Search for tag: "alcoholism"

Interviewer: What is the fine line between a few drinks to relax or blow off steam and a potential alcohol abuse problem?

Dr. Troy Madsen is an emergency room doctor at University of Utah Health. Dr. Madsen, I hear that doctors have a series of questions that they ask patients, and it's pretty accurate at indicating if somebody has a potential alcohol use problem.

Troy: We do have a screening tool we use. We all learn this in medical school, and it is something that we will then use in our practice, is a quick screen to say, "Does this individual potentially have an alcohol use disorder that we should look into further and ask some more questions and see, 'Well, how much are you drinking? Do you need some help?'"

This is a tool that's called the CAGE questionnaire. So the first C, the C stands for cut down. Have you ever felt you need to cut down on your drinking? The A is annoyed. Have people annoyed you by criticizing your drinking? So, for each of these, you get a point if you answer yes. G is for guilty, G of CAGE. Have you ever felt guilty about drinking? And E is for an eye-opener. Have you ever felt you need a drink first thing in the morning or an eye-opener to steady your nerves or get rid of a hangover?

Now, if you answer yes to two of those questions, so if you have a score of 2 or higher, it has a 93% sensitivity for identifying excessive drinking and a 91% sensitivity for identifying alcoholism. That means it's a pretty good tool for potentially identifying individuals who may be needing some help, again, just answering yes to two of the four CAGE questions.

Interviewer: When you say over 90% accuracy that that person may have a drinking problem, this is research supported?

Troy: It is. Multiple studies. This CAGE questionnaire has been around for many, many years, decades. They've got studies going back into the '80s on this. So it's something that's been studied over many, many years, many, many people.

If you're answering yes to two or more of these . . . let's say you've had people tell you, "You really should cut down," and let's say people are critical of you, you get annoyed by it, if you've got two of those four, that's potentially a sign that maybe you need some help. Maybe you do have an alcohol use disorder.

Interviewer: What if you just have one? Is that supported by the research? Does that necessarily mean anything?

Troy: So that's considered a negative screen. So, if you just had one . . . let's say you felt guilty about your drinking, so you got the one point there, but you didn't answer yes to any of those others. It's like, "Well, no one has ever told me I should cut down. I've never really felt annoyed. I don't really need an eye-opener in the morning to take care of a hangover," so if you just get the one, technically, that doesn't get you a point.

Obviously, there are a whole lot of other variables that play into this, like who you are hanging out with. If you're hanging out with people who are drinking a lot, they're probably not criticizing your drinking and you're probably not getting annoyed by it. So it's one of those tools where it's not a perfect tool.

The advantage of this tool is just something quick that we can do as healthcare providers. It's a quick screen. Just talking through those questions took us maybe 30 seconds. And if you're getting a score of 2 or higher, it doesn't mean you have an alcohol use disorder. It just means, "Let's do some additional screening to see if that's potentially an issue."

Interviewer: It's pretty amazing how accurate the CAGE questionnaire is, but is that where doctors stop, or are there some additional questions that a doctor might ask, or is there an additional resource that a patient could go to on their own to find out a little bit more information?

Troy: There's something called the AUDIT questionnaire, and if you search for that, you can find it online, but that goes through in more detail about getting into exactly how many drinks you have per week, how many you have at once, and getting into the whole binge drinking thing.

And some of those CAGE questions, it kind of goes through some of those again as part of it, but it's a 10-question questionnaire and that really then breaks things down by a score to say "Are you a medium risk? Are you a high risk? Are you at a point where addiction is likely?"

So it's an additional questionnaire. We don't need to go through all the questions on it, but I think that can be helpful as the next step to potentially see, "Is there an issue that I should get some help for, or where are things right now?"

Interviewer: And if somebody has taken the test and they're thinking, "Wow, maybe I should look at getting some help or I would like to get some help," what would the next step be? Because that seems like it could be intimidating.

Troy: If you're looking for inpatient treatment where you need inpatient detoxification and you need medically-assisted treatment to be able to just reduce your drinking or cut off from drinking, it's something you can talk to your doctor about. I think, regardless, I'd talk to your doctor, but they can help set those things up for you. There are many community resources available for that as well.

