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Not all of us can handle the same amount of alcohol. Different body types, genes, minds, and experiences affect our tolerance. Here, five students talk about their relationship with alcohol in the context of their own risk factors: A family history of alcoholism; fatigue and stress; small body size; medication interaction; and diabetes. Two experts suggest customized strategies for managing their alcohol consumption.
- Dr. Nathilee Caldeira is a licensed clinic psychologist at the Student Mental Health Center at Columbia University Medical Center, and the founder of Let’s Talk Psychological Wellness PC. (NC)
- Dr. Scott Lukas directs the Behavioral Psychopharmacology Research Laboratory at McLean Hospital in Belmont, Massachusetts, and the McLean Imaging Center. He is professor of psychiatry at Harvard Medical School. (SL)
* All students’ names have been changed for privacy. All students featured are age 21+.
Drinking while small-bodied
“I’m 4’11”, 87 pounds. It’s difficult when friends don’t think about the fact that I can’t drink as much as they can. I become intoxicated quicker. I drink occasionally, two drinks at most.”
Why is being small-bodied a risk factor when drinking?
- People with lower body weight have a slightly higher Blood Alcohol Content [BAC] after drinking the same amount as heavier people.
- Most women have a lower ratio of muscle to fat than most men, meaning they have less blood and water to dilute the alcohol.
- Women typically have less alcohol dehydrogenase (an enzyme that breaks down alcohol).
- The sex hormones interact with alcohol: Alcohol is often more intoxicating just before menstruation.
“I make it known before everyone is under the influence that I’m either not drinking or will only have one alcoholic drink. I stick to what I say, so I’m taken seriously the next time.
“I avoid situations where I will feel pressured. Although this didn’t used to be the case when I was younger, I never go out in social situations where there is drinking on a whim. Sometimes I tell everyone that I’m the designated driver. More often than not, my friends are understanding.
“When I do drink, I pre-plan: I have plenty of fluids afterward, and make sure that I eat and get a good night’s sleep.”
“Callie has high awareness, knows her limit, and already practices strategies to say no and reduce her drinking. She is managing her risk factor very effectively.” —NC
Red flags for small-bodied drinkers
- Hanging out with people you don’t know very well
- Hanging out with anyone who drinks excessively
- “Being firm and sticking to a plan is the best strategy.” —SL
- “Practice saying ‘no’ prior to going out, maybe role-playing with a friend or counselor. Ask and remind friends to support your decision about drinking limits.” —NC
- Drink more slowly: Use a larger glass with added seltzer or soda.
- Choose lower-alcohol drinks, e.g., light beer, mixed drinks with only 1 shot of 80-proof liquor, or regular wine.
- Alternate with non-alcoholic drinks: “A ‘virgin’ pina colada or ‘virgin’ daiquiri often looks exactly like the mixed drink, which may take some of the pressure off.” —SL
Drinking while medicated
“I take Lamictal every day for manic depression [bipolar disorder]. I have been taking it for seven years. If I drink too much, the medication will not work properly for the next day or so.”
Why is medication a risk factor when drinking?
- Interactions between alcohol and medication are common. Alcohol can amplify or reduce the effects of medication, and worsen your driving.
- “Alcohol does not mix well with any medication that is used to treat a psychiatric condition. The interactions are not always predictable, and they can change over time in the same person.” —SL
- Talk with your prescribing doctor or pharmacist about interactions between alcohol and medications, whether they are prescribed, over-the-counter, or herbal.
- Check for drug and alcohol interactions.
“I drink every weekend or every other weekend, usually locally-brewed wheat beers and white wines. I normally only have one or two, sometimes a little more if I’m not driving. Every once in a while I’ll have a lot to drink around close friends.”
Junot is right to be very cautious about driving: “If you drink while taking Lamictal, you can have increased dizziness, drowsiness, difficulty concentrating, and impaired judgment. Also, he still needs to set limits before he goes out with friends. If Junot enters a manic phase, he may not be able to control his drinking. Drinking at a bar is still risky unless he has a non-drinking buddy to watch over him. The effects can creep up quickly.” —SL
“Junot’s consistent medication use shows high commitment to his health and managing his mood symptoms. Nevertheless, he continues to practice habits that may put this health goal at risk (e.g., sometimes drinking in excess of two drinks).” —NC
Red flags for drinking while medicated
- Deciding to drink more than usual without close friends nearby
- Drinking unfamiliar alcoholic beverages, which may interact with your medication in unexpected ways
- A depressive phase, which raises the risk of self-medicating with alcohol
- Brief counseling sessions can help you decrease the frequency and amount of alcohol use, and help you strategize around the conflict between good health and risky habits. —NC
- Instead of relying on your instincts about what’s a safe environment, come up with a written safety plan that addresses if, when, where, and how much to drink; e.g., “Two alcoholic drinks diluted with extra seltzer, drinking only if the environment seems safe, and leave by 12:30 a.m.” —NC
Family history of alcoholism
“Both my parents were alcoholics. When I was growing up, my parents fought all the time and we were super-poor. I bounced between their homes, and my dad abused me. I’ve moved 38 times in 35 years. I have perhaps three alcoholic drinks a year, and I’ve been drunk three times in my life. There are a hundred other more fun things I can think of to do.”
