Self-neglect: a practitioner's view

Aging, Spring, 1996 by Wendy Lustbader

Self-Destruction Through Drugs or Alcohol

When approaching an older person's use of drugs or alcohol, it is important to distinguish between lifelong addiction and recent dependence on drugs or alcohol in response to later life losses. Lifelong addicts are deeply accustomed to blocking out painful feelings. They may never have learned how to tolerate anxiety, boredom, hurt, or frustration. In addition, the extent of their physical addiction may make it dangerous for them to try to stop alcohol or drugs without medical supervision. Hospital-based treatment for chemical dependency, covered by Medicare, is often the best option in these instances.

In contrast, those who have not previously depended upon alcohol or drugs as a means of survival tend to reach old age with a repertoire of coping skills. Having been able to endure life's hardships over the years, they become chemically dependent only after health problems interfere with their strengths or when too many losses occur at once. For instance, studies have shown that caregiving, retirement, death of a spouse, and disfiguring surgeries are the four major causes of alcohol dependence later in life. Receiving help that specifically addresses these issues may prevent the need for in-patient treatment and may set someone on a healthier course for bearing their difficulties.

When a relative refuses to accept help and continues on a self-destructive course, family members may find themselves stuck in the role of rescuer. For example, a daughter may be furious each time she has to give her alcoholic father money for food, yet insist "I can't let him starve to death." One alternative is for the family member to offer to hold a portion of the person's income solely for groceries and to parcel it out week by week. Another is to bring over the groceries, rather than give cash that might be used for alcohol. But such measures do not solve the dilemma of the rescuer role and consequent feelings of futility and anger.

Many people will not accept treatment until family members stop protecting them from the consequences of their addiction. Letting a loved one reach bottom is often essential to breaking through the addicted person's denial of their dependence on drugs or alcohol. Professional guidance in this effort is frequently a family's best recourse, as are support groups which aid the family in practicing "tough love" and setting healthy limits. A caseworker from the state's adult protective services division may also be able to assist with gaining the older person's willingness to enter a chemical dependency treatment program.

Destructive Entwinement: Parents Who Endure Abuse from Adult Children

Long into later life, some parents go on sacrificing their financial and emotional resources for the sake of a grown son or daughter. They put aside their own needs to the point of harming themselves. Their adult child may plead for help with overdue rent, bills for psychotherapy and associated medications, or projects and investments which are then converted into money for drugs or alcohol. The older parents may vow that this is the "last time" they will be fooled, or persuade themselves that "this time" their son or daughter will accomplish something, only to be repeatedly disappointed.