On May 15, Dr. Rosemary Ku interviewed Joseph Sosa, Substance Abuse Counselor. Below is a summary of their Q&A, edited for length and clarity.
Click on the following questions to view their answers.
Answered by Dr. Ku
Answered by Joseph Sosa
Dr. Ku's Answers
What is alcoholism or alcohol use disorder?
Alcohol use disorder, previously known as alcoholism or alcohol dependence, is a chronic medical condition that includes compulsive alcohol use, inability to limit drinking despite the negative consequences and emotional distress when not drinking. Alcohol use disorder affects over 14 million adults in the US, and less than 10% receive any treatment.
How much alcohol is too much?
Moderate alcohol use is having up to one drink per day for women or up to two drinks per day for men; this refers to the number of drinks on a single day and not the number averaged over many days. Regularly having more drinks than this or binge drinking, which is having more than four drinks on a given occasion for women or five drinks for men, are signs of excessive alcohol use.
However, alcohol affects people differently, so if you drink less than this but feel sick or have impaired judgment, your personal limit might be lower than this.
Who should abstain from drinking any alcohol?
People under the age of 21, women who are pregnant or may be pregnant, anyone who will be driving or needs to stay alert, and anyone recovering from alcohol use disorder should not drink any alcohol. Also, people with certain medical conditions or who are on certain medications should ask their doctor if they can safely drink alcohol.
How does alcohol impact health?
Excessive alcohol use can lead to serious problems for both mental and physical health. In the short-term, drinking can lead to alcohol poisoning, risky sexual behaviors, violence and dangerous accidents. Long-term consequences include mental illness such as anxiety and depression, heart disease, high blood pressure, liver disease, stroke, cancer, dementia, decreased productivity and strained relationships with loved ones.
What should you do if you or someone you know shows signs of unhealthy alcohol use?
If you think you or someone you know might have an unhealthy relationship with alcohol, please seek advice as soon as possible from a healthcare provider. They can conduct a detailed assessment and advise on the next steps.
Stress can often trigger people to cope with alcohol or marijuana. If you are of legal drinking age and/or can use marijuana legally, is it ok to use these substances to cope?
No, because you can become dependent on these drugs and make matters worse. If you continue to use these to cope with stress, it may become a habit. If you need to deal with something, my recommendation is to sit down and come up with a plan to solve the problems and always ask for help if you need it. I also recommend exercise for stress. I have a very high-stress job, and exercise always helps me.
What is the difference between healthy alcohol use and unhealthy alcohol use, and what are some red flags that someone might be drinking more than they should?
Women should drink no more than three drinks per sitting and no more than seven drinks per week. Men should drink no more than four drinks per day and no more than fourteen drinks per week. Some red flags to look out for are
- Drinking because of problems or to face stressful situations;
- Drinking as a response to anger towards other people, such as your friends or family;
- Drinking alone rather than with others;
- Poor performance in school and work;
- Avoiding school/work or leaving early to drink;
- Inability to stop drinking even when trying;
- Drinking in the morning and before school or work;
- Gulping alcoholic drinks as if to satisfy a great thirst;
- Loss of memory due to drinking;
- Avoiding honest conversations about your drinking;
- Getting into trouble because of drinking; or
- Drinking to the point of inebriation, even when not meaning to.
What is Alcohol Use Disorder, and who is most at risk of developing this?
When a drinking problem becomes severe, it is diagnosed as Alcohol Use Disorder or AUD. It is a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake and a negative emotional state when not using.
An estimated 15 million people in the US have AUD. It is most prevalent in young adults aged 18-35, though it can occur at any point during one’s lifetime (including in adolescence). AUD is far more common in men than in women.
To be diagnosed with AUD, individuals must meet specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under DSM–5, the current version of the DSM, anyone meeting any two of the 11 criteria during the same 12-month period, receives a diagnosis of AUD. The severity of AUD—mild, moderate or severe—is based on the number of criteria met.
If you believe you or your loved one may have AUD, visit the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) website to answer a few questions. Their website has excellent resources if you believe you or someone you know has AUD.
While most people with AUD can benefit from treatment, unfortunately, less than 10% of them receive any form of treatment.
Why should alcohol be limited? What are the short-term and long-term consequences on mental and physical health?
Excessive alcohol use can increase the risk of mental and physical health problems. Depression and anxiety are more common after heavy drinking, and people who drink heavily have worse mental health outcomes. If you have trouble sleeping, cutting back on alcohol might help.
The brain relies on a delicate balance of chemicals and processes. Alcohol is a depressant, which means it can disrupt that balance, affecting our thoughts, feelings and actions—and sometimes our long-term mental health. The feeling of relaxation we experience after a drink is due to those chemical changes in the brain. And as the alcohol begins to suppress the part of the brain associated with inhibition, some people feel more confident and less anxious.
Regardless of your mood, with increasing alcohol consumption, negative emotions may take over, leading to a negative impact on mental health. Alcohol is linked to aggression, and some people report becoming angry, aggressive, anxious or depressed when they drink.
Drinking too much over time can cause chronic physical health issues, such as liver damage, cardiovascular disease and multiple types of cancer. Alcohol is linked to over 200 diseases and health issues, including fetal alcohol syndrome, hepatitis and diabetes.
In your experience locally, what are the most common substances abused, and how have you seen that impact families or communities?
During my time working with high-risk teens, the most common substances that I have seen abused are alcohol, marijuana, cocaine and methamphetamines, with prescription medication on the rise. Often abused is Promethazine, a drug prescribed for cough containing codeine, a narcotic. It is often mixed with soda and hard candy to produce “purple drank,” “water” and “lean.”
The impact on families is devastating. Families are torn apart, and many don’t know how to get help or are ashamed to find help for a family member.
If someone is concerned that they or someone they know is dealing with unhealthy alcohol or substance use, what should they do?
First and foremost: Are they willing to get help? If the person is not ready to get help, it won’t work. They should speak to their doctor about unhealthy use.
Focus on results. Explain how their drinking could be affecting their health and how it will continue to cause harm. Express your concern for their well-being as someone who cares for them. Remember that it will take time to change. Expect pushback; they may be defensive and deny the problem. Try not to take it personally. Think of it as planting a seed that will blossom into new, healthy habits.
Prepare a plan. Have concrete next steps for them to choose from, in case they’re ready to get help. Look for local Alcoholics Anonymous meetings, find counselors within their insurance plan and research treatment facilities. Offer to give them a ride if they need one.
Seek support. Confronting someone about their heavy drinking can be hard on you, too. Talk to a trusted friend, counselor or spiritual leader about what you’re going through. You can also find groups of folks who are in the same situation as you are. Organizations like Al-Anon, Nar-Anon, and Alateen have networks all over the country and online to support those dealing with a loved one’s heavy drinking.
Stay connected. Continue to do things you enjoy together. Encourage their hobbies and healthy friendships. Be ready to stay the course and support them as they work on themselves and seek treatment. Go to an AA or NA meeting. Listen to what other people are saying about their addictions and how it has affected their lives.
In your decades of experience, what is the most surprising thing you’ve learned about addiction?
Addiction does not discriminate. It does not care about your age, ethnicity, education level, how much money you have or whether you’re a doctor or a janitor. It rips families apart. Also, once you are clean and have years of sobriety, it will wait for you to return. But I have seen addiction won over and have met people with 20 and 30 years clean.