The Alcohol 'Problem' Podcast

Alcohol and older adults with Dr Sarah Wadd & John Slater

October 11, 2021 James Morris / Sarah Wadd / John Slater Season 1 Episode 8
The Alcohol 'Problem' Podcast
Alcohol and older adults with Dr Sarah Wadd & John Slater
Show Notes Transcript Chapter Markers

In this episode we explore alcohol use and problems amongst older adults. Alcohol problems have been rising in recent decades amongst older drinkers, despite falls in consumption in other age groups.

We talk to Dr Sarah Wadd, a researcher at the University of Bedfordshire, about some of the reasons behind alcohol problems amongst older adults and what can be done.

John Slater also talks about his lived experience of developing an alcohol problem and his path to recovery, with help from the Drink Wise Age Well programme which ran from 2015-2020.

WARNING:
This episode contains mention of childhood trauma/abuse. If you may be upset by this you may not wish to listen.

If you need help or want support relating to alcohol use in the UK, please visit the NHS support page or Alcohol Change UK pages, or call Drinkline on  0300 123 1110 (weekdays 9am to 8pm, weekends 11am to 4pm). 

James Morris:

So thanks so much for joining me, Sarah, it's been kind of widely identified that we've seen declines in youth drinking. And that's kind of driven this sort of downturn in overall population consumption. But it's definitely not seen as amongst older adults, where perhaps even on some measures, older adults are drinking a bit more. Is that right? And can you tell me a bit more about the work that you're involved in?

Dr Sarah Wadd:

Yes, of course. And, of course, it's fantastic news that population levels of alcohol use are declining. But what I worry about is that that's masking, as you say, the increase in older adults. So we know now that it's 55 to 64 year olds who are most likely to, to exceed the recommended drink limits. And also, the number of alcohol related hospital missions in over 50 years have increased significantly. And the average age of death from an alcohol related problem is now 59. So we see a pattern where alcohol use is increasing in the older age groups. So it's really important that we try and understand why that is. And that's a lot of what our research is about. So one of the things that we're we're very conscious of is that alcohol is a really habit forming substance. So many people who, who are now in their 60s and 70s, when they were younger, there was kind of this perfect storm of high availability of alcohol, there was a lot of alcohol marketing, women were really starting to drink alcohol. And people didn't really know that much about the risks around alcohol. So those kind of habits that that cohort developed when they were younger, they're kind of just carrying them on into later life. And it's that population that our research is focused on. And whilst we understand that, for many older adults, alcohol is a very pleasurable experience, and the majority won't have any problems with that alcohol use. We're obviously particularly concerned about people who do.

James Morris:

Yeah, absolutely. And I think it's that cultural normalisation, I think is the kind of idea that's familiar of people that our call is, as you say, a potentially dangerous and addictive drug. But because majority of people don't experience serious problems with it, and is widely available and heavily marketed that, you know, is just seen as quite normal. So older adults kind of held on to that idea of alcohol is something that, you know, it's just, it's just that I'm a normal part of relaxation, or enjoyment, and so on. Whereas perhaps, you know, we don't know exactly the reasons for younger people's declines in consumption, certainly complicated, but maybe they do just come at it from a quite different perspective where there has been more discussion and awareness about or debate about, you know, how coal was no ordinary commodity, rather than just something that is kind of normal and expected.

Dr Sarah Wadd:

Absolutely. It's the same way, if you think about smoking, when I was younger, there was smoking was very common, and people didn't may have understood the risks. But there wasn't an awful lot of publicity, there wasn't an awful lot of action to try and get people to stop smoking. And the same with alcohol. It's only in kind of the last decade that we've seen this real kind of public health push to try and get people to reduce their alcohol use and, and whilst in many ways I come from a public health background myself, I really embrace that. But I also worry sometimes that we focus a little bit too much on the negative impact of alcohol without even discussing the benefits that people get from alcohol. And that's just so important because people drink alcohol for a reason. And as I've said, the majority of people, particularly the majority of older people, they will not experience harm from that alcohol. And it gives them an enormous sense of pleasure in life, they're actually doing really fascinating study at the moment on alcohol use in care homes. And when I was doing a bit of reading for the study, I found this this amazing experiments that were carried out in the United States in the 1970s. And what the researchers did, they did an experimental study, they took people who lived in nursing homes and who were on that they use a term geriatric who was in hospitals, and they gave half the group alcohol in moderation. And they gave the other half drinks that looked like alcohol, but didn't have any alcohol in it. And what they found was that the group that had this kind of moderate alcohol given to them, they were much more sociable, they were much more relaxed, and their morale was better. And they reported that they needed less sleeping medication. So I think it's really important that we keep in mind that for many people, alcohol use does have its benefits. And if we don't give attention to that, then some of the messages about harmful drinking kind of really fall flat with the majority of the population.

James Morris:

That's really interesting, because, you know, obviously there's also studies where they kind of not necessarily amongst older adults, but you know, don't find differences in the alcohol groups versus the placebo groups in terms of some of those effects. Sort of implying that a lot of it is the expectancies just, you know, people think that having a drink makes you more sociable and relaxes you, and therefore that's the kind of, or at least part of the active component. So yeah, it's often interesting to hear about the studies that show that there is obviously a mechanism as well, it is a kind of depressant of various systems, and that those have kind of benefits as well as downsides, particularly in kind of moderation, if we define it correctly. Yeah.

