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Melanie Cole (Host): Thanks for tuning in to Back to Health, the podcast that brings you up-to-the minute information on the latest trends and breakthroughs in health, wellness, and medical care. Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.

Host: And today, on this Women's Health Wednesday, we are discussing alcohol and drug awareness for women. Joining me is Dr. Jonathan Avery. He's the Vice-Chair of Addiction Psychiatry at Weill Cornell Medicine. Dr. Avery, it is always a pleasure to have you on. So, let's talk about women here because, even before COVID, you know, we saw all of this fancying up of wine and wine tastings and drinks and cocktails. And then, it kind of became a thing where we women were not using it so much to self-medicate, but in a way, and our anxiety and we're the caregivers to the world and all of the things that go through a woman's mind when we're in our, like, 30s, 40s, 50s, 60s. What are you seeing as far as women, alcohol consumption? Have you seen it on the rise? What do you see in Dr. Avery?

Dr Jon Avery: Thanks for having me back. I'm always happy to talk about topics in addiction. And this is one that's really important these days. And we're seeing women's drinking numbers at record levels. And as you mentioned, I mean, 30, 40, 50 years ago, drinking was sort of a men's game. Way more men presented for treatment. They were the ones presenting to our hospital for liver disease and we didn't see a lot of women getting into trouble with severe alcohol use. As the years passed and it became sort of more socially acceptable for women to drink like men, we saw those numbers start to rise. And even before COVID, we had started to see more young women presenting for addiction treatment than even young men. We were starting to say, "Oh, I see that, men and women are starting to drink the same, everything's equitable." But we know that women are more likely to get in trouble with substances than men because of their body makeup, chemistry. Not totally fair, but it's what we were seeing. And then, COVID happened. And COVID created unique stresses that affected a lot of women and women and non-Hispanic blacks saw the greatest increase in drinking during COVID.

Guest: And as you mentioned, a part of this is self-medication. Certainly during COVID, there was a lot of stress. But part of it is that a lot of beverages and beverage companies cater to women, there's increasingly flavorful and unique drinks for everyone. However, you want to drink, however you want to take it, there are options these days. And so here we are with women and really in general numbers quite high and more people in trouble than ever.

Host: Well, you know, so many women that I know in my age group in our 50s, as you say, we see this as it's just our time, it's our time. And nobody can bother us when we're having a cocktail or a glass of wine. And so for us, it kind of developed into this talk time, chill time, Netflix and chill in our little glass of wine. I mean, it really became a comfort thing. So if we were to look for replacements, now I use tea and try and take my cup of tea and hold that and use that. But if you were to think of some solutions for women as we start to identify, and actually first, Dr. Avery, why don't you tell us how we can identify whether what we're doing is just fun Sex in the City cocktails or if it's something that really is problematic. And then, tell us some things that we can maybe substitute or how we can kind of change those behaviors to get our comfort somewhere else.

Guest: Right. So, a lot of great questions there. I mean, one to start, how do we know we're getting in trouble? And that sort of happens when drinking becomes the answer to every question. You start needing it to unwind, what you're going to do to have fun. And it starts to sort of get in the way of other health behaviors, from going to the gym or spending time with family. And alcohol is a tricky one. It sneaks into one's life and, before you know it, it has an outsized presence. We have some frank numbers that help guide us as well. If you're drinking more than seven drinks a week as a woman and more than two to three on given occasions, that might mean you're more at risk to drink. We certainly know those with histories of trauma and mental health as well as family histories of addiction are more likely get in trouble as well.

And so if you start to think, "Hey, my drink number's creeping up. The drinking's starting to get in the way" or even worse, if you go to your doctor for the annual visit and then he says, "Hey, your liver enzymes are creeping up. It looks like alcohol is having effect on your body," then you really want to start to change, change that behavior, and that can be hard. And I often say, you know, change is the hardest thing any of us do in this life. And with addictive substances, it's especially hard cuz your brain is hijacked with the rewards of it. There can be subtle withdrawal states even if you're drinking mildly. And so, we often recommend if people want to try to moderate or cut down that they often start with a period of just not drinking at all, like take a month off. Dry January and Dry March, just sort of to let your body chemistry detox. And in that month, sort of assess what role it was playing in your life. If you're doing that or even if you're not, the idea as you were saying is to find replacement behaviors, find other things that can bring you joy, engagement. It can be tea, it can be Netflix, it can be socializing. A lot of drinking happens in isolation. If you can get around people, especially people that are in it with you, that can be especially helpful.

Host: Well, I think that that's smart too, because when we have a buddy system and we're all gathering together and we all say, "You know, let's just not drink tonight." And I mean, I want to get real here, Dr. Avery, because while many women have these problems and certainly mental health issues, can it also be true that you do have these drinks, but without addiction, without that, you know, maybe a take it or leave it, but really would rather take it? And I mean, I'm kind of part of my own therapy here, but really, is that possible? Do we have to look deep inside ourselves to decide whether or not this is something that is affecting us physically, mentally, emotionally, any of those things? Because I think, for some of us, that's the hardest part.

