March 11, 2022 • 18 mins
A listener wants to know if her drinking indicates a problem. Dr. Saltz reveals how to tell if alcohol is getting out of hand, and effective ways to cut back.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight, and advice. Most people drink some alcohol.
People drink to celebrate, to relax, or socialize with other people.
But when someone drinks an excess or drinks as a
way to cope with stressors or avoid problems, it creates
(00:48):
both physical and psychological issues. So today I'm answering a
listener's question about how much she's drinking ALC. Whole use disorder,
known in lay terms as alcoholism, refers to a problematic
pattern of alcohol use that leads to significant impairment or distress.
(01:13):
Because alcohol use varies greatly between people, it is less
about the total quantity of alcohol consumed and more about
specific problems, such as when drinking interferes with your home life,
or school or work. Drinking could be problematic if it
creates interpersonal difficulties with family and friends, or if it
(01:38):
leads to a decrease of other activities in life. Age,
family history, and how much or how often an individual
drinks are other important variables when considering someone's relationship with alcohol.
Alcohol abuse affects all genders, races, and ethnic lines. Nearly
(02:01):
fourteen million people, often more men than women, in the
United States, have a problem with alcohol use. Issues surrounding
alcohol are highest among young adults ages eighteen to twenty
nine and lowest among adults age sixty five and older.
But defining and diagnosing alcohol use disorder can be complicated
(02:24):
when you're working with a young adult because the lifestyle of,
for example, college students, often includes excessive use of alcohol,
making it difficult to tell whether it's a legitimate disorder
or whether it isn't. Moderate drinking is considered up to
one drink per day for women and up to two
(02:45):
drinks per day for men in the United States. One
standard drink contains roughly fourteen grams of pure alcohol, which
is found in twelve ounces of regular beer, five ounces
of wine, or an ounce and a half of spirits.
So filling your wine glass up to the top of
(03:06):
the glass isn't one glass of wine Alcohol use disorder
is defined by the d s M five, the Diagnostic
and Statistical Manual in psychiatry, as a problematic pattern of
drinking that results in clinically significant impairment or distress, which
takes the form of two or more of the following
(03:27):
situations within a twelvemonth period. Drinking more than intended, or
doing so for a longer period of time than intended,
Continually wanting or attempting unsuccessfully to cut down or stop drinking,
spending a lot of time getting alcohol, drinking it, or
(03:49):
recovering from its effects, having a strong desire or urge
at other times to drink, Failing to fulfill major work, school,
or home responsibilities due to drinking, Continuing to drink even
though it is causing relationship troubles, prioritizing drinking by giving
(04:12):
up or cutting back important activities drinking, and situations in
which it is physically dangerous in the words that would
be for example, binge drinking, Continuing to drink even though
one has a persistent or recurrent physical or psychological problem
(04:33):
that drinking has likely caused or made worse. Needing much
more than was once needed to get the desired effect
from alcohol, or not experiencing the same effect when drinking
the same amount and having withdrawal symptoms, which could be
trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, even
(04:57):
a seizure, or sensing things that are not there, or
drinking to relieve those withdrawal symptoms or avoid having them.
Alcoholism or alcohol dependence is considered the most severe form
of alcohol abuse. The d s M five integrates alcohol
abuse and dependence into a single disorder with either mild, moderate,
(05:21):
or severe classifications. So mild would be the presence of
two or three of the symptoms I mentioned, Moderate would
be four to five, and severe would be the presence
of six or more symptoms. When someone has been drinking
alcohol to access regularly and suddenly stops, they can experience
alcohol withdrawal. The symptoms are some combination of hand tremors, sweating, insomnia,
(05:49):
rapid heart rate, anxiety, depression, fatigue, irritability, and at most
severe hallucinations and seizures. Alcohol all withdrawal is a serious
condition that can become life threatening if not treated. Symptoms
typically develop within several hours to a few days after
(06:09):
a person has stopped or reduced drinking. It is important
for individuals who may have alcohol use disorder to consult
a doctor to be honest and forthcoming, to determine if
they have a drinking problem, and if so, to collaborate
with that doctor on how to handle it. While the
specific cause of alcohol use disorder is unknown, there are
(06:33):
environmental and genetic links. In other words, alcohol disorders run
in families. But another factor is the addictiveness of the
substance itself. Excessive alcohol intake changes the chemical makeup of
the brain in ways that contribute to an addiction drinking.
