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Alcohol, medicines and mood in later life
Why the same drink hits harder after 65, how alcohol mixes with common medicines, its links to sleep, grief and mood, and how to cut back or get help.
Many people enjoy a glass of wine with dinner or a beer with friends. But the body handles alcohol differently as we age. A drink that felt fine at 50 can cause dizziness, falls or confusion at 75, especially when mixed with medicines. Some people also start drinking more after retirement, the loss of a spouse, or when sleep gets harder.
This guide looks at alcohol through the lens of later life: body changes, medicine interactions, and the links between drinking, sleep, grief and mood. For the basics, see Alcohol and older adults.
Key points
- In 2024, about 45% of U.S. adults 65 and older drank in the past month, and about 11% binge drank.1
- With age, the same amount of alcohol leads to a higher blood alcohol level because the body has less water and muscle.2
- Alcohol can be dangerous with sleep, anxiety, pain, and cold and allergy medicines.2,3
- Drinking to improve sleep can make sleep worse, and alcohol can worsen or come before depression and anxiety.2
- Brief counseling from a primary care provider helps people who drink at risky levels.4 Strong evidence
How common drinking is after 65
In 2024, about 26.6 million Americans 65 and older drank alcohol in the past month. About 6.8 million binge drank, and about 2.9 million (about 1 in 20) had an alcohol use disorder in the past year.1 The number of drinkers in this age group grew by about 80% from 2002 to 2019, mostly because the baby boomer generation is so large.1
According to the CDC, about 41% of all deaths caused by alcohol in 2022 and 2023 were among people 65 and older.1
Why alcohol hits harder with age
As we age, we lose muscle and body water. That means the same drink leads to a higher blood alcohol level than it did when we were younger.2 Older adults are also more sensitive to alcohol's effects on balance, coordination, attention and driving.2 Aging also slows the body's ability to break down alcohol, so it stays in the system longer.3
As a result, older adults can run into problems at lower amounts than younger people. Women may be more sensitive than men.2
What counts as risky? For women of all ages and men 65 and older, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines risky drinking as more than 3 drinks on any day or more than 7 drinks a week.4 For some people, especially those who take certain medicines or have some health conditions, the safest amount is none.2
Check your own drinking with our free AUDIT alcohol test or the quick alcohol check.
Alcohol and medicines
Older adults are more likely to take medicines that interact with alcohol, and often take several at once.3 Some combinations are dangerous.
| Medicine type | What alcohol can do |
|---|---|
| Sleep medicines (such as zolpidem, temazepam) | Drowsiness, slowed breathing, memory problems3 |
| Benzodiazepines for anxiety (such as alprazolam, lorazepam) | Slowed or stopped breathing, poor coordination, overdose3,5 |
| Opioid pain medicines | Drowsiness, slowed breathing, overdose3 |
| Allergy, cold and flu medicines (antihistamines) | Drowsiness, dizziness3 |
| Acetaminophen (Tylenol) | Liver damage, especially with regular drinking2,3 |
| Aspirin and NSAIDs (ibuprofen, naproxen) | Stomach upset, bleeding, ulcers2,3 |
| Warfarin (blood thinner) | Bleeding, or with heavy drinking, possible clots or stroke3 |
| Blood pressure and heart medicines | Dizziness, fainting, changes in heart rhythm3 |
| Diabetes medicines | Dangerously low blood sugar3 |
| Antidepressants | Drowsiness, dizziness, worse depression3 |
Some herbal products, such as kava, valerian and chamomile, can also add to drowsiness with alcohol.3
The FDA warns that mixing benzodiazepines with alcohol or opioids raises the risk of overdose and death, mainly from slowed breathing. Do not drink while taking these medicines.5 If someone is very hard to wake or is breathing slowly, call 911.
Never stop or change a prescribed medicine on your own because you want to drink. Ask your doctor or pharmacist which of your medicines are unsafe with alcohol.
See also Medicines that can affect mood and memory.
Alcohol, sleep, grief and mood
Sleep. Many older adults use a nightcap to fall asleep. But drinking to improve sleep can make sleep problems worse.2 NIA advises avoiding alcohol for better sleep.6 See Sleep changes with age.
Mood. Alcohol misuse can worsen depression and anxiety, or come before them.2 A drink may calm nerves for an hour, then leave you more anxious the next day. See Anxiety in later life.
Grief and loneliness. Loss, retirement and living alone can lead some people to drink more. Drinking to cope with grief can deepen low mood and isolation. See Grief and widowhood and Technology and staying connected.
Memory. Alcohol misuse is linked to faster decline in memory, thinking and judgment.2 Heavy long-term drinking can cause alcohol-related brain damage. See Alcohol-related dementia.
