Do I Have an Alcohol Use Disorder?

0:00:13 William C. Moyers
We're glad you've joined us today for another in our series of Let's Talk podcasts. Produced and delivered to you by Hazelden Betty Ford. I'm your host, William C. Moyers. Welcome. You know, in the news media these days, the focus is often on opioids, Fentanyl, and overdose deaths. Or marijuana, its impact on young people, and the pros and cons of legalization. There's a lot of renewed attention to the dangerous effects of methamphetamines and there's a lot of discussion, a lot of focus, on the intertwined struggle for people with addiction and mental illness. Certainly, all of these are vital issues. But today our conversation is on alcohol and alcohol use disorders. It doesn't get the attention it should; indeed, alcohol remains the most used and abused drug in America. Its consequences are absolute. Deadly. The collateral damage to families and communities is extensive and more than ever, people are seeking treatment because they cannot stop drinking. Let's talk about this with two of my colleagues, Dr. Quyen Ngo and Dr. Stephen Delisi. Welcome.

0:01:23 Dr. Stephen Delisi
Thank you.

0:01:23 Dr. Quyen Ngo
Thank you.

0:01:24 William C. Moyers
Dr. Delisi is the Medical Director of our Enterprise Solutions, and Dr. Ngo is the Executive Director for the Butler Center for Research. Let me just start off by clarifying. When we talk about alcohol use disorder, alcoholism is part of that, yes Dr. Delisi?

0:01:39 Dr. Stephen Delisi
It absolutely is. They really are terms that are used interchangeably. That when we talk about alcohol use disorder clinically, it's what people know as alcoholism. So very interchangeable.

0:01:54 William C. Moyers
And why, Dr. Ngo, does the language matter?

0:01:57 Dr. Quyen Ngo
The language matters because one, we wanna reduce stigma. So the more we use this language, I think the more we normalize the fact that it is really prevalent in our country. And really worldwide. So it's important to use that language. And it's also important so that we understand the impact. Because how we talk about it describes how it impacts. So, you know, Steve may use alcohol use disorder or alcoholism. In my practice because I'm a Licensed Clinical Psychologist as well, I also talk about problem alcohol use--

0:02:32 William C. Moyers
Hmm.

0:02:32 Dr. Quyen Ngo
—Or heavy drinking. And so, there's a lot of language that helps for people to describe who may not be in the medical field or who may not be clinicians—

0:02:42 Dr. Stephen Delisi
Yeah.

0:02:42 Dr. Quyen Ngo
—To really understand that alcohol can really impact your life in so many ways.

0:02:46 William C. Moyers
Great point. Let's talk about who is susceptible to alcohol use disorder. Starting, Dr. Delisi, with the genetics.

0:02:53 Dr. Stephen Delisi
Yeah that's a great place for this conversation to start. Because knowing and understanding the risk factors give us an opportunity to identify individuals before they have problematic drinking. Or before they develop an alcohol use disorder. And that prevention, that early recognition, is really important. So you bring up genetics and that is one of the factors. Having first degree relatives who have themselves an alcohol use disorder or other substance use disorder, that we know to increase several-fold the risk of you developing an alcohol use disorder. But if I may just extend that as well—

0:03:38 William C. Moyers
Please!

0:03:39 Dr. Stephen Delisi
We've been starting to understand how the environment and our early life experiences—

0:03:46 William C. Moyers
Mmm.

0:03:47 Dr. Stephen Delisi
—Like adverse childhood experiences or traumas actually impact and affect how our genetics, our genes, are read into the building blocks of our brain and our bodies. And the more adverse childhood experiences someone has prior to the age of 18, we can see as much as two-to-fourfold increase in the risk of developing an alcohol use disorder in adulthood.

0:04:12 William C. Moyers
What about the other psychosocial factors that play a role in this, Dr. Ngo?

0:04:16 Dr. Quyen Ngo
Yeah absolutely. So, as Steve said, our genes don't act by themselves. We live in a world, we have an environment around us. And so, our surroundings really matter. And so, the age of first use for alcohol or any drug, it not only impacts us socially and sort of the risk that we may experience because of it, but it impacts our brain and its development as well and that goes for any alcohol or other drug that young people may try. It impacts us in terms of our environment as well. You know, when we think about the density of alcohol outlets, you know, liquor stores, you know, wine shops, that—how many locations there are within a specific unit—can increase your risk you can imagine, if you have a family history of alcohol use disorders. But you live in an area where there are a lot of alcohol outlets—

0:05:10 William C. Moyers
Mmm-hmm.

0:05:11 Dr. Quyen Ngo
—Then those two factors together combine to really increase your risk for alcohol use disorder.

0:05:17 William C. Moyers
Let me ask both of you, though, if you do have the genetics, where you have a history of, or you live in a tough environment or you struggle with trauma—is that automatically doom you to an alcohol use disorder?

0:05:29 Dr. Stephen Delisi
Great question. [Dr. Ngo nods, smiles] And the answer is absolutely not.

0:05:33 Dr. Quyen Ngo
Mmm-hmm.

