Why Alcohol Isn't the Cure for Pandemic Stress with Dr. Akhil Anand

Podcast Transcript

Nada Youssef: 

Hi, and welcome to the Health Essentials podcast, brought to you by Cleveland Clinic. Today, I'm your host, Nada Youssef.

              According to the dietary guidelines for Americans, moderate alcohol consumption is defined as up to one drink per day for women, and up to two drinks per day for men. However, with the ongoing pandemic, we find ourselves staying home more than ever, and many have turned to alcohol as a coping mechanism.

              This has caused alcohol consumption and alcohol sales to increase dramatically, and today we'll be talking about those consequences. I'm happy to have Dr. Akhil Anand here with me today to talk about alcohol, and the increased drinking culture during this pandemic. Dr. Anand is a Board certified addiction psychiatrist who works at Cleveland Clinic's Alcohol and Drug Recovery Center. Thank you so much for being here with us today.

Dr. Anand: 

Thanks for having me.

Nada Youssef:

Sure thing. For our viewers and listeners, please remember this is for informational purposes only, and it's not intended to replace your own physician's advice. Also, please note that this interview was prerecorded, and does not reflect any changes to COVID-19 precautions that may have been taking place after this recording.

              Alcohol consumption is already a major public health problem in the U.S. With spending so much time at home now, during this pandemic, it's only getting worse. Can we talk about, first of all, how much drinking is too much drinking?

Dr. Anand:

How much drinking is too much? That's a great question. What we usually ask our patients is, at any time in the year have you ever had four drinks or more in a day, for women; or five drinks or more for men? That, for us, is considered high-risk drinking. What's a drink? Well, a 12-ounce beer, a 4% percent beer, qualifies for one standard drink. Five ounces of table wine and one-and-a-half ounces of spirit count as one standard drink.

Nada Youssef:

Can you talk, in general, about the alcohol effects on our body?

Dr. Anand:

Yeah. I tell my patients this all the time. Alcohol, to me ... Alcohol, first of all, is a drug. It might be the most poisonous drug that I could think of, because it really affects every single organ system in our body, from head to toe.

              Literally, over time, chronic alcohol drinkers often have atrophy to the brain, which leads to dementia. It causes premature blindness, it causes oral cancers, esophageal cancers, stomach cancers, liver cirrhosis, liver cancer, kidney failure. It causes dilated cardiomyopathy, it affects your estrogen and testosterone levels. It decreases estrogen levels in women, causes osteoporosis, falls. Alcohol does it all, really.

Nada Youssef:

Can we talk a little bit about maybe what it does to our immune system?

Dr. Anand:

Great question. Alcohol affects the immune system pretty substantially. It decreases the production of white blood cells, so something like COVID-19, people with chronic alcohol use are vulnerable to developing a COVID-19 infection.

Nada Youssef:

Wow. How about sleep? Does it affect your sleep? Because I know we can drink wine before we go to bed and feel like it can make us sleepy. But does it keep us sleeping?

Dr. Anand:

Right. Alcohol does help you get to sleep initially, and then what happens is you eventually develop tolerance so folks will need more and more to get to sleep. But it never improves the quality of sleep. Most often or not, even though you go to sleep, the sleep quality is poor and the person is not rested.

Nada Youssef:

Sure. It seems like references to casual drinking are increasing. "It's five o'clock somewhere", "Mommy's little helper" and so on, have been around forever. But the longer the pandemic goes, it seems like these are pretty much exaggerated comments now. So, what do you say to people right now who are turning to alcohol as a stress-reliever?

Dr. Anand:

Yeah. Firstly, about this: I think those terms, the cultural norms that we have in America, I tell my patients that that's not everywhere in the world. It's just here. Really, it's here that it's culturally normal to discuss alcohol openly. It's okay to have your favorite celebrities advertise about alcohol, but that's not the case for everywhere else.

              As far as it being a stress reliever, again, that's a myth. Initially, it causes ... Yeah, it calms you down, removes your inhibitions. But over time, chronic alcohol use can lead to worsening anxiety and mental health issues. So again, it's something that I tell folks. Here, although we accept it as a cultural norm, it's not really the truth. It's just a myth.

Nada Youssef:

How does making light of drinking affect us?

Dr. Anand:

That's a great question. I'm not sure, but what we have started seeing is ... Although again, we worry so much about alcohol use, I want to say that in America, roughly about 6% of adults 18 and older suffer from what we call alcohol use disorder. So, I tell my patients this. It's more common than having red hair, but less common than having blue eyes. So, you will find folks with alcohol use disorder. Everyone knows folks, but it isn't very common.

              I do worry, though, with how openly we're talking about alcohol, and with this pandemic we've definitely seen a rise in sales at liquor stores. Trends are showing more and more, for example, the rate of drinking has increased in women, and the rate of drinking has drinking in the elderly. So, I think us normalizing it has impacted numbers, but for a pure alcohol use disorder, it's still not common. It's actually not near the majority of folks.

