Worried About a Parent's Drinking? A Guide for Adult Children

A holiday visit can be the first time you see it clearly. A parent who used to have one glass of wine now finishes the bottle before dinner. There is a bruise nobody explains, a story told twice in an hour, a recycling bin fuller than it used to be. You may not know whether you are seeing drinking, aging or something else, and it can feel strange to be the one worrying about a parent.

This guide covers why alcohol affects people more as they get older, the signs worth noticing, the medication risks, how to raise the subject, how to bring in your parent's doctor, and where to find support for yourself.

Why alcohol hits harder as parents age

Alcohol does not affect a 70-year-old the way it affected the same person at 40. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), older people are more sensitive to alcohol's sedating effects and to its effects on balance, coordination, attention and driving. Because the body carries less muscle and less water with age, some older adults reach a higher blood alcohol level than a younger person after drinking the same amount, and older adults can develop alcohol-related problems at lower levels of drinking. NIAAA also reports that alcohol misuse and alcohol-related harms are increasing among older adults, and faster among women than men.

That is how a parent can truthfully say they drink no more than they always have and still be at greater risk. The National Institute on Aging (NIA) notes that some older people feel alcohol's effects more strongly without drinking more, which makes falls, fractures and car crashes more likely. Older women are more sensitive to alcohol than older men.

Drinking can also start or grow late in life. NIA points to major life changes, such as the death of a spouse, a move to a new home or failing health, which can bring loneliness, boredom, anxiety or depression. NIAAA adds retirement to that list, and poor sleep as well: some older adults drink to help them sleep, which can make sleep problems worse.

Signs worth noticing during a visit

Alcohol problems in older adults are easy to miss because they can look like ordinary aging. NIA notes that the effects of drinking can be mistaken for other conditions, such as a balance problem, and that drinking too much over a long time can make some older people forgetful and confused in ways that could be mistaken for Alzheimer's disease or a related dementia. NIAAA lists these clues to a possible alcohol problem in an older adult:

• memory loss
• depression or anxiety
• poor appetite
• unexplained bruises or falls
• sleeping problems
• less attention to cleanliness or appearance

You may also notice the patterns a doctor asks about when assessing alcohol use disorder: drinking more or longer than intended, wanting to cut down and not managing it, giving up activities your parent used to enjoy, continuing to drink despite trouble with family or health, or shakiness, sweating, nausea or trouble sleeping as the effects of alcohol wear off (NIAAA).

No single sign proves anything. NIA points out that people who drink every day do not necessarily have alcohol use disorder, and that not everyone who misuses alcohol drinks every day. For a sense of scale, NIA's page on aging and alcohol, last reviewed in 2022, says men should not have more than two drinks a day and women only one, and that drinking less alcohol is better for health than drinking more (NIA). One drink means a 12-ounce regular beer, a 5-ounce glass of wine or a 1.5-ounce shot of 80-proof spirits. Our guide to the signs of a drinking problem walks through the criteria in more detail.

Alcohol and medicines: a risk that grows with age

Many older people take medicines every day, as NIA notes, and NIAAA warns that alcohol can stop some of them from working properly, or make them dangerous or even deadly. Aging slows the body's ability to break down alcohol, so it stays in the system longer, and alcohol and medicines can interact even when they are not taken at the same time (NIAAA). Some of the examples NIAAA gives:

• Sleep medicines, anxiety medicines, cold and allergy medicines and opioid pain relievers are all sedating, and mixing any of them with alcohol can be deadly. With medicines for anxiety, pain or sleep, alcohol also raises the risk of falls, injuries and overdose.
• Aspirin with alcohol raises the risk of stomach or intestinal bleeding.
• Acetaminophen can cause liver damage, particularly in people who drink chronically.
• Some cough syrups contain alcohol, which adds to the effects of a drink taken at the same time.
• Alcohol can change the blood levels and effects of some blood pressure medicines and antibiotics.
• With the blood thinner warfarin (Coumadin), occasional drinking may lead to internal bleeding, and heavier drinking can cause bleeding or the opposite effect, raising the risk of clots, strokes or heart attacks.

A practical step during a visit is to write down every prescription, over-the-counter medicine and supplement your parent takes and suggest they bring the list to their pharmacist or doctor. NIA advises asking a doctor or pharmacist before drinking alcohol with any medicine. Our articles on aspirin and alcohol and ibuprofen and alcohol go deeper on two common combinations.

When it cannot wait

Some situations call for help right away:

• If alcohol is putting your parent or anyone else in danger, NIA's advice is to call 911 or get similar help right away (NIA). That includes a fall with a head injury, new confusion, a seizure, or seeing or hearing things that are not there.
• Talk of suicide or of not wanting to live. Call or text 988, the Suicide and Crisis Lifeline, which also supports people worried about a loved one (mass.gov).

Be careful, too, about urging a parent who drinks heavily every day to stop all at once. NIAAA warns that alcohol withdrawal is potentially life-threatening when someone who has been drinking heavily for a long time suddenly stops, and that people with severe alcohol use disorder may need medical help to stop safely. Doctors can prescribe medicines that make withdrawal safer and less distressing, so the first step is a medical conversation (NIAAA).

