Alcohol - A Coping Strategy with a Downside
Soon after passing the Medical Board Exams, I found myself at home with my three month old baby and post-partum depression. I had decided to take a year off before officially starting to practice as a Naturopathic Doctor in order to bond with the baby I had barely gotten to know as I raced to complete my medical training. Those early months at home with my son Reed (now aged 16) were lonely and isolating, and it was during this time that I turned to alcohol as a coping mechanism. My husband worked long hours, my relatives lived far away, and every friend that I had made at school was busy starting a career for which we had worked so hard. I was left without a social network.
At first, alcohol provided a way for me to relax and unwind and offered a temporary anesthesia to the pain and loneliness that I felt day in and day out. Over the years that followed, my relationship with alcohol only intensified. It became clear after the birth of my third child that alcohol for me was no longer a choice but rather a necessity that I didn’t know how to live without. I am forever grateful that eventually and with many ups and downs, I was able to get sober. I now share my story and help others who struggle with alcohol dependence and addiction using an integrative approach, merging evidence-based natural medicine with conventional healthcare.
Alcohol as a Covid-19 Coping Strategy
As we retreated into our homes when the Covid-19 lockdowns began, I was reminded of those early days with my son when alcohol felt like a perfect and justifiable reward for making it through another day. The unprecedented financial and emotional stress due to Covid-19, along with the new demands of managing children’s home-learning, work, and households under social distancing orders, has resulted in huge increases in alcohol sales, hospitalizations for alcoholic liver disease, and people self-reporting that they are drinking far more than they did before Covid-19. According to Nielsen market research, alcohol sales nationwide were up 55% for the week ending March 21, 2020 compared with the year before.
Classified as a central nervous system depressant, alcohol is widely marketed, readily available, and socially acceptable. However, just like any drug, it is a powerful substance with a high risk of dependence and abuse. Like many physicians, I am seeing many people reporting they are drinking much more than they did during the previous year. Their health has taken a downturn with changes in weight, blood sugars, and liver damage related to the over-consumption of alcohol.
How Much is Too Much?
The National Institute of Alcohol Abuse and Alcoholism defines moderate drinking as up to two drinks a day for men and up to one drink a day for women. One standard drink is the equivalent to 12 oz of regular alcohol content beer, 5 oz of wine, or 1.5 oz of hard liquor. The recommendation is for men to drink no more than four drinks on any single day and no more than 14 drinks a week. For women, the drinking limits are no more than three drinks on any single day and no more than 7 drinks per week. To stay within the parameters of moderate drinking for a woman, a standard bottle of wine (750 ml or 25 oz) should last for five days. Drinking quantities of alcohol that stay within the strict definition of moderate drinking can be tough, and it appears that now many people worldwide are consuming considerably more. As you reflect on your personal drinking habits, or on those of your loved ones, here are some definitions to consider:
- Dependence occurs over time when the body adapts to the presence of alcohol and needs larger quantities to achieve the same effect as when the alcohol was first used.
- Abuse refers to a pattern of behavior where a person uses alcohol in amounts or in ways that are harmful to themselves or other people (i.e., affecting emotional and physical health or resulting in financial, work, and social consequences).
- Addiction is a compulsion beyond a person’s control to use alcohol. When someone has crossed over to addiction, they are no longer making rational decisions about when, where, or if they will drink. Many addicts describe drinking despite not wanting to because the compulsion was so great.
The short- and long-term health consequences of overuse of alcohol are well established. Excessive drinking can result in short term health risks such as accidents, violence, risky sexual behavior, alcohol poisoning, and fetal alcohol syndrome. Long term health consequences of drinking excessively include increased risk of cancer (breast, mouth, throat, esophagus, liver, and colon), pancreatitis, memory problems including dementia, depression, anxiety, heart disease, weakened immune response, gastritis, and liver cirrhosis.
Rather than solely focusing on the amount of alcohol a person is consuming, I think it is important to also consider the emotional dependence a person has developed with alcohol. We are drawn to drinking when both happy and sad because alcohol lights up the neurotransmitters associated with pleasure. Drinking alcohol can offer relief from the unpleasant symptoms associated with stress by decreasing fear and anxiety, relaxing muscles, and slowing rapid heart rates. The tricky part is that the higher your stress is, the more that relief is reinforced. For most people, experiencing that reward cycle in moderation is not inherently harmful, but for people like me it can become very serious. If you drink for stress relief, the likelihood of drinking larger amounts of alcohol during times of increased stressed is very high because you are already using alcohol as a coping mechanism.
Identifying a Drinking Problem
If you are concerned that you might be drinking too much or that your relationship with alcohol has changed, consider asking yourself these common questions posed at Twelve-Step meetings:
- Are you able to stop drinking for long periods of time comfortably?
- Once you start drinking, are you able to stop?
