Be Honest with Yourself
MEDICAL AND MENTAL HEALTH UPDATE
Welcome to day four of the MCBRIDE MENTAL HEALTH PRIMER.
Today we will be discussing substance use and abuse.
Particularly during the pandemic, I myself have noticed a stronger-than-ever gravitational pull toward a glass of wine and my son George’s chocolate chip cookies—like they are calling my name and insisting on an invitation into my hands.
But for those who have to (and even those who don’t), limiting or avoiding substances like alcohol can be challenging. Especially when our normal coping mechanisms for stress management (like having routines, getting regular sleep, and social connections) are severely constrained.
But before we go further, a disclaimer: each topic I am covering this week is complex and vast. I cannot begin to cover the breadth and depth of these mental health issues in these posts. Rather, my goal is to provide snapshots of common mental health issues I see regularly as a primary care doctor in order to remind people of the relevance of mental health in their everyday lives and overall health.
Today we’ll focus on alcohol, but as you know this is only one of many substances people grapple with every day.
Onward!
One of my most vivid memories from medical school was our student visit to an AA meeting. I had anticipated walking into a room full of bedraggled, washed-out people. Instead, many of the people looked a lot like me, my friends, or family members. It struck me how honest and real the discussions were. There was little pretense and lots of hard truths. With addiction in my family, I was immediately inspired by the power of straight talk and shared vulnerability.
After twenty years of practicing medicine, I continue to recommend AA and the twelve step program. Not just to patients struggling with alcohol addiction (really!) but to anyone trying to make a change in their life—or simply seeking a community of nonjudgmental, supportive people. (Of course, AA is only one of many roads to recovery but has benefitted many of my patients and family members over time.)
With being human comes suffering, pain, and negative emotions. And during hard times we naturally seek comfort and sometimes try to escape or “numb” uncomfortable feelings. For some people—whether because of genetics, brain chemistry, environmental or psychosocial factors—the urge to use alcohol (or opiates, nicotine, sugar, or other legal and illicit substances) overpowers our rational brain.
So what is the difference between substance abuse/overuse and the more frequent urge to drink wine as a way to “take a load off” at the end of a stressful day?
After all, wine is legal, socially acceptable, and tastes great. So patients often ask me: “how much alcohol is safe for me?”
I tell my patients (and myself) every day that it boils down to two main things: the quantity of alcohol and your relationship to it.
While to me there is no magic “number” of drinks that distinguishes a social drinker from an alcoholic, the amount of alcohol consumed is certainly relevant. And what’s “healthy” very much depends on the person. For example, the CDC says that (for adults of legal drinking age) up to 1 drink per day for women and up to 2 drinks per day for men is acceptable, but these are only broad guidelines. For example, 1 drink a day for most of my patients with diabetes, for example, is too many. And for my patients with alcohol addiction, any number above zero is too many.
Which gets at the question of our relationship to alcohol. I often ask patients to ponder this: if you are using alcohol to numb out uncomfortable feelings, to “self-medicate” underlying anxiety, depression, PTSD, or other mental health issues, or if you find that alcohol is controlling YOU more than you control IT, we need to address it as a medical issue—and not just a social habit.
Indeed, alcohol can significantly affect health and medical outcomes. It can exacerbate depression, anxiety, high blood pressure, heart disease, and arrhythmias, to name a few. It can also increase risk for breast and other cancers. In other words, our use of alcohol can be both the cause and effect of health problems that are worth talking over with your doctor.
My advice?
Notice your feelings—good and bad—and how they affect your relationship to alcohol. Ask yourself: Am I pouring this glass of wine because it’s a beautiful summer night and it pairs well with dinner or because I am trying to drown out worries and fear?
Try not to judge your feelings; rather simply notice them and ideally keep a log. You might see a pattern over time.
Ask your spouse or a trusted friend how they see your relationship to alcohol. Do they ever worry, notice patterns, or feel it’s too much?
Ask yourself: Do you regularly drink more than you plan to? Have you been unsuccessful at quitting before? Is alcohol interfering with your relationships or work? Do you spend a lot of time seeking opportunities to drink?
Be honest with your doctor about how much and how often you consume. Doctors offices are supposed to be judgment-free spaces, and we can help you best if we understand the full story.
Know that there is help if you need it—and now more than ever from the comfort of your home through virtual platforms. Whether it’s an honest talk with your doctor or a therapist, or engaging in AA, support groups, or other structured programs, there are myriad resources available to you—and you are not alone. (A good place to start is with SAMHSA, the Substance Abuse and Mental Health Services Administration.)
It’s almost Friday, and if you’re anything like me you are ready to REST and RESTORE! I am already planning ways to do that. (Getting outside, playing ping-pong with the kids, doing an outdoor distanced dinner with neighbors, watching some COMEDY on TV.) It’s funny how just PLANNING for fun makes life a little brighter. What’s on your relaxation agenda? Think on it, and I’ll see you tomorrow.
P.S. Pictured here is one of my favorite statues on the grounds of the Washington National Cathedral.