Other health effects
Alcohol raises the risk of falls, car crashes and other injuries in older adults.2 More than 1 in 4 older adults falls each year.7 Misuse can also worsen chronic pain, heart disease and diabetes, and is linked to several cancers.2 See Falls and fear of falling.
Signs that drinking may be a problem
Alcohol problems in older adults are easy to mistake for aging or illness. Possible signs include:2
- Memory loss or confusion
- Depression or anxiety
- Poor appetite
- Unexplained bruises or falls
- Sleep problems
- Less care about cleanliness or appearance
Other signs: drinking alone, hiding bottles, drinking more after a loss, or getting upset when someone mentions it.
What helps
Brief counseling in primary care
Strong evidenceThe U.S. Preventive Services Task Force recommends that primary care providers screen adults, including older adults, for unhealthy drinking and offer brief counseling to those at risk. Most programs were short, often one session of about 30 minutes, with feedback on how your drinking compares to others and a plan to cut back.4
Talk therapy
Strong evidenceCounseling such as cognitive behavioral therapy, motivational approaches, and mindfulness-based programs help people change their drinking.8 See Treatment for substance use.
Medicines for alcohol use disorder
Strong evidenceThree medicines are approved in the U.S. for alcohol use disorder: naltrexone, acamprosate and disulfiram. None is addictive.8 Your doctor will consider your other medicines and health, including your liver and kidneys.
Mutual support groups
Moderate evidenceGroups such as Alcoholics Anonymous, SMART Recovery and others offer free peer support.8 Some groups are just for older adults.
Practical steps to cut back
- Bring every medicine to your pharmacist and ask, "Which of these are unsafe with alcohol?"
- Count your drinks for one week. One drink is 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of spirits.
- Set a limit that fits your health and medicines, with your doctor's advice. Plan alcohol-free days.
- Replace the nightcap with a calming routine. Try muscle relaxation or CBT for insomnia.
- Find another way to cope with sadness or loneliness: a call to a friend, a walk, or a group. See Self-help for depression.
- Keep less alcohol at home.
- Tell your doctor if you drink every day, have tried to cut back and could not, or feel shaky, sweaty or anxious when you stop.
If you drink heavily every day, do not stop suddenly on your own. Alcohol withdrawal can be dangerous. Talk with a doctor about stopping safely.
For family caregivers
- Choose a calm, sober moment to talk. Lead with care and specific concerns: "I noticed you fell last week and I'm worried."
- Avoid labels like "alcoholic." Focus on health, safety and medicines.
- Bring it to the doctor. Ask for a medicine review that includes alcohol.
- Watch for mixing of alcohol with sleeping pills, anxiety medicines or pain pills.
- Look after yourself. See Helping a family member with substance use.
Special situations
Living alone. Drinking alone after a loss can grow without anyone noticing. Regular contact with family or friends helps.
Living with dementia. People with dementia may forget how much they have had. Alcohol can worsen confusion and falls. Families may need to limit alcohol at home. See Sleep, alcohol and smoking.
Cultural expectations. In some families and communities, drinking is part of social life. It is fine to say, "My doctor told me to cut back."
Frequently asked questions
Isn't a glass of red wine good for my heart?
Recent research links even low levels of drinking to higher risk of breast cancer and heart problems.2 Ask your doctor what is right for you.
Can I drink if I take a sleeping pill or anxiety medicine?
Why do I feel drunk faster than I used to?
Is it too late to change my drinking at 70?
No. Most people with alcohol problems benefit from some form of treatment, and many cut back a lot.8
When to get help
Call 911 if someone is very hard to wake, breathing slowly, having a seizure, or very confused after drinking, especially if they also took sleep, anxiety or pain medicines.5
If drinking comes with hopelessness or thoughts of suicide, call or text 988 any time. For local services, call the Eldercare Locator at 1-800-677-1116.
Sources
- National Institute on Alcohol Abuse and Alcoholism. Alcohol and older adults ages 65+. NIAAA, updated 2025. NIAAA
- National Institute on Alcohol Abuse and Alcoholism. Aging and alcohol. NIAAA, updated 2025. NIAAA
- National Institute on Alcohol Abuse and Alcoholism. Harmful interactions: mixing alcohol with medicines. NIAAA, 2014. NIAAA
- U.S. Preventive Services Task Force. Unhealthy alcohol use in adolescents and adults: screening and behavioral counseling interventions. USPSTF, 2018. USPSTF
- U.S. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. FDA, 2020. FDA
- National Institute on Aging. Sleep and older adults. NIH. NIA
- Centers for Disease Control and Prevention. Facts about older adult falls. CDC, updated 2026. CDC
- National Institute on Alcohol Abuse and Alcoholism. Treatment for alcohol problems: finding and getting help. NIAAA, updated 2025. NIAAA
Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.