In some people, it's just the sort of thing where they just reach a point and they just say, "I need help, and I need it now, and I need to make this happen, and I don't have time to wait on that." We see those individuals in the ER on a regular basis. You can come in. We can talk to you about options. In some cases, we admit people to the hospital for this if they are in withdrawal and they have severe symptoms. I'd say I admit people for this . . . it's a weekly thing for me where I'm admitting patients for this.

So, with any substance use disorder, I think the important thing is just reaching out for the help. And I think that's the hardest part, taking that initial step, but if you can reach out to family and say, "Hey, I've got an issue. I need help," I think that's . . . it's a huge thing just to be able to do that. Then you take it from there and you'll get the help you need as long as you just keep pushing forward.

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Scot: I'm sorry, give me a second here. I've got all these reminders coming up telling me I need to eat a salad.

Mitch: A salad.

Scot: What?

Mitch: Note to self: Eat salad.

Scot: Yeah.

Mitch: Okay. All right.

Scot: Because if I don't remind myself to eat, I don't. So I go, "Hey, Siri, set a reminder at 4:00 to eat a salad." And then at 4:00, I get a reminder that says, "Eat a salad," and I have to dismiss it so I can see all of my screen. If I want to set a reminder to eat a salad, there's nothing wrong with that.

Troy: It's a little odd, but that's all right. It's all right, Scot.

Scot: Providing information, inspiration, and motivation to better understand and engage in your health so you feel better today and in the future. The podcast is called "Who Cares About Men's Health." My name is Scot Singpiel. My role here is I own the microphones. I'm also the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Scot: So today, we're going to talk about something that can contribute to negative health outcomes. Now, on the podcast, we talk about the core four plus one more. Try to make it simple because sometimes I think people make health more complicated than it needs to be.

The core four is to be healthy now and in the future you worry about your nutrition, you worry about getting some activity, your sleep, your mental and emotional health, and plus one more is genetics because you can't outrun those genes. Sometimes you're just genetically predispositioned to head down a particular health path, although there are lifestyle things you can do to counter that. That's important to say.

And one of the other things we talk about too is we talk about addictive behaviors. And one I would imagine that many men at one point in their lives, whether they're younger or right now, have struggled with is maybe perhaps drinking too much.

There are some situations where somebody realizes they might be drinking too much and they want to do something about it. Then there are some situations where you're like, "Oh, no, I'm fine. I need to blow off some steam. I like to unwind." And maybe you don't realize there's a problem yet.

So we're hoping just to talk in a very non-threatening way about this because that really kind of changed my perception on how much is too much for alcohol.

Dr. Madsen, you're telling me about a screen that you do in the emergency room. And when we talk about alcoholism, we're not talking about the obvious . . . back in my day, we used to call them winos or the obvious person [slurs speech], like that all the time, the obvious.

Was that totally politically incorrect? I'm sorry, if it was.

Troy: It was, but . . .

Scot: We're talking about people that have three, four drinks a night. They otherwise live what would appear to be just a regular existence, but maybe that's a little too much alcohol. So tell me more about CAGE and what that indicates because that was eye opening for me.

Troy: It is. Yeah, it's sometimes surprising. It's one of those things too . . . I think, like you said, as I went into medicine and medical school, sure, you say, "Well, yeah, clearly this guy is an alcoholic. You can see it." But then you are sometimes surprised as you go through some of these questionnaires and some of these things that look at alcohol use disorder at people who are very, very high functioning who may have an alcohol use disorder. And in many of those cases, we see these individuals in the ER coming to get help, or maybe you're doing a screening tool and something comes up on that.

But we do have a screening tool we use. We all learn this in medical school. And it is something that we will then use in our practice, is a quick screen to say, "Does this individual potentially have an alcohol use disorder that we should look into further and ask some more questions and see, 'Well, how much are you drinking? Do you need some help?'"

This is a tool. It's called the CAGE questionnaire. And each letter in this, it's an acronym, stands for the question in the questionnaire. So the first C, the C stands for cut down. Have you ever felt you need to cut down on your drinking? The A is annoyed. Have people annoyed you by criticizing your drinking? So for each of these, you get a point if you answer yes. G is for guilty, G of CAGE. Have you ever felt guilty about drinking? And E is for eye opener. Have you ever felt you need a drink first thing in the morning, or an eye opener, to steady your nerves or get rid of a hangover?

Now, if you answer yes to two of those questions, so if you have a score of two or higher, it has a 93% sensitivity for identifying excessive drinking and a 91% sensitivity for identifying alcoholism.