Alcohol affects the physical and mental health of some people
(06:55):
differently than others, and in some it will lead to
an alcoho all related disorder, as I mentioned, abuse friends
and families, and the rate of the condition is three
to four times higher in close relatives of alcoholics, and
the risk increases with the closeness of the genetic relationship.
(07:17):
Environmental factors include cultural attitudes about drinking, availability of alcohol,
and substance abuse by peers. So, for example, I mentioned
that in college, it can be difficult to tell when
there's a problem going on because there's so much alcohol
available and because peers encourage the drinking to access the
(07:40):
risk of abusing alcohol increases if individuals use drinking to
numb themselves to their problems to cope with anxiety, with fears,
with stress or mood issues, and impulsivity is also linked
to alcohol abuse. How can I help with Doctor Gale
(08:02):
Salts will be back after the short break, so let's
get to my listeners question and see how can I help?
Dear doctor Sauls. I have had a difficult year, being
(08:22):
stuck inside with my family a lot and feeling very
stressed about everything from COVID to money troubles. When my
work day is done, I like to have a glass
of wine while I'm making dinner. It's relaxing and enjoyable.
In fact, it's one of the few things I'm really enjoying.
(08:43):
Over the last few months, I have been pouring myself
a second class while I'm cooking, and I can't say
I feel as relaxed as I used to after having it.
It's making me think about having a third one. But
it's also making me wonder if this is a problem.
How many glasses of wine and I are a problem.
(09:04):
I don't drink at all at other times of day,
and I don't get drunk. So part of me thinks
this must be fine, But another part of me wants
my glasses so much that I'm feeling nervous. It may
be an issue. What do you think? Because alcohol chemically
is an addictive drug. If you are drinking for the effect,
(09:27):
the effect of feeling relaxed, over time, whatever amount you
require to produce that effect will no longer do, so
you will need more to get the same feeling. This
is called tolerance, and over time, if you use less,
you may temporarily experience the opposite of that feeling, edgy
(09:50):
and jittery, which will likely make you crave your glass
even more. This is called withdrawal. Tolerance and with drawl
are hallmark signs of alcohol dependence. The old myth or
idea that alcoholics drink all day is just not true,
(10:10):
and alcohol dependence can happen to lovely and conscientious people
who don't realize they are building a regular habit over time.
This habit may not be interfering in your life, so
it's not yet abuse, but that you must do it daily,
that you are using more and now feel a need
(10:31):
to use even more, that you are thinking about and
craving your glass point to a developing problem. I would
suggest cutting back and now, and know that initially it
may not feel very good, but over a few days
to weeks that not good feeling will go away. I
(10:53):
don't advise just stopping cold turkey today, that could be
unsafe for you. But I do suggest cutting your second
glass in half for a week, than having no second
glass for a week, than half a one glass for
a week, and then every couple of days try having
(11:13):
no alcohol at all. Then you could resume with some
if this works out with for you, but I wouldn't
go above a glass a day. Then I think it's
important for you to find some other methods of relaxing
at the end of your day, Putting on great music,
chatting with a girlfriend, doing yoga, stretches, trying some paste,
(11:37):
deep breathing. If you want to replace just the act
of sipping on something delicious while you're cooking, consider some mocktails.
