Literature Review of Factors Related to Drinking Problems Among Older Adults
In the addictions field in general, it is often difficult to identify which factors are causes and which are effects of substance abuse (see review by Graham & Ekdahl, 1986). With older problem drinkers, distinguishing cause from effect can be even more problematic, as it is often impossible to identify which drinking-related factors preceded heavy drinking when the drinking pattern has evolved over 40 or 50 years. I
Even with "late-onset" alcohol abuse among older people (i.e., alcohol abuse that begins at middle age or later), causal factors are difficult to identify. This is most clearly demonstrated by the fairly large quantity of literature on the role of stresses/losses of aging (bereavement, retirement, loneliness, poor health) in the development of problem drinking. As pointed out by two somewhat recent reviews (Finney & Moos, 1984; Giordano & Beckham, 1985), clinical studies of older persons who have alcohol problems (Droller, 1964; Rosin & Glatt, 1971) have identified stresses of aging as major factors in the development of alcohol problems; however, epidemiological studies have found no relationship between age-related stressful life events and heavy or problem drinking (Barnes, 1982). Based on a model reported by Mackie in 1974 (cited by Finney & Moos 1984), Finney and Moos (1984) proposed that
stress as a causal factor in alcohol abuse might be considered an "INUS condition-that is, it is an insufficient but non-redundant (it provides an independent contribution) component of an unnecessary (other combinations of factors can also produce problem drinking) but sufficient composite condition" (p. 280). To expand on this statement in the present context, stresses of aging:
1. are an insufficient cause of alcohol abuse (i.e., some people experience stresses of aging and do not increase alcohol consumption or problems, or possibly even decrease alcohol consumption);
2. are a nonredundant component in the development of alcohol abuse (i.e., these stresses do play an independent contributing causal role, but only in conjunction with other factors such as previous drinking patterns, available coping strategies, and so on);
3. are an unnecessary condition (i.e., alcohol abuse can develop among older people in the absence of obvious stresses of aging); and
4. when combined with other factors, form a sufficient composite condition.