What Alcohol Does to Your Body: Harvard’s Dr. Sarah Wakeman With the Medical Facts You Need to Know

Do you even

know

what

happens in

your

body

and brain when you consume

alcohol

? No, it affects our behavior, our sleep, our mood, and many other parts of our

body

system. When a lot of people make a cocktail at home, it's like lug glug. glug glug gug and there are three drinks right there, the biggest risk of drinking would be if you drink more than 10 ounces of hard

alcohol

a week or 35 ounces of wine in a week, we drink the alcohol at night, but we don't really understand it.

what

is happening and how it is really impacting

your

experience of the day of your life today.

Hello, I'm your friend Mel. I'm so happy you're here and whether you're listening today for yourself or because someone you love shared this episode with you. I want to To welcome you to the Mel Robbins podcast family, it's truly an honor to spend some time with you today and I also wanted to thank you for something that you

know

you could be listening to or watching a billion things right now, but you chose to dedicate your time. to hear something that can help you create a better life and I think it's great and today's episode in particular will not only help you achieve that, but it could change your life or the life of someone you love today on the show.

You and I are going to receive a masterclass from one of the world's most respected and recognized experts on alcohol and its impact on your body, your brain and your life. I am so excited that you are here with me today and I have been looking forward to it. to this conversation for a long time and I'm going to tell you why because recently I've been focusing on getting super intentional about creating healthier habits, particularly around exercising more and taking better care of my brain and the more I do that. The more I question my relationship with alcohol, maybe you have questioned your relationship with it too.

I mean, if you think about it, you're eating all this healthy food and exercising and taking supplements and trying to learn and you grow and then you basically end the day, if you're like me, having a lunch or a glass of wine or a gin with IC, if you put it in that context, it's a little silly and I don't know if I've ever been in this situation where you go to see your primary care doctor and they ask you that question: how many drinks do you have a week? ? I can't be the only one who has lied to their primary care doctor before because suddenly you know. that the number is a little higher than it should be, I mean, I've been there and the more I find out about alcohol and talk about the

facts

, the more I think I have to do something about it.

Questions: Does drinking have any health benefits? Is there any amount of alcohol you can drink that is really healthy for you? It is the only answer available. Don't drink anything at all. Alcohol is constantly marketed to you and me. It's like what you You

need

to have a great weekend You have to have it as a tailgate You

need

it for every celebration It's what you drink when you want to relax at night Do you even know what happens in your body and brain when you consume alcohol? You don't know how it interferes with the medications you're taking and that's how I wanted to approach this today.

I don't want to lecture you. I want you and I to feel empowered with the

facts

because when you feel empowered when you understand something on a deeper level, don't you feel more motivated and actually able to make better decisions for yourself? Of course you do, and one more thing I wanted to point out to you if you're worried about someone in your life and you're drinking, this episode is a world class resource, just share it with them because if you haven't been able to communicate how worried you are, I guarantee that our expert today will make you reconsider your relationship with alcohol, Dr.

Sarah. Wakeman is here and she is one of the most recognized

medical

experts in the world. She will discuss how alcohol affects your health, your body and your mind. Dr. Wakan is the senior

medical

director of substance use disorders at Harvard's Mass General Brigham, which has been ranked the number one research hospital worldwide after studying at Brown University. Dr. Wakeman did her residency at Mass General, which is the best program in the country, where she was also chief resident, meaning she was the number one resident physician in In her class, she is an associate professor of medicine at the School of Harvard Medicine and director of the addiction medicine fellowship program at Mass General, and she squeezed us into her extraordinarily busy schedule and is here today at our studios in Boston to spend time with you and give to you. you and your loved ones the facts, science and research so that you and the people you love can make an informed decision about the role alcohol plays in your life, so help me welcome Dr.

Wakeman to the podcast by Mel Robbins. I'm very excited to be here, thank you for having me. Thank you for taking the time because I know you have an incredibly busy schedule, so let's get right to it. Dr. Wakan, can you explain to us what alcohol is and how it affects our bodies? Sure alcohol is a molecule, it's a water soluble molecule that is easily absorbed into the body through the stomach and small intestine when you drink it and it affects all the different parts of the body and body systems, particularly the brain. , so we feel the effects of alcohol soon after we start drinking and we can talk about what those effects are, but it affects our behavior, our sleep, our mood and many other parts of our body system.

You talked about alcohol as a molecule, which sounds very scientific to me. So what type of molecule is it? Know? Is it a poison? Could you explain more about the composition than what it actually is? Yeah, I mean, the way we drink alcohol is through a process called fermentation. um something that has sugar like grape juice or think of um beer, you know barley or potatoes or other um often starches are fermented and in that transformation process they form an alcohol, they form an alcohol molecule which then has a different effect on Our body alcohol is found in all kinds of different things, so obviously it's intentionally made through fermentation to ingest, but we also use it in cleaning products or as isopropyl alcohol or mouthwash or hand sanitizer, so there are alcohols to around us and they're used for a lot of different things, uh, well, when you say the category of hand sanitizer for cleaning, isopropyl alcohol, thinking of uses in a hospital and then I put it in the same almost familiar category as something that you would ingest in a cocktail, is it the same molecule as it is and in fact, some of my patients with more severe forms of alcohol use disorder drink hand sanitizer or isopropyl alcohol or mouthwash if they can't get alcohol regularly, which really It indicates the power of addiction once someone reaches that level of severity, but it is the same molecule with the same effect.

