The popular image of problem drinkers is, more often than not, a young person in town at 2am, or perhaps a middle aged person whose drinking may be in response to, and impacting on, family and work pressures. Younger and middle aged problem drinkers do get older of course and so can become older problem drinkers. It is also possible for problem drinking to emerge later in life for the first time. Drinking can become an issue for a variety of reasons later in life including becoming more social isolated through bereavement and retirement, chronic pain and insomnia, and increased family conflict.

Increased age brings with it a range of specific risk factors. Although most people continue to exhibit healthy cognitive functioning as they age our intellectual reserves, the spare capacity that comes in to play when under stress, become more limited and so heavy drinking can more easily push adequate functioning into the territory of poor functioning, with impaired memory, confusion, and poor decision making. As we become more physically frail intoxication presents greater risk of injury through falls, burns and cuts. Alcohol can act as a depressant and older adults are increasingly being identified as a high risk group for the development of clinical depression. Another critical factor to consider is the potential for alcohol to interact with medication, with older adults commonly prescribed a range of medications where this could be an issue.

As well as the risks associated with alcohol consumption there are potential benefits. In addition to the pleasure people gain from drinking alcohol, there is information to suggest that there are benefits to cardiovascular health with moderate alcohol consumption. These benefits are modest at best and don’t apply to everybody. Potential health benefits can easily be overemphasised and used to justify unhealthy drinking. The risk of over-doing it greatly exceeds the risk of under-doing it when it comes to alcohol consumption.

What is a safe level of alcohol consumption for older drinkers? National drinking guidelines are largely targeted at a younger population and may not be appropriate for older drinkers. The profile of drinking habits for older drinkers in New Zealand is typically frequent, often daily, drinking, but seldom in large quantities, more usually in the one to four drinks range. This contrasts with a youth pattern of less frequent but heavy drinking – i.e. a binge drinking pattern. This “steady state drinking” exhibited by older drinkers can appear harmless in contrast and flies beneath the radar. Given the health complications indicated above for older adults though it is cause for concern. For those in the 65+ age bracket it is advisable to drink no more than two “standard drinks” (1 standard drink = a can of beer or a 100ml glass of wine) and to have regular alcohol free days. If you are on medication discuss this with your doctor as even these amounts may be unhelpful.

Drinking problems can be difficult to identify in older adults as symptoms may be difficult to separate from possible dementia or depression. Deterioration in functioning can be difficult to pin down to the correct cause. This may lead family members, and even health professionals, to overlook the role of drinking. In addition, people who develop a drinking problem may become somewhat secretive about it and older adults are particularly prone to feeling shame under these circumstances and to also not want to bother relatives or burden the health system with their issues.

Talking with an older relative about their drinking may be an uncomfortable thing to do, but if you have any concerns, even if you are not sure, it is important to take the initiative and be honest about your concerns. If you are concerned about your own or someone else’s drinking call the Alcohol Drug Helpline on 0800 787797.

Dr Simon Adamson is a clinical psychologist specializing in alcohol, other drugs and behavioral addictions. You can learn more about him and his work at www.christchurchpsychology.co.nz.

How do we get information about things in life? Through direct experience, through education, and through observation. Whilst most of our observation is of things going on around us in everyday life, a lot of our observation is through the media – that is rather than observing “real life” we observe the lives of others in fiction and it’s estranged sibling “reality TV”. We can make a conscious effort to separate out what is real from what is not but how often do we do so? Take alcohol and drug use for example. While most of us will have plenty of direct or observational experience of alcohol use in our own lives this is less often true for drug use. New Zealand survey data suggests that most of us have tried cannabis but certainly with other drugs the level of experience is substantially lower. A lot of what we do know about “hard drugs” is likely to be formed through our exposure to movies and television.

