In our culture, alcohol is everywhere. We may have a drink or two at a family dinner or social occasion without even thinking about it. But studies have linked drinking with cancer, even when done in moderation. Long-term use can cause serious health complications, and you don't have to suffer from the disease of alcoholism to experience the consequences.
In honor of Alcohol Awareness Month in April, host, Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Baptist Health’s Miami Cardiac & Vascular Institute, welcomed a panel of experts to look into the effects of alcohol, the nature of alcoholism and how to help someone who is battling an alcohol addiction.
Guests:
Thomas Hammond, M.D.; neurologist with Marcus Neuroscience Institute
Kaitlin Elsbeth Ross, M.D.; family medicine physician with Baptist Health Primary Care
Kevin Wandler, M.D.; Chief Medical Officer with Advanced Recovery Systems
In our culture, alcohol is everywhere. We may have a drink or two at a family dinner or social occasion without even thinking about it. But studies have linked drinking with cancer, even when done in moderation. Long-term use can cause serious health complications, and you don't have to suffer from the disease of alcoholism to experience the consequences.
In honor of Alcohol Awareness Month in April, host, Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Baptist Health’s Miami Cardiac & Vascular Institute, welcomed a panel of experts to look into the effects of alcohol, the nature of alcoholism and how to help someone who is battling an alcohol addiction.
Guests:
Thomas Hammond, M.D.; neurologist with Marcus Neuroscience Institute
Kaitlin Elsbeth Ross, M.D.; family medicine physician with Baptist Health Primary Care
Kevin Wandler, M.D.; Chief Medical Officer with Advanced Recovery Systems
Dr. Fialkow: Welcome Baptist HealthTalk listeners.
Alcohol is all around us – at family dinner, Sunday brunch or get-togethers with friends. Some studies even say that drinking wine in moderation is good for your health. So we may have a drink or two in a social occasion without even thinking about it. But there are studies linking drinking alcohol with cancer, even when done in moderation. Long-term use can cause serious health complications, and you don’t have to suffer from alcoholism to experience the consequences.
It’s important to note that alcoholism is a disease – chronic, progressive and sometimes fatal in nature, and it affects an estimated 17-million adults in the U.S. April is Alcohol Awareness Month and on a recent episode of Baptist Health’s Resource Live, I spoke with a panel of experts about the effects of alcohol, no matter how much you drink – and how to help a loved one who is battling alcoholism.
My guests were:
Thomas Hammond, M.D.; neurologist with Marcus Neuroscience Institute
Kaitlin Elsbeth Ross, M.D.; family medicine physician with Baptist Health Primary Care
Kevin Wandler, M.D.; Chief Medical Officer with Advanced Recovery Systems
Let’s listen in:
Dr. Fialkow: Let's start off with the asking Kaitlin Dr. Ross a question. We know that alcohol its impact on our body starts from the moment we take our first sip but clearly there's a difference between social drinking and more problematic drinking. An occasional glass of wine with dinner, not really a cause for concern but these have cumulative effects and alcohol is beer as well as spirits and wine. Let's talk a little bit about the medical effects what are these cumulative effects of constant alcohol consumption?
Dr. Ross: So chronic alcohol consumption can lead to alcoholism. So that's often marked by uncontrolled drinking and an overall preoccupation with alcohol. So people who suffer from alcoholism will continue to drink even when drinking causes negative consequences in their life. Which we'll get into it in a little more detail later, but they usually know that their alcohol use is causing these negative effects in their life but that those consequences aren't enough to actually get them to stop drinking. Drinking can progress to alcoholism when someone starts drinking in an increased frequency and usually they start drinking more in one sitting as well. And their body eventually starts to become dependent on alcohol.
Dr. Fialkow What would be the more common medical things that we see? I know as a cardiologist people don't associate hypertension with alcohol and even moderate alcohol can affect one's blood pressure, sleep disturbances, but what are the more severe medical conditions that you may see in your practice that might make you think of alcohol related issues?
