Reconsidering Alcohol: A Physician’s Take on Stress, Sleep, and Midlife Health

Jul 3

4 min read

As we approach the fourth of July, we're sure to see an explosion of alcohol use, abuse, marketing and unfortunately, accidents.

It's the leader of substance use related deaths in America every year yet I expect to see TV and internet commercials and patriotic packaging promoting its use this week.

It's mind-boggling to me that drunk driving is still even possible. Al tracks everything we do but we can't prevent a car from being operated by someone who's had too much alcohol? If someone can explain that to me, I'd love to hear it. I'd also love to know more about impaired driving and marijuana use.

I used to drink regularly.

I grew up in a house where drinking with dinner and after dinner was normal. No one was drunk. Nothing happened.

I tried to make that happen for myself as an adult. I had so much brain fog (from exhaustion and chronic stress) even with one glass of wine at dinner that I stopped that routine before getting pregnant with my second child.

I certainly used alcohol as a so-called stress-reliever. Before we had kids, my husband and I would open a bottle of wine and watch a TV series together. I would feel like I'd melt into the couch, sometimes even drifting off to sleep.

Then I'd wake up because I can't sleep on the couch, maybe the TV would still be on and I can't sleep that way anyway.

By the time I'd had my second child, I was six weeks postpartum by the time I realized I could have a drink if I wanted to because I wasn't pregnant anymore. I hadn't missed it, so I just kept going.

I haven't had a drink in over one year.

I would not consider myself sober or call myself sober. I think that would be insulting to people who do use that term. I likely will drink again in my life, but on rare occasion.

Is this more than a personal decision for me? Is there medical merit to giving up alcohol?

The Guidelines

I always believe guidelines need to be taken and practiced with a grain of salt, they are only one way to assimilate information and deliver it to people, but here are some party lines on alcohol use:

Moderate drinking = 1 drink per day for women

This is compared to Excessive drinking, which can be defined in different ways:

Binge drinking (4 or more drinks on one occasion)
Heavy drinking (8 or more drinks in one week)
Drinking while pregnant
Drinking at age less than 21

I haven't often seen alcohol use during pregnancy, at least that gets reported (this is self-reported by the patient), but I have seen it.

I certainly see considerable marijuana and tobacco use in pregnancy.

The Risks

While moderate is better than excessive, moderate is not without risks.

Moderate alcohol use has been associated with multiple cancers:

Breast
Mouth
Throat
Esophagus
Colon
Liver

Excessive drinking particularly is associated with:

Accidents
Violence
Overdose
Pregnancy loss, fetal alcohol syndrome

The Trends

There's likely some selection bias in my perception that sobriety is gaining popularity since the social media algorithms filter to us based on our own preferences.

I'm certainly not on board with many, or most, trends but this is interesting.

Called "sober curious" or "intermittently sober", movements are gaining popularity to treat alcohol use as occasional or rare rather than regular.

Some cite just not wanting to and others report improved physical health as their motivation for cutting back or ceasing alcohol use.

Good for anyone younger than me who came to their senses earlier than I did. I'm just happy to be in the place that I am now, not feeling reliant on alcohol for stress relief, companionship, as a stand-alone activity or a necessary part of other activities.

I've instead found stress relief with habit changes:

exercise including yoga (for twenty years now)
mindfulness
stillness
prayer
better sleep

These are all a work in progress and some days are better than others but my consistent effort has made a big difference already.

I have a family member who has been sober for decades. She's also an exercise enthusiast. I remember her once saying that she could be addicted to Oreos if she opened up a pack but instead she chooses to be addicted to exercise (not in an unhealthy way).

While we've found non-substance ways to replace alcohol, others have an increasing trend toward other substances, THC and CBD, according to one report.

I'm not sure that trading substances is a similar solution. Marijuana products vary greatly in concentrations and preparations, and with newer legalization there are fewer safeguards regarding its use particularly with driving.

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