Dr Sarah Wadd:

And actually, somebody, a practitioner that works in a care home told us that there was some people who, they weren't able to drink alcohol any longer. So they were given that they kind of lost capacity to make decisions for themselves. And they were given drinks that looked like alcohol. And apparently, they talked about having a hangover The next day, even though they hadn't had alcoholic tools. So if you say that kind of expectancy of, of kind of like the effects of alcohol is definitely very real, that I just I do think it's really important. We talk about the benefits of alcohol as well.

James Morris:

Yeah, I totally agree. And I think I think there were a lot of people who, within the public health and broader alcohol debates do advocate the same, they are quite aware of, you know, the dangers or risks of just constantly going on about the negatives without recognising, you know, the benefits of Alcoa. And not just that, but also that if people are sensitive to the idea of being of nannying, or being told what to do that people will kind of push back if they feel that they're being pushed at all to kind of make decisions that, you know, they feel capable of making themselves. So yeah, I totally agree. So in terms of older adults, then, is there a way of drawing the line? Or what would we maybe say is kind of alcohol use that we could recognise as beneficial or kind of low enough risk to be fine? And when should we start being concerned and maybe trying to develop interventions or programmes to try and support older adults with what we might describe as alcohol problems?

Dr Sarah Wadd:

Yeah, it's a really good question. And it's a really tricky question as well, because of course, for people of any age, the amount of alcohol, it's safe for person to drink really depends on lots of different things. So it depends on of course, your gender, but also on your weight and your fat composition, that that kind of variability is even more marked in older adults. So if we think we use the term, older adults to describe people who age 50, and over, so that is just a huge population. But if we think of somebody who's reasonably healthy, and who's perhaps age 52, they can probably safely drink or reasonably safely drink the same amount as people of any age. So of course, the recommended drink them, it's a 14 units a week, but then there will be some people who perhaps are aged 50 to 53, who may be taking medications that interact natively with alcohol, or they may have a health condition that's made worse by alcohol. And for them, no level of alcohol use may be safe. And then of course, if we think about the people, perhaps in the 80s, and 90s, by that age, the way that we metabolise alcohol has really changed. And so it's much more difficult for our bodies to metabolise alcohol. So in that age group, again, no level of alcohol may be safe. So that means it's really difficult to give the whole population messages about how safe it is to to, to drink, how much alcohol is, is safe for them to drink, because it really depends on the individual, that's particularly the case as we get older.

James Morris:

Yeah, it's interesting, because in an episode, with Tom Chivers, we talk about the limitations of health risk messages. And the alcohol guidelines as just this is not particularly useful as a kind of one size fits all. But the idea, I think that that becomes even more relevant amongst older adults is, is important. And again, going back to what we were saying about recognising the the benefits, you know, some some people argue that there is no safe level of alcohol for anyone at any age. And, you know, I think sort of technically from a health point of view, that's, that's correct, in the sense that, you know, some risks like maybe cancer risk starter any level of alcohol use, albeit, you know, very tiny, increased risk factors, and the kind of more recent evidence suggesting that the heart health benefits kind of confounder effects rather than an actual effective of the alcohol. But yeah, you know, it's about being realistic that those health risks might be very smaller in the balance of people's lives overall, and some of the other benefits that they bring the alcohol is is you know, is fine and not something that we should be kind of intervening in.

Dr Sarah Wadd:

Yeah, absolutely right. the right word there is balance isn't and, of course, we know that no level of alcohol use is complete. Be safe. And I think it's really important that people have that information. And perhaps we didn't have that information 20 years ago, but also just acknowledging that many of the things we do in life are not safe. Driving a car is not without risks. And most of us will make the decision that the benefits of being able to drive a car outweigh the risks. So for just people at those lower levels of alcohol use, these are the kinds of things that people even subconsciously the kind of risk benefit analysis that they're carrying out. Just so keen to make sure that, that we acknowledge that and don't just focus on the people and the terrible problems that occur and the terrible life experiences that some people have when they do get into trouble with their alcohol use.

James Morris:

Yeah, absolutely. And I think David Spiegelhalter said something like, you know, commenting on alcohol related guidelines, there's no safe level of living, but we don't recommend abstinence from living. So yeah, everything is about trying to kind of get that balance. But But yeah, in terms of where alcohol has become a problem for older adults, what what are kind of some of the unique challenges in terms of reaching or engaging with that population? And I'm certainly conscious that I think there's a kind of legitimate reason why many people might feel like, you know, someone who drinks heavily as an older adult, that that's a pleasure that they have, and it would be wrong to take that away from them. And again, I think there's that's the kind of issue of balance, isn't it, reducing the harms without, you know, maybe recognising that there are some benefits or positives, or very understandable reasons why people do generally develop problems with alcohol.

