How's Your Relationship with Alcohol?
The gray area between social drinking and dependency 🍷
ICYMI 👉
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I recently saw a patient who came in to see me, concerned that her blood pressure reading had been high at another doctor's office. Having never had high blood pressure before, we discussed the potential causes. Was she more stressed than usual? Had she been consuming more salt? Was she on any new medications?
When I asked her if anything else was going on—chest pain, shortness of breath, or changes in her habits or hormone therapy. She said, "No, but I haven’t been sleeping well and I keep having some stomach issues, and, to be honest, I’ve been more irritable than usual. Maybe it’s just stress?" I told it’s very possible.
I then gently inquired about her drinking habits.
"Oh, I don’t drink too much," she replied quickly. "A glass or two of wine a few nights a week, maybe a little more on the weekends. But it’s not like I’m getting drunk. It’s just part of my routine."
I nodded. "I hear you. And you’re not alone. Many people drink moderately without thinking much of it. But, I do wonder if alcohol could be contributing to the things you’re experiencing. I’m not saying alcohol is the only factor, but it could be worth exploring whether it's playing a role."
This conversation is one I’ve had countless times in my practice. Usually it goes well, especially when patients know I am not there to judge, label, or reprimand them (the fear of judgement is a common reason people do not report on their alcohol use to doctors.). Nonetheless I fully understand why mild or moderate drinkers can feel defensive when their doctor suggests that alcohol might be negatively affecting their health. In my experience, people who aren’t overtly debilitated by alcohol use often think it doesn’t affect them.
Of course alcohol use—and people’s relationship with alcohol—lies on a continuum. The line between casual drinking and problematic alcohol use isn’t always clear. But many people who wouldn’t identify as having a drinking problem still experience negative health effects from alcohol. The space between social drinking and dependency is a gray area. It's one that is often overlooked.
I get it. Drinking alcohol is a socially acceptable and legal way to relax, wind down, and enjoy a meal. It is woven into the fabric of American life. (Remember when, during the pandemic, bars were open but schools were closed? Don't get me started....)
I, too, love alcohol. I find it delicious and fun to consume. I also have had to reckon with my relationship with alcohol—not because I drank "too much" but because I drank too little to imagine it had an effect on me. But it did.
The Health Effects of Moderate Drinking
We often hear that moderate drinking—typically defined as one drink per day for women and two for men—is "safe." But emerging research challenges that notion. Even within these guidelines, alcohol can have insidious effects on physical and mental health.
Blood Pressure and Cardiovascular Health
Alcohol has a well-documented impact on blood pressure. While a single drink may lead to temporary relaxation, regular drinking—even at moderate levels—can contribute to sustained hypertension. A 2019 study in the Journal of the American College of Cardiology found that individuals who drank regularly had a significantly higher risk of developing hypertension compared to non-drinkers.
Additionally, alcohol can increase the risk of atrial fibrillation (irregular heart rhythm) and other cardiovascular issues. The "French paradox"—the idea that moderate wine consumption protects the heart—has been largely debunked in recent years. While some studies suggest that red wine contains heart-healthy polyphenols, these benefits are outweighed by the risks associated with alcohol itself.
Sleep Disruption
Many people use alcohol as a sleep aid, believing that a nightcap helps them unwind. While alcohol can induce sleepiness, it ultimately leads to poor sleep quality. It disrupts REM sleep, fragments sleep cycles, and contributes to early-morning awakenings. Even moderate drinking reduces sleep efficiency and increases the likelihood of waking up throughout the night.
Chronic sleep disruption, in turn, exacerbates other health issues, including increased stress hormones, reduced immune function, and higher risks of anxiety and depression. Anyone in peri- or post-menopause can attest that alcohol revs the engine of hot flashes and night sweats and is a buzz kill in middle age for this reason alone.
Gut Health and Digestion
Alcohol is an irritant to the digestive system. It disrupts gut microbiota, increases intestinal permeability (commonly known as "leaky gut"), and contributes to acid reflux and gastritis. Even moderate alcohol consumption alters gut flora, which can lead to inflammation, bloating, and digestive discomfort.
In people with conditions like irritable bowel syndrome (IBS), alcohol can be a major trigger. Yet, many people don’t immediately connect their digestive symptoms to their drinking habits. In the modern era of gut microbiome as big business for online wellness practitioners, I commonly hear about patients taking oodles of supplements for their gut health but haven't been counseled to take a break from the booze. Of course, alcohol isn't the only cause for GI distress, but add a little stress to a regular alcohol habit and who, in their adult life, hasn't experienced an angry colon as a result?
Mood and Mental Health
Alcohol is a depressant, yet it’s often used to relieve stress and social anxiety. While it can produce temporary relaxation, regular consumption is linked to increased risks of anxiety and depression. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that even moderate drinking can contribute to mood instability and irritability.
This is partly due to alcohol’s impact on neurotransmitters like serotonin and dopamine. It initially boosts these chemicals, creating a pleasurable sensation, but over time, it depletes them—leading to mood swings, anxiety, and even depressive episodes.
Not to mention the behavioral health effects of alcohol, even in moderate amounts. From diminished concentration to having a short fuse at work or at home, drinking “one too many” can affect our every functioning and relationships
Cancer risk
Earlier this year, the then-Surgeon General issued a new warning about alcohol’s link to various cancers—including breast, esophageal, and colorectal. I wrote more about that here.
When Does Drinking Become a Problem?