Consider something fun but alcohol free. They make alcohol free
beers and even alcohol free spirits. It's not that you
(11:58):
have to never drink, it's the regularity and increase that's
the issue. The sooner you cut back, the easier it
will be to do so. And if in trying to
cut back you find that you really can't do it,
then it is time to check in with a mental
health professional who can help you do so. I hope
(12:23):
that was helpful, So let's talk about specific treatments for
alcohol dependence. Many people with alcohol problems don't recognize that
their drinking has become problematic. Others are not ready to
get help. It is important for each person to consider
the pros and cons of drinking and to decide whether
(12:43):
cutting down or quitting altogether is what's necessary. Abstinence from
alcohol is strongly recommended for people who have tried cutting
down but could not stay within their limits, have been
diagnosed with an alcohol used disorder, are experiencing the symptoms
of one have a physical or mental condition that is
(13:06):
caused or worsened by drinking, are taking a medication that
interacts with alcohol, And of course, those who are or
may become pregnant. Others might benefit from just reducing their
alcohol intake to reduce the impact of consequences associated with drinking.
(13:29):
When drinking is associated with problematic behavior caused by significant
intoxication or withdrawal symptoms like nausea, vomiting, agitation, insomnia. Detox
may be required to start the process of treatment. Detoxification
is done in a control and supervised setting in which
(13:49):
medications relieve the symptoms of the detox. It usually takes
four to seven days, during which time you would be
checking for other medical problems which might have been caused
by the drinking issue, checking the liver, checking for blood clotting,
and having a balanced diet with vitamin supplementation might be
(14:11):
important if you've been drinking a lot following detox. Alcohol
recovery or rehab programs help an affected person in maintaining
abstinence from alcohol. They offer counseling, they offer medical care
and psychological support for when you leave, and education about
(14:34):
alcoholism and its effects is part of the therapy. Many
of the staff and rehab centers are people who have
recovered from an alcohol use disorder, and they help serve
as role models. Programs can be inpatient with the person
in a facility during the treatment, but they also can
be outpatient with the individual attending the program while they
(14:56):
live at home. It's important to remember that other psychiatric
conditions like depression or bipolar disorder or anxiety disorders can
coexist with alcoholism. In fact, they may be driving the
drinking in and of themselves. But it's impossible to really
(15:17):
diagnose well another underlying disorder and treat it while alcoholism
is ongoing, which is why it's so important to treat
that first. So if there is an underlying disorder, you
really need to attend to treating that and then getting
to the bottom of the other one. Because people may
(15:39):
use alcohol as a form of self medication, this is
why these often coexist together. Three oral medications die sulfur
am also called antibuse, naltruck Zone, and accamprosate are currently
approved to treat alcohol dependence. In addition, an injectable, long
(16:02):
acting form of mal truck zone is available and can
be used. These medications have been shown to help people
with dependence reduce their drinking and avoid a relapse to
heavy drinking, which is really important, and achieve and maintain
abstinence if that's the best path. Mal truck Zone acts
(16:22):
to reduce the craving for alcohol and those people who
have stopped drinking, and a campersate is thought to work
by reducing symptoms such as anxiety and insomnia. They may
follow lengthy abstinence. Disulfram discourages drinking by making individuals feel
sick if they drink alcohol, and that, of course, is
(16:44):
negative reinforcement. Other types of drugs are available to manage
the symptoms of withdrawal that may occur if you're going
through alcohol dependence and then stop drinking, but early recognition
of these symptoms and immediate treatment is important because it
can help prevent some of them and it can drastically
(17:05):
limit their severity. Also worth discussing is twelve step programs
that help you stick to abstinence as the cure for alcoholism.
The harm reduction approach is more individualized. A person who
suffers may choose to use alcohol less as opposed to
full abstinence, but the aim is to really reduce the
(17:28):
consequences of their alcohol use. Alcoholics Anonymous describes itself as
a worldwide fellowship of men and women who help each
other to stay sober. It's recognized as an effective mutual
help program for people recovering from alcohol abuse, but even
those who are helped by it usually find that AA
(17:51):
meetings work best in combination with some other form of treatment,
something that includes counseling and medical care as well. Do
you have a problem I can help with? If so,
email me yet. How can I help At Seneca women
dot com. All centers remain anonymous and listen every Friday too.