Dr Sarah Wadd:

Well, we did do a study which which was really enlightening. And we did a postal anonymous postal survey with 17,000 people aged 15, over from across the UK as part of the drink was a 12 hour programme. And we people were able to take part no matter what their level of alcohol use. And we found that 17% were increasing risk drinkers and 3% were harmful drinkers, and the rest were kind of lower risk drinkers. And so we looked to see how those different groups, what was different about them. And we found that the reasons for drinking were different. So perhaps not surprisingly, the lower risk drinkers said they were they drank, we need to be sociable, whereas the highest high risk drinkers really drank alcohol to relax and to cope with things like stress, or depression, or pain, or loneliness, and boredom. But one of the most striking things was we asked people if they if they drank any more than they did in the past. So these are people who were older, and who are now drinking more than that when they were younger. And amongst the harmful drinkers, people who drank more. Now in the past, more than half of them said that that was because they've lost their sense of purpose in life. And that loss of sense of purpose is such a key issue for people actually, of any age, but particularly as people get older. Now, sense of purpose can mean different things to different people, it can mean it really is about what what makes us what makes life worth living to people what makes people want to get out of bed in the morning. And for some people, it might be their job, it might be caring for their grandchildren, it might be taking up a new hobby, learning a new instrument volunteering. And so when people are starting to have an issue with their alcohol use, or if we know that they've lost their sense of purpose, it's really important that we support them to develop a new sense of purpose. One of the things one of the activities that was in the drink quite a while programme and drink was edgewell was a programme that was delivered across the UK, it was National Lottery funded, huge, huge programme. And one of the things they did was they laid on social activities for over 50 years. And that was people no matter what level of drinking they had. So they included people who hardly drank at all. And also people who came through that alcohol treatment service who were who were in early stages of recovery, and just taking part in those social activities had a really positive impact, not just on their alcohol use, but that was obviously the key measure, but also on their sense of well being on their levels of anxiety and on their levels of depression. So putting people in the position where they have that sense of purpose, again, is really important if they're at risk or if they're already experiencing harm. Another really important concept is the concept of resilience. And we know of course, that life throws curveballs at us all but particularly as people get older, they go through many life transitions, things like retirement and bereavement. And that can be really tricky. So drink Weiss agewell, delivered a tort programme. To try and increase people's resilience to try and improve their coping strategies, so when these kind of things did occur in their lives, they were better able to cope with them. And they didn't necessarily have to turn to alcohol. And again, that was found to be really effective, particularly in those who entered with a low level of resilience. That they exited the torque programme, it was only I think, only about 10 weeks with much higher levels of resilience. And again, in that group, their levels of alcohol use had decreased. So there's plenty of things we can do, where we know somebody is at risk, or we know somebody is experiencing a problem with that alcohol use. And it's really important that we understand that people I've interviewed people who have been drinking have had a problem with alcohol for 50 years, and they've got into treatment, they've received the right interventions, and they're now in recovery, or they've been in recovery for many years. So it's really important that we understand that no matter how old someone is, no matter how entrenched that alcohol problem, people can still recover.

James Morris:

What's so interesting about that is it you know, certainly in terms of the sense of purpose that that really underlies the you know, the complex relationship between you know, alcohol problems and mental health or mental well being and you know, how that they cross over so much. And, you know, long history of this issue, this challenge of kind of people falling through the gaps or kind of services not working together as well as they could or even worse, you know, being excluded from one service or having a mental health issue or vice versa. But But yeah, again, I think that that applies to alcohol problems in general, but perhaps even more so or this with this kind of more stark identifies of that. in, in, in amongst older adults, particularly as maybe life events change or maybe bereavements become more common, or just ending ending work, or kind of physical health problems as well. I guess all those factors come in that can kind of really throw up this kind of these challenges around sense of purpose and mental well being.

Dr Sarah Wadd:

Yeah, it's really interesting. You mentioned mental health, because something else we did was we looked at the people who were aged 50. And over who went into the drink wise age well, treatment services, there was hundreds of people that went through the service, and we asked them questions as they entered the service. And it was absolutely striking how poor the mental and physical health was of people when they entered the service. So a quarter had been hospitalised in the last 12 months a quarter have been to a&e and emergency ambulance in the last 12 months and such low levels, such poor levels of mental health. And of course, we can never tell whether it's the mental health that has led to or contributed to the development of an alcohol problem, or vice versa, or kind of like a combination of the two. But more than half of the people when they entered the service said that they felt that life wasn't worth living. I found that really hard and hard to hear. And I think four in 10 heads had attempted suicide at some point. So when people enter those services, life is pretty tough. And one of the other things that was really interesting, this perhaps particularly relates to older adults is the very high levels of cognitive impairment and people when they were entering the service. So almost half of the people when they went into the service had a level of cognitive impairment. So that means a brain function was affected. So that all sounds pretty bleak. But the good news is when people go through a service and when they are able to cut back on their drinking, then for many people, their cognitive functioning will return to normal or it will return to almost normal and their mental health improves their sense of well being improves. Now there's no quick fixes. Of course, many people will have engineering problems, but I just think it really emphasises to me the importance of getting people the help and support they need and that as I said, no matter how old somebody is, they they can address that problem alcohol use, and they can massively improve their quality of life.