I already learned something that if you are watching us on YouTube you can see that my mouth is open. I don't know why I never connected the dots on that, it's actually the exact same chemical. the actual alcohol molecule that we think of fancy, you know, Cosmopolitan is no different than what's in isopropyl alcohol, let's just say I never knew that, I think it's an indication of how much we get into it and don't really think in what we do. We're absolutely doing it, I mean it's so socialized into a part of the culture and a part of the celebrations and events that I think it feels like a part of life.

Are there negative impacts to having a beer or glass of wine every night? I mean, how

does

that impact you? Yeah, this is probably the most fascinating area of ​​research where things have changed and come and gone over many decades of science and it's actually a bit of a complicated question to answer, which is why I think there's been very confusing sometimes in studies. contradictory about this, so if you want to try to understand what the impact of low-risk drinking, moderate RIS drinking, high-risk drinking, high-risk drinking, you have to figure out how to study it, so you have to follow the population over time to see. what happens and then you have to figure out how we isolate the effect of alcohol and from the beginning there were many studies that showed that low risk drinking or drinking in moderation we are actually healthy.

I seem to remember something like a glass of red wine. are antioxidants really good for you I don't know if it's red wine The lobby tells us that one criticism of those studies showing that low-risk alcohol consumption is healthy is that the group that is often used as a kind of group The comparison is people who don't drink at all, but it turns out that many people who don't drink at all may not be drinking because they have chronic health problems or because they actually used to have an alcohol use disorder and are now in remission or recovery. and may have health consequences that lead to higher mortality compared to people who drink at a low-risk or infrequent level, which is why many of the more recent studies have used infrequent drinkers as a sort of control group. control or comparison group and I think it's really helpful to understand the data that way.

There was a really big study this year that looked at hundreds of thousands of people who had been surveyed from the 1990s to their mid-teens. 201 teenagers and they did a really classy job. trying to answer this question and the things they did differently than other studies is they first controlled for other healthy behaviors, lifestyles, chronic conditions, because one question is a person who drinks a glass of wine a day, maybe they're also running every day and you know how to do other types of health promoting behaviors and maybe that person who chose not to drink at all has lung cancer and that's the reason they don't drink, so they actually controlled all of that and they saw him in the low risk category.

There seemed to be a slight decrease in mortality and that wasn't true for cancer, so any amount of alcohol is associated with an increased risk of cancer and that's a very important thing to know, especially if someone has a personal family history of cancer. that's strongly associated with alcohol consumption and so taking that into account when making decisions about alcohol is really important. What is it about the alcohol molecule that increases the risk of cancer? You know it's different for every type of cancer and I think. We are just beginning to understand this. If you take breast cancer, the things that seem to increase hormone levels are often associated with a risk of cancer, so I think it's an area of ​​active research to understand why alcohol and breast cancer.

In particular, they are so closely related to other types of cancer that it is a little clearer that they tend to be liver or intestine cancers that are strongly associated with alcohol and that makes sense if you think of alcohol as a potential poison that enters the intestine and is metabolized. because your liver causes changes, that's an area where we see a lot of cancer risk. Can you talk to us about what you're seeing in relation to alcohol and liver failure or just how it's affecting people's liver? Yes, one of the main health damages caused by alcohol.

Especially excessive alcohol consumption is liver damage and what we see happening is this progression where the first thing that happens is inflammation of the liver and when the liver becomes inflamed you start to have fatty deposits in the liver, so the The first type of step is what is sometimes called fatty liver, so it's the deposition of fat in the liver, which can actually be completely reversed if you stop drinking or make changes, and that's the amazing thing about the liver, it's a truly regenerative organ, so you can remove 80% of someone's liver and they would be fine, but there is a point where you cross a threshold where you can no longer repair the damage and that is when you reach a stage called therosis , so from the deposition of fat you begin to have scars, your body deposits all this scar tissue because of the chronic inflammation in the liver and when the liver scars so much that it becomes very rigid and begins to not function well, that's therosis and we often used to think of therosis as something that happened to people decades later.

I'm seeing people. they were in their early 30s with uterosis in the hospital and I think those are some of the most heartbreaking cases because people thought this wasn't on their bingo card, they didn't even think this was a concern, you know, they were drinking a lot. I thought it was like that their social circle was doing the same thing and then all of a sudden they were in their 20s and 30s in the hospital and their liver failed, and you know there's very little we can do at that point other than organ transplant , which is a big problem and it is not something that is accessible to everyone, it is something that is being seen increasing at an increasingly younger age, yes, and there are actually many studies that show it, so between 2010 and 2020 there has been a significant increase in alcohol-related liver failure, especially among women and people increasinglyyoung people, and even just after the start of covid we saw about a 25% increase in classified alcohol deaths after the start of the pandemic, so the pandemic was difficult for many reasons, but certainly increase in alcohol consumption throughout the country and with that liver disease and liver failure.

Wow, how

does

alcohol affect the kidneys? So one of the main effects that people have probably experienced is that it makes your kidneys less sensitive to a hormone that your body produces, called ADH or antidiuretic hormone and then you urinate more, if anyone has ever noticed that when they drink, they urinate a lot more and it's not because you're hydrated because that's what I thought that's why I have more fluid in me but actually it's because it's blocking a hormone exactly so regardless of how much you drank you're going to urinate more because to this blocking the effect of normal hormonal function in the kidney and that can lead to dehydration, which is one of the many reasons why you feel really bad.