The first step after you have determined that you are drinking too much is to cut back or stop all together. Each person is unique and each person’s relationship with alcohol is unique. Many alcoholics will report experimenting with “controlled drinking”, typically unsuccessfully, for many years before getting sober. While a casual drinker can easily take months off from drinking alcohol, those who have developed dependance will have difficulty going even a few days. When I work with patients, I find it important to help them explore their relationship with alcohol by discussing the steps of the addiction cycle, as shown here.
Dependence on alcohol usually occurs when you need to drink larger quantities in order to achieve the desired calming effect. Over time this dependence can develop into abuse where alcohol use results in harm to you either emotionally, physically, socially, or financially. Eventually you can crossover into addiction when the compulsion to drink is so great that you feel out of control.
NaturoMedica’s Integrative Approach to Alcohol Dependency
When we have a patient in need of support around alcohol, we embrace a multi-step approach.
1. Address mental and emotional health and consider in- or out-patient treatment for alcohol abuse.
Exploring your relationship with alcohol and reviewing the steps of the addiction cycle are important components of addressing your mental and emotional health. We will work with you to determine your need for in- or out-patient treatment, and there are many organizations and groups aimed at drinking in moderation or cessation. Different programs work for different people, and if you need a program, regardless of your belief system, there is a program suited for you.
2. Identify and correct nutritional deficiencies created as a result of excessive alcohol consumption.
The process of metabolizing alcohol uses certain nutrients, and over time these will become depleted causing normal body functions to suffer. B vitamins are especially vulnerable to becoming deficient with alcohol use. B complex vitamins such as thiamin, riboflavin, niacin, B6, B12, and folic acid are essential to mental and emotional well-being. Interestingly, deficiencies of other nutrients created by alcohol use, such as vitamin C, magnesium, calcium, zinc, iron, potassium, and chromium, can contribute to negative feelings which lead a susceptible person to consume more alcohol. Basic blood work can be obtained to identify common nutritional deficiencies and alcohol-induced liver disease through any commercial laboratory. Additionally, NaturoMedica offers more extensive nutrient testing through specialty labs that looks at the inadequate amounts of vitamins and minerals which can result from overconsumption of alcohol.
3. Support the liver.
Because the liver is the primary organ of detoxification, it is vital to address liver health when attempting to reverse the negative effects of alcohol. Milk thistle is a powerful antioxidant and anti-inflammatory herb which has been shown to encourage repair of hepatic cells. Other herbs we use to support the liver include burdock root, ashwagandha, dandelion root, and kudzu. (Note: In order for these herbs to assist in detoxifying and healing the liver, you must first stop consuming alcohol.) Liver Support by Vital Nutrients is a comprehensive supplement to support the cell of the liver to detoxify and heal from damage.
4. Use nutritional supplementation to help with cravings.
Some nutritional supplements can help with alcohol cravings. Imbalances in blood sugar are an important piece to consider as alcohol is easily converted to sugar in the body. We become accustomed to the increased amounts of sugar with even small increases in alcohol use, and when alcohol is removed, most patients report that they crave sugar intensely. Eating a balanced healthy diet free of simple carbohydrates and sugars will aid in a more stable blood sugar and therefore help with sugar cravings. Alcohol is a depressant. When alcohol intake is stopped by someone who has been regularly consuming alcohol, rebound anxiety can occur. I often use sedative herbs and neurotransmitter support such as skullcap, kava kava, magnolia, GABA, and L-theanine to help reduce anxiety. Cannabidiol (CBD) has recently been shown to be effective at reducing both cravings for alcohol as well as anxiety in those who have become dependent. It is best to work with a physician to help you find the appropriate CBD product because there is variability in product potency and purity. Medications such as Naltrexone and Gabapentin may be used in some cases to help control alcohol cravings.
5. Establish healthy eating habits.
Drinking can affect our food choices. People who drink more are less likely to consume the daily recommended number of fruits and vegetables, are less likely to exercise, and tend to have disrupted sleep. Studies have shown that when alcohol is consumed with meals that food intake increases by as much as 30%. Over time the increase in calories and decrease in exercise result in weight gain. A whole systems approach focused on diet, exercise, sleep, nutrition, and mental health is needed to overcome the long-term effects of drinking.
An integrative approach such as the one we offer at NaturoMedica can help you develop a healthy relationship with alcohol. It is important to recognize when your alcohol intake is no longer benefiting you or those around you and actually causing harm. If this is you, then we can help you get back on track by helping you decrease your alcohol intake and address your stress and anxiety in healthier ways. We aim at restoring the body to vital health by establishing a nutritious diet and active lifestyle. We address specific nutrient deficiencies and prescribe medicinal herbs that can support liver function, stabilize mood and sugar cravings, and improve sleep. Personally, I find that helping people through this process is one of my most rewarding experiences as a physician.