James Morris:

And, you know, the drink wise agewell programme has ended now but yeah, I've certainly heard a lot about you know, some of the successes it's had an impact and some really great stories from you know, people who've lived experience who've engaged and benefited from the programme. But yeah, also, you know, that that need for treatment services, unfortunately, alcohol treatment services have, you know, just suffered from the the kind of continuing cuts to public health services. But you know, we have had people like Dr. Tony Rao, who you know, for years have been banging the drum of the need for kind of investment and delivery of services that address these needs. So yeah, I think the cases is really strong and you know, we need to keep keep championing that and you know, we need kind of need the policy and structural level drivers that also not only Resulting in kind of support and investment in the services and kind of hopefully turning that kind of trend of disinvestment around. But also perhaps some of the more structural drivers that contribute to poor mental health and maybe sense of purpose more generally, as well, I think,

Dr Sarah Wadd:

yeah, completely. And the issue with alcohol treatment services, as you say, is just it's across the UK, isn't it, and it's, it affects all age groups. But when we speak to people who work in alcohol services, they'll often say that those services are not always best place to work with older adults. And that's not because there isn't the desire there for the workers to provide the best service because we know so many of them that they work so hard, and that they're doing their best that because they have such large caseload, often, older adults who may have very entrenched drinking behaviours, and so may require a longer period of work, they kind of fall off the list. And also, many of the older adults that we talk to say, I went to my local treatment service, and it's often alcohol and drugs, and actually felt quite intimidated by being around people who perhaps were using drugs. And they just felt really quite threatened in that environment in some work that we did a number of years ago found some older adults actually being really bullied and intimidated in residential treatment services. So the alcohol treatment sector is absolutely crying out for more investment. And hopefully we're going to see that but I think, sadly, older adults are particularly impacted by that.

James Morris:

Yeah, definitely. And you know, even in the days when there was a bit more funding around specialists, alcohol services for older adults, or kind of projects were still rare.

Dr Sarah Wadd:

Yeah, that they were often funded on a short term basis, and they did a bit of fantastic service for a short period of time, and then they went. And I think perhaps the best model pragmatically is to have specialist workers working across services. So specialists, older adults, workers, or there may even be specialist workers dealing, working with those who are quite hard to reach or hard to engage. Because we know from drink wise as well, that developing that expertise and working with older adults and, and understanding the issues like cognitive impairment and medication interactions, and this kind of what people do when when they've lost that sense of purpose when their children have flown the nest. And when they're retiring, that level of expertise can be so important. And those couple of lower case loads, I just absolutely vital to the recovery of some older adults, although I should should say that also when when we spoke to some older adults that they really didn't want to go into a specialist services, they said, why would I want to do that, but I'd much rather be with with people of any age, and they felt quite vitalized by being with younger people. So So of course, nothing, nothing suits everyone, does it? We have to think of people as individuals. Yeah.

James Morris:

Yeah. And again, that's like the kind of upskilling or training of people from, you know, across the kind of health and social care and wider community sector as well to, you know, have that understanding about alcohol use, and the risks and cognitive impairment and those other issues and be able to kind of, you know, do kind of brief interventions or referral, where, where appropriate, I suppose.

Dr Sarah Wadd:

Yeah, and one of the other things that didn't, I said, well found, which is actually really cost effective intervention is peer groups. So groups of people aged 50 and over supporting each other, and they do have to be managed in the right way. It's not a case of just spelunking people in a room and saying chat and have a cup of coffee, they do need to be managed, but people seem to get so much strength out of that peer support and so much strength out of talking to people who aren't who weren't the same kind of placing their lives in a really understood that the kind of stresses and strains they were under. And for the amount of money for the cost of delivering peer support groups for over 50 years. You just think why isn't every service doing them? Because they just they had really, really good results. And people really enjoyed going to them?

James Morris:

Yeah, that's that's super interesting, because I think there's been an expansion or growing availability of peer support, particularly online, I suppose with with a pandemic. But yeah, I think there's a general view that the kind of mechanism of peer support whatever kind of philosophy or approach it takes is that is that kind of strength of identification and support that you gain from from others. So yeah, I think that that makes a lot of sense. So what about in terms of a pandemic and older adults? Do we know much so far about some of the effects there's had and some of the ways that we might be able to kind of respond to that? Yeah,

Dr Sarah Wadd:

well, obviously the evidence still emerging, but we think it's quite similar to other age groups in the sense that perhaps the majority of the population of the population of over 50 is that the alcohol use hasn't changed that much. So they need neither increase their drinking or decrease their drinking. But there is a group who has increased their drinking. And these are, tend to be people who already used alcohol to cope. So they may be heavier drinkers, they often drink alcohol, because they're bored, or they're lonely or because of that, that's loss of sense of purpose. And of course, in lockdown, so many of us have experienced that. And there is yet another group who actually reduce the alcohol use during lockdown. And that tends to be people who perhaps were social drinkers, so they would only drink when they went out with friends. And of course, during lockdown when that was taken away from them. They weren't doing that so much so that alcohol reduced. So it does seem to be a bit of a split, but because older adults are more likely to live alone. And because many older adults with alcohol problems, as we've said, have actually got pretty high levels of anxiety and depression. For many people. It has been a really, really tough time. And it's also interesting that we did some research that was led by my colleagues, Paulina Trevino from Glasgow Caledonian and Janice Seddon from the University of Bedfordshire. And they interviewed people who were in recovering during lockdown. And some of the stories that people told were actually of finding finding lockdown a really positive experience that really helped them in their recovery. So somebody said it was a godsend, lockdown was a godsend, because of course, they had less access out there, their friends weren't going out drinking, so it's much easier for them. And somebody else said his friends were going out and doing the shopping. So he didn't have as much alcohol. So he said it was a river running dry. Rather than it was him deliberately cutting or able to cut back on his alcohol use, it was just the kind of environment at that time meant that there was less alcohol around it and less social drinking. So it of course, it just highlights that people are just such a diverse group, aren't they and for some people, the lockdown has had a negative impact on the drinking others, it has had a positive impact. But we need to make sure that the people who have perhaps have increased their alcohol use a little bit or who are now struggling with their drinking, get the support that they need, and get the support in in the way that they choose to have it.

