Barriers to Receiving Help

In a three year study, we examined the range of personal and systemic obstacles to treatment facing older adults with alcohol or other drug problems.  

Only a very small percentage of seniors who have a drinking problem receive treatment. Up to this point, it has generally been assumed by many that seniors who have alcohol problems are unwilling to seek treatment. Much of the responsibility (or "blame") for the discrepancy between the apparent need among the seniors and their (lack of) use of current treatment programs has been placed on their attitudes and beliefs. 

It has been assumed (and it is common to hear) that few seniors seek or receive treatment because 

This may be only one small part of the real problem that many seniors have in accessing appropriate treatment.

Systemic issues that can significantly reduce the likelihood that seniors will be directed to treatment programs. Once in a particular program, a senior can still face major challenges in being effectively served by the program. Systemic problems may include


The Need for Appropriate Treatment


Types of Barriers to Treatment

In the course of talking with seniors experiencing problems and agencies that provide treatment services, we found many barriers that effectively "shut seniors out." Several of these have been noted in the gerontological  literature.

Attitudinal and Behavioural

The Senior: An older adult may deny having problem, may not recognize the symptoms of alcohol abuse, or may wrongly interpret alcohol-related symptoms as aging effects.

An older couple may face social barriers, including privacy and generational issues- such as the expectation "don't wash your dirty linen in public."

Seniors' unwillingness to enter treatment may be a result economic circumstances (they can't afford treatment). Some seniors believe that it is inappropriate to spend money on themselves for treatment (self denial; saving it for the children's inheritance)

Being labelled both "old" and "alcoholic" can create a double stigma.

Family, Friends, or Peers:

Family may feel uncomfortable discussing the issue, believing that it shows disrespect to one's elders. They may accept or rationalize the problem (ignoring the negative aspects of the senior's drinking behaviour). Family and friends may engage in enabling behaviours- shielding or in some way easing the immediate problems created by drinking or drug use (Meagher, 1987). For example, buying the alcohol for the senior because he or she can no shop. Family may engage in behaviour such as taking parents out of programs or encourage them to leave; sabotaging the help or situation; making excuses for the senior's actions:

Research indicates that women have twice as many active enablers as men (Tabisz et al. 1993). Family sometimes avoid confronting the problem because it may mean having more contact with the parent or having to examine family dysfunctions. Others avoid the issue out of concern over collateral issues, such as protecting the family inheritance.



Seniors Organizations, Care Facilities

These are two groups that one might consider as having an important role in identifying  alcohol problems. However, there are challenges such as:

The Catch 22 Situation

Older adults with alcohol problems are often excluded from alcohol services because of age, and from geriatric services because of their alcohol problems.



Professionals and Paraprofessionals (people in a position to detect alcohol problems) may

Barriers within the Alcohol and Drug System


Even Specialized Services for Seniors Can Create Barriers



Agency's mandate:
Agency's admission criteria: e.g. ambulatory, able to take care of personal needs; no medications, effectively exclude many seniors.

Staff's attitudes- at reception; on intake


Curtis, J.R., Geller, G., Stokes, E.J., Levin, D.M. & Moore , R.D. (1989) "Characteristics, diagnosis and treatment of alcoholism in elderly patients" J. of the Amer. Geriatrics Society 37 (4) 310-316.


Graham, K. & Romaniec, J. (1986) "Casefinding vs. right to privacy: a general dilemma emerging from a study of the elderly" J. of Drug Issues 16 (3) 391-5.

Gulino. C. & Kadin, M. (1986) "Aging and reactive alcoholism" J. of Geriatric Nursing 7 (3) 148-151

Lasker (1986)""Aging alcoholics need nursing help" J. of Gerontological Nursing 12 (1) 16-19

Naik, P.C. & Jones, R.G. Jones (1994) " Alcohol histories taken from elderly on admission" Br. Med. J. 308 (6923) p.248.

Pruzinsky, E.W. (1987) "Alcohol and the elderly: an overview of problems in the elderly and implications for social work practice." J. of Gerontological Social Work 11 (1-2) 81-93.

Rehmar. M. (1988) "Sensitizing practitioners, families and elderly persons" Pride Institute J. of Long Term Home Care 7 (2) 22-29



Widner, S. & Zeichner, A. (1991) " Alcohol abuse in the elderly: review of the epidemiology research and treatment" Clinical Gerontologist 11 (1) 3-18.


Page last updated Tuesday June 22, 2004

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