Scot: Wow.

Troy: It's a pretty good tool for potentially identifying individuals who may be needing some help, again, just answering yes to two of the four CAGE questions.

Scot: That is fascinating. And this is research-supported? When you say over 90% accuracy that that person may have a drinking problem, this is research-supported?

Troy: It is, multiple studies. This CAGE questionnaire has been around for many, many years, decades. And so it's something where it's been studied. Then they've looked at individuals who are testing positive on this. They've got studies going back into the '80s on this. So it's something that has been studied over many, many years and many, many people.

If you're answering yes to two or more of these . . . let's say you've had people tell you, "You really should cut down," and let's say people are critical of you, you get annoyed by it, if you've got two of those four, that's potentially a sign that maybe you need to look into . . . maybe you need some help. Maybe you do have an alcohol use disorder.

Scot: What if you just have one? Is that supported by the research? Does that necessarily mean anything?

Troy: So that's considered a negative screen. If you just had one, let's say you felt guilty about your drinking, so you got the one point there, but you didn't answer yes to any of those others, like, "Well, no one has ever told me I should cut down. I've never really felt annoyed. I don't really need an eye opener in the morning to take care of a hangover," if you just get the one, technically, that doesn't get you a point.

Obviously, there are a whole lot of other variables that play into this, like who you are hanging out with. If you're hanging out with people who are drinking a lot, they're probably not criticizing your drinking and you're probably not getting annoyed by it.

Scot: There's two of the four right there.

Troy: Yeah. So it's like, "Yeah, you're covered there." It's one of those tools where it's not a perfect tool.

The advantage of this tool is just something quick that we can do as healthcare providers. It's a quick screen. Just talking through those questions took us maybe 30 seconds. And if you're getting a score of two or higher, it doesn't mean you have an alcohol use disorder. It just means "Let's do some additional screening to see if that's potentially an issue."

Scot: And just very briefly, because I'm curious, why do you do this? If somebody comes into the ER, why are you concerned if they might have an alcohol use disorder?

Troy: That's a great question. I'm concerned, number one, because if the patient is under my care, and they do have an alcohol use disorder, and they're not drinking alcohol, and let's say they're there for a prolonged period of time or they're admitted to the hospital, they can go into alcohol withdrawal. And if they have alcohol dependence, physical dependence on alcohol, they can have life-threatening symptoms.

I mean, alcohol withdrawal, it's not something you want to mess around with. People die from that. So I want to know, number one, is there potentially an issue there? And number two, if there is, let's make sure we treat it. Let's make sure they get the medication they need to prevent that.

Alcohol is an interesting thing. Every year, about a week after New Year's, I'll see someone come in the ER, maybe just a few days after New Year's, who their New Year's resolution was to stop drinking. They stopped cold turkey, and I see them a few days later with severe alcohol withdrawal, sometimes to the point where it's life-threatening.

So you can really see the dramatic effects of people who may have an alcohol use disorder, the impact it has on their body, and that's why I want to know, "Do they have an issue?" so I can make sure I treat that and prevent it.

Scot: If somebody has an alcohol use disorder, now that's going to be that obvious alcoholic, right? Like, it's going to be very obvious. Or is it not necessarily as many drinks as I might think that it would take to form an alcohol use disorder?

Troy: Yeah, it's really not. Over my career, I'm kind of at a point where you don't get surprised by a lot. But I think early on I was sometimes surprised by some individuals who would come in the ER looking for help and wanting to get help, and recognizing they had an alcohol use disorder. These are CEOs of companies. These are even local celebrities or very high-profile individuals who are very high functioning. I mean, they're very successful in their career. They do very well, but they do have an alcohol use disorder.

And it's not the stereotypical image, like you said, of someone who's out and publicly intoxicated and tripping over themselves. It's not that image. It's something where it affects people in all walks of life, and people who are extremely successful, to maybe that stereotypical image of someone who does clearly have an issue. So, yeah, it's not always obvious.

Scot: So the CAGE is just a quick screen that you use to determine if somebody might have alcohol use disorder. If you're answering yes to two or more of those questions, it might be worth a little bit more investigation into your life or just an honest look.

