Seniors, Alcohol, and Culture
The term "culture" has many different meanings. For example, culture of a group may be equated with a specific language, and with specific customs. It can also refer to
Seniors in Canada can come from several different ethnic cultures and several different other types of cultures. Their "culture" may be their family background. Culture may have different forms, such as the general expectations of the area where they live.
For example, people in many northern communities speak of the expectation ("the norm") that people drink alcohol. While this is particularly the case among young people, it can also affect older people. In some communities, alcohol is commonly tied to the pace of the community "You work hard, you play hard, you drink hard." Many of the social activities in the community may be associated with drinking (such as playing or watching hockey, or curling). In this environment, it may be harder for a senior who is trying to cut down his or her drinking.
Seniors living in this regional "culture" explain that they are faced with the difficult trade off -- being under the expectation that they will drink at friend's houses and social events, and people treating them differently if they do not. They risk losing those relationships if they no longer drink.
It is very important to understand the impact that the potential loss of these relationships can have on a senior's life. Often there are not other opportunities to build new relationships and the individual may not have the skills and personal resources to easily build new relationships.
Seniors, Culture and Seeking Help
When we were conducting seniors and service providers focus groups in different parts of Canada, people told us other ways in which culture can affect a senior who is experiencing a problem in his or her life. Culture can affect help seeking behaviour. For example, service providers in northern Ontario explained the strong sense of pride and strong belief in independence and "doing it on your own" among the older Finnish residents, who had moved into the area when it was first being opened up.
They were often the local pioneering families. Handling
your own health, personal, family, or other problems was a cultural expectation,
and not being able to handle them on your own was seen as a sign of
personal weakness. Thus, you might easily hear a person
talking about "I'll fix it on my own”; or
expressing the belief that he or she “should not need the help of others to
deal with this problem”.
Service providers in some communities in British Columbia refer to "a Pioneer Ethic" or a "Cariboo Ethic": Many of the people who lived and worked in northern regions of the provinces in the 1930s, 40s, and 50s are alive today and they are still fiercely independent.
|"Up here in the
early days, people worked hard, played hard and drank hard, Those who
couldn't hack it, could simply leave..."
"Not drinking or being able to hold your alcohol was a sign of weakness, that you weren't a real man..."
It is important to understand the ways in which cultural expectations, attitudes and assumptions will affect whether
- a senior acknowledges there is a problem,
- the person seeks out help,
- and the type of help the person is likely to accept.
In these "cultural" circumstances, look for ways to reach out to the older person in a "normalizing" way, and offer assistance in a way that the older person does not see it as undermining his or her independence. Look to ways that express help of others as
- building the person's continuing independence, and
- something we all need at some point.
Do Other Countries and Other Cultures Outside of Canada Experience Less Problems with Alcohol?
Ever heard a statement like this? "Well, you know…. it's just our North American culture. … In England (or France or Italy), it's quite different... they don't have alcohol problems there…"
No doubt about it, seniors can have alcohol problems there too.
France & Italy
In France, 25% of males and 11% of female residents at 174 "resting homes" (nursing homes) had chronic alcohol problems (1 a). Another study found that 9% of geriatric patients (3% of women and 18% of men) showed symptoms of alcohol dependence. Alcohol problems were also associated with benzodiazepine treatment and nicotine dependence. (1b)
A study of 2010 patients of all ages seen by a sample of 145 general practitioners in the Auvergne region of central France, found that 16% of the patients consulting their general practitioners had an alcohol problem. Of these there were far more men than women (27% of men and 5% of women). On average, 25% of these patients had not been previously identified by the physician. Diagnosis seemed particularly difficult in women: 11% of women aged between 36 and 45 had an alcohol-related problem, and these problems went unidentified in 60% of the cases.(1c)
In a study of 400 people with alcohol problems seen in an internal medicine department at an Italian rural hospital, they found that 60% of the patients were 60 years old and over. (2)
Over the last 15 years there has been a significant decrease in alcohol consumption in France. This has lead to remarkable health statistics - for example, the frequency of liver cirrhosis in the country has decreased by one half (3). Even so, there are currently about 9000 deaths per year in that country from cirrhosis of the liver (6282 men and 2681 women). The risk of a person in France with alcoholic cirrhosis developing liver cancer is 20% within 5 years. (4) In France,10% of the deaths by cancers are attributable to the consumption of alcohol (5).
