Name: Andy Wolf

Age: 74

Occupation: Grandfather

Case file: Andy is an elderly Native American with a history of hypertension (high blood pressure). Andy lost his wife several years ago and is going through stages of depression. His family recently sought help at the Yellow Creek Treatment Center because of suspected problems associated with alcohol abuse.

Andy’s story: I don’t have a drinking problem. I drink occasionally to deal with the recent loss of my wife, that shouldn’t label me as an alcoholic. Arnold doesn’t understand and is turning his wife Faith against me. The only one who cares is my twenty-year-old granddaughter, Carlene.

Arnold’s point of view: My parents use to drink a lot together when Mom was alive, but when she died, Dad started to drink more heavily. He won’t admit it, but I know he needs help. That is why I admitted him. His high blood pressure is getting worse, and he refuses to take his medication. He said they make him drowsy and weak.

Faith’s point of view: Oh, every once in a while I would drive Andy to the store to “buy a few groceries.” I realized I was being his enabler when I would see him later with a pint of whiskey. It hurts me to know that I provided access for him to get his booze.

Carlene’s point of view: Grandpa hasn’t been himself lately. When I used to visit him and Grandma, he would always be cooking and cleaning; smiling and telling me stories of when my dad was my age and, boy, how he used to get into trouble all of the time (laughing). Now when I go see him, he is moody and mean. He doesn’t even shower some days. His house is dirty, and he doesn’t cook as he used to. He doesn’t even cook my favorite chokecherry pudding and frybread anymore.

Andy’s Doctor: It’s been hard to diagnose, since Andy has other health complications that cover his underlying problem with alcoholism. Although he is frequently a patient, he denies his problem with alcohol use and argues about taking his medications.

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Setting: Yellow Creek Treatment Center with all of Andy’s family present.

Counselor: I’m glad you all could make it today. I wanted to meet with everyone to discuss the situation of a family member, Andy Jackson, and the possibility of alcohol abuse. Andy’s doctor is also here with us today to indicate any clues whether or not alcohol abuse is present. This meeting will hopefully provide us with answers to our questions and guide us toward our next step in helping Andy. Now I know Andy is going through a tough time right now, and with your support, he will get better. Can any of you tell me what made you first detect Andy’s drinking problem?

Arnold: Well, first off, I’ve noticed Dad’s been real forgetful these past few months, even forgot it was his birthday the other day.

Carlene: It seems like he doesn’t take care of himself anymore either, smells like alcohol a lot. He doesn’t like me to come over and visit that much either, and when I do he always has some kind of bottle next to him.

Andy’s Doctor: Andy’s been missing a lot of his scheduled appointments. Instead, he has been coming into the Indian Health Service for emergency accidents that could have been easily prevented. He’s been having abnormal test results in his glucose readings and liver enzymes, both signs of possible alcohol involvement.

Faith: I’ve noticed he hasn’t been eating much lately, getting skinnier and skinnier even though I’m always giving him a ride to the grocery store. If he doesn’t buy food, I don’t know what he’s been buying.

Counselor: Well, all of you have indicated signs, symptoms, and clues to drinking problems in older patients. By looking at the list, can each of you tell me what specific alcohol-related problems in Andy you have recognized?

Andy’s Doctor: Worsened hypertension, possible heart and liver damage.

Faith: Compromised nutrition and jeopardized overall health status.

Arnold: He has a distinct loss of memory and mental health degradation. He may also have had adverse drug interactions for his hypertension, explaining why he hasn’t been taking his meds.

Carlene: Grandpa has depression and doesn’t seem to care about him or us anymore.

Counselor: The manifestation of alcohol-related problems may take physical and psychosocial forms, and in older persons include the problems that you have all mentioned. Another way to find out if Andy’s alcohol is a problem is by answering yes to any of these questions. In order to understand Andy’s situation, let’s look at some vital information. Here is a table of the most common causes of death among Native American elders and US all-races elders. Doctor, can you tell us which ones are related to alcohol use?

Andy’s Doctor: Problem drinking affects the elderly population differently than the young; it causes fewer traumatic fatalities than in young people, but is more likely to exacerbate seniors' coexisting illnesses. In older patients, heavy drinking may complicate health conditions through adverse alcohol-drug interactions, dietary or medication noncompliance, cognitive impairment, psychiatric illness, or other mechanisms such as hypertension or gastric bleeding. These effects of alcohol abuse increase morbidity and mortality among older people in medical settings. Alcohol is a common factor in liver disease and cirrhosis, cancers of the mouth, larynx, and esophagus. Heavy consumption of alcohol can also do direct damage to the heart, complicate health problems such as hypertension and diabetes, and compound the nutritional deficiencies common in the elderly. I can see a direct link between some of the causes of death among Native American elderly and the use of alcohol.

Counselor: Doc, you seem to know the impact alcohol has on health, but how easy is it as a health care provider to diagnose alcoholism?

Andy’s Doctor: About 10% to 15% of elderly patients seeking medical help for any reason have an alcohol-related problem. However, it is common to overlook these problems because of health complications commonly experienced with aging. Therefore, it is easy to miss alcohol and drug problems in elderly people. Andy is not alone, however, as alcoholism affects between 5- 12% of men and 1- 2% of women in their 60’s. Moreover, the percentage is probably even higher in the Native American communities. There is insufficient research to report the accurate percentages among Native Americans.

Counselor: Even more complicating in Native American communities, is the stigma associated with treatment centers and diagnosis of being alcoholic. Many Indians go undiagnosed or untreated until they have long-term consequences from the alcohol, such as cirrhosis or cardiovascular disease.

Andy’s Doctor: Moderately heavy drinking, such as 2 to 3 drinks per day, clearly increases the risk of hypertension and probably also increases the risk of several other conditions such as diabetes, breast cancer, head and neck cancers, and hip fracture. Because this level of alcohol use increases the risk of medical conditions, it must be considered medically hazardous.

Arnold: But Dad already has hypertension.

Andy’s Doctor: The more reason why he should not be drinking. Even in moderate amounts, alcohol has been shown to aggravate hypertension. Although light and moderate drinking is cardioprotective, the risks may well outweigh any potential benefit in some cases. Older patients with any signs of congestive heart disease or hypertension should be advised to abstain entirely.

Arnold: So what we can we do now?

Counselor: In order to help Andy and his problem with alcohol abuse, here are six steps to follow. You have already done the first step, you have received support and have shared your concerns. The best overall strategy to help Andy is to increase his interaction with others. Losing his wife has provoked his dramatic use of alcohol and isolation from others. Getting Andy involved in peer relationships and social programs and giving him a meaningful role in which he is socially engaged can make his treatment a success.

Carlene: I guess I’ll just keep bugging him about my frybread.

Counselor: That is the best you can do for him and his problem with alcohol, Carlene. And for Arnold and Faith, think of this as YOUR AA treatment: Availability and Acceptance. As long as you condone his behavior and provide him access to alcohol, his condition will not improve. Do you understand?

Faith: I think my car just broke down (smiling).

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