Guest: Yeah. No, it's hard. I mean, to look inside and understand what role alcohol's playing or even to figure out why you're feeling the way you are about things in your life, your partner or your job, your kids, that's hard work. And sometimes having a drink or anything else is preferable to facing some of these harsher realities of life. And so, yeah, I mean, I think if you're going to moderate or drink a lot or drink a little, doing that work is critical, I think. I mean, you only live once, it's important to get your head around the important things like meaning and what's important.

But I'm not here to scare people either. Like most people, about three-fourths of people will drink and not get into trouble with drinking. Most can moderate, have a drink here or there and be totally fine and live a normal life. And so, it's not everyone that gets in trouble. It really is those people that are at risk that, have that family history or the drink numbers start creeping up and they can't cut down, or they're using it to self-medicate. They're the ones we really focus on because they're the ones that not only can drink and get them in big trouble, but stopping is especially hard because you're using it, trying to fight genetics and trying to fight self-medication and sometimes they need medications and therapy to really get to a safer spot for drinking.

Host: Well, and another thing when we're talking about replacement behaviors, you know, with marijuana being legalized in many parts of the country, and I know when we talk to our kids about this, Dr. Avery, that's a different deal. And you and I have talked about kids and discussing drug and alcohol awareness and use with them and we worry about our kids. But when it comes to us, and we are the ones feeling like we are in control of our lives, plus we're in control of everybody else's life and we're doing 52 things at once, and we're running the house and have our jobs and I mean, there's a lot that we women do. And now with marijuana being legal, are we looking at harm reduction here as well? Are we looking at prevention? How are we looking at this now as a way to sort of take the edge off. And in some cases, Dr. Avery, is something like that better or worse than Xanax, Prozac? I mean, you know, we're all on Lexapro or something. How do we weigh the risks and benefits of those kinds of things to help us take some of that anxiety away?

Guest: It's a great question and it's the question people are asking more than ever these days with the legalization of marijuana and all the different ways that you can consume it these days, right? You don't have to be smoking in front of the kids. You can have an edible or a tincture or something. And I mean, CBD is basically in every product that exists these days. And so, it's definitely everywhere. It's part of our social fabric and its role in our lives and our society's still being defined. And it'll be interesting to see what happens.

The truth about weed in adults is that it's probably safer than alcohol. About 90% of people will be able to use marijuana, they're not using daily and not get into trouble while one-fourth of people who drink will end up in trouble with it. So, it does have a bit of an enhanced safety profile. You know, you don't get the liver disease and some of the more severe cardiovascular and cognitive effects you can get with alcohol. So, there is a safety profile, but that doesn't mean it's safe necessarily. When you start smoking daily or using marijuana in any form daily, you know, it starts to increase your odds of getting addicted to it and you can get addicted in the same way as with alcohol and other substances where it starts to get in the way of your function. And we know once you start self-medicating with it for sleep, anxiety, depression, it tends, even if it helps those things at first, to make those things worse long term, because it isn't like exactly an antidepressant that we have pretty good evidence that it will help depression and anxiety in the long term. It seems to only help in the short term and in the long term make things worse. And so it's not a great self-medication strategy. But it's probably safe than alcohol. Used moderately, you probably won't get in trouble. But figuring out the right way to talk about it, talk about it with our kids, talk about it with ourselves, is as important as figuring out the right way to think about drinking in its role in our life.

Host: So I'd like you to end with your best advice for the women like me that are listening and your expertise and everything you've seen. What do you want us to know about drug and alcohol use in our homes and out in society and out for dinner and all the things, I mean, let's just say that we look forward to, Dr. Avery. I know I do, and I'm sure many women listening do as well. What do you want us to know when we're thinking about this? Looking forward to it without kind of ruining our excitement over it, but yet tampering down the fact that it is something that we look so forward to. Do you know what I'm saying?

Guest: I do. it's a balance and it is hard. It is certainly something that we look forward to at the end of the week, as you said, or in a social gathering. At the same time, I've never seen that person at the end of their life that says, you know, I really wish I drank and smoked weed a little more. The regrets tend to be in the opposite direction. And so, I think most people, again, will use and will be totally fine.

But if you're one of those who is at risk from trauma, you're self-medicating, your usage is going up, my best advice is to, one, talk about it, understand how you're using it, and then to seek help sooner than later. You don't want to be one of those people with regrets. You want to be one of those people that's able to enjoy it or able to get it and get your use in track before it becomes a problem. And so, be open and honest about your use with your clinicians, with yourself, with your family. Certainly if you start to hide things, you might be in trouble. And I think that honesty and openness will allow you to self-correct if things tip in a negative direction.

Host: I agree with you. It certainly is so important and we have to look at ourselves and what we're doing and understand the pressure we're under, but not look to self-medicate, just as you say. So, thank you again, Dr. Avery. Your advice is always so welcome and spot on. Thank you again.

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. We're so glad you joined us for Women's Health Wednesday. We hope you'll tune in and become part of a community and a fast growing audience of women looking for knowledge, insight, and real answers to hard questions about their bodies and their health, and we did that today for sure. So, please download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify and Google Podcasts. And for more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole. Thanks so much for joining us today.

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