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Melanie Cole (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And joining me today is Dr. Jonathan Avery. He's the Vice Chair of Addiction Psychiatry at Weill Cornell Medicine and the Program Director of Addiction Psychiatry Fellowship. He's here to tell us about sobriety and alcohol use disorder today. And Dr. Avery, it's always a pleasure to have you with us today. So as we start, I'd like you to first tell us about the work that you're doing as it relates to alcohol use disorder and what do you see every day.

Dr Jonathan Avery: Well, one, thanks for having me back. It's always wonderful to be on this podcast and to participate in all the great work that you're doing. Most of my work is around alcohol. You know, you hear a lot about the opioid epidemic, about youth vaping, some of the other things that pop up in the news. But it really is still alcohol that gives Americans most of the trouble.

In fact, at our hospital we see about nine times more people coming in with the medical consequences of alcohol than for other substances of abuse. And potentially, that has gotten a lot worse during COVID. And so, my work here is focused a lot on understanding why people get into trouble with alcohol, understanding the role stigma plays, and us sort of not having open and honest conversations about our alcohol use and then thinking about different treatment options to tackle problematic drinking when we get in trouble.

Melanie Cole (Host): And we're going to get into all of that. Now, you mentioned in the last couple of years and COVID, really it has caused this rise in alcohol use disorder, right? And that has shown that there's been an increase in substance abuse across the spectrum, and we've got social media painting that rosy picture of it since the pandemic, right? Colleges, bingeing, I mean, it's been played up quite a bit. Tell us a little bit about the combination, the intersection, Dr. Avery, of substance use disorder and stress, because that seems to be one of the driving factors in many people's excuses as it was or reasons for starting, has been kind of the stress of everything we're living in.

Dr Jonathan Avery: That's right. I mean, I think self-medication and the self-medication hypothesis of addiction or alcohol use helps us understand that a lot of the reason that alcohol use becomes problematic is, as you said, to help relieve some of the stress. And as a society, we've been under a ton of stress these last couple years. COVID-19 pretty much created all the stressors that can lead to mental health issues and addiction. It resulted in a lot of anxiety about one's physical health that resulted in financial stress. The kids were stressed. We saw the biggest increase in substance use among women and non-Hispanic African-American populations who were especially stressed during the pandemic as well. And so, the stresses was felt on so many areas of our life. And so, it's not surprising that people have turned to alcohol. And you're right, in some ways, it was almost sanctioned, like social media and our peer groups were all like, "Oh, it's COVID-19. There's nothing to do. We can't go to the gym. We can't exercise and socialize as before. So, let's just drink." And they opened up delivery of alcohol to everyone's home. It's sort of made it easier. And in the end, a lot of more people were in trouble with drinking than before.

Melanie Cole (Host): So, we've seen on TV and the media people that work the steps, we're going to talk about different treatments, but they do different things and then they use the term sobriety or living a sober life. Can you tell us, Dr. Avery, what does that really mean?

Dr Jonathan Avery: Those terms get confusing and they can mean different things to different people. I think we used to think that recovery from alcohol use or sobriety was abstinence. And still a lot of people when they say sobriety or resolution of an alcohol use disorder, they're often saying that they don't drink at all anymore, that they recognize that it, any alcohol causes them difficulty. And so, they completely abstain. But we now are a little more flexible in our definition of what healthy alcohol use or rather not having a problem looks like these days. And we do think certain people can moderate alcohol use, that is they can get in trouble, drink a lot during COVID-19 or because of stressors. But then, more than we previously realized can return to healthier drinking where it's one or two drinks here or there and not a big problem. And so, the sum of all that is sobriety means a lot of things to a lot of people historically, just abstinence. But we're being more flexible in terms of understanding what recovery looks like these days.

Melanie Cole (Host): So as much of the media and ads talk about New Year's resolutions, we have holidays and all kinds of things going on. When you mentioned that some people can moderate, that recovery looks a little bit different now, it's a much more personalized approach. What does that look like around drinking less and just in general getting healthier? What does that mean?

Dr Jonathan Avery: So, alcohol use disorder or alcoholism, when it's a problem, that's when you're drinking in a way that impairs your function. That means it's getting in the way of relationships, work, your physical health. And so, we sort of all agree on that almost. Then, there's sort of at-risk drinking, that's when it might not be impairing your function yet, but you start either drinking almost daily or you start bingeing, that's when you might have more than three to five drinks on a given occasion. And that's when you start finding yourself potentially getting into trouble with drinking, especially if it's regular bingeing or more daily use.