Dr. Ross: So the more severe things would be something like liver damage. People can have neurological complications which I know we'll talk about later can be associated with a lot of 'cause usually it isn't caused by alcoholism but they can go, it can be tied in a lot of psychological issues, depression, anxiety, again sleep disturbances like you mentioned and then a lot of accidental traumas as well.
Dr. Fialkow: So again, affects quality of life, affects all the parts of the body, can affect mental States, sleep many parts of our daily routines and health. To Dr. Hammond, Dr. Ross mentioned neurological components. What are the more common neurological complications we see with consistent and excess drinking? And I guess there are two different things just regular drinking and then the real excess and will define that at some point.
Dr. Hammond Well obviously, acute intoxication can cause all sorts of troubles. When people drink too much they get into auto accidents. So we see them as head injuries, falls for the they've lost their balance a little bit and they tripped and fall or injure themselves. So the acute intoxication or when people drank more than they thought they did or that kind of thing, that's the acute stage stuff. Then there's the issues of chronic effects on the nervous system. When one gets into drinking regularly then the peripheral nervous system gets affected. This causes numbness and tingling in the feet and an impairment of balance because the longer nerves in the body get damaged by the persistent alcohol effect. Then there's the cerebellum, which is a balance area in the brain that gets affected particularly adversely with chronic alcoholism that's another reason for balance impairment. And one of the reasons the police put you through that walking the straight line businesses is because balance system gets impaired with alcohol.
And then there's cognitive issues. The cognition declined somewhat and there's a chronic alcohol dementia called Korsakoff syndrome, which is a true problem but there was a fascinating study done in Britain called the British alcohol study that ran from like 1985 through 2017. And they followed 550 people over all those years regarded related to their alcohol use. And in the last 10 years, the thickness of the memory cortex in the brain and they also gave people memory tests. And the people who were teetotalers actually had the healthiest looking brain. Even the people with a few drinks a week had some shrinkage of their cortex but the people who had three or four or five drinks a day had substantial decrease in memory cortex. The memory declines a bit over years if you continue to drink.
Dr. Fialkow: When in your practice, do you see people that come to you for specific neurological complaints and you then are able to make the diagnosis that perhaps it's alcohol related or is it pretty much determined before people get to you?
Dr. Hammond: Well, it's a lot of people that are closet drinkers they've been somewhat hidden and you have to broach the topic what is your usual consumption? I drink a little bit every day or I only drink on weekends. But the people who are persistent are mostly daily drinkers you always have to try and chase that around a little bit and see whether or not they're actually drinking more than the family is aware of because usually we see them because of balance problems or memory issues. That's a common issue for me.
Dr. Fialkow: Kaitlin you mentioned in some of your introductory comments, some of the things that might differentiate someone who we would consider a safe social drinker even though there might be some medical consequences with someone who might have a problem. This is a very serious conversation but one of the jokes we use in the medical practices, how do you define an alcoholic? And the answer is someone who drinks more than a doctor. And what it basically means is it's hard to define what truly determines someone who really has alcoholism. So how do you and your practice and what can you report regarding how we can help people determine if they or a loved, really has the level of alcohol consumption that becomes really a concern?
Dr. Ross: Well, exactly. That's a good point 'cause one of the things that, we know is as a lot of alcohol abuse can start with some of these episodes of binge drinking and episodes of acute intoxication and that's where you're at risk for some of these more short-term injuries like motor vehicle accidents or acute trauma or impaired judgment, or you might engage in activities you wouldn't otherwise engage in. And those are things that can have long-term consequences or even fatal consequences. But over time, generally people increase the frequency of their alcohol abuse and develop emotional relationship with alcohol. So often instead of just going out every once in a while drinking to have fun, they'll start to using alcohol in order to avoid boredom or relieves stress, relieving anxiety, improve their mood. And this can, eventually result in more frequent drinking but also can result in dependency on drinking both the psychological dependency to the point where someone starts using drinking as a coping mechanism for one of these issues. And that's when risky alcohol behavior can become a more long-term chronic problem like alcoholism. Also, people start to develop a more physical dependency on alcohol so people can start developing a tolerance to alcohol. You'll notice you'll need a few more drinks at one time to reach the same level of buzz or intoxication that they had before. And they start developing withdrawal symptoms when they're not drinking alcohol. And all of these are signs of chronic alcohol use in a more severe problem. And eventually he started developing the health complications as well that we had discussed.