Dr Gavin Cape from the University of Otago has suggested that depictions of drug use in cinema fall in to five main groups: Tragic hero (e.g. Trainspotting, Leaving Las Vegas), Rebellious free spirit (e.g. Easy Rider), Demonised addict/homicidal mania (e.g. Reefer Madness, Once Were Warriors), and Humorous/Comedic user (e.g. Arthur, Saving Grace). . Movies often use stereotypes which can act as shortcuts so we can safely make some assumptions about a character’s back-story without the director needing to waste precious screen time. For example if someone is shown as an illegal drug user the connotation is of deviance, corruption, untrustworthiness, and mentally unstable. This raises the question of whether movies and the media more generally simply reflect social norms or help shape those norms. Movies can reinforce stereotypes, as famously occurs in the 1936 movie Reefer Madness showing drug crazed youth corrupted by cannabis. Alternately they can explore contentious social issues, for example the 2000 movie Traffic which sought to show the illegal drug trade from the perspective of various agents.

A recently released documentary by film-maker Martin Spurlock (POM Fabulous: The Greatest Movie Ever Sold) puts the spotlight on the growing trend of product placement in cinema and on TV. Product placement is a subtle form of advertising whereby the product is visible and usually shown in a positive light as either incidental background or as a more explicit part of the script. We know when we are viewing a formal advertisement, while product placement is more insidious. Specifically by not being clearly identifiable as an advertisement we may fail to bring critical judgment to bear on the implied claims of a product. If a soft drink is advertised as healthy and for cool people we can decide whether or not this is plausible, but if we see a succession of representations of movie/TV characters who are healthy and cool consuming that soft drink we may have our perceptions for the product altered without us realizing it. As restrictions on advertising for smoking become stronger the ability to depict smoking in other forms of mass media becomes more important to the industry. If New Zealand takes the sensible route of placing greater restrictions on the extensive advertising and promotion of alcohol (approximately $320,000 per day currently) we might expect to see product placement becoming a more important part of the alcohol industries arsenal. Cinema and TV provide a great source of entertainment and have an important role to play is exploring and reflecting our society, but we do need to be vigilant as consumers of that entertainment that we are not being “programmed by the programmes”.

Dr Simon Adamson is a clinical psychologist specializing in alcohol, other drugs and behavioral addictions. You can learn more about him and his work at www.christchurchpsycholoy.co.nz.

Most of us enjoy a drink, and it’s only a few idiots who spoil it for everyone else, right? Well, that depends on what you mean by “a few”, and how much we are prepared to tolerate before we consider there’s some “spoiling” going on. If you had 100 Kiwis who were drinking together, how many would you consider had a drinking problem? 2 or 3, 5 maybe – or if you were bring a bit pessimistic, 10? Actually, it would be about 25. And that’s just people with a current drinking problem. The majority of us have had a sustained pattern of hazardous drinking at some time in our life. That’s not an exaggeration, it’s a fact.

We are all aware that drinking is particularly a concern for young people. While this is true, we shouldn’t lose sight of how much problem drinking there is for the rest of the adult population. For example, a third of men in their 40’s and 50’s are hazardous drinkers, putting their health, relationships, and work at risk. And it’s not just men, the same is true for about a quarter of women in their 30’s. We need to think not only about the harm this drinking is doing for these adults and our communities, but also the example this is setting for young people. Concerned about your teenagers’ potential for getting in to trouble with alcohol? Take a good, hard look at your own drinking – and that of your friends and other adults that teenagers exposed to. Remember, drinking doesn’t have to be “out of control” to be sending some pretty unhealthy messages about the importance of alcohol and the normality of intoxication.