The next day, because you get dehydrated from drinking, what happens to your gut microbiome? We are learning a lot about the importance of a healthy gut, how does alcohol affect it? Yeah, so alcohol, I think there's growing research on how it affects the microbiome. Certainly, again, with a lot of alcohol. levels, it seems to damage the microbiome and we see this in patients with liver disease, but also the impact of alcohol itself, the kind of two main things it does, one is it creates more leaks in the intestines, so people may have heard of something like that.

Leaky gut, you know, the walls of your gut become more porous, so things that aren't meant to come out of your gut do and can cross the blood-brain barrier, so this whole idea of ​​the brain gut type axis is a really growing area of ​​research and knowledge, so alcohol can do that you can also change the composition of your microbiome, as can white flour that is high in fat and sugar, like the Western diet, but there are a lot of studies now that demonstrated. that some of the modifiable things if you want to improve your intestinal health are to reduce your alcohol consumption and stay away from that type of high-fat, high-sugar, high-carbohydrate Western diet.

You know, I'm sitting here listening to you and I'm thinking why the hell do I drink this? Yes, I think it is important to understand what the risks are that we often don't talk about and assume that this is something harmless that is just a part of life, my personal perspective. is that every health behavior exists on a spectrum and it's really important to understand what that spectrum is, where I am at and then what my personal health goals are and actually stop and think about how alcohol fits into my life, like what I like it?

That I do not like it? It is worring me? What is this amount of alcohol doing to my health? Are there any health benefits to drinking alcohol? My opinion is that we shouldn't think of it as a health benefit, so as a doctor I would never tell a patient that I think you should start drinking a glass of wine a day for your health. It's true that we used to say that people used to say that you know, this idea of ​​a glass of red wine is healthy um, I think framing is wrong. I think that doesn't mean you can't drink alcohol and we should talk about that, but thinking of it as a health-promoting behavior probably isn't the best way to frame it now that there are so many things we do in life that most likely would be to do none of that, so if your goal is to have zero risk, you should probably never drive your car, never go skiing, you know, never fly on a plane, never eat bacon, never go out.

The sun and people are not going to live that way, so I think it's very important to understand what the risks are, how this fits into my life in general and when I should be worried and how I can make changes to lessen them. risks, so if you find that you are really stressed in your life and are turning to alcohol as a stress reliever, it probably won't be a healthy way to cope and can lead to long-term problems, especially if you're trying to live a life where you are more mindful or more present or present for your children or your partner, or you know you are trying to get in shape and want to wake up in the morning to exercise if you are drinking every night, you probably won't feel refreshed by morning, you'll notice, you know you don't have the same exercise capacity, so I think just figuring out what this alcohol ritual is like, what role it plays in your life and it doesn't have to be that you stop drinking completely and I think that that's a really important message because that may not be people's goal, but if you feel like maybe this is causing me some problems, maybe this is actually counterproductive to my other health goals make some changes cut back take a rest those are all really healthy ways that you can start to really explore your relationship with alcohol yeah, you know, I love the fact that you're an addiction specialist and you have a very realistic approach because I agree with you that it feels as if you were inside or outside.

I think it's scary for a lot of people to feel like there's only one option: drink or drink. Don't do it, and for many people, not drinking at all is the absolutely empowering choice, but I love what you're saying: you need to wake up and understand what your motivators are and what really matters to you at this point in your life. and if you care about producing more at work or being more present or reaching your potential, you need to look at the role alcohol plays in your life, yes, from a medical perspective, how much drinking is drinking too much, yes, from a medical point of view research.

The biggest risk of drinking would be if you consume more than 10 ounces of heart alcohol per week or 35 ounces of wine per week for a woman or anyone over 65, so we're starting to see heart risks. health, such as increased risk of dementia, impact on your liver, your digestive tract and other serious conditions, you know, I'm sitting here thinking about you as a doctor and a researcher and how I think many of us lie to our doctors about how much we drink really and we're not even aware of what the serving size really is because when a lot of people make a cocktail at home it's like glug glug glug glug glug and there's three drinks right there or you've had several large glasses of wine that basically I mean that you've had all seven glasses of wine in one night and you think oh oh, I only had a couple of drinks, but I bet when you're watching someone get a scan, there are probably times when you think, yeah, that's someone who has a Drink a lot because I can see it in the brain, yes, and I think there are a lot of important points hidden in that, so first we all lie.

I tell my dentists that I floss every day. We don't want people to like us and approve of us. So I expect people to lie to me, especially if they don't know me, and for most people, because of the tremendous stigma around substance disorders, there's a lot of shame and worry, for a lot of people their experience hasn't been as good. It happens to them when they say they have a problem with alcohol or other drugs, and as a doctor, I feel like it's up to me to gain someone's trust and also educate them. I mean, there is nothing more heartbreaking to me than when I see someone you know in the terminal stages of liver failure, for example from alcohol, and no one has told you beforehand what the risks are that this could happen, what kind of drink is seen on the bottom of the wrist, often you have never had that conversation.

So we're going to see people in their 30s come in, they literally die during that hospital admission and if you look back, they had touch points with doctors, maybe they were drinking a lot and no one stopped to talk to them about it, and I think which is a true testament to how in the medical system for so long we have viewed substance use and addiction as something separate from the rest of healthcare, it is not our job to be a behavioral issue, nor a moral issue, nor a It's a question of willpower, but this is a health condition like any other and I think the medical system and doctors need to feel comfortable talking to patients about it, asking them the right questions, giving them the right education and partnering with people to Make healthy changes when you sit down with someone who comes in.