Dr. Fialkow: Dr. Wandler, let's let's bring you into the conversation. Specifically we mentioned alcoholism is a disease and it can affect anyone any age, gender, ethnicity, big people, small people has nothing with religious beliefs and whatnot. We can't really predict anyone's drinking habits but there are factors that have been shown to be more reliable and who might be abusing alcohol might have a tendency y to abuse alcohol. Can you talk a little bit about what those risk factors are for alcoholism when that becomes a problem?
Dr. Wandler: Yeah, alcoholism, like you said, touches everybody. Everyone's family practically has someone in it who has known someone who has alcohol use disorder, alcoholism. I think the things that we see I've been in this field for a very long time so the things we see are really early drinking. So, there's kids that are 11, 12 years old that are drinking on a regular basis usually binge drinking at that point and then it develops a direct drinking. If someone starts drinking, say at 15, before 15 they're probably four or five times more likely to develop alcohol use disorder, alcoholism than someone who waits until they're 20 or 21 when it's legal. But then it's been mentioned, there's genetics with this and probably, I don't know four times more likely to develop an alcohol use disorder if you have a family member who has alcoholism and that's huge. And then there's all what we call trauma today there's the dysfunctional family whatever that means, broken homes, divorce, if a family member, if a parent has an alcohol use disorder their parenting skills may not be quite as good or they may not be engaged as much. I think Dr. Ross mentioned depression and anxiety and that's genetic as well. And so someone who has, sometimes for me it's hard, I'm a psychiatrist so it's hard to decipher what came first, the chicken or the egg I E depression, anxiety or substance use disorder or trauma. Native Americans, has the highest usage of alcohol use disorder and then Caucasians are next and then Latino's are third and at least in the United States, that's how that works
Dr. Fialkow: For someone who might have a tendency to become an alcoholic, a true problem, drinker dependence. Is there a difference between beer and wine or liquor is one a higher trigger than the other?
Dr. Wandler: I don't think so. We look at we define an alcoholic beverage as 12 ounces of beer or five ounces of wine or a shot of a hard liquor, such as vodka, gin, whiskey, whatever. And so that's, they're all equal. That being said, if you have an empty stomach and you drink three shots of whiskey then you're more likely to feel that 'cause you can't really chug three beers quite the same time. The guidelines that we have for women, women get cheated on this is really one alcoholic beverage a day is all they should consume. And no more than seven in a week. Men somehow are are given double that so males could drink two alcoholic beverages a day and not be considered officially a problem or no more than 14 drinks a week. So, that's a lot of beer or wine, or
Dr. Fialkow: And even that's conventional wisdom, it's a rule of thumb but you have to individualize the persons response.
Dr. Wandler: - You are right. A lot of people drink five drinks in one day, and then they go a few days without drinking anything. But if you do five times three, you take 15 and you've exceeded, what's considered "safe for men."
Dr. Fialkow: So to that point, that's a good segue to a question for Dr. Ross people tolerate alcohol differently some people can have a drink and they can get buzzed other people as one of those can drink several drinks and may not necessarily feel it. What are the different stages of alcoholism? And again, I think this is certainly important for the viewer, but maybe a loved one of the viewer that they may recognize and be able to help someone. So can you speak a little bit to the different stages if you will, of what may lead to an alcohol dependency?
Dr. Ross: So generally, one of the first stages is is binge drinking. So that I know we talked about the recommendations for men and women binge drinking is defined as four drinks for women and five drinks for men over the span of about a few hours. And it's generally the amount that that can make you acutely intoxicated. And this is when you can experience some of the negative consequences from some of these accidental injuries we had mentioned earlier people may be involved in accidental falls motor vehicle accidents, drowning, their judgments impaired they may engage in activities they would not normally do like spend money or unprotected sexual intercourse or engage in other drug use. So some of these complications from binge drinking can be some of the first signs that someone's having a a problem with alcohol.