And so, these holiday times do provide the opportunity for a lot of bingeing, a lot of holiday parties, a lot of family get-togethers, a lot of stress of being with family and end of the year. And so, you have to be careful that these events, which almost sanction at-risk drinking, don't lead you to get into an alcohol use disorder, an alcohol problem. And that's sort of why dry January often follows this December, is that people do tip in a negative direction and at times need to correct and take some time off to get things back in order.

Melanie Cole (Host): Well, that segues beautifully because, as we've seen, there's an influx of new alcohol-free beverages, products for sober people. With the holidays, it can be difficult, as you say. It's almost sanctioned to go to some of these parties. What do you recommend as far as people that want to go to these parties? They want to have something in their hand, they want to have a beverage and feel like they're, you know, part of the group. But there's so many on the market and some have additives and preservatives or, you know, sugar substitutes, all kinds of things. Do you have any that you like to recommend or ways that people can tackle that?

Dr Jonathan Avery: Well, one thing that people notice when they are more mindful of their drinking or they stop drinking is that they're not alone. Like I think at first when you're trying to tackle your drinking, you sort of think you're the only one. You think everyone in your life drinks and no one has a problem and no one's abstinent. It's sort of like life before kids, like you don't recognize that everyone's got kids on airplanes and you missed like a whole aspect until you have them. And it's same with not drinking. Once you stop drinking, you sort of look around and you're like, "Hey. That guy's not drinking" and "Oh, I forgot you were in recovery for all these years." And so, I think that's one thing to know is that you're often not alone. And going into these holiday events, it is nice if you have a bit of a partner in crime, I will say, to sort of speak what your motivation is or goal is, "Hey, I only want to drink one drink at the company or work party" or "I'm trying to abstain for now" or "I've had a problem, I'm not drinking." So, I do think it's nice to not be alone.

And then, yeah, there are good alternatives these days in terms of drinks that are increasingly tasty. There're those non-alcoholic beers, non-alcoholic cocktails, or even just getting a seltzer and having something to hold in your hand can be enough for a lot of folks.

And people often say, "What do I do if people ask me for a drink?" Or they get really worked up about toasts or things like that, no one cares. They think that people are going to care going in. But in the end, if you've got something in your hand, or even if you don't, everyone's all in their own world anyways. And so, people forget there's not the peer pressure like one might imagine in high school. And so, people are often finding that they're able to do it and they're not alone once they really start to tackle it.

Melanie Cole (Host): I agree with you. No one really notices that stuff. As you said, they're not alone. I'd like you to tell us about some resources, things that you recommend that you can mention to help people that are living a sober life or that are in recovery, or even trying to moderate support so they feel like they've got a community and people that can help them in times of stress. You know, we've seen, again, on TV and stuff, people call their sponsors, that sort of thing. Tell us, when you're working in addiction psychiatry, Dr. Avery, what resources do you recommend to people to really help them stay on track if they've made this decision?

Dr Jonathan Avery: So, the bad news about COVID-19, it caused a lot of stress, caused havoc in all these areas of our life, mental health crisis, addiction crisis. The big silver lining from COVID-19 is that it did increase the menu of options of treatments and supports that are available to folks and have made them increasingly available, even from your own living room. And so, that menu looks like the classic menu, 12-step groups, AA that have been around for a hundred years. You work the steps, you get the sponsor. But it's not for everyone. It can be time intensive, sort of the in-person nature of it can be tricky. There are now Zoom 12-step groups, so you can Zoom in these days. But there's plenty of AA alternatives as well. Some of the big free peer-based ones are things like Smart Recovery. There's different mindfulness-informed groups that one can join. And so, there's increasingly a lot of options often available by Zoom or online.

Also now, there's good medications to treat alcohol use disorder. There's meds that help you drink less. There's meds that help cement abstinence. And these meds you can get from your internal medicine doctor. There's also now online platforms. If you just look up medications for alcohol use disorder, you can log onto an app and get them delivered to your house with a short visit with a clinician. And so, those are increasingly available. There's also good therapies. And when you're really struggling, there are outpatient rehabs and inpatient rehabs that have been around for a while. But often, people are trying to tackle these new, often online, but I do think in-person's nice too. But there's plenty of interventions for however you think you might want support and that's been one silver lining of this COVID-19 mess.

