Stress Relief or Something More? When Casual Drinking Becomes Problematic

0:00:13 William Moyers
Hello and welcome to Let's Talk, a podcast series produced by Hazelden Betty Ford. Today our topic is stress and alcohol. In these times especially it seems like every day is a stressful day. A pandemic, economic turmoil, political discourse, changing jobs, extreme weather phenomena. A world that seems to be upside down and changing faster than we can keep up with. A stressed-out world too. But what happens when stress gets mixed with alcohol? After all, many people will find an elixir to the stress of daily life with a glass of fine red wine, a cold beer, or a shot of warm whiskey. Hello, everybody, I'm your host, William C. Moyers, and my guest today is Damir Utrzan. My colleague at the Hazelden Betty Ford Foundation. Dr. Utrzan is the Manger of Mental Health Services for our organization. He's also an adjunct Assistant Professor at Hazelden Betty Ford's graduate School of Addiction Studies. His academic and professional credentials are impeccable. But let me call out that he has earned his Doctorate in Family Social Services, couple and family therapy specialization, from the University of Minnesota and I can go on, but, as it relates to our topic today, Damir knows firsthand about the intense stress of upheaval from what happened to him as a child, in what was then known as Yugoslavia. Welcome, Dr. Utrzan.

0:01:39 Dr. Damir Utrzan
Thank you for having me, William.

0:01:40 William Moyers
Thanks for being with us. Tell us about your childhood experience back then.

0:01:44 Dr. Damir Utrzan
Yeah as you briefly eluded you, I was born in the former Yugoslavia which has since become Bosnia and Herzegovina. And it's been over 30 years ago now when interethnic conflict and genocide at that time displaced the largest population in human history. And my parents are interethnic, my dad's Serbian Orthodox, my mom Bosnian Muslim. And so they were in a relationship that before the conflict was acceptable and encouraged but then during and after the conflict, became a catalyst for violence and—and discord against groups that previously got along just fine. So my mother and I we left to live in Germany with her oldest brother while my dad remained behind 'cause he was drafted into the Serbian military. And we tried to get along and then rebuild our lives to the extent we could. While my father looked for ways to get out.

0:02:37 Dr. Damir Utrzan
[continued]
But, you know, after several months, my mother and I decided to return because they couldn't be apart. And so we moved around the—the war-torn country trying to find peace and stability, which was and remained elusive. And so, we returned to Germany and it wasn't until really I was in graduate school that I found out my father was trafficked across the border by the Mafia at that time. Because he didn't have documentation.

0:03:04 William Moyers
Hmm.

0:03:04 Dr. Damir Utrzan
Him and I would sit and talk about all the different things we've gone through as a family. And that's when I realized that my personal experience with alcohol had a really profound impact on my understanding of the illness, the disease if you will, and how it impacts functioning across a lifespan.

0:03:22 William Moyers
So how does alcohol work to reduce stress or affect stress?

0:03:27 Dr. Damir Utrzan
Right. So in order to understand that, I think we need to first define operationalized stress.

0:03:31 William Moyers
Huh.

0:03:31 Dr. Damir Utrzan
Broadly speaking, stress is defined as a phenomenon when an individual's ability to cope psychologically and physiologically to a contextual factor exceeds a certain threshold. So with that understanding, when we turn to alcohol specifically but really any other substance, it activates the gamma aminobutyric acid neurotransmitter in the brain which has a depressant effect.

0:03:56 William Moyers
Huh.

0:03:56 Dr. Damir Utrzan
And that depressant effect induces a calm state of relaxation with one to two glasses depending on the type of liquor within half an hour.

0:04:03 William Moyers
Mmm-hmm.

0:04:05 Dr. Damir Utrzan
And those are the short-term gains.

0:04:06 William Moyers
Hmm. So there's nothing wrong with people having stress and we all have stress in our daily lives, is there anything wrong with having a drink after a stressful day, or after you put the kids to bed, or when you come home from work?

0:04:21 Dr. Damir Utrzan
As with so many things in our field, it depends.

