The question:
Is it true that alcohol tolerance drops with age?
The science:
Some people in their 60s and 70s may notice that their usual glass of red wine with dinner seems to hit them a bit harder than it did in their younger years.
In most cases, this is unlikely to be caused by a drop in tolerance, which is a decrease in the effects that drugs or alcohol have after months or years of use, experts said. Other factors may be at play.
Older people tend to be more susceptible to cognitive and physical impairments from alcohol, which places them at higher risk for falls, car crashes and other issues such as depressed breathing when combined with opioids, research shows.
One theory suggests this may be because our body composition changes as we age, and those changes influence how alcohol affects us. A 2023 study posits that, as we get older, there is a decrease in lean muscle and an increase in body fat, resulting in less water in the body. This decrease in body water leads to a higher blood alcohol concentration, or BAC, with each drink, causing more significant impairments, research shows.
Another possibility is that our metabolism slows down, and alcohol is processed more slowly, leading to elevated blood alcohol levels and more notable impairments. A recent laboratory study, however, did not find an age-related decline in alcohol metabolism.
These changes in body composition, blood alcohol levels and possibly alcohol metabolism do not seem to explain all the increases in alcohol-related impairments as we get older, said Aaron White, the senior scientific adviser to the director of the National Institute on Alcohol Abuse and Alcoholism.
When people notice that alcohol is having a greater effect than it once did on things such as balance and coordination, reaction time, attention, memory, driving performance and more severe hangovers, it is more likely because of the normal changes in brain function that occur with age, White said.
“Alcohol is doing what it always does, but as the brain changes, the impact of alcohol becomes bigger,” he said.
What else you should know:
The increased sensitivity to alcohol puts older people at higher risk for more significant impairment - and consequences - when drinking alcohol, which is compounded by certain medical conditions and medications.
Medical conditions
Gait issues often come with age, and when combined with alcohol, which can affect balance and cognition, put older adults at an increased risk for falls, research shows.
Alcohol also can impair memory, sleep and other things, particularly among older populations, experts said.
And alcohol misuse, drinking in a way that could cause harm, can increase the risk of developing or worsening certain medical conditions such as chronic pain, cardiovascular disease, diabetes and respiratory infections, according to the National Institute on Alcohol Abuse and Alcoholism.
Medications
Older people are more likely than younger people to be on medications. And certain medications, particularly ones that interfere with cognitive function, such as antihistamines, antidepressants, antipsychotics and antiepileptics, can influence the effects of alcohol, said Peter Martin, a professor of psychiatry and behavioral sciences and pharmacology at Vanderbilt University School of Medicine.
Benzodiazepines are the most concerning, he said.
“It really can addle your brain,” he said. “These drugs don’t do well with alcohol.”
Older adults who have medical conditions or are taking medications should consult their physician about possible interactions with alcohol before drinking, experts said.
The bottom line:
Some people may experience an increase in alcohol-related impairments with age. But it may have less to do with a drop in tolerance and more to do with changes in brain function that make people more susceptible to the impact of alcohol on, for instance, balance and coordination, reaction time, attention, memory, driving performance and subsequent hangover severity.
- Washington Post