James Morris:

Yeah, on the COVID episode that we did, you know, we had that kind of rich diversity of experiences, including not unsurprisingly, the different lock downs, you know, have been whether it was the weather or what what was going on with their work, or their family networks. They're all there's so many factors and variables at play. But yeah, we did have one person who was saying they'd recently given up drinking, but the pandemic help because the pubs were closed, then that's what they felt that there was going to be the danger or trigger point for them was that, you know, they like to go into the pubs and drinking, but just knowing that they weren't open was was a big help

Dr Sarah Wadd:

course. And that's why for the interesting to see how that kind of pans out in the long term with the people who've reduced the alcohol use will continue without lower level drinking, and people who've increased alcohol use will will continue with that higher level of drinking as well, we just don't know yet any time will tell.

James Morris:

But again, you know, and as you're describing, then the importance of those environmental contacts, you know, underlie why, you know, there are such strong calls for, you know, curbs on pricing and availability and, you know, good evidence to support those in terms of kind of the structural drivers of levels of alcohol use in homes, and I think in turn the way that they kind of do shape cultures and attitudes and norms. So yes, still lots to do in terms of going forwards both, you know, kind of at the structural and policy level, and as we've discussed, you know, the interventions that we can do on the ground, but I think you've given a you know, really good insight into some of the issues, you know, will be very complex, and some of the things that can and have been done that can make a difference. Are there any final reflections or how does all this work? Does it kind of inform how your own relationship with alcohol?

Dr Sarah Wadd:

Yeah, it's interesting because I've never really drank alcohol which people find quite strange for somebody who spent the last kind of 20 years in alcohol and drug research and there's no particular reason for that. It's just I've never really got that many benefits from it. But my research does constantly have an impact on me and I think this kind of study that I've described about looking at the the use of alcohol and care homes and really speaking to older people and saying how central it is to their life is really made me rebalanced my thinking because coming from A public health background whilst I've always thought people should be able to make their own choices, it's really just made me understand that kind of risk benefit analysis and where that lies and where that lies particularly in the population that I focus on. And that's people aged over 50. So we don't want to focus only on people who have alcohol problems. So that's, that has been the group that that is my most of my research has been focused on and it will continue to focus on and it gives me because of the great distress when I when I see some of the the poor mental health and poor physical health that we see from the people that we interview, and that have gone through the rigorous edgewell service. But also acknowledging those that for so many people, alcohol is a pleasure. And that it's really important that we we don't try and push the the messages about harms too hard and alienate that population who may just decide to cut back a little bit because they're experiencing negative consequences. We need to be thinking about the whole population and be equally concerned about the whole population.

James Morris:

Yeah, I completely agree with with everything you said there. And I think it's really impressive that for someone who alcohol doesn't really do anything for you can still recognise that, you know, certainly in moderation or, you know, carries lots of benefits for other people. And you know, have such a kind of nuanced understanding and take on, on trying to fight how we try and find that balance. And I think you and, and other colleagues through the drinkwell agewell programme, and Tony and others that have been doing this for a while have been have done a really good job in terms of trying to really raise this issue, because I think there is a stigma and reluctance to address kind of issues amongst older adults in particular. But thanks so much for coming on the show.

Dr Sarah Wadd:

It's been my pleasure, thank you.

James Morris:

Next I spoke to john Slater about his lived experience of alcohol problems and recovery. This contains a brief mention of childhood trauma, which may be upsetting for some listeners. So thanks so much for joining me, john, can you just tell me a bit about your story and how an alcohol came into your life or how it came to be a problem?

John Slater:

Yeah, I suppose the place to start maybe is where it became a problem. And then I can track back from there. But essentially, I wasn't working. And my parents and step parents were ageing, kind of before long, I found myself being the main carer, you know, with Parkinson's and Alzheimer's, immobility, all sorts of problems, really. So my life kind of really quite drastically changed. And I found myself cross crossing quite a number of boundaries, in terms of care. And what I needed to do. Now I was really struggling with the fact that my life was getting tied into this, and there was resentment. But I really wasn't happy with that resentment being there, because I love these people. And I found that quite that really quite difficult. And I also found that wasn't a lot of help when parents become like that. And I kind of got stuck in a situation that I couldn't change that I hadn't expected to be in. And I guess that's no different from a lot of other people at my age, who may be seeing parents are becoming ill, or there's bereavement or you lose work. Kids are leaving home all the things where life starts to change, so I couldn't really change what was going on. So I kind of started to change my state, if you like, and I found I found a glass of wine was a great escape in the evening. And then gradually, you know that one glass became two became a bottle became two bottles, became unaffordable, became the cheapest one I could find and became secret, a lot of guilt and I'd really, really knew I got a problem when I found myself hiding bottles in a recess in the cupboard. So people wouldn't know and it kind of made me relate to things I'd I'd seen, you know, being psychiatric hospital and seeing guys on the addiction programme and how they would they would hide the bottles, bottles of booze in In the hedge on the way in, so I kind of felt I wasn't in control of this anymore. And it just started as something enjoyable. You know, it's just a way to relax into our mind lack of shows, so many people do. And then suddenly, you've got this problem that I couldn't control. And I really couldn't believe I was I was in that situation.

