Alcohol Awareness Week

We live in a society that normalises alcohol use and even glorifies it. It is one of the few substances viewed as not illicit and, in fact, people often find fault or shame individuals who may choose not to drink. However, alcohol is classified as a toxic, psychoactive and dependence-producing substance that is a Group 1 carcinogen.

Research suggests alcohol as being highly associated with physiological health risks such as bowel cancer, liver cirrhosis, cardiovascular and gastrointestinal diseases. Some of the mental health risks associated with alcohol use are depression, anxiety, psychosis, suicidality and self-harm, and sleep disorders. The WHO (2023) recently declared that contrary to popular belief, no amount of alcohol consumption, regardless of its quality or price, is safe for our health.

Something not many are aware of is that alcohol withdrawal can be fatal. Some of the withdrawal symptoms include anxiety, tremors, delirium and seizures, to name a few, and so caution must be exercised if one decides to abruptly stop drinking especially in the case of a severe alcohol use disorder or addiction. Alcohol awareness week gives us an opportunity to spread awareness and knowledge to understand the exact nature of what we are putting in our bodies so that we can make informed choices.

One of the most common questions asked when someone speaks to an addiction specialist is, “How do you know when drinking crosses the line into problematic drinking?”

The simplest way I know to answer this is by explaining two concepts (which are covered by Alcoholics Anonymous) : Powerlessness and Unmanageability.

Powerlessness is when we look at the evidence around us and try to pick out when our drinking has been out of control and how it has started to impact our life. Examples of out-of-control drinking can be going often on benders or binge-drinking and waking up the next day feeling terrible with hangovers and feelings of guilt and shame, or it could be that it is difficult to sit with feelings like loneliness, boredom or/and anxiety and feeling the need to have a few glasses of wine to drink almost every day to deal with it all.

Unmanageability may show up in our relationships when they start to get impacted. We are less productive at work, our hobbies and interests fall away, financial issues may arise, or we start getting in trouble with the law.

Sometimes, admitting can take time and be difficult due to denial about just how powerless or unmanageable our life has become. It is important to remember that denial is a defence mechanism which gives us protection from pain and shame. If we are looking for a more formal taxonomy for problematic drinking, the DSM-5 recognises it as Alcohol Use Disorder (AUD) which can have mild, moderate and severe sub-classifications. 

Diagnostic Criteria

To diagnose AUD, the DSM-5 requires that an individual meet at least 2 of the following 11 criteria within a twelve-month period:

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. There is a craving or a strong desire or urge to use alcohol.
  5. Recurrent alcohol use results in a failure to fulfil major role obligations at work, school or home.
  6. There is continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  7. Important social, occupational or recreational activities are given up or reduced because of alcohol use.
  8. There is recurrent alcohol use in situations which are physically hazardous.
  9.  When alcohol use is continued despite knowledge of having persistent or recurrent physical or psychological problems that are likely to have been caused or exacerbated by alcohol.
  10. Tolerance, as defined by either of the following:
    • A need for markedly increased amounts of alcohol to achieve intoxication or desired effect
    • A markedly diminished effect with continued use of the same amount of alcohol
  11. Withdrawal, as manifested by either of the following:
    • The characteristic withdrawal syndromes for alcohol
    • When alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms

Severity Specifiers

The severity of AUD is categorized based on the number of criteria met:

  • Mild: Presence of 2-3 symptoms
  • Moderate: Presence of 4-5 symptoms

Potential Recommendations

Control drinking which involves risk management, better boundaries, trigger management/avoidance and tracking consumption may be one way to go. However, abstinence still appears to be the most effective way to understand your drinking patterns and live a more fulfilled life. Something that has been found to be quite useful is referring to the Preparation Stage from the Transtheoretical Model of Change to come up with a Goal and a Plan related to abstinence.

‘Dry January’ or ‘Sober October’ popularise 1-month sober stents. However, 3 months (which may feel more challenging) may be a more beneficial goal to consider. Some of the physiological benefits experienced include improved liver function, sleep, immune system, metabolism, skin health, gut health and digestion. Some of the mental health benefits observed are reduced anxiety, stress and depression levels, better relationships, better cognitive functions (higher productivity and clearer thinking), emotional regulation and coping mechanisms, and increased self-esteem and confidence.

Additionally, doing just a month can mean that even though we have taken alcohol out of our lives, we may replace the dopamine released with other things such as sugar, caffeine, porn, work, over-exercise (may lead to injury) or online shopping. You may use these dysfunctional coping-strategies to avoid addressing core issues. So, the 3-month abstinence period gives the brain more time to stabilise and an opportunity to notice how you may be substituting or replacing one addictive substance for another substance or behaviour.

To summarize, in deciding to control your drinking, a month or 3 months of abstinence from alcohol may be some goals worth considering.

The next step would be to put a plan on how to achieve your goal and this requires a truthful introspection and reflection of the things which may help. A focus on good health involving routine exercise, a healthy diet and regular sleep are basic pillars to start this process with. Additionally, structure and routine, accountability to a friend, partner or parent, and the connection to self and others can also be very helpful. Getting back to hobbies such as reading, cooking and sports and using this opportunity to get one’s life in order may be other beneficial strategies. Connection with others (friends and family)  and connection with yourself can also be extremely important to keep these changes going. 

Some useful tools that can be added to your routine and help you connect to yourself are:

Journaling

Tapping

The Future of Mental Wellness Has Arrived

Mindfulness and meditation

Connecting with others can sometimes come with anxiety around being left out. This is very normal and just a reflection of how big a part of our lives drinking has become. It might be worthwhile to try to connect with people over a walk or exercise or a coffee to be able to experience sober and fulfilling conversations. Additionally, it can often be difficult to manage environmental triggers like work-related dinners or social drinking events. Some ways of managing these are by telling people beforehand about what you are doing, having a non-alcoholic drink already planned, for example, sparkling water or tea, having a script ready in your head for people who insist that you drink, working on boundaries and saying “no.”

If you do have difficulty stopping for 3 months, it may indicate the “powerlessness” mentioned above and the need for a different plan to achieve your goal. It might be helpful to seek support and speak to a mental health therapist specialising in addiction to get a better picture of what might be occurring and come up with a tailored goal and plan.

Top Resources/Books

Written by Vedanta Attri, The Cabin

To meet with a professional psychologist or counsellor, call The Other Clinic at 8809 0659 or email us hello@theotherclinic.sg.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Manthey, J., Rehm, J., & Shield, K. (2022, November 19). Alcohol and health. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02123-7/fulltext 

Varghese, J., & Dakhode, S. (2022, October 8). Effects of Alcohol Consumption on Various Systems of the Human Body: A Systematic Review. Cureus. https://doi.org/10.7759/cureus.30057

WHO (2023, January 4). No level of alcohol consumption is safe for our health. https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health

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