the alcohol will actually fuel depression, rather than alleviate it. Attacking or confronting Mom with her drinking is not likely to help and may, in fact alienate her further from the help that she needs.

Also, if she lives alone and is relatively independent, don't waste your time looking for the bottles or pouring it out. She'll always be able to get more. My suggestion would be for you to make an appointment for her with her doctor for a check-up. Make sure that you go to this appointment with her and be present in the room during the interview (you may also want to prime the doctor first). Then, in a gentle, non-judgmental way, make sure that the issue of alcohol use is addressed with the doctor so that he or she can explain the medical consequences of her continued drinking.

The physician can then refer you to a counselor or psychiatrist with expertise in alcoholism as it affects the elderly. Sometimes inpatient rehabilitation is warranted, sometimes medication to help prevent physical problems of detoxification, sometimes the diagnosis of an underlying disorder such as depression or chronic pain is made so that appropriate treatments can be begun and the need for self-medication dissipates.

Despite all the best of intentions, it is possible that your mother may not want to stop drinking. As long as she remains independent, you will not be able to prevent her. If she suffers from a serious fall or other calamity, it will not be your fault. She will have her choices and must deal with the consequences of those choices.

A very useful place for finding out more about coping with an alcoholic relative is the twelve step program, Al-Anon, which exists in most localities. There is usually a local information number in the white pages or available on line. Al-Anon meetings are safe places to gather information, share feelings and learn how to detach from an unmanageable situation with courage and with love.

If and when your mother stops drinking and is sober, that is the time for a family discussion on whether she should live with you or in another situation. There are many, many options available for senior living. A professional geriatric care manager can help you decide what is best for the whole family. If your mother doesn't want to live in your home, that's not a reflection on you. Some seniors prefer other arrangements.