Now is a critical time to be considering the place of alcohol in our community. Parliament is in the final stages of considering wide-ranging alcohol law reforms. This brings us to the whole issue of balancing personal freedom against limiting harm. Changes suggested like putting up prices, changing hours of operation, and reducing outlet density are all measures that most of us might find inconvenient on occasion. In addition, we think these measures may be too blunt, targeting us (the “ok” drinkers), rather than targeting them (the “problem” drinkers). But the fact is that the “problem” drinkers are a big part of society, and the proposed measures are targeted. A modest price rise won’t have much impact on moderate drinkers, but is going to be felt by those at risk – the young drinkers and the heavy drinkers. There are also some really well supported changes that won’t have any negative impact on most drinkers – like limiting advertising, and reducing the blood alcohol level for drink-driving from its current level (which actually allows people to drive while intoxicated in New Zealand). It’s not the public who are against these recommendations, it’s segments of the alcohol industry. I wonder why… Unfortunately, the government’s response looks like it’s going to be pretty limp. While there are some good changes around licensing requirements in the pipeline, what’s been proposed really does look like tinkering around the edges of the problem.

The business of running the country must be hugely complex and choosing the right policies is a real challenge. However, identifying effective, proven ways to reduce the enormous harm done be alcohol is easy – the research has been done over and over in many countries. All that’s required is for the government to have the courage to act. They might find that courage more readily if the public was willing to express its concern. If you want to express your concern, visit www.alcoholaction.org.nz for information on how to contact your local MP, and what you might say to them, as well as other helpful information and links. If you’re concerned about your drinking or someone else’s drinking, call the Alcohol Drug Helpline on 0800 787 797.

While many people drink alcohol moderately, there are many others who drink in a problematic way. At the more severe end of drinking behavior is alcohol dependence, a term which covers those who experience symptoms including loss of control over amounts and frequency of drinking, and increasing preoccupation so that drinking takes up a large amount of the person’s time. People with alcohol dependence may also develop tolerance so they need to drink larger amounts to have the same effect, and experience withdrawal symptoms when drinking stops. A person with alcohol dependence may experience all of these symptoms and is at risk of the problem worsening, including major impact on health and social functioning if they don’t cut down or stop altogether.

Much more common than alcohol dependence, however, is problem drinking, where drinking can be seen as normal and certainly similar to what your friends are doing. Problem drinkers often find the amount they drink on any one occasion has a habit of getting away on them, with good intentions going out the window after the first few drinks. For these people, drinking can affect their health, impact on work, and lead to arguments with friends or family. Problem drinking is also associated with risky behaviour, such as drink-driving or getting in situations where risk of physical or sexual assault is increased. Alcohol brings your guard down, so that you say or do things you regret later. This may be embarrassing and can have quite a significant impact on relationships – if you haven’t experienced it yourself then you probably at least know someone who has behaved inappropriately while drunk and had some explaining to do the next day!

If you’re drinking above the recommended drinking guidelines promoted by the alcohol advisory Council (ALAC) then you’re at risk of experiencing these problems. The ALAC guidelines recommend that men drink no more than 6 standard drinks per occasion and no more than 21 standard drinks per week. For women these figures are 4 and 14. Many alcohol products state the number of standard drinks they contain, but as a guide, a bottle of wine equals 8 standard drinks and a can of 4% beer equals one standard drink. The drinking guidelines also suggest you have at least two days per week without alcohol.

For problem drinking there are some good self-help resources online (start with www. hadenough.org.nz) or you might consider talking it over with a health professional such as a psychologist or GP or contacting the Alcohol Drug Helpline (0800 787 797). For heavier drinkers, making changes may require more sustained attention. This will particularly be the case if loss of control is a prominent feature and if drinking is used to deal with underlying emotional problems. Treatment options include regular therapy, medication, AA meetings, and for the most addicted drinkers, medical detoxification and residential treatment.

If you are wondering about whether or not your own drinking is a problem, try taking this test on the website of the Alcohol Advisory Council. The site also contains many other resources for people concerned about their own drinking or for those concerned about someone else. The Like a Drink website contains a number of brief video clips of real life experiences of New Zealanders who have had a problem with their drinking.

The Alcohol Drug Helpline is a confidential support and advice service where you can talk to someone about your drinking or drug use, or your concerns about the use of someone you know, and can receive advice on available services in your area. The helpline operates 10am to 10pm seven days a week. Phone 0800 787 797.