Reckon With Alcohol
Yet another patient sheepishly asked me last week, “Do you think I’m drinking too much?”
It’s a great question and one we might all ask ourselves as we step into a spring full of graduations, weddings, and celebrations with friends—and as we reflect on the past two years of pandemic pandemonium. For some of us during COVID, the casual glass of wine on a Friday night has become two, three, or just more than we meant to. For others, the weekend unwinding has turned into a nightly undoing.
Over the last two years, I myself have felt the gravitational pull toward my favorite drink (bourbon in cold weather, tequila or pink wine in warm weather) at the end of a long week or workday. I’m quite aware of the relative ease of pouring a drink at the end of the day compared to the effort of strapping on walking shoes and trotting around the neighborhood with my pup. (I’m also quite familiar with the conversation I have with myself about how great I’d feel after the latter—but how much I want the former.)
Let’s face it: Alcohol is wonderful in many ways. It’s legal, fun, and delicious. It can help us de-stress. It can signal the end of the work day and the beginning of our free time. It can alleviate the rub of the “second shift” at home—whether that’s bathtime for the kids or the drudgery of doing household chores. Alcohol lubricates our social lives. People are less inhibited—and often more fun to be around—when they’ve kicked up their heels and thrown a few back.
But alcohol comes with a price tag. From a chemical standpoint, alcohol is a depressant. Even though it might not feel like a depressant when it’s coursing through our veins, regular alcohol use can cause—and exacerbate—a depressed mood. It can drag down our energy, accentuate anxiety, and perpetuate a cycle of self-loathing.
And then there are the behavioral effects: from saying things we regret the next day to impulsive eating, Tweeting, and table-top-dancing, alcohol impairs our judgment. It can threaten—and forever alter—our relationships and lives.
We can’t forget alcohol’s effects on our physical health. From weight gain and bloating to elevated blood pressure and blood sugar levels, there’s no organ system that alcohol doesn’t affect. Moreover, alcohol is highly addictive for the subset of people who are predisposed—as a result of genetic, environmental, situational, and behavioral factors. Given how harsh alcohol can be on our bodies and minds (and despite my fondness for it), I sometimes wonder how alcohol is even legal.
This is not to suggest we should ban alcohol. Hooboy! Nor do I think that consuming alcohol is morally reprehensible—or that everyone who drinks is destined to be depressed, diabetic, and addicted. Not at all.
I’m saying that during times of stress and uncertainty, it’s perfectly normal to seek ways to self-soothe. Whether it’s taking a hot bath, zoning out on our phone, or pouring a glass of wine, we all need ways to cope. Given the diverse array of stressors in our lives (and in our world), it’s not surprising to me that my patients seem to be drinking more than they did in the past—and that we’ve seen a surge in alcohol-related deaths in this country during COVID.
For lots of people, the problem isn’t quantity or frequency; it’s the relationship with alcohol that’s gotten wobbly and weird over the last few years.
The questions are: How do we know what is “too much”? How do we know when an affinity is really an addiction? Where do we draw the line between recreational alcohol use and problem drinking? And who is the arbiter of these decisions, anyway?
There is no simple answer to these questions. There is no “right” amount of alcohol to drink. There is no number of drinks that, for every person, cleanly distiguishes an addiction from “reasonable” use. Moreover, the relationship with alcohol varies widely among different people. In other words, for people who have struggled with alcohol addiction, even one drink might be one too many. And for people whose relationship with alcohol is purely about pairing it with dinner, nightly ingestion can be perfectly appropriate.
So when I’m trying to help a patient answer their own question— “Is it too much?”—I ask them to ponder two main questions:
What is the amount—the quantity and frequency—of alcohol you consume? If it’s 7 drinks a week, for example, is it one drink every night with dinner, or is it abstinence during the week and a 7-drink binge on a Friday night? If it’s two drinks per week, is it two drinks right before your morning meeting with your therapist? Or is it two drinks with your dog as you relax on the sofa? (Note that not drinking whatsoever is never an unhealthy approach. I never recommend that a non-drinker start consuming alcohol to benefit their overall health!)
What is your relationship with alcohol like? What is the context? Are you using alcohol to avoid uncomfortable feelings like worry, loneliness, or boredom? Or are you drinking to enjoy nights out with friends? Are you drinking because you think you are supposed to—in order to fit in with a new friend group? Or to ease the blind-date jitters? Is your first drink mostly about hunger because you didn’t eat enough during the day—and then one drink becomes two or three simply because you ate too late and because alcohol (especially on an empty stomach) impairs our ability to stop?
In other words, simply asking someone “How much do you drink?” in a vacuum isn’t terribly helpful. It also sets people up to think the question is a moral test instead of a medical question—and is the reason people often fudge the truth about their drinking to their doctors.
But as I regularly say to my patients, my office is a judgment-free space. In fact, shame is actually what propagates addiction—whether it’s to alcohol, drugs, sugar, or social media. One of the worst feelings in the human brain comes from not feeling in control of our own behaviors. It’s why we feel remorse the morning after a big night out on the town. Unwittingly inflicting self-harm not only grates against our psyche, it can further the shame narrative that only perpetuates the dysfunctional behavior.
So when thinking about our own drinking, the first step is to remove shame from the conversation and to be honest with ourselves (and our doctors if we have one). After all, we all have habits that are good for us; we all do things that are bad for us, too. We all engage in behaviors that are considered virtuous and healthy; we also all engage in behaviors that other people might judge us for or that we feel ashamed about. It’s part of being human. We are flawed and imperfect and not always great at self-regulation with things that give us pleasure—like food, drugs, alcohol.
The next step is to figure out the quantity of alcohol that is appropriate given our underlying health conditions and risks for disease. That’s where your doctor can help. As examples, conditions like atrial fibrillation, sleep apnea, and diabetes are generally better with less booze. Symptoms like insomnia, menopausal hot flashes, and fatigue are best served by lightening up on alcohol consumption—each for different reasons. A patient who’s having trouble controlling her blood pressure, for example, might benefit from reducing her alcohol intake even if she isn’t drinking “too much” in the scheme of her whole health.
Next, it’s time to drill down into what drives the urge to drink, particularly if the quantity is more than you or your physician would like it to be. For example, if it’s driven by hunger after a day at the office without adequate time to forage for food, you might simply need to eat more during the daytime and/or have a hearty snack at 4 pm. If it’s from boredom, it might be time to find a good hobby. If it’s from depression or anxiety, it might be the moment to seek out a good therapist or to adjust your medication. Just like prescription medication is, alcohol is a chemical, too—and when we find ourselves “self-medicating” with alcohol, it’s time to bring our whole selves to the doctor.
For many people, grappling with their alcohol use can be quite difficult and even painful. It can require disarming a shame narrative, acknowledging a messy internal world, and daring to feel unpleasant feelings. For others, all it takes is a simple “check-in” with ourselves—aligning our intentions for good health with the practice of it. This is why “Dry January” has become so popular: Turning the page into the New Year is a forced reminder to reset.
So I’ll gently remind you right now (and myself while I’m at it!): It’s never a bad day to reclaim control of our day-to-day health.
At the end of the day, a dose of self-reflection on the heels of the past two years (and the last few weeks pondering boosters and BA.2) is good for our body and mind. Whether it’s pondering how much we drink, how much screen time we consume, or how to better prioritize exercise or sleep, taking a bird’s eye view of our everyday habits can be the birthplace of change. (And if we still end up wanting a cocktail, that’s okay, too.)
I will see you next week. Until then, be well.