Dr. Fialkow: Kaitlin, if I can interrupt before you go to the second point, does it matter if they're doing it on their own watching TV, or if they're out socially with friends with four to five drinks?
Dr. Ross: No, it does not matter.
Dr. Fialkow: Yeah, yeah, exactly. It's the same amount of alcohol and it's the same it's basically the amount to make you intoxicated. So you're right in some cases, some of these people might not experience the same consequences if they're at home drinking this amount, maybe have less opportunity to become involved in any kind of accidents. So it might be a little it could be a little bit harder to identify depending on the situation, but that's the amount that they give you the four drinks five drinks in one sitting.
Dr. Fialkow: So the binge drinking would be the first step apologize for interrupting.
Dr. Ross: Right, right, yeah. And then the step the second step is moving on to increase the amount of increased frequency of drinking. So instead of maybe binge drinking every once in a while, going out to a party you start doing it every weekend or even every day. And again, this can be the kind of thing going out with friends or doing it by yourself. So this increased drinking can progress to what we call problem drinking that's the next step. And that's when people not only are they drinking a lot and maybe having episodes of binge drinking where they're acutely intoxicated but they start experiencing negative consequences in their life. So this could be problems at work, school, relationship problems, legal problems, financial problems. Some of this can be stuff that's related to their behavior while they're intoxicated. And other signs of problem drinking can include a change in their friend group behavior or increased social active activity or even social isolation. So, it's important to note that a lot of these behaviors can be a little bit harder to identify during the pandemic when we've all been socially isolated at home and working from home as well. People may not be having some of the same negative consequences with work or legal troubles or that kind of thing, but that's still one of the hallmarks of problem drinking when you start. And also we started experiencing health complications as well.
The next stage would be what we call alcohol dependence. So that's not only are you drinking a lot and really your life is suffering because of it but your body's physically dependent on the alcohol. So, it's really become part of your routine you've lost control over your alcohol consumption it's not really an activity anymore it's more of a coping strategy to sometimes relieve some of this anxiety, stress or whatever it is that maybe got you started to increase your frequency of alcohol use. People may do stuff like lie about their alcohol use, hide like physically hide bottles of alcohol or something like that, so you could notice some of that behavior. And they also may start acting developing withdrawal symptoms of withdrawal like tremors, irritability, nausea, palpitations, sleeping issues when they're not drinking. So you might notice a change in someone acting differently in the morning or something like that or even some people start maybe having alcohol in the morning. This is something they might be more likely to hide but that's definitely a sign of alcohol dependence. And this eventually leads to an addiction to alcohol. When someone really has the psychological physical need to drink and they really feel they need to drink alcohol to feel normal and feel better.
Dr. Fialkow: So it's great information and it's not as if a switch is flipped and you go from one stage to the next, it actually can be a very gradual transition which is why self-reflection or looking at others and you're looking, to support loved ones is important. There's binge drinking increased drinking, problem drinking, alcohol dependence and then the true addiction and alcoholism is the transitions. Dr. Hammond, again Dr. Ross mentioned a couple of we mentioned a couple of comments about the self-control decision-making again the brain effects you talked about chronic alcohol effects. Talk a little bit about what happens when people are drinking which makes them wanna drink, the pleasure and some of the other components of that. If you could speak a little bit towards, what happens to the brain when someone is drinking.