Why is family alcoholism a risk factor when drinking?
- Alcoholism can run in families, according to an extensive body of research.
- “If people in your family struggle with alcohol abuse, you’re not doomed. Up to 30 percent of an individual’s risk of alcoholism is genetic. The environment and your own experiences contribute 70+ percent.” —SL
- Researchers’ estimates of the genetic influence on alcohol use disorders is somewhat mixed. The National Institute of Alcohol Abuse and Alcoholism says genes are responsible for about 50 percent of the risk for alcoholism. The quality of parenting, which can be impaired by alcohol abuse, also affects children’s risk of developing an alcohol use disorder later.
“This has absolutely influenced my relationship with alcohol, as has watching people do stupid things while drinking. I refused to drive with anyone who has had even a sip. I am often the designated driver. I’ve called the cops on an ex who got behind the wheel while drunk.”
“Both parents have a known alcohol-use disorder and there’s a history of interpersonal trauma. This places Sam at high risk for alcohol misuse, abuse, or dependence. However, Sam shows high awareness of how personal history contributes to risk and practices preventive habits, and is doing an excellent job.” —NC
“We often see the children of parents with an alcoholic-use disorder go to the extreme and never touch any alcohol, because they’ve lived through the devastation that excessive alcohol causes.” —SL
Red flags for people with a genetic susceptibility
- You may be especially sensitive to environmental triggers. “The smells of preferred alcoholic beverages are the primary cues. People, places, and even events are secondary cues. Seeing a drinking buddy unexpectedly can trigger the craving for alcohol.” —SL
- If there’s a history of trauma, you may be at greater risk for difficulties and stress in intimate relationships. —NC
- “Knowing that you have a family history of alcoholism is key. And know your cues, which are specific to individuals: One person may crave beer and have no reaction to whiskey or vodka. If you used to go to a specific bar to drink, then go to a different establishment for dinner.” —SL
- “If you can’t easily cut down, switch to a different beverage; perhaps pick one that is not so tasteful. This strategy will help reduce the number of drinks per night.” —SL
- Put a limit on your drinking: Figure out your limit.
- Drink slower: “‘Savoring’ the drink spreads out the absorption over a longer period so that blood alcohol levels do not get dangerously high. Avoid ‘chugging’ or any drinking games. Drinking games are designed to have you fail, and they promote more drinking.” —SL
- Seek support from an individual therapist or a support group such as Adult Children of Alcoholics, Al-Anon, or Alateen.
Fatigue + stress + alcohol
“I love to have my friends over and throw back a few beers. I’ve been fatigued and stressed due to school. How much I drink depends on my mood. I’ll have a beer at least two or three times a week, but other times I’ll lose count.”
Why is fatigue + stress + alcohol a risk factor?
- Alcohol is a depressant. Its effects can be exaggerated when you’re fatigued, depressed, anxious, or stressed.
- “Alcohol can reduce the ‘perception’ of stress. But with increased use, continued drinking actually dampens your stress response mechanisms, and it becomes a cycle of dependency because heavy alcohol use causes a good deal of stress (worrying about withdrawal signs, getting sick, having an accident, etc.).” —SL
“I’m a pretty casual drinker. I have a beer at least two or three times a week when school is in session. During breaks from school, it’s not unusual for me to go on three- or four-day benders. Summertime is full of vacations that I take with friends, and we always have alcohol on us. If I’m stressed, drinking helps me forget about that stressor for a while. Alcohol doesn’t have that much of an effect on either my stress or fatigue levels.”