Nada Youssef:

Are there specific concerns we should be aware of when it comes to drinking during this pandemic?

Dr. Anand:

Right. I tell my patients all the time, if you're drinking, you're not wearing a mask. And then also, oftentimes people are drinking in very hot spot areas, like bars and restaurants. Again, high transmission rate areas and chronic alcohol use, all of these look like a bad prognosis for patients.

Nada Youssef:

When you talk about isolation, how is isolation changing our habits?

Dr. Anand:

This is definitely a different time in our ... I've never experienced this, so it's definitely an unusual time. I have found that with my patients ... And again, I'm at the ADRC, so a lot of my folks unfortunately have alcohol use disorder in some form. Isolation, lack of routine, boredom makes these folks, unfortunately, more vulnerable to start drinking or continue drinking again.

Nada Youssef:

It might be easier to tell when maybe someone else has trouble with alcohol, but how do I become aware of my own personal habits, and when to go for help?

Dr. Anand:

Right. If you as a person are worried about your drinking, that's a red flag. But more importantly and specifically, if you're having difficulty controlling your drinking, if you intend to drink one drink but you end up drinking more, and if you're coming to a point where you can't cut back on drinking and you're spending a lot of time either recovering from alcohol or thinking about alcohol, these are huge red flags that you should try to address as quickly as possible.

              How to go about that? Well, you can talk to family and friends and see what they think about your drinking. You can go to a primary care doctor whom you trust. You can ask for an intake at ADRC here at Lutheran. There's also lots of great websites out there. There's the NIAAA, the National Institute of Alcohol Abuse and Alcoholism; NIDA, National Institute of Drug Abuse; SAMHSA, that have plenty of resources.

              If you're worried that maybe someone close to you suffers from alcohol use disorder and you want to have help from your end, there's also great groups like Al-Anon and Adult Children of Alcoholics. So, there's a lot of resources out there, but you have to ask.

Nada Youssef:

Can you tell me, what is binge drinking, and how can we make a conscious effort to stop binge drinking?

Dr. Anand:

Yeah. Binge drinking by definition means, for women, four drinks over two hours; or for males, five drinks over two hours. Again, I stress that these guidelines, they're pretty concrete. They don't really address the age of the person, the weight of the person, the tolerance, absorption, medical conditions. But those are kind of by definition.

              I am very concerned about binge drinking, because a lot of people say, "You know, I don't drink all week. It's only on a Saturday night with my friends." The problem with binge drinking is, not only does it really disinhibit your behaviors, it can lead to, obviously, car accidents, et cetera.

              But it overall can sort of have like these micro-blackouts, which can really affect your overall cognition and make bad decisions. So, over time, you may not be drinking every day that way, but it can have long-term side effects on your brain. So, I am not a big proponent ... I'm concerned about binge drinking almost as much as I'm concerned of chronic daily drinking.

Nada Youssef:

Currently we live in Ohio, and there is currently a 10:00 PM curfew for all alcoholic sales, and restaurants and bars have to close at 10:00 PM. So, we see many people venturing out to get their own alcohol to bring home. Is that a good idea? Could it be creating a bad habit?

Dr. Anand:

It's not a good idea. As far as the curfews go, yes. Definitely, I think that's helpful for reducing the transmission rates of COVID-19. But whether you drink at a bar or at home, you're still drinking, and the negative impact alcohol has on your medical and mental health and your immune system here, it's just not good. No, it's not good.

Nada Youssef:

Now, can you tell us some alternatives to help people cope during isolation, when they usually maybe look for alcohol to cope?

Dr. Anand:

Right. I think this has been a very interesting human experiment for all of us. It's been definitely a challenge for me. What I tell patients is, this is a time to self-improve, to learn better or more about yourself. Ideas, for example, that I tell my patients, is to get active, go on walks, pick up an exercise, hiking.

              I, personally, have enjoyed these Zoom parties, like I do with my family and friends. We play card games and board games with one another, and they're all over the country, in Canada, where I'm from. So, it's staying active, learning more about yourself, bettering yourself. Also, other things you can do is picking up hobbies that you stopped doing because you were so busy with life, or exploring hobbies that you wanted to do that you couldn't have gotten a chance to do because you didn't have the time.

              Other things I tell my patients is, this is an odd opportunity that we have that we can give ourselves extra self-care. When's the last time you took a bath? Sometimes I ask my patients. When's the last time you got to read a book that you enjoy to read? Or, take an online course that you've always wanted to do? So, although this is a very difficult time and it's really important to accept the reality of what's going on right now, this could be a time of growth, as well.

Nada Youssef:

Excellent. Very informative, and I love the self-care message. I think we're all kind of on the same boat. That concludes our podcast today. Thank you so much for being here today, Dr. Anand.

Dr. Anand:

Thanks for having me.

Nada Youssef:

To make an appointment with the Alcohol and Drug Recovery Center here at Cleveland Clinic, please call: 216-363-2120. And for more information, you can visit: clevelandclinic.org/adrc.

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