Alcohol Awareness Month Q&A

For #AlcoholAwarenessMonth, we asked Dr. Lauren Malishchak to answer some common questions regarding alcohol use:

Why does alcohol affect people?

Many of alcohol's effects come from its impact on a receptor in the brain called the GABA receptor and its enhancement of the effects of GABA, a neurotransmitter. GABA is an inhibitory neurotransmitter and has roles in ensuring that electrical activity in the brain is well-regulated, with roles in control of our motor system, anxiety, sleep, and more. With this, we can see why alcohol intake can make someone sedated, less anxious, uncoordinated, and more. With time and regular, repeated exposures to alcohol, the brain starts to produce less GABA which can lead to tolerance. This tolerance means that people will need more alcohol to get the same effect, and can experience withdrawal without alcohol.

What health problems can excessive alcohol use cause?

Excessive alcohol has been implicated in many different health conditions. Everything from malignancy, including breast and head and neck cancers, to cardiovascular diseases like hypertension, cardiomyopathy, and cardiac arrhythmias, as well as liver disease, including alcohol-associated hepatitis and cirrhosis. While some of these diseases improve or resolve when people stop drinking alcohol, unfortunately, others are permanent.

Can someone experience alcohol withdrawal after they stop drinking, even if they have not had a problem previously?

Yes. While we understand factors that might put an individual at increased risk of experiencing alcohol withdrawal when they stop drinking, we cannot predict with 100% certainty if any one individual will experience withdrawal and how severe that withdrawal might be. Advancing age, increased number of daily drinks, long periods of daily drinking, and comorbid medical illnesses all increase the likelihood that someone will withdraw if they suddenly stop drinking. If you are drinking regularly, you should consult with a doctor before trying to stop drinking on your own.

Have you seen a rise in the amount of people choosing to live a sober life?

On an anecdotal basis, yes, certainly. Many of my primary care patients tell me they are choosing not to drink for a variety of reasons. Some because of their awareness of the possibility of developing potential health issues related to alcohol, others choose not to drink because of family history of alcohol use disorder and concerns they could also be affected by addiction. I have been referred patients by other providers who do not meet criteria for having an alcohol use disorder, but want to strategize about how they can maintain control over their drinking before a problem arises. Fortunately, as a society, our awareness about the impact of alcohol seems to be growing, which has influenced how, what, and when we consume.

How does someone know if they have a problem with alcohol? Are there physical signs?

As physicians, we have a set of criteria that we can refer to in helping us determine if a patient has a substance use disorder. For patients who are concerned about their use and wondering if it might meet criteria for a use disorder, I'd encourage them to reflect on the "4 C's". These are:Cravings for the substanceLoss of control of use of the substance (drinking more volume or more frequently than intended) Compulsive drinking Experiencing consequences as a result of drinking. For example, losing relationships with family or friends or losing a job. If you have one or more of the 4 C's, this is potentially concerning for development of a substance use disorder and warrants further conversation with your doctor.

What advice do you have for those who want to limit their alcohol intake?

If you feel like you want to cut back, but are uncertain about how to do so, I'd encourage you to speak with your primary care doctor or to come in for an appointment at any of the Bridge Clinics across the MGB system. We'd be happy to talk about your current patterns of drinking and how you might begin to make changes. For many people, it can be as simple as trying to limit drinking to weekends or special occasions, like holidays. For others, it can be helpful to reflect on what might be leading the person to drink, as some use it as a way to medicate anxiety or to deal with stressors. Others may primarily drink due to peer pressure. In these instances, it might be helpful to think about substituting 0% ABV drinks, which are becoming increasingly popular, with many new brands of alcohol-free wine, beer, and cocktails available on the market.

Why do hangovers get worse as we age?

There are multiple reasons that hangovers can get worse with age. Both our body composition and our metabolism change as we age, so our bodies become less apt at clearing alcohol from our bloodstream. The use of other medications and the development of medical problems, which both increase with age, may also impact our ability to metabolize alcohol.

What advice would you give to someone who feels they need to drink to overcome social anxiety?

I would strongly encourage you to speak with your primary care doctor or psychiatrist. We have excellent treatments directed at both generalized and social anxiety; you should neither have to suffer in silence nor rely on a substance to combat anxiety or other mood symptoms. Your doctor can help strategize about whether it may be helpful to see a therapist to develop coping strategies to deal with heightened anxiety related to specific situations. If drinking has started to become problematic in these types of situations, they may also strategize with you about the use of either daily or as needed medications that can help to reduce alcohol consumption.