(18:12):
How can I help with me? Doctor Gale's Salts
These are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight, and advice. Most people drink some alcohol.
People drink to celebrate, to relax, or socialize with other people.
But when someone drinks an excess or drinks as a
way to cope with stressors or avoid problems, it creates
(00:48):
both physical and psychological issues. So today I'm answering a
listener's question about how much she's drinking ALC. Whole use disorder,
known in lay terms as alcoholism, refers to a problematic
pattern of alcohol use that leads to significant impairment or distress.
(01:13):
Because alcohol use varies greatly between people, it is less
about the total quantity of alcohol consumed and more about
specific problems, such as when drinking interferes with your home life,
or school or work. Drinking could be problematic if it
creates interpersonal difficulties with family and friends, or if it
(01:38):
leads to a decrease of other activities in life. Age,
family history, and how much or how often an individual
drinks are other important variables when considering someone's relationship with alcohol.
Alcohol abuse affects all genders, races, and ethnic lines. Nearly
(02:01):
fourteen million people, often more men than women, in the
United States, have a problem with alcohol use. Issues surrounding
alcohol are highest among young adults ages eighteen to twenty
nine and lowest among adults age sixty five and older.
But defining and diagnosing alcohol use disorder can be complicated
(02:24):
when you're working with a young adult because the lifestyle of,
for example, college students, often includes excessive use of alcohol,
making it difficult to tell whether it's a legitimate disorder
or whether it isn't. Moderate drinking is considered up to
one drink per day for women and up to two
(02:45):
drinks per day for men in the United States. One
standard drink contains roughly fourteen grams of pure alcohol, which
is found in twelve ounces of regular beer, five ounces
of wine, or an ounce and a half of spirits.
So filling your wine glass up to the top of
(03:06):
the glass isn't one glass of wine Alcohol use disorder
is defined by the d s M five, the Diagnostic
and Statistical Manual in psychiatry, as a problematic pattern of
drinking that results in clinically significant impairment or distress, which
takes the form of two or more of the following
(03:27):
situations within a twelvemonth period. Drinking more than intended, or
doing so for a longer period of time than intended,
Continually wanting or attempting unsuccessfully to cut down or stop drinking,
spending a lot of time getting alcohol, drinking it, or
(03:49):
recovering from its effects, having a strong desire or urge
at other times to drink, Failing to fulfill major work, school,
or home responsibilities due to drinking, Continuing to drink even
though it is causing relationship troubles, prioritizing drinking by giving
(04:12):
up or cutting back important activities drinking, and situations in
which it is physically dangerous in the words that would
be for example, binge drinking, Continuing to drink even though
one has a persistent or recurrent physical or psychological problem
(04:33):
that drinking has likely caused or made worse. Needing much
more than was once needed to get the desired effect
from alcohol, or not experiencing the same effect when drinking
the same amount and having withdrawal symptoms, which could be
trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, even
(04:57):
a seizure, or sensing things that are not there, or
drinking to relieve those withdrawal symptoms or avoid having them.
Alcoholism or alcohol dependence is considered the most severe form
of alcohol abuse. The d s M five integrates alcohol
abuse and dependence into a single disorder with either mild, moderate,
(05:21):
or severe classifications. So mild would be the presence of
two or three of the symptoms I mentioned, Moderate would
be four to five, and severe would be the presence
of six or more symptoms. When someone has been drinking
alcohol to access regularly and suddenly stops, they can experience
alcohol withdrawal. The symptoms are some combination of hand tremors, sweating, insomnia,
(05:49):
rapid heart rate, anxiety, depression, fatigue, irritability, and at most
severe hallucinations and seizures. Alcohol all withdrawal is a serious
condition that can become life threatening if not treated. Symptoms
typically develop within several hours to a few days after
(06:09):
a person has stopped or reduced drinking. It is important
for individuals who may have alcohol use disorder to consult
a doctor to be honest and forthcoming, to determine if
they have a drinking problem, and if so, to collaborate
with that doctor on how to handle it. While the
specific cause of alcohol use disorder is unknown, there are
(06:33):
environmental and genetic links. In other words, alcohol disorders run
in families. But another factor is the addictiveness of the
substance itself. Excessive alcohol intake changes the chemical makeup of
the brain in ways that contribute to an addiction drinking.