0:05:34 Dr. Stephen Delisi
When we talk about these risk factors, we are meaning just that. That they increase risk. Not that they determine one's outcome. And so, we think about this resilience and positive experiences and family systems, community systems, really can have a moderating effect. And then reduce that risk.

0:06:00 William C. Moyers
Mmm.

0:06:01 Dr. Stephen Delisi
So, the good news out there is as very true, having these risk factors are something to pay attention to, to be aware of, but not to think, 'Oh my goodness, then now I'm doomed to this as the outcome.'

0:06:17 William C. Moyers
Go ahead, Dr. Ngo.

0:06:17 Dr. Quyen Ngo
Yeah, absolutely. I just wanna jump in and say absolutely it's not deterministic in any way. And the more we study the brain and our biology, then the more we understand that the brain is what the scientists like to call plastic. Which is not sort of the plastic bottle that you imagine [Dr. Delisi laughs, nods] but it means that the brain learns and it grows. And so, even though you may have these genetic risks, even though you may live in high-risk environments or have high-risk factors around you, it still means that you can teach your brain and you can learn so that you aren't, you know, don't ultimately end up with an alcohol use disorder.

0:06:54 William C. Moyers
Let's talk about the various degrees of alcoholism or an alcohol use disorder. I know that we have at-risk drinking and heavy drinking and blackout drinking. Dr. Delisi, could you speak to the first two of those please?

0:07:07 Dr. Stephen Delisi
Sure. So first of all, the healthcare field loves to have terms and definitions. [Dr. Ngo and William Moyers chuckle] So let's just start there. Put that out there. But these are terms that actually do have some importance to help us to understand when is a level of alcohol consumption really concerning, right?

0:07:25 William C. Moyers
Mmm-hmm.

0:07:25 Dr. Stephen Delisi
And so at risk is a term that means just that. That the amount of alcohol that's being consumed places the individual at risk for other health consequences. By definition, for women, that level is set at more than three drinks per day or more than seven drinks in a week.

0:07:49 William C. Moyers
Hmm.

0:07:48 Dr. Stephen Delisi
And for men, those numbers are more than four drinks per day, or more than fourteen drinks over the course of a week. Heavy drinking is a term that we use to connotate that the individual is having episodes of drinking, typically more than five drinks at a time, more than five times over the month. About six percent of the U.S. population is drinking at that level—

0:08:15 William C. Moyers
Mmm.

0:08:15 Dr. Stephen Delisi
—Really high risk then of developing an alcohol use disorder.

0:08:19 William C. Moyers
And Quyen, what about blackout drinking?

0:08:21 Dr. Quyen Ngo
Yeah, so, blackout drinking often is a consequence of binge drinking or heavy episodic drinking. And the National Institutes of Health define binge drinking as about four drinks or more within a couple-hour period for women, or drinking to the point where you—if you were to operate a vehicle—you'd be considered driving under the influence. For men that's five or more drinks within a couple-hour period. And blackout happens when you have had enough to drink to the point where you lose consciousness or you lose awareness completely. It can affect short-term memory. And it's something that within research and at the National Institutes of Health they're very concerned about.

0:09:01 William C. Moyers
I know that we—a lot of our viewers of these podcast series—are people who just wanna know more about their own or a loved one's issues with the topics that we talk about. And they may not be doctors, they may not be researchers or have their PhD. But they're worried. So what are some of the sort of 'general' markers, if you will, the warning signs, that somebody might have one of these three degrees of drinking? Whether it's DUIs, sexual assault, and so on--could you all talk about that?

0:09:33 Dr. Stephen Delisi
Yeah, sure. So, what I would say is first and foremost, if you as an individual have some concern that you might have—

0:09:44 William C. Moyers
Mmm.

0:09:44 Dr. Stephen Delisi
—Problem with the alcohol, listen to that intuition.

0:09:47 William C. Moyers
Ah.

0:09:48 Dr. Stephen Delisi
Right? If you have concern of a loved one, again, listen to that. Further, I would say you're looking for problems fulfilling obligations. For family, for work, for school. Sleep difficulties. Appetite changes. Memory changes. Developing tremors or sweating. When not able to have a drink, are you experiencing some symptoms of withdrawal? Again, feeling nauseous, headaches, dizzy, anxious, and then shaky. Those would be some of the symptoms that you really wanna pay attention to.

0:10:24 Dr. Quyen Ngo
Yeah and I would say in addition to sort of your internal cues to what I like to call 'take the temperature' of the people around you. Which has been more difficult during the pandemic.

0:10:34 William C. Moyers
Yes.

0:10:34 Dr. Quyen Ngo
But really checking in with other people about, you know, 'Hey, have you seen any changes,' or, 'Do I feel differently lately, like when we're talking, when we're interacting, does it feel different to you?' And just be open and honest about some of those conversations. And really thinking about some of those guidelines for what heavy episodic drinking is or what binge drinking is. You know and when we say four to five drinks, it's not sort of the 'we're gonna pour in and just here's the glass.' [chuckles, gestures to suggest a huge, tall glass] There are really specific measurements. So we're talking when it's liquor it's a shot glass. One beer. One wine glass. And not a huge wine glass—

0:11:12 Dr. Stephen Delisi
Right, not a big goblet.

