The Drawbacks of Using Alcohol to Cope

Spotlight: John Kelly, PhD,

Massachusetts General Hospital, Director - Recovery Research Institute, Associate Director - Center for Addiction Medicine & Program Director - Addiction Recovery Management Service

The EAP turned to MGH addiction expert, John Kelly to better understand why alcohol is not a good, long-term coping mechanism and how to identify and incorporate healthier alternatives. Dr. Kelly explains that with increased use, your body becomes accustomed to the alcohol, representing a greater tolerance and a risk of addiction and toxicity related health concerns. You must drink more to get the same effect over time. This in turn leads to cascading effects in the brain and body, including serious health impacts.

The main barometer to keep in mind is the frequency of use and amount of consumption of alcohol. This is relevant to all aspects of the discussion below and how you should evaluate your use of alcohol as a coping mechanism.

Alcohol, Stress and Mental Health: A Two-way Street

Does alcohol cause stress and mental health issues or do these issues lead to unhealthy drinking? Both can be true. They feed off each other. Either way, together they represent an unhealthy combination for coping.

• Alcohol misuse can result in individuals (especially adolescents) being more at risk for epigenetic effects. This means that certain genes are catalyzed (turned on) by alcohol and can lead to a predisposition for depression and anxiety or alcohol use disorder itself
• Drinking can produce or worsen existing symptoms related to mood and anxiety disorders

Depression and Anxiety

Alcohol is a depressant. Although it may initially act as a stimulant and provide a sense of euphoria, this effect is temporary. Eventually, “what goes up, must come down.”

• Regular drinking can perpetuate and intensify symptoms of depression
• There is also a strong link between alcohol misuse and suicide

Dr. Kelly describes an anxiety-alcohol cycle for some people who drink to manage anxiety:

• Anxiety
• Alcohol use
• Relief
• Anxiety from alcohol withdrawal
• Alcohol use and possibly, a need to increase amounts to get the same level of relief

It is very common for people with social anxiety to turn to alcohol to cope in certain situations. Used occasionally, alcohol can enhance social interaction, increase disinhibition, and produce euphoria. This is not a long-term, sustainable solution, however.

• You may need to drink more to get the desired effect over time
• Alcohol may have a negative impact on interactions if it contributes to social and behavioral functioning
• You may not have access to alcohol in all social circumstances

Trauma

For some, trauma, and its side effects (anxiety, for example) can lead to alcohol misuse and alcohol addiction. Once again, alcohol can provide short-term relief but cannot help you to adequately address trauma. Dr. Kelly points out that drinking heavily also can lead to an increased likelihood that you will suffer traumatic events, such as accidents, fights, injuries, and relationship issues.

Alcohol and Psychiatric Medications

Dr. Kelly cautions against mixing alcohol and medications. Alcohol interacts with medications in an unpredictable manner, so it’s generally not recommended.

• Using anti-anxiety medications with alcohol (combining sedatives) results in an amplified effect. This is particularly dangerous with Benzodiazepines . When combined with Benzodiazepines, just 2-3 drinks may cause a black-out (e.g. a complete absence of memory regarding the time you during which you were under the influence of both drugs)
• Alcohol is a variable that could impact the effectiveness of your anti-depressant or other medications. If you are using alcohol and notice that your anti-depressants are not working, consider quitting for 30 days. A “sobriety sampling” (not using for a set period of time) can help determine if alcohol is a factor in whether your anti-depressant is helping, or whether alcohol is contributing to your mood and/or your anxiety problems

    Negative Effects of Alcohol on Healthy Coping Mechanisms

What if you are using alcohol as well as more sustainable stress release practices (improving sleep, diet, exercise)? It’s always a good idea to gauge what might work for you. It’s possible that alcohol might minimize the potential benefits associated with healthy lifestyle practices.

Sleep

Sleep is a vital component to physical and mental health. Poor sleep habits can trigger stress, depression, anxiety, health issues (diabetes) and impact our ability to cope.  John stresses that using alcohol to aid in sleep is detrimental to achieving healthy sleep.