Signs that alcohol may be affecting your health—even if you don’t identify as having a "problem"—include:
Using alcohol as a way to relax, unwind, or cope with stress
Feeling irritable or anxious when you skip a night of drinking
Needing more alcohol over time to achieve the same relaxing effect
Experiencing sleep disturbances, digestive issues, or mood swings that improve when you reduce alcohol consumption
Feeling guilty about drinking habits or hiding the extent of your consumption
According to the CDC, excessive alcohol use—whether in the form of binge drinking (4+ drinks for women, 5+ for men in one sitting) or heavy drinking (8+ drinks per week for women, 15+ for men)—is associated with increased mortality risk. But even regular moderate drinking carries risks that many people overlook.
Rethinking Alcohol’s Role in Your Life
If you recognize yourself in any of these patterns, it doesn’t necessarily mean you need to quit drinking entirely. But it might be worth reassessing your relationship with alcohol. Here are some steps to consider:
Track Your Consumption: For one week, log every drink you consume. Pay attention to when and why you drink—whether it’s social, habitual, or stress-related.
Experiment with Breaks: Try going alcohol-free for a few weeks and see how you feel. Many people report improved sleep, better mood, and increased energy.
Assess Your Triggers: Are there specific situations or emotions that drive your drinking? Understanding these can help you develop alternative coping strategies.
Seek Support: If cutting back feels difficult, you’re not alone. Consider talking to a doctor, therapist, or joining a group like Alcoholics Anonymous (AA) or Moderation Management. The comments section of my previous post on alcohol contains a bevy of other great suggestions!
Final Thoughts
The goal is to approach alcohol with awareness of the risks and curiosity about your relationship with it. Shaming yourself for drinking is as unproductive as a doctor judging you for it. So make sure you are approaching the conversation with yourself with honesty and self-compassion. It’s normal to want to relax. It’s normal to want to fit in socially. It’s normal to think something that is legal and everywhere around you is fine.
But that doesn’t mean it isn't worth taking a closer look.
Whether you choose to drink less, take breaks, or abstain entirely, the key is making informed choices that support your well-being. And if you find yourself wondering, Is alcohol affecting my health more than I thought?—it’s worth exploring the answer.
QUESTIONS 🙋🏻♀️
Do you have any plans to adjust your drinking habits?
If you have ever quit drinking in the past, how have you done it?
If you are a non-drinker, how has your health improved/not improved as a result?
Has a doctor ever changed how you think about alcohol?
What’s for dinner tonight?
I’m all ears!
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
The last time I had a drink was April 2024, nearing a year ago. Okay, a lot of drinks. Far, far too many that night. Usually--meaning, if I am very honest with myself, about 75 percent of the time--I'd stop at two. The other 20 percent of the time I'd go to three. Ish. But a handful--a rather big handful-- of times in my life I went overboard, as if responding to some internal pressure building, building, building. Heeding a goblin-like little voice that would insinuate itself into my head: "come on--you know it's been a while. Call up _____ and go OUT." Go where people were drinking. Heavily. I'd get the odd, but unmistakable, urge to let loose. Blow off steam. And when I'd get these urges I'd want to indulge them without my husband around. And then I'd come home and get massively, ridiculously ill, and have a debilitating hangover the next day. It was BAD. Really, really bad, some of these nights, not only for my health but, I have to admit, my safety. Then I'd drink nothing for a few weeks or a month, then go back to having a glass of wine or two a few times a week....
I can't remember when I first heard the phrase "relationship with alcohol" but it immediately struck an uneasy chord, maybe because by the time my children were, say, 10 and 6 I had begun to think about my drinking the way someone thinks about some secret messed up relationship with some horrible boyfriend who you know is terrible for you but you want them anyway. I drank more after I had children than before, which is pretty much the case with every single mother friend I have. I wanted a glass of wine or more about half the nights during the week, and by "a glass" I do not mean some demure 5 ounce little standard pour (those only exist in restaurants). And on nights I didn't drink I often thought about it. Just LOOK at me not drinking tonight. Oh, I haven't had a drink in three whole days now, let's have two tonight. I deserve it. Damn, I can't wait for that party on Friday because this is a SHIT time of it I'm having here, now, with myself. No, my thoughts in the moment wouldn't be that well articulated but the underlying sentiment was true: a difficulty sitting with myself (as a woman/parent/human being), staying in the present. I'd want to get away from and out of myself, my head, my perception of my own inadequacies. And that meant having a drink. Or three or four.
I suppose I quit because I got tired and unnerved by the thinking about it, the wanting it, the rationalizing I'd do about when I could have it and when I couldn't or shouldn't. (The last blowout night was just the last straw.) It took up too much space in my brain. I also quit because I've NEVER had a good tolerance for it--one half a glass of white wine would give me a buzz, and I wouldn't stop at that. I quit because I started to feel like my drinking was a slippery slope, and the ground underneath my feet was getting a little steeper, a little slicker.
Hi Dr. Lucy,
There is a medication called Naltrexone that curbs alcohol cravings much like the weight loss meds. It starts at 50MG, and I learned of it through my son's friend who really struggled, and he was at 150 MG.
I was having a major surgery with no alcohol the week before and after and was nervous, so I asked my GP for the lowest dose which he thanked me for (hadn't heard of this) and happily prescribed. I took it for that time period and thought maybe it was a placebo, but was successful. Now my husband is having a knee replacement and I will be home alone with him, caretaking for months so I thought I'd try it again with the left over script. BINGO. One pill.
Please share in your newsletter. I'm shocked there is little awareness, or marketing of this very useful aid - instead of old fashioned will power.
I'm curious what you'll find out.