Dad—Thinning waves of white hair mostly covering the scar on the back of his head—fondles a goblet of Barolo and swallows the last of it. A shot glass full of grappa waits on the table. I catch the gaze of my wife and our two teenagers. My mother looks for something in her lap.

Where, I wondered, was the man from nine months earlier—weak, grimacing, shaky. The man who confided: “I want you to know how ashamed I feel,” and who, for the first time, referred to himself as a “high-functioning alcoholic.” As sick and broken as that guy was, I wanted him back.

We bid my parents goodbye last summer, hoping they would have a smooth move from their home in the Northeast to a gated community in Florida. That state was facing the peak of its COVID crisis. “Be careful,” I’d say, in call after call. And yet, somehow, they were always in a store, at the bank, in a restaurant; a parade of electricians, painters and landscapers marched through their house. Over FaceTime, I could see masks hanging from their chins.

My father, characteristically, resisted his retirement and fixated instead on a task—completing what amounted to the final brief of his legal career. But the stress, compounded by the move, computer problems and a new difficulty maintaining focus, sent him into a tailspin. A lifelong drinker, he was now finishing a fifth of vodka every other day. When Mom started complaining about him being “out of it,” I chalked it up to the usual.

The first time he went to the ER was to stitch up a large, unexplained cut on the back of his head. Two weeks later he was back, after he fell on his way to bathroom, soaked himself in urine and couldn’t get up. He was in intensive care for a week.  Scans and blood tests showed one underlying cause for his falls—alcoholic liver disease and a form of muscle wasting called alcoholic myopathy.

But the reason for his rapid cognitive decline remained unclear. I located a neurologist affiliated with a top-rated national clinic, hoping the doctor could tease out the threads of alcoholism, depression and family history of dementia to deliver an explanation—and with it, some indication of what lay ahead.

As for so many people of my age, it fell to me to steer my parent’s illness—research his providers, schedule appointments, coordinate care with doctors, physical therapists and the insurance company. I was disappointed, but sadly not shocked, to find that no one wants to talk about substance use disorder in older adults. Nearly one in five people over age 60 has a problem with controlled substances. “ETOH,” the diagnostic shorthand for ethyl alcohol, was all over my father’s medical records. Where were the referrals to counseling? The neurologist ordered a cognitive assessment and multiple screenings for mercury. But they never asked if my father knew where to find an AA meeting.

It took my going to Florida to get him into support groups. He got an AA sponsor. And even though the cognitive tests had shown significant and likely permanent impairment, even though he refused to take dementia medications he’d been prescribed, he started getting not only stronger, but mentally sharper, too. He remembered things. Over my objections, he was cleared to drive again.

And here he was, back to visit for my daughter’s graduation—mentally “together,” more or less. And drinking. Gently, I bring up the dark days of last year. I mention a study on COVID in older adults who had no traditional symptoms—cough, shortness of breath—but who did report confusion and forgetfulness, along with weakness and falls. “Maybe,” I say, “that helps explain why you were so out of it.” He looks at me, confused: “What?! I was out of it? When?” We remind him of the lost months. “Well,” he says, with a shrug,  “I was probably drunk!” He laughs. No one laughs with him.