• Alcohol may help you to fall asleep, but it interferes with REM – dream and deep sleep, which is important for brain and body restoration
• Alcohol’s novel sleep-inducing effects wear off over time, and sleep problems become worse
• The liver becomes sensitized to alcohol, creating a need to drink more to sleep

Exercise

As mentioned above, use of alcohol can relieve stress and release endorphins, which trigger pleasure and help you to cope temporarily. Exercise provides a more natural mechanism for producing endorphins, but too much drinking may limit the benefits of exercising.

• Many people mistakenly believe that exercise can compensate for drinking
• According to a study by the American College of Sports Medicine, people with higher fitness levels actually consumed more alcohol than those who exercised less
• Bouncing back with a “work hard – play hard” philosophy starts to become less attainable with age. There is no “health halo” in which exercise negates the impact of drinking

Healthy Eating

Small amounts of alcohol will not jeopardize a healthy eating or weight maintenance regimen, but keep in mind that alcohol represents “empty” calories with no nutritional benefits. This alcohol calculator can help you keep track of alcohol-related calories.

    New Research Challenges the Health Benefits of Moderate Drinking

If you drink in moderation to address stress, you may want to consider some other ways of coping. Historically, conventional wisdom was that modest levels of drinking were safe, or even protective of certain conditions, such as cardiac disease. Newer research indicates that even moderate drinking carries significant health risks and does not increase heart health.

• The Lancet reported that drinking more than 100 grams of alcohol (7 glasses of wine or beer) a week, was associated with an increased risk of death from all causes
• Specifically, Dr. Kelly highlights the toxic impact of alcohol – just 20 grams of alcohol a day (about 1.3 standard drinks) increases:
  – The risk of breast cancer in women by 20%
  – Esophageal cancer in men and women by 86%
• A previous EAP News Feature discussed particular health risks in women who drink
• A study with MGH participation, concluded that even a short-term increase in alcohol consumption during the COVID-19 pandemic may substantially increase long-term alcohol-associated liver disease (ALD) morbidity and mortality

    How to Know if using Alcohol to Cope is a Problem

Dr. Kelly suggests looking out for these warning signs:

• Your frequency and amount are beyond recommended standards or are increasing
• You need to drink more over time to get desired results
• Alcohol itself  becomes more of a priority in your life
• You are preoccupied with drinking and when you can drink again
• Drinking starts to cost you more than money – impacting different areas of your life (e.g. relationships, work, health)
• Your physical health is suffering
• Others report concern about your drinking

    Swapping out Alcohol with other More Successful Coping Methods

• Try to understand your alcohol use habits
  – Why specifically are you using alcohol, under what circumstances and when?
  – Pinpoint the areas where you need to make changes
• Try a tool for measuring and evaluating your drinking. Maybe you don’t have a diagnosable “alcohol problem”, but you might be trending towards a gray area, between healthy and unhealthy alcohol use. It’s much easier to change alcohol habits sooner rather than later.
  – NIAAA – Rethinking Drinking – Assess and Change Risky Drinking Habits
  – Less – Alcohol Tracker
  – Drink Control
  – Sober Tool
  – NOMO – Sobriety Clocks
  – CAMH – Saying When
• Consider replacing alcohol with evidenced-based treatments for mental health conditions
  – Develop a healthier, more adaptive skill set, via modalities such as Cognitive Behavioral Therapy (CBT)
  – Use medications that are specifically targeted to treat your mood/anxiety issue and are prescribed by a medical professional
• Learn to have fun without drinking
• Consider incorporating coping practices that are sustainable, with predictably positive outcomes
  – Lifestyle
  – Balanced Diet
  – Mindfulness
  – Building Resilience
  – Social Connection
  – Spirituality
  – Gratitude

Resources

• Mass General Brigham EAP – Information on Alcohol
• MGH Recovery Research Institute
• Self-help Supports
• Resources for Substance Misuse in Healthcare Workers
• Help for those Coping with Substance-misuse in a Loved one

About the MGH Recovery Research Institute

The Recovery Research Institute is a leading nonprofit research institute of Massachusetts General Hospital, an affiliate of Harvard Medical School, dedicated to the advancement of addiction treatment and recovery.