How does your practice help you discover your relationship with alcohol? What is a list of symptoms that you would say? These are all indications that this could be a problem. Yeah, that's a great question, so I'll go through a sort of checklist. that's what I'm thinking about when I talk to someone about alcohol, so first, you know, understanding how much they're drinking, just the general amount and how often, is important as a kind of indicator of what their risk might be, but then I really do. The important questions are: are they drinking more than they want?

Then they may have set an intention and are realizing that they are actually always drinking more or spending more time drinking or recovering from drinking than they intended if they had tried. You have tried to make changes and have not been able to do so. Have you tried to cut back or tried to quit drinking and really couldn't? That's a very important sign that you may have lost control of your drinking. Are you drinking even though people in your life are concerned about it or your spouse is expressing concern or is it affecting your job or your ability to perform in roles that matter to you?

Do you drink even though it is actually making you more anxious or worsening your physical or mental health? in some way and then we often think about craving, which is a kind of strong psychological urge to want a drink, so that you can't get the idea of ​​having a drink out of your mind, that's something we can see with the disorder by alcohol consumption and then There are two physical symptoms, which is the idea of: Do you need to drink more to get the same effects? Do you need to have four drinks? Now before, one or two would give you that effect and you feel bad if you stop drinking, so there's that.

It's kind of a checklist that we went through and I think it really addresses those kind of general areas of losing control, using compulsively despite the consequences and then craving, that was very helpful and one of the things that really resonated with me is that you've tried stop drinking more than you want, you feel anxious and yet you continue to do it and you're in this cycle of wishing you could control this and yet you feel like you can't and yet if you know, He's not tripping. at night or you feel like I can hold a conversation.

I'm not fainting. I don't get behind the wheel of a car. There's this assumption that it's under control, but I love how you just defined it because you're M, you're making us really look at ourselves and ask the honest question what is it really and even just that question, are you drinking more than what do you want to drink? If you answer that question honestly and if you are listening. right now for yourself or are you listening to someone you love and care about. This is an amazing starting point because we're not arguing about how much you're drinking, we're not arguing about your behavior, we're really talking about the honest answer to what your relationship with him is and whether you really have control over his ability to use it or not. use it and that's powerful now, Dr.

Wakeman, where I want to pivot next is that I'm starting to see this picture where, as a renowned researcher and expert on the topic you're talking about, I want to focus a little bit on amplifying the impact everyday life in which most of us are not present. that we drink alcohol at night because, at least in my own experience, it is like an easy lever to pull to tell my brain that we are no longer working, this is what I do as my ritual to move into the night. have a glass of wine, but we don't really understand what is happening and how it is impacting your day-to-day life experience.

I want to pause briefly so we can hear a few words from our sponsors and I also want to remind you. If you're worried about someone, send them this episode right now while you listen to our sponsors, because a lot of times they can't hear it from you, but from someone like Dr. Wakeman, who has such a balanced approach and is a recognized expert on this topic, It might actually be the thing that makes someone wake up and want to do better, so I'll be waiting for you after a few quick words from our sponsors. Thanks for sharing this with anyone who needs to hear it. and I'll see you right after the break.

Welcome back. I'm Mel Robbins and I'm so glad you're here. Thank you, thank you for sharing this episode with absolutely anyone in your life who you think needs to hear this. and today I'm spending time with Dr. Sarah Wakeman from Harvard, so Dr. Wakan, can you explain to us what are some of the other everyday things that people experience when they drink that they may not realize?Are they related to drinking? Yes, is cool. A very common question is worsening acid reflux. If you have heartburn that is strongly associated with alcohol, which actually relaxes the part of the esophagus that allows the acid to come back, many times people struggle with terrible heartburn and don't realize it.

While those two glasses of wine probably have a direct impact on other things, we know that alcohol can dehydrate you, so you may notice that your skin changes, it affects the way you sleep, so you may feel less rested when you wake up in the morning. tomorrow. or waking up in the middle of the night and not being able to get back to sleep, so there are many small, everyday ways that alcohol may be affecting your health and experience. What are some of the benefits you would almost experience? Immediately if you stop drinking completely or cut back heavily, what kind of health benefit would you experience in your daily life?

Yes, you will see a lot of real benefits. Quick things to make you sleep better and feel more recovered, you can lose weight, there are a lot of calories in alcohol, so if your goal is to lose weight, you are drinking a ton of liquid calories, so you might find that's better. You find that your exercise capacity increases because you rest more, you don't have a hangover and you can exercise in a way that makes you feel different, you may find that you are less irritable and more present for your loved ones. your mood actually improves over time your skin may look better you are less dehydrated your hormones are more regulated so you may have less acne so all of those benefits you can often see in a very short time and that can reinforce yourself as you decide what you want your long-term goals to be to really see what life is like with less or no alcohol, how alcohol affects the range of female hormones, from estrogen to progesterone, for starters, how it affects your hormones, yeah I think this is an area of ​​growing research and understanding and I think people are also really interested in drinking during menopause and, you know, what to think about all that, um, a couple of things, I think that many of the symptoms that people experience during menopause, such as hot flashes, will be worse with any amount of alcohol.

