En español | Imagine Jen, a recently retired 67-year-old daughter, who moves into the home of Clara, her 91-year-old mother with moderate dementia, to care for her after the pandemic forces Clara’s adult day program to close. Fearing infection, the two women go out little. Jen tries to break up the dullness of their days by pouring them each a glass of wine during dinner. After a few months, she finds she is also having a glass in the afternoon whenever she’s stressed by Clara’s repetitious questions. Before long, Jen is taking a third glass before bed to help her fall asleep. She notes to herself nervously she has never before had this much alcohol daily. But she rationalizes that wine is helping her cope during these extremely tough times.
According to the American Psychological Association, nearly 1 in 4 American adults, like Jen, have been drinking more because of COVID-related stress. Other studies have found that women, more than men, have increased their drinking to excess. Health officials are concerned these increases will lead to bad health effects, including hypertension, liver disease and alcohol dependency.
Many studies over the years have linked caregiver stress and increased alcohol use. While there are no published studies yet about the pandemic drinking of family caregivers, it stands to reason that more of them — especially the 60 percent who are women — have been turning to alcohol.
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Unlike cocaine and heroin, alcohol is a legal substance that many Americans use to relax after a hard day’s work or when out with family and friends. In moderation, it may even have good health effects, including reduced heart disease. But there has always been strong justification for medical concerns about overindulging too often. Most caregivers realize, too, that drinking too much compromises the care they give to their loved ones. How can stressed caregivers gauge whether their drinking is a problem? Here are some ideas:
Figuring how much is too much
According to the Dietary Guidelines for Americans 2020–2025, moderate drinking is considered two drinks per day for men and one for women. The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking for men as more than four drinks a day or more than 14 per week; for women, three drinks per day and more than seven per week. These are general guidelines that don’t apply to everyone. Those with certain conditions, such as pregnancy, or on certain medications may be advised by their doctors to not drink alcohol at all.
By these guidelines, Jen would be considered a heavy drinker. But caregivers need to take into account other factors to determine whether they should consume less. Genetics matter greatly. If a caregiver has a parent or sibling with an alcohol use disorder, or any other substance use disorder, then they may be genetically susceptible to developing a drinking problem and should keep a tighter rein on how they use alcohol.
Consider using an alcohol screener
Because it is often hard to determine whether a person’s alcohol use is or isn’t an innocent pleasure, health care professionals often use short screeners — such as the CAGE questionnaire, Alcohol Use Disorders Identification Test (AUDIT) and Michigan Alcohol Screening Test (MAST) — to quickly gather diagnostic information. These screeners are available online for caregivers to test themselves and then bring the results to their primary care providers to discuss.
For example, the CAGE asks four questions about whether an individual has thoughts about cutting down on drinking, feels annoyed by others’ criticism of her drinking, feels guilty about her drinking, or drinks as soon as she wakes up. The more affirmative answers a caregiver gives to these questions, the more likely she is drinking too much.
How to cut back
Increasing awareness is the first step toward any behavior change. Caregivers should keep track of the number of drinks they are having. Oftentimes, this is enough to give them increased control over their intake and then choose other ways to manage stress, such as taking a walk, talking with a friend, or using breathing exercises. Or they may decide to eliminate a drink they’d ordinarily have at a certain time of day. If these techniques don’t work, then caregivers should discuss the situation with a health care provider.
When she realizes she is having three drinks every day, Jen decides to eliminate her bedtime drink and instead take a non-habit-forming sleeping pill her doctor prescribed. She also decides to join an online yoga group to reduce her stress. She hasn’t given up all alcohol — she doesn’t want to — but feels like she is no longer risking her health by her pandemic drinking.
Barry J. Jacobs, a clinical psychologist, family therapist and healthcare consultant, is the co-author of Love and Meaning After 50: The 10 Challenges to Great Relationships — and How to Overcome Them and AARP Meditations for Caregivers (Da Capo, 2016). Follow him on Twitter and Facebook.