In France the social cost of the consumption of alcohol, tobacco, and illegal drugs is more than £21 billion ($52 CDN) a year. In an official study by Professor Pierre Kopp of the Sorbonne, states that alcohol was responsible for nearly 53 per cent of the overall social costs presented by legal and illegal drugs. In Canada, Australia, and Scandinavian countries, tobacco constitutes the greatest social cost. (6)
"The report shows that the entrenched idea that the French have no problem controlling their drinking habits is false. It says that consumption is "exceptionally high and the final bill is extremely heavy. There is a collective misunderstanding of the dangers of alcohol in a country where a regular intake is perceived as a protection against heart problems." (also, 6)
In a newly released report, Ireland identifies the dramatic change in the country's drinking patterns as a result of increasing affluence and having the fastest growing economy among the European Union (EU) countries. The number of litres of alcohol consumed per capita in Ireland increased from 5 litres in in 1960 to 14.2 litres in 2002. Between 1989 and 1999, most European countries were showing a decrease in their drinking (Italy's per capita consumption decreased by 20% for example). In contrast, Ireland showed a 40% increase, putting it third in per capita consumption among EU countries.
Ireland estimates the costs of alcohol related problems in their country at 2.366 billion Euros. (7)
Seniors' Alcohol Use in Ireland:
In Ireland, 60.8% of senior men are regular drinkers, as are 38.8% of senior women.
Drinking seems to be a common leisure or social activity among older adults in Ireland. Compared to other age groups, much higher rates of seniors drink 5 or more days a week (for example, 26.3 % of the older men and 33.0% of the older women are drinking this frequently, compared to 4.9% of the males aged 18-24 and 4.2% of the women in the younger age group).
While the level of high risk drinking* per session decreases among older age groups compared to younger people, it is still 9.1% among senior men, and 11.1% among senior women. *High risk drinking in Ireland is defined as 70 grams or higher of pure alcohol for men and 50 grams or higher for women (with no adjustment made for age).
A significant percentage of older men and
older women in Ireland drink over the recommended weekly upper limits (16.2% and 21.2% for older men and older women, respectively). The recommended weekly
limits in Ireland are 14 standard drinks for women and 21 standard drinks
|Men 65+||Women 65+|
|Regular drinkers (drank alcohol during the last month)||60.8%||38.5%|
|Drink 5+ drinks per week||26.3%||33.0%|
|Drink over the recommended weekly limits||16.2%||21.2%|
The report, also gives the "Drinks Industry Group" response to the Interim Report, where the Industry states it would not do any good to reduce overall consumption.
Jewish Culture: In a recent conversation with professionals about older adults in the Jewish community in Montreal, Canada, I was told that they felt alcohol problems were rare among Jewish people. Is that the case?
An 1998 American study surveying of members of the Jewish Alcoholics, Chemically Dependent Persons, and Significant Others (JACS) offers some insights into the issue. (8)
Stereotypes: It has been suggested that there are possible deterrents to alcohol problems among Jewish people. These include:
The solidarity of the Jewish community,
The emotionally sustained tradition and family organization.
The fact that wine is a religious symbol and is first drunk in early life.
The fact that alcoholism would be disruptive to the unity of the Jewish people.
The religious teachings of Judaism which regulate alcohol consumption.
Sobriety is a Jewish value. (as reported in (8))
While possible explanations, none of these preclude alcohol problems from developing.
They found that 45% of 538 survey respondents were chemically dependent; 25% were chemically dependent and had a significant other who was chemically dependent as well. Another 29% had significant others who were chemically dependent (but they were not themselves).