Alcohol affects the physical and mental health of some people
(06:55):
differently than others, and in some it will lead to
an alcoho all related disorder, as I mentioned, abuse friends
and families, and the rate of the condition is three
to four times higher in close relatives of alcoholics, and
the risk increases with the closeness of the genetic relationship.
(07:17):
Environmental factors include cultural attitudes about drinking, availability of alcohol,
and substance abuse by peers. So, for example, I mentioned
that in college, it can be difficult to tell when
there's a problem going on because there's so much alcohol
available and because peers encourage the drinking to access the
(07:40):
risk of abusing alcohol increases if individuals use drinking to
numb themselves to their problems to cope with anxiety, with fears,
with stress or mood issues, and impulsivity is also linked
to alcohol abuse. How can I help with Doctor Gale
(08:02):
Salts will be back after the short break, so let's
get to my listeners question and see how can I help?
Dear doctor Sauls. I have had a difficult year, being
(08:22):
stuck inside with my family a lot and feeling very
stressed about everything from COVID to money troubles. When my
work day is done, I like to have a glass
of wine while I'm making dinner. It's relaxing and enjoyable.
In fact, it's one of the few things I'm really enjoying.
(08:43):
Over the last few months, I have been pouring myself
a second class while I'm cooking, and I can't say
I feel as relaxed as I used to after having it.
It's making me think about having a third one. But
it's also making me wonder if this is a problem.
How many glasses of wine and I are a problem.
(09:04):
I don't drink at all at other times of day,
and I don't get drunk. So part of me thinks
this must be fine, But another part of me wants
my glasses so much that I'm feeling nervous. It may
be an issue. What do you think? Because alcohol chemically
is an addictive drug. If you are drinking for the effect,
(09:27):
the effect of feeling relaxed, over time, whatever amount you
require to produce that effect will no longer do, so
you will need more to get the same feeling. This
is called tolerance, and over time, if you use less,
you may temporarily experience the opposite of that feeling, edgy
(09:50):
and jittery, which will likely make you crave your glass
even more. This is called withdrawal. Tolerance and with drawl
are hallmark signs of alcohol dependence. The old myth or
idea that alcoholics drink all day is just not true,
(10:10):
and alcohol dependence can happen to lovely and conscientious people
who don't realize they are building a regular habit over time.
This habit may not be interfering in your life, so
it's not yet abuse, but that you must do it daily,
that you are using more and now feel a need
(10:31):
to use even more, that you are thinking about and
craving your glass point to a developing problem. I would
suggest cutting back and now, and know that initially it
may not feel very good, but over a few days
to weeks that not good feeling will go away. I
(10:53):
don't advise just stopping cold turkey today, that could be
unsafe for you. But I do suggest cutting your second
glass in half for a week, than having no second
glass for a week, than half a one glass for
a week, and then every couple of days try having
(11:13):
no alcohol at all. Then you could resume with some
if this works out with for you, but I wouldn't
go above a glass a day. Then I think it's
important for you to find some other methods of relaxing
at the end of your day, Putting on great music,
chatting with a girlfriend, doing yoga, stretches, trying some paste,
(11:37):
deep breathing. If you want to replace just the act
of sipping on something delicious while you're cooking, consider some mocktails.
