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Why Age and Alcohol Don’t Mix

Research shows we process liquor differently over time. What does that mean for your health?

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Early in the pandemic, my drinking changed. Our 20-something daughter fled New York and moved back home, bringing Brooklyn cocktail culture with her. Mules, Manhattans, margaritas, martinis — my beer-or-wine routine was pleasantly upended. But despite a half century of (mostly) sensible drinking experience, hangovers suddenly became more frequent.

Our family wasn’t drinking alone. During the early days of the pandemic, 14 percent of older adults reported drinking more, according to a national survey by University of Michigan researchers. (However, 27 percent drank less, possibly because work-related and social drinking became less frequent.) Of those ages 50 to 80 who do drink, 23 percent downed three or more drinks in a typical session.

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That’s unhealthy for anyone. But it’s especially unhealthy for people our age because we can’t process alcohol — or deal with its effects — as well as we used to, says Alexis Kuerbis, an associate professor at Hunter College of the City University of New York, who has studied alcohol and other substance use among older people.

Excessive drinking accelerates some of the aging process in the brain.​

“It’s about age 50 that these biological processes start happening,” she says. Specifically:

  • Your body loses muscle, gains fat and carries less water in the bloodstream. Because muscle holds more water than fat, this means there’s less water in an older body. So any alcohol you consume isn’t diluted to the degree it was when you, say, pounded beers in your 20s. Result: a higher blood-alcohol content.
  • Your stomach and liver don’t produce as much of the alcohol-digesting enzyme called ADH, which leads to a higher blood-alcohol content that’s sustained longer, even if you’re not drinking any more than you did when you were younger. Women have less ADH than men to start with, which is why they are less able than men to clear alcohol from the body.
  • Our ability to perceive the effects of alcohol diminishes after age 50. We’re less able to sense whether our reflexes or balance has been diminished, so we don’t gauge our sobriety as accurately. “Just like our eyesight might fail or hearing might fail, our perceptions are failing,” Kuerbis tells me. “We can’t sense that we’re getting more intoxicated as we age. We think we’re fine.”

But we’re not fine, says George F. Koob, and he should know: At 74, he’s the director of the National Institute on Alcohol Abuse and Alcoholism. We perceive ourselves as having more tolerance than we really do, and that misperception only increases the more intoxicated we become — so that fourth beer at the barbecue seems to be having little effect. “The body doesn’t pay attention to those signals the way it did the first hour,” Koob explains. Which is why too many of us slide behind the wheel instead of calling an Uber.

Dehydration is a factor in hangovers

And what about my more severe hangovers? Those are partly from dehydration, a common condition among older people, sober or not. (Our sense of thirst, funnily enough, is dulled with age.) Alcohol pulls water from your body, hence my cotton mouth and headache.


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I ask Koob if just drinking more water would dilute the alcohol in my system. Nope. “You’re just going to pee more,” he informs me. Staying hydrated may help limit a blood-alcohol surge, he says, but the physiology of aging will prevail. And the old trick of alternating drinks with something nonalcoholic can help you pace yourself, he adds. But that system may indicate you’re still planning on drinking too much in one session and risking harm to your liver.

How much is too much booze?

The old standby maximum of 14 drinks per week for men and seven for women is still a solid guide, though emerging research finds that really no amount of alcohol is safe for our health. Drinking at levels beyond that “accelerates some of the aging process” in the brain, Koob says. Our brains normally start shrinking in middle age, but older people who drink too much show marked loss of volume in the frontal cortex, a 2018 study found.

The frontal cortex controls our executive function, Koob explains. Impulsive and compulsive behavior can be affected and lead to alcohol misuse. It’s a vicious circle: Alcohol misuse can speed up aging, and that aging process can lead to more alcohol misuse.

Koob estimates there are 200 medical conditions that are worsened by alcohol, including the obvious, such as liver disease, as well as some not so obvious, like cancers, especially oral cancers. Others include high blood pressureimmune system disordersstroke risk and diabetes.

Alcohol even contributes to wrinkles by impairing your skin’s antioxidant defense system.

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And the notion that alcohol helps us sleep is bass-ackward — it may make us drowsy, but it wrecks the quality of our sleep.

When to dial back your drinking

I’ve always been healthy and fit, and I kid myself that a little poison can’t hurt me. But by pushing the 14-a-week limit at my age, I’m also pushing my luck.

I don’t want any of those problems, so I have joined the ranks of the “sober curious,” a newish term that essentially means being both thoughtful and challenging of your drinking impulses. As a guide, Koob suggests abstaining for a certain period to see how it feels. “If you feel better when you’re not drinking, your body is telling you something.”

It’s true that I sleep better and feel better on mornings after abstaining. My drinking — mostly beer in the summer and wine in cooler months — tends to be mindless and habitual. Which is why the “mindful drinking” movement appeals to me. Make it less of a habit and more of an event. Ideally when I drink, I’ll pause and ponder the intriguing viognier in my glass before raising it to my lips. I’ll savor it.

Rosamund Dean, in her book, Mindful Drinking: How to Break Up With Alcohol, suggests carefully counting how many drinks you have — and noting where, when and why the imbibing happens. There is, she suggests, a middle ground.

“So while we don’t want to give up drinking altogether,” she writes, “we do want to wake up clearheaded because we were able to resist that third glass of wine the night before.”

Sounds like a plan.

Editor's note: This story, originally published March 04, 2022, has been updated to reflect new information. 

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