James Morris:

So did you say suddenly? What over what kind of period of time did it really do think turn from something that you might have described more as no a bit of relaxation to something that became a problem.

John Slater:

That's interesting, isn't it, because I say Suddenly, I think the realisation is sudden, but you know, that probably not that long, though, not just probably built up over a few, a few months, you know, just just gradually gradually increasing. And, you know, I look back at quite staggered me, or the amount of alcohol that I could actually, I could actually take and not fall over or, you know, find that I could still function, which, which is another part of the problem. Really, you know, I didn't suddenly hit rock bottom, I kept going, really. But I think there's another side to why it became a problem. But really to do with my own my own ways of coping, in that I'd had, I've had trauma in my childhood. And I think that left me a difficulty in how I might actually deal with things. And life. And I remember seeing a documentary about someone and trying to work with them with their issues around drinking excess alcohol. And he went to see a psychiatrist, and the psychiatrist said, Oh, this is this is most likely around bipolar disorder, we need to take this really seriously, you need to start medication, and science, he said, he saw it in that light, and then the specialist around alcohol, saying, you know, what, we need to concentrate on this stuff, and you're drinking alcohol, that's the only thing that matters. That's our focus. Then he went to see a clinical psychologist, and they talked. And behind all this emerged about his childhood, or a sexual abuse as a child. And that was, that's a similar situation for me, and I see many older men, as I, as I work for a male survivor support group. I see many of those men who struggle with drugs and alcohol. And it's, it's a kind of means to cope, I think, when you can't cope, it's, it's a means to escape, especially when you're stuck. And you can't resolve or you can't move on. It's It's such a way to try and be there, it's a way to try and keep going. Until it's it's it's no longer possible, really takes you over.

James Morris:

And I think that that's a really powerful example of I think what happens, in many ways that the problem, alcohol problems is that we often focus on, as you've kind of said, the alcohol itself, but also kind of life events that might maybe trigger an onset of heavy drinking or alcohol problem development. But actually, you know, those triggers kind of get the focal point where it's actually there's a whole story and life and set of experiences that we carry in into those trigger points that are kind of there and might get overlooked. So yeah,

John Slater:

and I think the important point about that is it's not it's not a separate issue. I don't think it's a case of, yes, I got a problem with drinking. And I also happen to have a mental health problem. To me, the two are inter intertwined decision, this was my means to cope. So even when we talk about, I know there's talk about your diagnosis where we actually need to look at the fact that person has an alcohol problem or a mental health problem. But you know, to the actual person, they're one and the same, then they're not separate. And you don't deal with that. And often there's this thing of let's deal with the alcohol issue. Then we can look at getting new, some psychological support around things or psychiatric support, as if they're two separate things. And I think that also makes people very wary about somebody entering into say trauma therapy, if they're dealing with their alcohol issues at a certain point. Something may well be the case but I found it very helpful when I did get support around my alcohol but I was also seeing a trauma therapist and those people were able to work together and the whole point in a way around the trauma therapy, it there's this idea that you're dragging up the past and Is this the time to be doing that when you're trying to reduce your alcohol was actually was actually going on within the trauma it was helping me understand about the difficulties I was having emotionally in coping with my emotions, because of the trauma and how to find other safe ways to be which actually helped in the long term with me being able to let go the alcohol without feeling that I wasn't safe anymore because that was you know, the outcome was my way of coping and to let go of that I needed to have other ways to cope and to and to feel safe

James Morris:

so can you tell me a bit more about how you found out cold support services and what happened what role they played in in GE I don't know if you use the term recovery or see it in that way but

John Slater:

Well, I I don't know I knew I needed to do something I think that was the thing I was I was I knew I was drinking excessively and it's quite difficult because there's there's things that draw you away from doing anything about it there's there's the fear of finding out that you're doing yourself damage if you want to stop that damage and there's social factors so you know if you talk to friends about it, and it's like oh, we can it's not that much you know, you needn't worry or or the opposite when you say you think you got a problem you want to wait till you get it down in larger bottles of vodka and this and where I've been so that kind of throw your back but I guess what drove me to do something about it was I knew if I kept drinking like that it wasn't going to be good news on I was already feeling abdominal pains I was becoming moody at home and it was it was affecting my my family I'd have a very short temper so that kind of drove me to the surgery waiting room and you know I remember sitting there outside the door waiting to go in front of things you know, why can't I cut this down? What am I doing to myself? What are they going to think of me I quite hated myself I felt quite old and quite stupid and I was very afraid that they were going to tell me I was an alcoholic and I needed to go to the gay meetings or something like that. And I really worried about having another label on me having already had that in the psychiatric system on another label to cope with and so really when I got in to see the doctor I it's difficult and you kind of leave it right to the end and you just mentioned it in passing you just minimise a bit and I got a blood test and that came back all right so you think oh that's okay and then you get the odd leaflet but nothing really happened and there was all those things you know, I thought should I approach drug and alcohol services and mobile they laugh at me think it's not that much of a problem or something all the opposite, you know, I've find my whole life being taken over to to deal with this stuff. But I just like other people, I think when you got a problem, you just start googling. You just start searching on the internet. I came across this organisation called drink wise agewell working with people have alcohol issues with people over 50 so I thought I would you know, I would I would give that give that a go. And it felt a really big step to ring them. I felt very nervous about that nearly backed out and I think what you know from what I've been used to in the past what was so lovely is is somebody just had a chat with me. We we just had a really good conversation. And as the conversation went on, I started to feel safe. I I felt welcome. I didn't feel we were going through a tick box process. And you know, if if this person was assessing me on the phone, I certainly didn't notice that or feel that. And I think what helped there considering all the stigma and everything. It made me feel at ease. It didn't didn't scurry away. And that, in turn, helped me get to the first meeting I had with a worker in the organisation with Carrie, which was, you know, brilliant, it was only a few days later. And I think the second bit was that I, I was in a nice, we know, when we met, it was a nice place it was it was a nice community centre with a cafe, there were exhibitions on a normal life was going on, it wasn't going somewhere separate, different, or that had, you drink too much alcohol stuck all over the top of it. So I kind of, you know, that kind of felt Okay, so that was the start of trying to work with this. And we sort of built up trust, we work together. And I think what was lovely it was it was collaborative. I wasn't told what to do, if you like, and we just work together on it. And that really helped me helped me discover what I needed, and wanted to do. And as we worked, you know, we worked on what was my relationship with alcohol without actually labelling it without saying, you know, because I did discuss how am I an alcoholic? What, what is happening here. So, so we held off from from sticking on the labels I and just sort of tried to work it through what might help. And I think it was really good to be with people that didn't, they didn't present as they know, we know better. You know, I didn't feel I was sat in a room with this professional telling me what to do. And some ways you kind of want that, don't you? It's that classic doctor thing, you know, help me get better Help me Help me stop doing this. But in the end, it was far more valuable to have somebody that was going to work with you to help you work it out with their support and with others, because then you found a way of dealing with things that would stick rather than diminish?

James Morris:

Yeah, I think yeah, that's, that's part of the appeal of of labels is a way of trying to identify a problem and put a name on it, then then that kind of implies that you've identified the problem, and therefore, you can identify the solution. But yeah, I think as your your story explains, or illustrates, so well, that, you know, these things are so much more complicated than that. And, you know, labelling can be important for some people, as part of that process of making sense and recovery through certain routes. But I think for most people, whether they label or not, there is also that more complicated unravelling and exploration of it of an alcohol problem and everything that is connected and lies beneath it. And just as you say that, that kind of need for a kind of non judgmental, you know, non kind of finger wagging or telling kind of approach from, from anyone that's kind of helping you do that. And I guess that's a big part of the value of peer support is no one has that kind of position of power as a kind of practitioner. But yes, any good practitioner really tries to ensure that the person feels equal and that they're the person that will ultimately be doing the work and that the practitioners role is more of a guiding one.

John Slater:

Exactly. So that's how I feel I was met with, you know, skill rather than power. And really, it was it was more, more than somebody having power over, it was empowering. By the, by the, by their intervention, or, you know, even down to things I noticed that, you know, there was a point where Carrie did sort of lay into me about what I was doing, you know, the damage and the risk. And when I thought was so skillful, he did it at a point where I wouldn't walk away, if he did done it. And another point, I'd add could have felt quite ashamed and just, you know, out the room might not, might not come back. And it was that intense patience of working with things, I think there was so important rather than trying to process you and get you through and get you sorted if they could, it was a case of you know, they would hold the hope he was holding the hope for me even when I couldn't see it. And we tried all sorts of different you know, we tried different ways of cutting down little techniques to not start drinking so early in the day, understanding about the amount of calories I was doubling your calorie intake by by doing that, no to a whole load of things around that and amazingly, you know, through all that, I did get to a point where I thought, why I need to stop. I couldn't take the idea that I would never drink again. So we just arranged that, prepare, and then I would stop for a while. And we'll see how it goes. I managed that for I think about four months. And then I'm starting to then you start to think, okay, so I'm managing. So does that mean, I might be alright to drink or doesn't it? So maybe I could control it. Now, I found that break. And we talked about that i was i was gonna go away on holiday to France. And I thought, it's a lot of wine in France, isn't it, it's gonna be tricky. It's part of the fun to go in there. And we, I was going to a group as well, then we talked to every people in the group. And then I made my own decision that I, it would be best if I didn't. And I got to France. And then on a lovely sunny day, and I thought I've come on, you've managed so well, what's what's wrong with one class, and I had one glass of wine on my 60th birthday, in a garden overlooking the sea. And I thought, that's fine. I don't want another, it's okay. But then I had another glass The next day, and then two glasses a day after that. And by the end of the week, I was I was having bottles of wine in, in the currently in the cottage there. I thought, Oh, okay. And I think that was the point I've learned for myself. Yeah, no, you have to stop. That's the that is the only way you can you can manage it. So that, you know, although it set me back, it was a useful lesson to really understand where I was, what I needed to do. And when I when I came back from the holiday, and I went to the group of MoMA. So first reaction was to Bly not say anything about this whatsoever. But then I thought, well, what the heck is the point of being here, you know, because I was, you were sitting there with people that wanted to just cut back a little bit. So people that were just about to go into rehab, but but found that group, and that support, very helpful. So that helped me to be honest about it, really, and with the support of that group, and carry the worker, you know, I managed to build up over the next few months to how I would tackle that, again, and managed to, to deal with that. But I think there's what also helps is, is within the group work when you have in these groups, is it's really helpful in little practical ways. even talk about ideas about how you cut down and people have tried this non alcoholic, you know, is it any good and all sorts of different things like that, but we also came up with things for ourselves. So I think we encouraged us to do and we came up with the idea of having an art exhibition, because a few of us sort of got an art background and things. And that really helped working on that, because I become quite isolated in life and sort of pulled away and, and that really helped me get in contact again reminded me that I did have skills, I did have abilities, I wasn't worthless. And it was great to be connecting with other people and actually doing something positive. And that in itself started being my way back into life is like, you know, where the problem came out with a life if you like, so the concentration wasn't purely on alcohol, it was on the relationship of alcohol with the rest of your life and you know what else needs what else needs to happen in your life, that's going to help you deal with alcohol and a better way that that's gonna help you not use repeating behaviours, addictive behaviours to actually manage to cope.