0:04:24 William Moyers
Ahh.

0:04:25 Dr. Damir Utrzan
There's nothing inherently wrong with having a glass of fine red wine as you mentioned in the introduction with dinner or during social events and gatherings, but on the other side of the spectrum, which is what makes it so easily accessible, is the maladaptive coping. So, when we get into a pattern of drinking and consuming alcohol after the end of the day, to feel relaxation, warmth, in our body, over time we become used to that. And that can exponentially increase over time. And before we know it, we are drinking two to three glasses of wine at the end of the day to get that same feeling. And it doesn't become an issue or problem until we no longer are able to function without it.

0:05:11 William Moyers
So, if people have stress in their lives and we all do, if people use a substance like alcohol which many people do, although I can't because I'm in recovery, just because they use a substance like alcohol it doesn't mean they're gonna become dependent on it?

0:05:27 Dr. Damir Utrzan
No, no, you're right. And you bring up something important that the term dependence and I keep going back to definitions. Because so much of societal stigma is around our understanding and definition of terms.

0:05:37 William Moyers
Yes.

0:05:38 Dr. Damir Utrzan
In 2013, the American Psychiatric association reclassified substance use disorder from being a dependence-related issue to just collapsing it into substance use disorder.

0:05:49 William Moyers
Uh-huh.

0:05:49 Dr. Damir Utrzan
That move was done for two reasons: one, to really delineate definitions so there's not crossover substances. And two to reduce stigma. Because substance use disorder implies something very different than substance use dependence.

0:06:04 William Moyers
Which term do you prefer? I mean, laymen like me as a recovering person I know the term alcoholic or alcoholism, substance use disorder, addiction to alcohol and other drugs, they're all effectively the same, yes?

0:06:17 Dr. Damir Utrzan
Right, they are. And part of it just our evolution of understanding. And I would say that for a family friend or a loved one—

0:06:25 William Moyers
Mmm-hmm. Mmm-hmm.

0:06:25 Dr. Damir Utrzan
It doesn't matter. What you call it. But in the clinical world we tend to refer to it as substance use disorder because it depersonalizes the problem externally rather than something being wrong with the person.

0:06:37 William Moyers
We know that stress affects the human body. You refer to that. How does it affect it physically and emotionally and mentally?

0:06:43 Dr. Damir Utrzan
Right. So, the effects cut across multiple domains of functioning. Physiologically depending on again the type of liquor consumed and the alcohol content, within a matter of really 30 to 45 minutes you'll start to have a warm feeling in your body. You'll start to sweat so you'll get a galvanic skin response—

0:07:02 William Moyers
Hmm.

0:07:02 Dr. Damir Utrzan
—will enter. You will start over time to really lose memory, focus, and your inhibition will be significantly reduced. Psychologically and emotionally, alcohol is actually a depressant. So what it does, it reduces which speaks to kind of that stress you were eluding to, the hormone—the hormones responsible for the body's stress response. And so that's also one of the reasons why we typically hesitate diagnosing depression for two to three weeks following withdrawal. Because the symptoms mimic each other so much.

0:07:38 William Moyers
I think it's interesting I mean I know that alcohol is a depressant 'cause I've heard experts like you talk about it and yet, people get the effect of feeling good. It's that warm-bodied feeling, that sense of relaxation and yet, it's a depressant.

0:07:49 Dr. Damir Utrzan
Right. Because you have to think about depressant in the sense of reducing—

0:07:53 William Moyers
Yeah.

0:07:54 Dr. Damir Utrzan
—Or curbing the effects of anxiety and stress, not necessarily inducing clinical depression as you would think.

0:07:59 William Moyers
Uh-huh. Yeah. How does stress affect cravings for alcohol?

0:08:03 Dr. Damir Utrzan
Right. So going back to that pattern that I was briefly talking about—

0:08:06 William Moyers
Yes.

