Maybe you’ve never turned teetotaler during “Dry January”…maybe you’ve always turned a cold shoulder to “Sober October.”
But if you’re among the tens of millions of Americans who consume alcohol on a regular basis, you may be among the growing ranks of the “sober curious,” wondering whether it would be smart to cut back on or even stop drinking…and exactly how to stop drinking alcohol. Many drinkers seem to be doing just that in the aftermath of the COVID pandemic, a stressful time during which alcohol sales in the US soared by more than 40%.
It’s long been known that alcohol consumption can lead to a litany of health problems, including cirrhosis of the liver, kidney disease and birth defects…as well as lowering your immunity to infections and raising risk for potentially fatal accidents. Now there’s also clear evidence that drinking can raise risk for at least seven kinds of cancer—mouth, esophagus, voice box, throat, liver, colorectal and breast cancer in women. And many health experts have concluded that evidence supporting moderate consumption of red wine to reduce risk for heart attack and stroke is not as strong as previously thought.
Emerging consensus: Any level of alcohol consumption carries health risks—even though the federal government’s official Dietary Guidelines for Americans continue to say that men should have no more than two standard drinks a day and women should have no more than one standard drink daily. (A standard drink is five ounces of wine, 12 ounces of regular beer or 1.5 ounces of distilled spirits such as gin, vodka or whiskey.)
Alcohol is toxic to the brain, and after prolonged heavy use, it can cause alcohol-related brain damage. For these and other reasons, some people should avoid drinking entirely—pregnant women, of course, as well as anyone with liver disease or a substance-use disorder (or a family history of one). Even minimal alcohol consumption can lead these people down a perilous path. Along with opioids and cannabis, alcohol is among the most misused substances, with heredity accounting for roughly half the risk. Others who shouldn’t drink…
Anyone with post-traumatic stress disorder (PTSD) or another anxiety disorder: While a beer, glass of wine or a cocktail can have a transient calming effect by raising brain levels of the relaxing neurotransmitter gamma-aminobutyric acid (GABA), habitual drinking tends to cause even greater anxiety.
Anyone with dementia or a family history of dementia: Alcohol can impair memory and raise risk for neurological disorders (including peripheral neuropathy, which causes painful tingling sensations in the extremities).
Anyone taking certain medications—including antibiotics, antidepressants, anticoagulants and even over-the-counter painkillers—should avoid alcohol. It can have dangerous interactions. Check with your doctor or pharmacist anytime you fill a prescription.
For people who aren’t at heightened risk for alcohol-related health problems, there’s nothing wrong with enjoying an occasional drink—perhaps a glass of champagne at a wedding celebration. Just be aware that every alcoholic beverage you consume causes inflammation throughout the body, making your organs work harder than they otherwise would.
The current edition of the Diagnostic and Statistical Manual—sometimes called the bible of psychiatry—outlines 11 criteria that doctors and therapists use to identify people with alcohol-use disorder. The following questions can help you determine if you are misusing alcohol…
For a more rigorous way to determine whether you have a drinking problem, visit the AUDIT-C for Alcohol Use diagnostic tool (mdcalc.com/calc/2021/audit-c-alcohol-use). Other helpful resources can be found at the website of the National Institute on Alcohol Abuse and Alcoholism (niaaa.nih.gov/), which defines heavy drinking for men as consuming five or more drinks on any single day or 15 or more drinks per week…and for women, consuming four or more drinks on any day or eight or more drinks per week.
Good news: No matter how much or how little you drink, cutting back even just a little will lower your risk for health problems.
Keep a written log of your alcohol use. Each time you have something alcoholic to drink, jot down what kind of beverage, how much and what the circumstances were. Once a week, review the log and look for drinking patterns…and consider ways to disrupt them.
Examples: If your log indicates that you tend to have a glass or two of wine every time you make supper, you might say to yourself, I won’t drink each time you don your apron. If you notice that you imbibe to excess when dining out with friends, consider substituting a mocktail or another nonalcoholic beverage for your usual drink. If you tend to reach for the bottle when you feel strong emotions such as sadness or guilt, consider other less harmful ways to cope, such as meditation, crafting, or other hobbies. If you want to brush up on healthy coping skills, seeking out individual therapy or counseling is always a good idea.
Keep alcohol out of your home…to avoid the temptation to drink.
Consult a doctor. If yours isn’t well-equipped to counsel you about drinking, he/she should be able to refer you to a someone who is—ideally a doctor board-certified in addiction medicine or addiction psychiatry. Alternatively, the Psychology Today website (PsychologyToday.com) lets you plug in your zip code to find therapists in your area with expertise in the treatment of alcohol problems.
Consider a support group. Short- and long-term outpatient and residential treatment programs, beyond Alcoholics Anonymous, now are widely available.
There are three prescription medications approved for treatment of alcohol use disorder. Naltrexone, which comes in oral and once-a-month injectable versions, works by reducing cravings for alcohol. The oral medication acamprosate also curbs cravings but is prescribed less frequently because it costs more than naltrexone and must be taken three times a day. The older drug disulfiram discourages drinking by causing headaches, vomiting and other unpleasant symptoms when alcohol is consumed.
New finding: Semaglutide (Wegovy) and similar prescription weight-loss medications seem to reduce the urge to drink. But it will likely take years of research and clinical trials before the FDA approves these drugs, known as glucagon-like peptide-1 (GLP-1 agonists), for use to treat problem drinking.