Actually yes, because alcohol dilates blood vessels, so you may have experienced that if you drink a couple of glasses of wine you feel flushed and hot, it's just happening. to amplify the experience you are having during hot flashes, so if you are trying not to have hot flashes, drinking will be your enemy because it will make things worse, such as sleep disorders, which are very common in the mood swings of menopause. and alcohol can affect all of them and it can be a difficult cycle because you may be drinking because your mood is actually low and you're having a hard time falling asleep, but then the alcohol is actually counterproductive and makes those symptoms worse in the long run. talk a little bit about sleep because alcohol doesn't affect your sleep in a very negative way yeah and people will be surprised to hear that because it makes you fall asleep faster so people often like oh , alcohol helps me sleep because I fall asleep very quickly. but when we think about sleep architecture, there are different sleep cycles that people are probably familiar with, like REM sleep, which is deep, you know, rapid eye movement sleep, but there are different cycles that you body, your brain naturally cycles through the night and the balance of those.

Cycles are really important for achieving restful sleep, which is when your body rests and heals, and what alcohol does is change the composition of those cycles so that you enter deep sleep more quickly and have less time in the phases. normal sleep. And then your sleep architecture is disrupted and you don't get the same restful sleep, so you might wake up at 2:00 in the morning, you know, after falling asleep really quickly, but then you wake up and you can't go back to sleep. . asleep or you may wake up in the morning and just not feel refreshed even though you were completely asleep, you know you are sleeping too deeply because your brain doesn't have time to restore itself the way it needs to.

I have another question, Dr. Wakman, can you walk? Tell us what's happening in your body in terms of what we call a hangover, so you've gone out at night, you've had a little alcohol and you wake up, what a hangover is and what's actually happening in the body. As you withdraw from alcohol, yes, hangovers are fascinating and I think people are still trying to understand exactly what's going on. Definitely, what we call a hangover is often a kind of constellation of symptoms that include a headache. I feel anxious, I often have a kind of decreased exercise tolerance, so you can't, you don't have the same aerobic capacity that you had before.

I feel irritable. Those are all kinds of hangover symptoms that people have. you've probably experienced that there's an older school of thought that was actually mild alcohol withdrawal, so withdrawal happens when you drink so much that when you stop drinking you actually have symptoms, it seems like that's probably not the case, constellation of symptoms is quite different, so The idea is that it's actually a combination of two things: one is dehydration, so we already talked about how alcohol makes you urinate more and therefore you become dehydrated, and the another are actually byproducts of the drink you're drinking. drink itself, either the type of breakdown products of alcohol or there are certain types of spirits and drinks that have other types of molecules that can build up and make you feel even sicker, so for example, clear alcohol tends to cause less discomfort. hangover than black alcohol and that is probably due to the other substances it contains, but they are actually toxic byproducts and dehydration.

If I had to summarize what causes a hangover, why is anxiety one of the most important SYM symptoms of a hangover and alcohol withdrawal, yeah, it's probably the effect of these byproducts that, so, you know, are still impacting the way your body works, your brain and your body takes a long time to excrete them, um, and then we can see, really feel that. anxious Restless kind of gross feeling afterwards, does alcohol affect cortisol or any other type of hormones that are in the brain that play a role in anxiety? Yes, it does especially over time and hence what we see when people who drink have been drinking.

Over a long time, your body actually starts to adapt because our bodies are very adaptable, so if your body is used to having three or four drinks a night, your body will start to adapt to that and what we see are actually changes. in the brain, so you see changes in the number of receptors you have, the number of hormones you have, your dopamine levels, your stress hormone levels, um, so your brain is actually adapting to the effects of alcohol, so one thing you can see is that you don't really get the same effect, so before two glasses of wine made you feel a certain way and now you need four to feel the same way.

That's a concept called tolerance, that your body is adjusting to having that alcohol around all the time. and your brain is actually changing the opposite of that, meaning if you suddenly stop drinking, you're going to feel sick, you're going to feel shaky, you might get a headache, you might feel anxious, you might feel nauseous. , um and This is because your body has become so adapted to always having alcohol on board that it actually takes time to reset those changes when you really stop and think about the roller coaster you're putting your brain, your hormones, and your body. you pause and that's what I wanted to do with this conversation is make you stop and think about what's really going on, yeah, and the reasons why you're seeking it, can you talk a little bit about that for anyone who's taking prescription medications during anxiety or depression the impact that alcohol can have yes, there are a couple of really important things that you need to know first, alcohol itself can cause depression and anxiety, so if you feel that way, even if you feel that at that moment it is helping to relieve symptoms, there is actually something called substance-induced mood. disorder where it can go, it can seem to everyone like you have depression and it is actually caused by excessive alcohol consumption over time, so it is possible that if you are drinking a lot, you are actually running, already You know, working again at Cross purposes with your efforts to try to control your depression or anxiety, the other thing is that there are some types of medications that are really dangerous when mixed with alcohol and anxiety medications, in particular, especially any medication. doctor that also has a kind of slowing effect, so some people take medications in a class called benzodiazapine, so things like sanx, clopin or Adavan, when mixed with alcohol, have a kind of combined effect that can actually slow down your breathing, it could cause an overdose, it could make you very sick, it could affect you even more sooner, um, so it's really important not to mix those medications with alcohol.

Wow, how does alcohol compromise memory? So alcohol affects all parts of the brain, including the amydala, which is an area that establishes memory. And you know, it has complicated actions in the brain, so it increases in some ways. um more hormones that slow down, so we think of it as a depressant um because it kind of slows you down and relaxes you um and decreases more it excites the excitatory neurotransmitters um in the short term because in a way your consciousness is being affected, you won No. it's about creating new long-term memories. Excessive alcohol consumption can actually cause dementia, it can cause serious memory problems.