Melanie Cole (Host): Wow, I didn't even know about some of those, Dr. Avery. That was so informative. One of the things that I've seen over the years with my friends, family, if one partner has had alcohol use disorder, substance abuse, any of those things, but the other partner does not, and they like to have a drink now and then, they like to have a glass of wine or champagne or whatever it is, a beer, but their partner is abstaining, Do you have some advice for those kinds that are like, "Okay, now what do we do?" or people that are just starting a recovery program, but they've got a partner that really doesn't have that issue?

Dr Jonathan Avery: Yeah. There are a couple of aspects to this that are worth addressing. One is that, you know, alcohol use does impact the whole family and family members can a range of responses to it. And so, you know, we're often, one, incorporating families into treatments and, two, encouraging family members their own support as a loved ones going through this. And there are, just as I described, the groups where folks struggling with alcohol use. There are similar groups, Al-Anon, a therapist-led group called CRAFT, a range of other online and in-person supports for families so they can get the support to figure out how to tackle their loved one's use best for them.

And when you are in recovery and the people around you or a loved one are drinking some or drinking little, I think the main thing is to just communicate as you would with any issue in a relationship, sort of what your hopes are or what your needs are, or what you need for abstinence. And then similarly for the loved one who wants to drink, I think just being open and honest about what that looks like, how we can do it in a way that's respectful of each other and, you know, that can be hard. If the loved one's not stopping drinking while it's really triggering the other, you know, there's some deep relationship issues there that are worth exploring or the role of alcohol use in the loved one. At times when someone struggles with drinking or mental health, they become the identified patient, so to speak. But really, it's the whole system that needs, you know, some work in order to make everyone happy going forward. And so, I think the key really though is being open and honest about everything, getting the help when you need it and then, hopefully, that'll lead to good outomes.

Melanie Cole (Host): Well, I think that's a great point that you make and families need to be involved in that recovery and treatment for all kinds of use disorders. And as we get ready to wrap up, Dr. Avery, I would like you to offer your best advice. You know, you've mentioned some treatment options. You've mentioned when some red flags, function, you know, daily activities, that sort of thing. I would just like you to summarize for us what you want friends and family to do if they suspect a person of serious issues with overuse of alcohol. To whom do they turn? I'd like you to just offer your best advice for what we've been seeing in society and how we can kind of wrap our heads around this alcohol consumption that as a society has been sanctioned, but yet can be really detrimental to people.

Dr Jonathan Avery: I think the first thing is in our families, in our communities, schools, wherever, we want open and honest conversations about drinking and substance use. And so, you know, in families, they recommend even talking to kids as early as age nine about, you know, substances and mental health issues. And the hope is that it's something that families and individuals are constantly checking themselves on, having conversations about. And so, when someone in the family unit is in trouble, that we're not having that first conversation when people are in crisis mode. But that it's a conversation that's already started. You know, we are aware of their risks and the family history and all those things. I think that's the best approach, that sort of prevention, you know, talking-about-it approach. But that's not always possible and sometimes the loved one or someone that you're having a new romantic relationship with or, you know, it's not a conversation that's been easy in the family. And so, when that happens, when you're looking to confront someone about their use, the mistake is that people just berate the person, they finger wa at them, they shame them. And we used to think that would work actually. We used to almost sanction that. But we've realized now that that doesn't work, that that pushes the substance use to the secrets.

And so, these days we just encourage sort of a kind, open, you know, "I'm worried about your drinking. You know, I know it can be hard to talk about, but look, I'm here, I know about options. I'm happy to get help together." And if the person says, "No, not right now," say, "All right. But look, I'm here to talk about it. And if you don't mind, I'd like to check in occasionally about it." You vary the intensity based on what the relationship is. But you know, that's sort of the spirit, one of more kindness and openness than shame-based.

Melanie Cole (Host): That's great advice, Dr. Avery. What an excellent guest you are as always. Thank you so much for joining us. Come on back and educate us some more anytime. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcast, Spotify and Google Podcast. And for more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. There's so much great information there. I'm Melanie Cole. Thanks so much for joining us today.

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