0:08:07 Dr. Damir Utrzan
—Over time, it's really subconscious. That we start to drink one to two glasses a day which then moves to three to four. And that's a behavioral component. And then you start to associate it through positive reward, whether that be socializing or different events where it's socially acceptable. And maybe even encouraged. So that drives a wedge between what is maladaptive, if you will, or an ineffective coping strategy, with you know just being around people you love.

0:08:34 William Moyers
Yeah. Yeah. Does trauma create stress?

0:08:39 Dr. Damir Utrzan
Well, you bring up another good point that generally we refer to trauma as a type of stress. And it is referred to as traumatic stress. So there are multiple types of change again over the past decade, but traumatic stress is something that happens to a person whether that be human-made such as war and conflict as we discussed—

0:08:58 William Moyers
Mmm-hmm.

0:08:59 Dr. Damir Utrzan
—Or a natural disaster. As a displacement induced by climate change.

0:09:04 William Moyers
Hmm.

0:09:04 Dr. Damir Utrzan
And that also pushes the body beyond its ability to cope effectively.

0:09:08 William Moyers
What's your counsel when somebody starts to use alcohol to take the edge off so to speak, and then discovers that they have a hard time stopping their use of alcohol?

0:09:19 Dr. Damir Utrzan
It's so important to be honest above all with yourself. It is really challenging to start to understand, conceptualize, maybe even accept, that there may be a problem. And it may be even harder to have a conversation with family or friends and reach out. So it's much easier to kind of get back with that cycle of withdrawal. But sitting and trying to understand what you're going through is I would say the first step to recovery.

0:09:42 William Moyers
Huh. What about the use of appropriate medications to address people who are struggling with stress, for example, or anxiety?

0:09:55 Dr. Damir Utrzan
Yeah. So, we know from countless years of research, that the body is such a unique and complex mechanism in that if the stress or anxiety, the depression, is strong enough, it can effectively override any psychotropic intervention.

0:10:09 William Moyers
Ah.

0:10:10 Dr. Damir Utrzan
And we refer to that as psychosocial symptoms. So, often times you will see people who have for example withdrawal symptoms from drinking alcohol. They may have a stutter or they may have the shakes but that in turn induces anxiety of when am I going to get the next drink. And that's a complex dance between neurochemicals—

0:10:30 William Moyers
Huh.

0:10:31 Dr. Damir Utrzan
—And various other hormones of the body.

0:10:32 William Moyers
What's the role that meditation plays in helping people cope with stress?

0:10:38 Dr. Damir Utrzan
Yeah, so, medication for some people is an effective way to learn those coping strategies by themselves. Because really we don't wanna use it as replacement. Because then you're taking one thing for another. And again, if you have a clinical subset of symptoms that really prevent you from functioning in your daily life, in your work, in your family, then that is certainly the first intervention. But we really wanna move towards understanding integration and coping with not just psychotropic intervention.

0:11:07 William Moyers
What is your counsel then or what are some tips for managing stress without alcohol or other dangerous or addictive substances?

0:11:15 Dr. Damir Utrzan
Again, going back to being honest with yourself or reaching out to friends, family, loved ones. And recognizing that as much as you feel alone—

0:11:24 William Moyers
Yes.

0:11:24 Dr. Damir Utrzan
—That there are other people who feel the same way.

0:11:26 William Moyers
Huh. [smiles] Sense of community, togetherness.

0:11:30 Dr. Damir Utrzan
Exactly. And think about the history of Alcoholics Anonymous, Narcotics Anonymous, that started with community, with fellowship. And, you know, people think of it as something related to an abstract concept—

0:11:41 William Moyers
Mmm-hmm.

0:11:41 Dr. Damir Utrzan
—But it really means that you know what, I'm not alone, there's other people. And at the end of the day, you and I can talk about similar experiences like the conflict in the former Yugoslavia, but our experiences are going to be different.

0:11:53 William Moyers
In fact I often talk about the fact that addiction is an illness of isolation and the antidote to it is that first word of the First Step of the Twelve Steps: We! Or community, and your point is that community is an effective support mechanism or support system for people who are going through a tough time.