0:11:14 Dr. Quyen Ngo
Right. Exactly. [laughs] You know. But so really thinking about, you know, when I'm making this drink, it may be that one drink is counted as four or five drinks.

0:11:24 Dr. Stephen Delisi
Very good point.

0:11:25 Dr. Quyen Ngo
So really paying attention to those things and checking in with other people too.

0:11:29 William C. Moyers
Dr. Ngo, you mentioned the pandemic—we're coming out of it as we're recording this in the summer of 2022—but we talked off-camera that the effects of the pandemic are gonna be around for a long time. What are some of the effects that the pandemic has had on alcohol use disorder? The prevalence?

0:11:48 Dr. Quyen Ngo
Well we've seen an increase, really. We've seen an increase in both drinking as well as in formal alcohol use disorders. Heavy episodic drinking. And we've seen that compounded by other risk factors that were increased during the pandemic. So things such as intimate partner violence or domestic violence. So my history is in doing research with intimate partner violence and domestic violence, that has also increased during the pandemic. And there are studies now that are coming out to show that as incidents of domestic violence and intimate partner violence has increased, that has also increased drinking. And that in fact there are more and more individuals who are drinking to cope. And so, they are really exacerbating each other—

0:12:35 William C. Moyers
Mmm.

0:12:35 Dr. Quyen Ngo
—It's something I think we're really gonna have to pay attention to moving forward.

0:12:37 William C. Moyers
Yes.

0:12:39 William C. Moyers
We only have about five minutes and we could sit here for an hour and talk about this—

[Dr. Ngo and Dr. Delisi laugh]

0:12:42 William C. Moyers
You all are great. Not only do you know it all but you're—the way you communicate it is very powerful. And I'd love to have you back another time. But in the time that we have left, Dr. Delisi, what do you tell somebody who has a loved one who has alcohol issues? What's your counsel?

0:13:03 Dr. Stephen Delisi
Yeah. My counsel, William, is that there is help for this very treatable illness. That sometimes you feel alone, you feel isolated, you feel as though you and your family are the only ones dealing with the alcohol. That's just not true. And so, my counsel is take note. Again, trust that inner wisdom that you have. And reach out for help. Seek the guidance of a trusted health professional—

0:13:35 William C. Moyers
Mmm-hmm.

0:13:36 Dr. Stephen Delisi
For an assessment and for the evidence-based treatments that work. We still live in a world where because of stigma and because of that isolation, people don't seek out the help that's there. And so only a very small fraction get the help that's available.

0:13:54 William C. Moyers
And Dr. Ngo, I know you've done a lot of work in your role as the leader of the Butler Center for Research around the efficacy and the role that virtual care plays. People who might have an alcohol use disorder, they don't have to 'go off to treatment' [uses air quotes] to get help—

0:14:09 Dr. Quyen Ngo
Mmm-hmm.

0:14:10 William C. Moyers
—Could you talk about that a little bit?

0:14:11 Dr. Quyen Ngo
Yeah, absolutely. So, our organization like many other healthcare organizations during the pandemic moved to virtual care. And so we have followed a little over 2,700 of our patients during that time. To see how that transition affected treatment and how people are doing afterwards. And we've really found that that virtual care works as well as in-person for many people. And so, there are more options out there, there's more recognition that it doesn't have to be walking into a building. And so, if you have co-occurring things like anxiety, if you've had a history of trauma and you're afraid to go out, you know, there are options out there for treatment. So definitely reach out and talk to people and ask for that help.

0:14:57 William C. Moyers
[nods emphatically] You talked about options, but Dr. Delisi, what is your response to the option that somebody try to wean themselves off of alcohol or otherwise try to control their drinking?

0:15:08 Dr. Stephen Delisi
Yeah, that's a really important question, William. Thanks for bringing it up. Because alcohol is one of those substances that trying to wean yourself off—if you have been someone who's been drinking heavily and for a period of time—that that withdrawal can be life-threatening.

0:15:25 Dr. Quyen Ngo
Mmm-hmm.

0:15:25 Dr. Stephen Delisi
Alcohol withdrawal is one of those that if not appropriately assessed by a health professional, and in many cases managed by a physician, it can result in fatality. So, what I would always recommend is if you've gotten to the place where you think now is the time that I need to stop drinking, first go see your physician or your primary healthcare provider for an assessment.

0:15:54 William C. Moyers
That's a good message to leave us on today. And I wanna thank both of you, Dr. Quyen Ngo and Dr. Stephen Delisi, for being with us today. And for helping us to carry the message. About the fact that alcohol use disorder can be treated. That treatment works and that recovery is possible. So thanks for being with us today. [turns to camera] And thanks to all of you! For tuning into this important conversation about alcohol and alcohol use disorder. We hope you'll tune in again to learn more about substance use disorders, treatment, and recovery issues. Because as we know at Hazelden Betty Ford, treatment works and recovery is possible. We'll see ya again. [smiles]