Dr. Hammond: Yeah. The the neurobiology research and alcohol use disorder has been quite interesting. There are three major brain structural areas that get affected. The basal ganglia are deep structures in the brain which probably a big role in the reward system for the brain. Okay and so this is where your pleasure centers are so to speak and alcohol like other addictive drugs, tickles that area very well and the pleasurable sensation you get a little bit of a high from having a alcoholic beverage triggers the need or the desire for more of it. There's another brain area called the amygdaloid complex, which has a little bit to do with the negative aspect of alcohol withdrawal. When it comes out of your system, a little bit of how you behave to that anxiety that can happen as the drug leaves your system. And then there's the third part of this package is called the prefrontal cortex. That's really where your behavior control is that's your executive function. That's where your control centers for your behavior are. And that's where you actually develop an anticipation or the thought about the next drink. And that's how the addiction end up actually happens as time goes on. I think the public should be aware that than adolescents, the brain is much more susceptible to addiction or the addictive capacity of alcohol, like it is with other drugs. And then a teenager if I decided to start drinking there's about 10% or 11% chance I'd become addicted to alcohol. I'm not young anymore. Adolescent decides to do that it's about a 30% chance to get addicted. So it's almost a threefold increase in the addictive capacity for these drugs so that an alcohol is in that package. But anyway, these, the brain wiring gets set up a little bit by the reward system, to really enjoy it and then before you know it they don't like the withdrawal part and then the prefrontal cortex gets to anticipate the next drug, and suddenly your frontal cortex has to control your behavior. And that's where you can get into trouble by inappropriate decisions in terms of what's going on when you're drunk.
Dr. Fialkow: It's hard for someone who has alcohol dependency to quit drinking. Why is it so important for someone suffering from alcoholism why can't people just say, well, it's not good for me I'm gonna give this up?
Dr. Wandler: It's a chronic disease. I work with alcoholism, that's what I do and drug dependency. We have a center that we've partnered with Baptist hospital of near West Palm beach and we have an outpatient clinic also we're really close to the main campus of Baptist. And so we are working with people trying to get them the help they need. Sometimes we have to use family members, or loved ones or their partner or whatever, to help get them into treatment, 'cause they don't wanna give up that pleasure they have. For those that like Dr Ross said, you have gone to the very severe end, stopping drinking the body starts reacting negatively called withdrawal and it's uncomfortable. When they start shaking they may start throwing up, diarrhea, headaches, cardiac issues and for someone who's been drinking a long time and a lot of alcohol, they can go into a very serious state called a delirium tremens or DTs as we call it, which is a medical emergency. They have to go to the ICU to be treated.
Dr. Fialkow: I think part of that take home point again is it's a disease, it's a dependency we don't judge. In my practice I tell people who smoke I don't judge you you're addicted to cigarettes let's try and work to figure out how we can help you get rid of that dependency. That's something that the person may even want to continue smoking similar with alcoholism. So question from the audience Dr. Ross related to that, if someone's seen a friend go from a social drinker to drinking a bottle of wine every night or more, how can a loved one how can someone help a loved one who has a drinking problem get help and go to treatment?
Dr. Ross: So one thing you can do is just start off by talking to them when you know that they're going to have time to talk when you're both calm, no one's drinking no alcohol involved and express your concern in a very caring way. So, avoiding any blame, judgment maybe get them to open up a little bit about why they've been drinking, if they've been experiencing any new stressors or anything, increased loneliness or anxiety or if they even see their alcohol use as a problem 'cause a lot of people don't. So, it's actually, alcoholism is really marked by denial of their drinking and the problem that they're having. So, it's normal for expect a little bit of pushback when you're bringing up your concern to a loved one and realize you might need to have a few of these conversations with them before they acknowledge that their alcohol use is problematic and are really ready to change. And try not to act negatively when they do this, but you can really start there's a lot of different places you could start in terms of getting them help. So, you could even just go to your primary care doctor, bring that up. You could bring them to a counseling session, therapy session, an AA meeting you could call it helpline. And sometimes for someone who's has an alcohol problem or is an alcoholic, it can be a little scary to start off with this so you might want to offer to accompany them to one of these sessions if they want that. Another thing you could do is if they're having if they're experiencing any medical side effects from their drinking, if they're at the GI doctor with horrible gastritis or liver problem you can enlist the help of the doctor there to explain to the patient the relationship that alcohol has on their physical health and really encourage treatment,
Dr. Fialkow:
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