0:12:10 Dr. Damir Utrzan
Yeah that's right. And I think about clients who share their stories, friends and family, when they describe the first time they set foot on our campus at Center City.

0:12:16 William Moyers
Yeah. Yes.

0:12:18 Dr. Damir Utrzan
From the moment they cross our threshold. And they are greeted with a warm smile and an encouraging word—

0:12:23 William Moyers
Yes.

0:12:23 Dr. Damir Utrzan
—For perhaps the first time in their life.

0:12:25 William Moyers
Yeah. We only have about two minutes left, we could go on and on I find it fascinating your level of expertise and your ability to explain it in terms that even I understand. But what happens if it all seems like it's just too much? Somebody says they're just stressed out. What happens next? What's your counsel? If they feel stressed out.

0:12:46 Dr. Damir Utrzan
You know given everything that's going on in the world today—

0:12:48 William Moyers
Yes.

0:12:48 Dr. Damir Utrzan
—I would be more concerned about people who say they're not stressed out. [Moyers laughs] So, if you feel like it's too much, you're too stressed out, you're overwhelmed, reach out to someone, to anyone.

0:13:00 William Moyers
Yeah.

0:13:01 Dr. Damir Utrzan
Start connecting. Try to make a plan and rely on others to help you pull through if you will. It doesn't have to be a journey you take on your own.

0:13:09 William Moyers
And what about family members? How can they spot a loved one who is stressed out or in dire straits as a result of stress and anxiety?

0:13:18 Dr. Damir Utrzan
You know often times we have gut feelings that we may or we may not listen to because we all know our loved ones better than sometimes they know themselves. And broaching the conversation from a place of compassion and caring rather than directive does much more to promote change, both short-term and long-term, than some of that frustration that can come out in lieu of.

0:13:41 William Moyers
Mmm. Can you give us a resource or two before we close where people can go to find more information? About what we've been talking about?

0:13:49 Dr. Damir Utrzan
Absolutely. So of course people can go to the Hazelden Betty Ford Foundation's website where we list various different resources. Outside of that, The Substance Abuse and Mental Health Services Administration, a branch of the Department of Health and Human Services, really does a lot of the research in the data-driven approaches to gather resources and make them available to people nationwide.

0:14:10 William Moyers
Last question with less than a minute to go. I can't help—we've sat on this set here over the last two, three, four years and done lots of podcasts. I've always found it unbelievable that I have gone from being a patient at Hazelden in 1989 to get to see and listen to and talk with people who are experts across the continuum of our mission. And beyond. And I'm just struck—this is the first time that we've been together—I'm awed by the next generation of leaders in our organization. [gestures to Dr. Utrzan] And the sheer amount of expertise that you have and your ability to articulate it. I really appreciate it. I've gotta ask you on a personal note—

0:14:46 Dr. Damir Utrzan
Yeah?

0:14:46 William Moyers
—What fires your passion? Why do you do the work that you do?

0:14:52 Dr. Damir Utrzan
You know, speaking to what we discussed previously, what are the odds of you and I sitting down and talking about a single event in time from different perspectives? You're reporting on it on another continent and me going through it myself, and yet we sit here today and share a common theme and life experience. And that's what drives me. The hope and the first time that people experience that you know what, life can be better regardless of what happened.

0:15:17 William Moyers
Yes. And thank you so much for your expertise. And really instilling in our viewers and our listeners that sense of hope and help and healing. So, Dr. Utrzan, thank you for being with us today.

0:15:27 Dr. Damir Utrzan
Thank you for having me, William.

0:15:28 William Moyers
[turns to camera]
And thank you all for joining us as we always remind our listeners and viewers on this podcast, remember that addiction to alcohol and other drugs—it does not discriminate. But treatment does work and recovery is possible. So if you're feeling stressed out or anxious or wrangling with whether or not you're an alcoholic, remember that the most important thing you can do is reach out and ask for help. And do it now. I'm your host, William C. Moyers, I hope you'll join us for another edition of Let's Talk. See ya soon.