There is actually a unique condition that we usually only see with alcohol, where the part of the brain that creates new memories is damaged and People basically have an amnesia syndrome where they can't create new memories, so they can only remember things from the past, but they can't create any new memories and that's a very extreme example, but we see it in the hospital and it's really scary when it happens, what do you see when you look at the brain of someone who has had a lot to drink versus someone who is occasional or very light?

We actually see brain damage in people who have had chronic heavy drinking for many years, so if you take an image of the brain like with a CT scan or with an MRI um what we describe it is volume loss, so that normally you want to see a big, healthy, robust brain and as you get older and with types of dementia, one thing we see is the brain starts to shrink, so as if the actual functional parts of the brain are smaller, we see that the process is accelerated by excessive alcohol that we consume very frequently, for example, someone who is 50 years old and who really should not have a loss of volume in their brain at that age, but if they have been consuming alcohol in large quantities for a long time, we often see that your brain looks like a much older brain, because of that shrinkage, and then there are very extreme examples like this rare memory condition where we literally see that. part of the brain almost dies like you can see it light up it's been severely impacted that's scary, very scary we have so many listeners around the world who flooded us with questions when we told them you were going to be here and a lot of them are about how to treat with someone they love and who are drinking, yes, so I really want to hear your advice on what specific things to do and what mistakes to avoid when there is someone in our lives. what we're worried about, how to approach this, what's the best way to bring it up, what's the worst, and by the way, I want to remind you that if you're thinking about someone in your life while the sponsors are talking to please share this episode, let them Dr.

Wakeman talk to your loved one. It could be a life-changing gift for you to hear this, so thank you in advance for being generous in sharing this with the people you love and I will be waiting for you. Dr. Wakeman, after a short break, welcome back. I'm L Robbins and you and I are here today with Dr. Sarah Wakan from Harvard. Dr. Wakan. I would love to get your advice on what you would recommend to someone if their spouse doesn't think they have a drinking problem, but it's a problem for you, yes, I think these are very important questions and, for me, one of the biggest tragedies. surrounding substance use disorder is that often family members and the general public have been taught what not to do, so I think it's a great thing to talk about first, it's important define what an alcohol use disorder is because that's what we're talking about, you know, there's excessive alcohol consumption that we worry about long-term health effects. and then that's where alcohol has become a problemin your life and really the definition of an alcohol use disorder is losing control over binge drinking and consuming it despite the consequences, so if you continue drinking even though your partner shared that they are really worried about You or you've started having problems at work because you're calling in sick or continuing to drink despite related health problems, then your doctor says you know what your liver tests are. elevated, you really need to cut back on your alcohol consumption and you continue to drink, these are all signs that alcohol has started to play a different role in your life.

Approximately 15% of the population will have an alcohol use disorder in their lifetime, making this a very common disorder. More common health condition than many other conditions we see, the good news is that it is completely treatable, most people will recover. I think we often have it in our minds that this is like some terrible, stigmatizing, recalcitrant condition that no one gets better from, and that's not the case. It's true and that notion that you know something to feel desperate about, I think creates a lot of the stigma and shame. There is a good deal out there, people will recover, but they need care and support, so I think the first thing.

What you can do if you are a loved one is simply share your concerns, not in a blaming way, not in a judging way, but in a loving way, as you would with anything else with someone's health. . I have observed that this is why you are worried explore what the person thinks and that becomes really important because when it comes to addiction it really doesn't matter at all that's why I think that early to make changes in your alcohol consumption, the only thing that matters en They think their life will improve somehow and so they actually start doing it.

Somehow unravel what this person's goals are and how alcohol gets in the way of achieving them, that becomes the job and a partner can be a wonderful mirror for that. You know, I know you're working toward a promotion at work and you mentioned it. You had to call out sick twice this week and your boss is frustrated with you. What do you think about that? So really explore it and ultimately you're empowering the person so that they feel like they can make a change and that you're supporting them. them, but you're not forcing them, which is often where people feel like you're stuck in having to do what's the mistake that you see people making.

I think people have heard these notions of tough love allowing you to hit rock bottom. Probably the biggest fallacies, for people who aren't familiar with those concepts, the idea that tough love is that you should really make things difficult for a person and that if the consequences pile up, the person will eventually get better. The idea that if you are kind or loving to someone, you are actually hurting them in some way and hitting rock bottom, is this idea that people have to fall so far and suffer some terrible consequence before they make a change. They're all really problematic concepts for a couple of reasons, so first of all, the definition of alcohol use disorder is not being able to stop even though bad things happen to you and a lot of people drink because it's a powerful mechanism. coping and some of the things that make you nervous.

People at risk for alcohol use disorder are traumatic life experiences, untreated anxiety and depression, not feeling good about yourself, so having the only people in your life that you love and rely on. You trust tries to slow you down and tell you what you are doing. Something terrible and giving an ultimatum is not really going to help you get better. None of us make difficult changes when we feel threatened or punished or unsupported. We do it when we feel loved and safe and we have hope that our life can be better. and as a loved one, that is probably the greatest gift you can give the person.

Now it's complicated because you're impacted by their behavior, so it's very easy as a provider. One of the things I love about doing this job is because I've been on the other side and I've had family members and it's a different experience as a doctor. Whether my patient continues to drink or not does not affect me personally. I can just be their partner, their champion, work with them for families. There are times when the behavior becomes so unsafe that people have to stay safe and set limits and that's okay. I think the distinction is that you're not doing it for the person's benefit, so if you kick someone out of your house it won't necessarily help them get out. better, but there may come a time and place where people need to do that for their own safety or emotional well-being, um, but for that human being to help someone get better and this is where the conversations above are so important, it's really love and support them and work together on it and make sure that they find access to good treatment that is available and available.