How to bring it up with your parent

Talking to a parent about their drinking can feel like a role reversal, and it is easy to keep putting off. NIA offers suggestions for how to approach the topic (NIA):

1. Choose a sober moment. Talk when your parent has not been drinking, which rules out the holiday table and the end of a long evening.
2. Say what you feel and what you have seen. "I am concerned about your drinking" is a complete opening. Add one or two specific things, such as a recent fall or a new prescription.
3. Offer facts and skip the labels. NIA suggests avoiding labels such as "alcoholic" and starting with something like "I want to share some things I've learned about how alcohol affects the health of older adults."
4. Ask to join a doctor's appointment. This can be an easier yes to get, and it brings in someone your parent already trusts.
5. Offer practical help. Suggest plans that do not involve drinking, and offer rides to a counselor or a group meeting.
6. Expect more than one conversation. NIA notes that overcoming alcohol use disorder is an ongoing process that may include setbacks.

If you have brothers or sisters, agree beforehand on who will speak and what you will ask for, so your parent hears one calm message. Our guides to talking with a loved one about addiction and the difference between enabling and helping cover what to say and which kinds of help keep a drinking problem going.

Bringing in your parent's doctor

A primary care doctor can be a strong ally, and asking about alcohol is a recommended part of primary care. The U.S. Preventive Services Task Force recommends that primary care clinicians screen adults 18 and older for unhealthy alcohol use and offer brief counseling to people who drink at risky levels (USPSTF).

Privacy law still leaves room for you to help:

• You can share your concerns. HHS guidance on HIPAA says it in no way prevents health care providers from listening to family members or other caregivers who have concerns about a patient's health and well-being, so the doctor can factor what you report into your parent's care. HHS adds that information a family member shares under a promise of confidentiality may be withheld if the patient later asks for their record and releasing it would likely reveal who said it (HHS).
• Sharing back usually needs your parent's okay. A doctor may talk with a family member who is involved in a patient's care when the patient agrees or does not object, and may use professional judgment to share what is in the patient's best interest when the patient is injured or otherwise unable to give permission (HHS). When a patient who can make their own decisions objects, HHS says the provider must respect that, unless there is a serious and imminent threat to health or safety that the family is in a position to lessen (HHS).
• Legal authority changes things. If your parent has given you legal authority to make health care decisions for them, HIPAA generally treats you as their personal representative for the health information that relates to that authority. State law sets how far that authority reaches (HHS).

If you write to the doctor or call the office, keep it factual: what you saw, when, and which medicines you know about. Then encourage your parent to raise it at the next visit, or ask to come along.

Doctors can also prescribe medication. NIAAA lists three medications approved by the FDA to help people stop or reduce drinking, naltrexone, acamprosate and disulfiram, and describes all three as nonaddictive. Its Alcohol Treatment Navigator notes that any primary care or other doctor can prescribe them (NIAAA).

Treatment options, and where to look

Treatment for alcohol use disorder can be outpatient or inpatient, and it can combine counseling, mutual-support groups and medication. No single approach works for everyone. For older adults, NIA suggests looking for a counselor who knows about alcohol problems in older people, a support group for older adults, individual, family or group therapy, or a program such as Alcoholics Anonymous.

Two free places to start:

• The NIAAA Alcohol Treatment Navigator helps adults find alcohol treatment for themselves or for an adult loved one. It has no commercial sponsors, and it lists the questions to ask any provider.
• State lines connect you to local care. In New Hampshire, dial 2-1-1 to reach The Doorway, which helps people who are worried about someone else. In Massachusetts, the free Substance Use Helpline answers around the clock at (800) 327-5050, by call or text (mass.gov).

If your parent lives in southern New Hampshire or the Boston area, the Clear Steps Recovery admissions line, (603) 769-8981, is answered 24/7, and admissions can talk through options with you in confidence. Our help pages for New Hampshire and Massachusetts list more local resources.

Support for you

Worrying about a parent's drinking is stressful, and it can stir up old memories if drinking was part of your childhood too. NIA encourages family members to look after themselves: bring in siblings or friends so you are not carrying this alone, consider counseling if you notice anxiety or depression, and try a group for families.

• Al-Anon is for people who are worried about someone with a drinking problem. NIA lists its meeting line, 888-425-2666, and meetings can be found at al-anon.org.
• Adult Children of Alcoholics and Dysfunctional Families (ACA) is a fellowship for adults who grew up with alcoholism or other dysfunction at home. Its official site is adultchildren.org.
• Local family groups. Our family support page lists free groups in New Hampshire and Massachusetts, including Al-Anon in both states and Learn to Cope, with links and phone numbers.

A parent's drinking can also matter for your own health. NIAAA notes that genetics play a role in alcohol use disorder, with heritability estimated at about 60 percent, and that parents' drinking patterns may influence a child's later risk. That makes this a good season to pay attention to your own drinking as well.

If you or your parent is in crisis, call or text 988. SAMHSA's National Helpline, 1-800-662-4357, is free, confidential and open around the clock.