“While Briona is aware of her stress levels and the conditions that exacerbate it, she doesn’t seem aware of the risk of managing stress through alcohol, and she demonstrates inconsistent behavior when trying to do this. She is not managing her risk factor very effectively.” —NC
Red flags for drinking while stressed or fatigued
- Increased stress, post-exam periods, breaks and vacations
- “Excessive drinking places you and your friends at greater risk for driving while intoxicated, getting into cars without a designated driver, arguments and fights, and poor sexual health decisions.” —NC
- “Thoughts like ‘Having a few drinks makes my troubles go away’ predict future alcohol dependency problems.” —SL
- Anxiety: “If you have an anxiety disorder, you are more than twice as likely as someone without an anxiety disorder to develop an alcohol dependency.” —SL
- “Try counseling sessions with a specific focus on stress and alcohol misuse, healthy strategies, and stress-management tools.” —NC
- “To develop more consistent habits, monitor your alcohol use by keeping a diary. Set a goal for alcohol use, including places, frequency and amount, and how friends can help.” —NC
- “I know this sounds corny, but get plenty of sleep! The cycle of being tired all the time will increase stress, blood pressure, diabetes risk, depression, and a whole host of other problems that an individual might try to self-medicate with alcohol.” —SL
- Guide to managing your stress
Drinking while diabetic
“I use insulin and check my blood sugars three or four times a day. My friends know I’m diabetic, so they always watch out for me. I drink anything, really, but I try to drink low-carb beer and mixed drinks with diet pop.”
Why is drinking while diabetic a risk factor?
- Most people with diabetes can safely consume alcohol in moderate amounts, according to the American Diabetes Association (ADA).
- It is very important to monitor your blood sugar and be alert for symptoms of hypoglycemia, which can be similar to those of intoxication.
- The ADA recommends a limit of one drink a day for women, two for men.
- “Alcohol increases triglyceride levels [a risk factor for diabetes and complications of diabetes] and can interfere with the positive effects of oral insulin products.” —SL
- Consult a doctor about managing your own situation.
“I usually drink twice a week. Since alcohol brings down blood sugars, I will occasionally have a drink made with real sugar. I always carry sugar pills. My friends can tell if I look shaky and sweaty, and they come and ask if I’m OK.”
“Christophe is aware of his health condition: He monitors it regularly, and he’s willing to adjust his behavior, but he is not managing the risk factor very effectively. Alcohol lowers blood sugars, but it’s more complicated than that. Over time, alcohol can reduce the effectiveness of insulin and raise glucose levels. He should consult his own health care providers about his. Christophe seems to act on good information when he has access to it.” —NC
Red flags for people with diabetes
- Socializing with people who may not know about your health condition.
- Deciding to drink more frequently and consuming increased amounts of alcohol.
- “Signs of hypoglycemia include: blurred vision, rapid heartbeat, pale skin color, sweating, shaking, and skin tingling. Other signs that will be apparent include: sudden mood changes, nervousness, fatigue, extreme hunger, and eventually a quick loss of consciousness.” —SL
- Drinks may have more hidden calories than Christophe realizes, and then he could be thrown into a dietary imbalance, increasing the risk of complications.”—SL
- Talk to your doctor about safer alcohol use while managing diabetes.
- “Adhere to a rule about what types of drinks can be consumed safely, and then follow a strict limit.” —SL
- “Only individuals who have their diabetes and blood sugar well under control should consider social drinking. The calories provided by a single drink should be counted as two fat exchanges. Alcohol also stimulates appetite in many people; that can cause overeating and is a problem for people with diabetes.” —SL
Strategies for managing your alcohol consumption
Practice saying “no” to a drink
- Role-play with a friend or counselor.
- Ask and remind friends to support your decisions about drinking limits.
Alternate and/or dilute your drinks
- Ask for “lighter” alcoholic drinks with less alcohol, or in a larger glass with added seltzer or soda.
- “Ask for a ‘virgin’ pina colada or ‘virgin’ daiquiri. These drinks look exactly alike, which may take some of the pressure off.” —SL
- Alternate alcoholic drinks with water, seltzer, or soda.
Shake up your habits
- Switch to a different beverage—one that isn’t your favorite.
- “Avoid ‘chugging’ or drinking games. Drinking games are designed to have you fail, and they promote more drinking.” —SL
Know your cues
- Cues or triggers are specific to individuals. Know what yours are. One person might crave beer and have no reaction to whiskey or vodka.
- “If you used to go to a specific bar to drink, then go to a different establishment for dinner.” —SL
More strategies here:
- “Increasing the duration that it takes to finish a drink—‘savoring’ the drink—spreads out the absorption over a longer period so that blood alcohol levels do not get dangerously high.” —SL
- Impose limits, e.g., “I know I can handle one drink an hour after food, and I max out at two drinks a night.”
Try strategic counseling
- Brief counseling sessions can help you decrease the frequency and amount of your alcohol use, and address specific risk factors.
- Consider a support group, such as Adult Children of Alcoholics, Al-Anon, or Alateen.
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