I want to just dwell on this point that if someone reaches for alcohol and it becomes a coping mechanism to deal with stress. or dealing with a health issue or a mental health issue or any insecurity, it's scary to give up on the coping mechanism and what do you see when it comes to the psychology of someone whose family is like you have a problem and we're worried? with you and yet it goes on like, what's the shame or fear that you have? Well I can't really get over it if I don't have alcohol or it's just easier and what's the problem with having a glass of wine or two a night, yeah there are so many important pieces there.

I think there's a lot of stigma in our society about alcohol use disorder and substance use disorder, and people rightly feel very ashamed and secretive, and sometimes long after they've started to worry about themselves. same. "They're afraid to tell anyone else because they think someone will judge them or treat them badly and that stigma and fear of bad treatment or judgment actually keeps people from seeking help for a long time. I think the other really important piece is that when you" When eliminating something that has played a powerful role in someone's life, you need to fill those spaces with other things.

I think our kind of puritan roots as a society is that we have this idea that like if you're doing something wrong, you should just take it back. Pick up your boots and take it off and White Knuckle and actually it should be hard, you know, that's often our kind of tough love ideas and hitting rock bottom is like, well, you're, you're like you've done something. bad and you know you don't have willpower so we're going to make it difficult for you when in fact the broader concept is why someone would make changes and how our life is going to get better and how we do it.

It's easy to make a change and so if you think about any change you've made in your life, if you set yourself up for success, you'll be much more likely to be able to make that change, so if you suffer from trauma depression. anxiety you will not be able to just stop drinking without help you need help to treat the trauma of anxiety, depression and also treatment for alcohol use disorder that is not because you are weak that is not a failure and if you are not able to do it you will achieve your goals with whatever intervention and support you are receiving, that is a sign that that support is not enough for you, so really move from this idea that the person is failing to thinking about how the system, the treatment, the resources are failing and how we adjust that instead of blaming the human being who is suffering.

I just want to thank you. I think it's very comforting because a lot of what you hear about this topic is not drinking and I was hoping Dr. Weman would come here and just take your fist and slam it on the counter and talk about the lives ruined by alcohol and you know you can have that experience in your family as you listen to us, but what she is saying is that you have to understand how someone feels and what is really going to work for them to want to see that something else is possible for them?

Dr. Wakeman. I have another question for you. Many parents write about college-aged children, excessive alcohol consumption, and twenty-somethings who also drink. Do you have scripts or similar opening sentences to address this topic because I feel like most of us don't even know how to bring it up? Yeah, I think ideally it starts young, ideally you're having these conversations very early. with children in a pragmatic way, not as a scare tactic, so we know that things like you dare to know this, like I'm going to scare you so that this is what alcohol and drugs do to your brain, Kids actually use more drugs after seeing those kinds of things that aren't helpful, kids see through adults when they are all or nothing about things, so having these Nuance conversations like you're surrounded by friends who drink a lot, what do you think about it?

What has been your experience? What are some concerns you might have about this? And talking about the very practical risks that aren't necessarily like addiction to liver failure, that aren't going to be resonant to a 19-year-old, but you know, you've gotten yourself into a situation that you don't feel safe in, you know. , getting into a sexually vulnerable position with someone who does something you don't want to do, missing class the next day, so talking about relevant personalized issues that may arise for that child and then, most importantly, making the decision. person that your child feels safe talking to, you know that you want them to feel comfortable coming to you to talk about small things, so that they can come to you to talk about big things and so you can share all this a way that doesn't feel judgmental doesn't feel accusatory really opens the door to continued conversations rather than making someone feel like their parents are blaming or judging them so for someone who has never approached this MH and the Alcohol runs in the family this way.

It's something that really triggers us all. Is there a way to break up the conversation just so the person listening can take something from us or you know, take from this conversation? Okay, I'll express my feelings and then. I'm going to ask you about yours because most people get very defensive when you talk about this and then that just shuts down the conversation completely. Well, first of all, it's not too late, you haven't failed, none of us are perfect at this. These are difficult conversations and we haven't learned how to do them, so it's never too late, no matter how many times you've ignored him or how you know an unproductive conversation.

I think at that moment probably the most important things you can communicate are: I love you. I'm worried about you. I am here to help you. I know the treatment works. This is how I can support you. Like many things, you're talking about yourself. about your care and concern, you are rooting everything in how much you love this person and you are offering to be a partner and help them find support and treatment and it may not happen that day, it's usually not that frequent a trip Towards recovery is your winding journey of a thousand small steps, very rarely is it that dramatic leap that we see on television, so don't lose hope and know that those small moments of kindness and support are actually progress and are part of the journey. of the person and ultimately improving, um, if you're the one that really just wants to cut down on alcohol, then if you're listening and you want to cut down on alcohol, I think first figure out your why, how do you help them? to discover your why when it comes to? to your relationship with alcohol, yeah, I think the first thing is understanding how alcohol fits into your life and so people can do this at home by just keeping a drinking diary, so even just writing it down on your phone or in a notebook when you want to have a drink. of what activities you associate with drinking what you know when you drink how many drinks you have during what periods of time it's kind of like keeping a food diary where it actually makes you more aware of like oh, I feel compelled to I want to eat this because I feel very upset about this fight I just had.