They found the number of Jewish men and Jewish women with alcohol problems about the same (which is different from other groups, where men with alcohol problems tend to outnumber the women considerably).
Some earlier writers had suggested that the "causes" for alcohol problems among Jewish people might include lower education, poor income, being alienated or experiencing loss of religious conviction. None of these assumptions was supported in the study. The median household income was $60,000 per year, with 28% of respondent reporting incomes of $100,000 per year or over. The median education was graduation from college, with 47% obtaining graduate degrees of higher. Only 30% of the respondents self identified as not affiliated with a particular religious category of the Jewish faith or as being non-practicing in their faith.
Dual Addictions: Alcohol is the drug of choice. However, 71% of the people who were chemically dependent in the survey reported having dual addictions. Alcohol was the most common first addiction, with sedatives and tranquilizers appearing frequently as a second addiction.
Older Adults: Thirty one percent of the chemically dependent people in the study were aged 56 or over. Twenty four per cent of those who were chemically dependent and had a significant other who was also chemically dependent were aged 56 and over.
Seeking Help: The researchers state the impression that "Jews do not become alcoholics remains the predominant opinion about alcoholism in the Jewish Community. This continuing impression is disturbing because
(a) it contributes to the denial process in alcoholics and their families, delaying intervention and treatment;
(b) it discourages accurate diagnosis among health professionals who may fail to consider alcohol problems in Jewish patients,
(c) it inhibits leaders of the Jewish Community from addressing the problem, and
(d) it hinders members of individual congregations from seeking help within the Jewish community." (at page 74)
The researchers found "Chemically dependent Jewish people and their families exist and need help, but those that seek recovery are often unable to find the help they need within their own communities." (at page 83) The study found that chemically dependent Jews respond to the same therapeutic methods as other people with alcohol use problems. Ninety-seven per cent of the respondents rated educating rabbis and the Jewish community as extremely important.
(1a) Batel, P. (1995) "Treatment of alcoholism in France" Drug and Alcohol Dependence, 39 (Suppl.) S15-S21.
(1b) Lejoyeux, M., Delaroque, F., McLoughlin, M. & Ades, J. (2003) Alcohol dependence among elderly French inpatients. American Journal of Geriatric Psychiatry, 11(3):360-364,
(1c) Malet, L., Llorca, P.M., Boussiron, D., Schwan, R., Facy, F., & Reynaud, M. (2003) General practitioners and alcohol use disorders: Quantity without quality. Alcoholism: Clinical and Experimental Research, 27(1),61-66.
(2) Lutterotti, A. (1967) De l'aspect social de l'alcoolisme dans la viellessse. Rev. d'Hygiene Med. Scolaires Universitaires, 15, 751-760. And Gaillard, A. & Perrin, P. (1969) L'alcoolisme des personnes d'agees. Rev. Alcoolisme, 15, 5-32.
(3) Warsell, L. (1994) "New radiance in the Triclour: Changes in French drinking patterns" Nordisk Alkoholtidskrift 11 (5/6) 275-279.
(4) (27 septembre, 2001) La nouvelle campagne de communication: L'alcool pas besoin d'etre ivre pour en mourir. p. 18. Online at: www.alcoologie.org/archives/cnam-cfes-presse-09-2001.PDF Published by l'Assurance Maladie sécuritié sociale et Comité Français d'Education pour la Santé.
(6) Globe Magazine. "Cost to France of alcohol and tobacco culture". Online at: www.ias.org.uk/publications/theglobe/99issue4/globe9904_p19.html
See also "The Flipside of French Drinking": www.marininstitute.org/NL2000.html
(7) Strategic Task Force on Alcohol, Interim Report, May, 2002, Department of Health and Children, Eire.
(8) Vew, S.L. & Blume, S. (2001). The JACS Study I: Characteristics of a population of chemically dependent Jewish women and men. Journal of Addictive Diseases. Vol. 20(4) 71-89.
Page last updated Friday April 29, 2005
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