Consider something fun but alcohol free. They make alcohol free
beers and even alcohol free spirits. It's not that you
(11:58):
have to never drink, it's the regularity and increase that's
the issue. The sooner you cut back, the easier it
will be to do so. And if in trying to
cut back you find that you really can't do it,
then it is time to check in with a mental
health professional who can help you do so. I hope
(12:23):
that was helpful, So let's talk about specific treatments for
alcohol dependence. Many people with alcohol problems don't recognize that
their drinking has become problematic. Others are not ready to
get help. It is important for each person to consider
the pros and cons of drinking and to decide whether
(12:43):
cutting down or quitting altogether is what's necessary. Abstinence from
alcohol is strongly recommended for people who have tried cutting
down but could not stay within their limits, have been
diagnosed with an alcohol used disorder, are experiencing the symptoms
of one have a physical or mental condition that is
(13:06):
caused or worsened by drinking, are taking a medication that
interacts with alcohol, And of course, those who are or
may become pregnant. Others might benefit from just reducing their
alcohol intake to reduce the impact of consequences associated with drinking.
(13:29):
When drinking is associated with problematic behavior caused by significant
intoxication or withdrawal symptoms like nausea, vomiting, agitation, insomnia. Detox
may be required to start the process of treatment. Detoxification
is done in a control and supervised setting in which
(13:49):
medications relieve the symptoms of the detox. It usually takes
four to seven days, during which time you would be
checking for other medical problems which might have been caused
by the drinking issue, checking the liver, checking for blood clotting,
and having a balanced diet with vitamin supplementation might be
(14:11):
important if you've been drinking a lot following detox. Alcohol
recovery or rehab programs help an affected person in maintaining
abstinence from alcohol. They offer counseling, they offer medical care
and psychological support for when you leave, and education about
(14:34):
alcoholism and its effects is part of the therapy. Many
of the staff and rehab centers are people who have
recovered from an alcohol use disorder, and they help serve
as role models. Programs can be inpatient with the person
in a facility during the treatment, but they also can
be outpatient with the individual attending the program while they
(14:56):
live at home. It's important to remember that other psychiatric
conditions like depression or bipolar disorder or anxiety disorders can
coexist with alcoholism. In fact, they may be driving the
drinking in and of themselves. But it's impossible to really
(15:17):
diagnose well another underlying disorder and treat it while alcoholism
is ongoing, which is why it's so important to treat
that first. So if there is an underlying disorder, you
really need to attend to treating that and then getting
to the bottom of the other one. Because people may
(15:39):
use alcohol as a form of self medication, this is
why these often coexist together. Three oral medications die sulfur
am also called antibuse, naltruck Zone, and accamprosate are currently
approved to treat alcohol dependence. In addition, an injectable, long
(16:02):
acting form of mal truck zone is available and can
be used. These medications have been shown to help people
with dependence reduce their drinking and avoid a relapse to
heavy drinking, which is really important, and achieve and maintain
abstinence if that's the best path. Mal truck Zone acts
(16:22):
to reduce the craving for alcohol and those people who
have stopped drinking, and a campersate is thought to work
by reducing symptoms such as anxiety and insomnia. They may
follow lengthy abstinence. Disulfram discourages drinking by making individuals feel
sick if they drink alcohol, and that, of course, is
(16:44):
negative reinforcement. Other types of drugs are available to manage
the symptoms of withdrawal that may occur if you're going
through alcohol dependence and then stop drinking, but early recognition
of these symptoms and immediate treatment is important because it
can help prevent some of them and it can drastically
(17:05):
limit their severity. Also worth discussing is twelve step programs
that help you stick to abstinence as the cure for alcoholism.
The harm reduction approach is more individualized. A person who
suffers may choose to use alcohol less as opposed to
full abstinence, but the aim is to really reduce the
(17:28):
consequences of their alcohol use. Alcoholics Anonymous describes itself as
a worldwide fellowship of men and women who help each
other to stay sober. It's recognized as an effective mutual
help program for people recovering from alcohol abuse, but even
those who are helped by it usually find that AA
(17:51):
meetings work best in combination with some other form of treatment,
something that includes counseling and medical care as well. Do
you have a problem I can help with? If so,
email me yet. How can I help At Seneca women
dot com. All centers remain anonymous and listen every Friday too.
(18:12):
How can I help with me? Doctor Gale's Salts
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