You can identify that with alcohol as well, as you mentioned before. I'm really stressed at the end of the day so I come home and I want to have a glass of wine, understanding how alcohol fits into your life is an important first step and then figuring out what goals you're working on right now and that could change over time, but again if you're the target. It's something related to fitness or wellness or health that you may find after learning more about alcohol and the role it plays in your life that you actually want to change the amount you're drinking and then you have your why, my why. it's me.

You know I trained for a marathon and found that when I drink I have a hard time waking up and doing long runs, so I'm just going to drink that day and keep it that way? quantity, so it is very specific and that is important for behavior change. If you establishthis kind of broad general goal of I'll never drink again because alcohol is bad, you probably won't do it because it's hard and it's not really like that. I relate to you as a human being, as much as you can, make it a specific and measurable time, so for the next 3 weeks I'm going to try this and then I'm going to re-evaluate it, that makes it much easier to make changes. and stick with it over time, well that's great advice because I feel like a lot of us have had that experience where you go to a big wedding and you're like that's it, I'll never drink again, I can't do this to myself. and three days later you go out for someone's engagement and now you're like, oh, I should have a glass of wine and you're back, so I think I'm pretty clear about what your goals are and I'm up for it. a B, if you write down your goals you will see that alcohol doesn't exactly help any of them and there is a lot of advice available, but you want to make it as easy as possible for yourself, so if your goal is to reduce drinking again, you don't want to have a week when you're full of going out to happy hour with people you really want to set yourself up for success, so organize your social activities around non-drinking activities, make a plan if you'll be in a situation where you would normally drink, and You'll have a glass of sparkling water in your hand the moment you walk in the door.

You'll have a friend who knows you're working on who your partner will be and setting those intentions, those ideas, tools and tricks ahead of time will make it much easier for you to ultimately reach the goal of reducing expenses if you don't feel supported by your family or your partner. or friends, what advice would you give people for negotiating and navigating that big question? I think first letting people know your intentions, so sharing what your goal is is really important because people can't support you if they don't know and if I've always drunk a certain way with your partner, your friends and suddenly you no longer, they are not going to be like what is happening, whereas if you say hello guys, I know you love me and I support eat me I want to share with you that my new goal is that you know not to drink more than one drink a day or only drink on Friday and no more than two.drinks or whatever or don't drink at all and this is the reason why I'm doing this because I'm worried about myself or I'm doing this because you know it feels counterproductive to my health and really I want your support and this is how you can support me, so you're really framing it as they become partners with you, you're not criticizing their drinking because often people feel like, Oh, I'm a little self-conscious. , this person is going to be judging.

I or they think I'm bad, you're just asking for their help and it might seem like instead of meeting for drinks, you're meeting to go to a yoga class or you're meeting to go for a run or you know, you left the person. Know why you're going to order sparkling water instead of a drink and so you can be really concrete both to yourself and what those tools are like, but also to the people in your life, to let them know how they can help. you and sometimes people can't do that and that happens every time we make a big change, people may have experienced that if they decided to lose weight with Dr.

Journey or change their life in some way, there are people who really fit our lives. for certain points and that can't travel with you through that transformation and that's sad, but if you find that despite those conversations someone is really destructive to the change that you want to make and doesn't support you, then that may be more of a question. broad on the type. of that relationship's role in your life I thought I knew a lot about this topic and this just goes to show you that there is always something new that you can learn so I have another question Dr.

Wakan what is your message to someone who is struggling with this? your relationship with alcohol yes, I think I would like to talk for a moment about alcohol use disorder. I think we've been covering some of the health harms of alcohol consumption, whether at a low, moderate or high risk level for anyone. Someone who is struggling with alcohol use disorder is worried that he may be struggling with alcohol use disorder. Treatment for alcohol use disorder works. You will recover. Finding a trusted healthcare provider you can partner with is part of that journey, but really hoping this is not. a hopeless condition, it won't be with you forever, you will be in a place where you will be free of this and there are treatments available and just getting them like you would for depression, diabetes or high blood pressure is the most important thing and this is not a matter of shame or willpower or being mean and I hope that people feel like they can come and get the help that they need and for the person who had this conversation shared with them from a family member.

Who is probably worried about their alcohol consumption? What is your message to that person? This can be very difficult to hear, especially in a society that still stigmatizes alcohol use and alcohol use disorder. I think I took this as a message of love. they care about you, they share your concerns and they are there to support you and they want to be a part of this journey to help you live the best life you can live and whatever that means and hopefully it will be a moment to pause, think and get the support you need to make some changes.

Dr. Sarah Wakan, thank you very much for being here with us today, thank you for the work that you are doing. It is really changing and saving people's lives and us. I appreciate the time and wisdom you poured out on us. Thanks Mel for inviting me. It's a real pleasure. I hope these words reach people who are working to improve their lives or who are worried about someone they love. And I also want to make sure. that you are listening to that in case no one else tells you that I tell you that I love you and I believe in you I will talk to you in a few days and you are here with me on YouTube I want to be sure to tell you that I love you, I believe in you and I believe in your ability to create a better life and I hope that everything you learned today makes you feel empowered to do so, so hit subscribe because that's one way you can really support me. bringing you this content every day and I know you're thinking what can I watch next Mel, let me tell you, you're going to want to watch this understanding for yourself the first thing you need to do to live an authentic life. life