Why It's So Hard To Recover After Drinking As You Get Older

Here's how your body responds to alcohol as you age.
As you age, your body's ability to process alcohol changes.
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As you age, your body's ability to process alcohol changes.

Chances are hangovers feel worse and recovery after a long night gets to be a difficult process the more birthdays you have under your belt. It’s no surprise from a biological standpoint: When your body changes as you age, its ability to process alcohol also changes.

“When you’re young, you have a lot of plasticity in how you respond to things that are toxic,” said George Koob, director of the National Institute on Alcohol Abuse and Alcoholism. “You lose some of that as you get older.”

As you age, a long night of imbibing can get riskier. In recent years, alcohol abuse and dependence have more than doubled among older people. Your body also just can’t keep up in the moment.

“What used to be a normal amount of alcohol you could drink and not get overly intoxicated now changes,” explained James Galligan, a professor of pharmacology and toxicology at Michigan State University. “Because your system doesn’t work as well [when you’re older], you’re likely to end up with higher blood alcohol levels than you would’ve when you were much younger.”

So how exactly does your body respond to alcohol when you’re no longer in your 20s?

Your body doesn’t metabolize alcohol as effectively when you’re older

Alcohol is neutralized in a two-step process that takes place in the liver, according to David Sack, the chief medical officer of Elements Behavioral Health.

“Alcohol is converted to acetaldehyde, which is responsible for a lot of the negative effects of alcohol like headaches, flushing and dizziness,” he said. It’s then converted to acetic acid, which is excreted in urine.

The system works well in younger people, Galligan said.

“But just like anything else, when you get older, things don’t work like they used to,” he added. “As people begin to get into their 60s or 70s, the enzymes that metabolize alcohol don’t work as well.”

“Just like anything else, when you get older, things don’t work like they used to.”

- James Galligan, professor of pharmacology and toxicology at Michigan State University

“Some of that may be the result of the normal aging process, but part of it may be due to illness,” Sack said. “Moderate to heavy drinkers can cause injury to their liver. They have changes in the efficiency in which their liver processes alcohol.”

A recent study found that both the brain and the liver are more sensitive to the toxicity of alcohol as you age, affecting your response to liquor. In turn, what you normally drank when you were younger will have a greater effect when you get older, Galligan noted.

A number of lifestyle factors play a role in how you process alcohol as you age

Your proportion of body fat as you get older is one factor in how your body processes alcohol, Sack said.

“Alcohol, unlike most other drugs, is only distributed in the water parts of the body. So if you have less water to body fat, more of the alcohol reaches the organ,” he said.

Other illnesses can also contribute to the inefficient metabolism of alcohol. Hepatitis C, for instance, can affect the liver’s ability to clear alcohol and other drugs, Sack noted.

Using more medications can also play an enormous role in how you process alcohol, according to Koob. “The elderly tend to take a lot of medications, and some can interact in a bad way with alcohol like Xanax or Valium, for instance,” he said.

How long you’ve consumed alcohol across a lifetime can also affect how you process liquor

If you ever drank while underage, that may also play a role in how you metabolize alcohol, Koob said. In fact, underage drinking is even associated with impairment of cognitive function.

“Excess drinking can affect the frontal cortex, which is the slowest part of the brain to mature and why they advocate against underage drinking,” he added.

And over time, heavy drinking itself can affect how you process alcohol in the future, Sack noted.

“There are people who started drinking in their 20s and 30s and are now in their 60s that tend to have more emotional problems like depression, drink more continuously and have more treatment for alcohol-related problems,” Sack said. “And there are those who start drinking when they’re older, as in their 50s and 60s, who tend to be healthier and have fewer consequences.”

“The liver has a lot of excess capacity if you don’t keep injuring it.”

- David Sack, chief medical officer of Elements Behavioral Health

While the health benefits of drinking a glass of red wine or two have made headlines recently, the studies are mixed and moderation is ultimately key to your health, Sack said. And surprisingly, hangovers don’t always worsen with age, as one study found ― but it truly depends on your lifestyle.

“The liver has a lot of excess capacity if you don’t keep injuring it,” Sack said. “It’s an amazing organ.”

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