James Morris:

And, and that's something Sarah identified as a, you know, consistent theme across all of her research. You know, it's that kind of sense of purpose or loss of sense of purpose that is often the kind of underlying reason or trigger for kind of many older adults drinking and that's why programmes like drink wise age well partly have been so effective is helping people to kind of regain that in some way. So is that is that how you kind of see it from here and going forward, just continuing to kind of build those kinds of things that kind of maybe heavy connections and meaning and I know you're you're involved with setting up and running a social enterprise and I guess that kind of keeps you pretty busy and gives you a strong sense of purpose as well. Is that how you say going forward

John Slater:

Yeah, and I think it shows the value of that kind of approach, you know, when you're treated as a human being when and when it's not only group work, but you're understood individually, and it's collaborative. And you can start to connect them. And if I think, you know, effective, what had happened to me is I'd had a series of episodes around mental health, I'd ended up in psychiatric hospital, three times, in the end, I was encouraged to go on an ill health pension, which I eventually did, and to be medicated, basically, you know, people say, well do this for two years and see how you go, then people are assuming you're on these medications for the rest of your life, and you become, you've come to feel very worthless and separated from society, you know, you had all this value in the work you were doing. And then you know, that that's all gone, and you don't really feel trusted or worthwhile. And then, you know, by this type of approach, and this work, you can start to see the worth in yourself, you can start to be empowered, you can start to connect, you start to connect to other people. And then, you know, yeah, it's amazing, you know, so out of that, not only did drink wise, agewell helped me work through these issues. But they also helped me reconnect, and they did it in a very direct way to start with, so they asked me, if I'd do some voluntary work with them, and some lobbying around the issues, then go into a meeting in London, meeting MPs, and going around the house of commons. And, and I guess I was, I was starting to feel, you know, that you were working with researchers, and professionals in the field, and you with your lived experience, and others with lived experience on a really, genuinely equal basis, you know, not just wheeled in, so we can, we can share, we've got some people with lived experience, but I mean, that they built their programmes up on those three elements, using those three types of expertise. And I think that's why it was so successful. And, and for me, it really did help me gain the confidence, you know, certainly, it helped me go back to work. And, you know, I've now created my own company. And as of the first of September, I will be paid full time, I'll be adding a living again, after 15 years, unemployed, effectively. So it's, you know, that's what it does, you know, it builds you, it doesn't mean, you don't have scary moments, or you think, Oh, God, am I up to this, what am I doing, but it gives you the skills to, to manage that. And I guess, with all my experience that I've had, over the years, from my mental health problems, started back in the 90s is, one thing I think I've learned and I look back on is, you know, all the issues around mental health. And the psychiatric admissions, and the medications that I calculated has cost in the region of 62,000 pounds. And not to mention the amount of money I lost in earnings. But that's what it's probably cost the country. And then I look at what has really helped, which is trauma therapy, which would be about 3000 pounds, low cost, support from drink wise, agewell and voluntary peer support. And here I am, you know, being able to function and enjoy life a lot more and not be dependent on substances. And I just think, you know, that to me, that just sounds a much better deal not only for me, but for society and for the public purse. And I think if we want to see more people and older age, you know, managing to cope with life and recovering from excessive use of and substances for all of us really, then we need to take that very seriously and not just keep doing the same thing, because that's what we've always done.

James Morris:

Yeah, absolutely. I think the you know, it's a long running issue in alcohol treatment and prevention. That Yeah, we just haven't been taking the opportunities, policy wise and investment wise to address it upstream particularly in terms of prevention and drink wise, Ah, well I think mainly lottery funded or entirely lottery funded, you know, there's been so much so many good stories and, you know, feedback around it. So, you know, kind of has shown that that those kind of approaches and you know, really, really are worth worth investing in, but we just need to keep making that case and trying to build kind of public support to kind of pressure political support as well as I think some of the broader structural stuff like minimum pricing and restrictions on advertising perhaps, but but john, thank you so much for, for coming on and sharing your story. That's, that's a, you know, a really powerful example, I think of, you know, some of the ways in which our core problems can affect older adults, but but the ways in which there are, you know, ways that we can support that and you continue to, you know, by sharing your story and doing the work that you're doing now, I think kind of giving a lot back, so thank you again, so much.

John Slater:

Yeah, thank you, James.

Dr Sarah Wadd
John Slater