I believe at some point in my life, in my younger years, I was running around with some people who drank a lot and I probably, by definition, was an alcoholic. I think if somebody would have called me on it, I probably would have dismissed it or would have gotten annoyed by it. This group always used to say, "You know what? We blow off steam, we party hard, but we go slay the dragons the next day. We get up and go do our jobs and we function, so that's not a problem." But actually, in retrospect of what I've learned, that could possibly be a problem.

Troy: And that's a challenge, like you said there, because I think that's what a lot of us will think is that, "Hey, it's not affecting my life. I get my job done. I get my work done. Work hard, play hard," whatever the mantra may be. Again, the people I've seen that have surprised me are very, very successful, but clearly they have an alcohol use disorder.

Scot: All right. And to look at it a different way, according to the National Institute on Alcohol Abuse and Alcoholism . . . Now Dr. Madsen, Troy, talked about some attitudinal things that he asks questions, the CAGE test. This is actually, according to them, their drink guidelines. If you're drinking more than this amount, then you are beyond the moderate or low risk range. And for men, they say no more than four drinks in a day, or no more than 14 drinks per week.

So if you're sitting down in any given day, like on a Saturday, and you're drinking more than four drinks, that is considered beyond moderate or low risk. Or if you are having more than 14 drinks per week . . . like, if you sit down and you have a couple of beers every day, according to them that's low or moderate risk. But if you go to three beers every day, then that's not.

Their guidelines are based on the standard drink sizes. Do you know what these are, by the way, Troy?

Troy: I usually have to look it up. But yeah, it's basically 12 ounces of beer, it's 8 to 9 ounces of malt liquor, 5 ounces of wine, or 1.5 ounce of 80 hard proof liquor. So that's what is considered one drink.

Scot: Yep. So if you have a mixed drink and you do a double, if you do three ounces of liquor, you're done for the day to be considered moderate or low risk range. If you're over that and you do that more than a couple of times a week, that four drinks per day, then they're considering that that's beyond moderate or low risk range.

Troy: But to clarify this, Scot, you're saying four drinks per day. But that's once a week if you're having more than four drinks. And then they're saying 2 drinks a day, 14 total in a week.

Scot: Yeah. So they're saying no more than 14 drinks per week, but they're saying in any given day, you could have 4.

Troy: Sure. So you could come home and you could have 3 evenings a week where you have 4 drinks, for a total of 12, and there you're not over the 14. So I guess it's kind of how they're defining it.

But even there it's interesting. I think you said maybe it sounds like a lot, 14 drinks in a week, but if a person is coming home, and let's say in the evening their usual routine is to sit down and have a couple of beers or whatever, right there, if they're having 2 beers a day, they're right at that 14 mark. And then if you have one evening a week, you go out and you have 4 drinks, right there you're over the 14.

So you can see how it doesn't . . . it sounds like a lot, but when you think day to day, if that's part of your routine, you can get over that 14 number fairly easily.

Scot: There are two considerations when it comes to alcohol use. One is the physical impacts it has on your body. Troy talked about alcohol withdrawals, which could be potentially deadly. What are some other physical problems that drinking can bring about that you've seen?

Troy: Well, there are certainly the immediate impacts, just intoxication. It increases your risk of accidents and injuries. Just affects your judgment. That's definitely a component of a lot of injuries we see in the ER. It seems like that magnifies your risk. If you're on a motor vehicle, if you're on an ATV, you're around fires, anything like that, you're increasing your risk of being injured in those sorts of things.

Then there are just the obvious physical effects. And sometimes these aren't immediate, but just the cumulative effects of individuals who it affects their liver. And then with the liver effects, you can have liver failure, which is a devastating thing. That's just awful to have. It's not something that is easily treated and sometimes requires a transplant. And even there, it requires being able to get a transplant. Unfortunately, people do die on the transplant list while awaiting that after they've had an alcohol use disorder and have had effects from that.

That can also lead to gastrointestinal bleeding, so bleeding in the stomach. We have people who have liver disease that then that makes them more likely to have bleeding. They can have severe bleeding, life-threatening bleeding. So it definitely has impacts there.

It also increases your risk of cancer. We've had studies come out showing that moderate drinking can improve or reduce your risk of heart disease. But then I think further studies that have come out in the last 10 years have shown that potentially the impact of alcohol use on cancer, and here we're even talking moderate alcohol use or potentially even just a drink a day, potentially the increased risk of cancer may outweigh the reduced risk of heart disease.

The instructions that have been given through the internal medicine physicians and family physicians is that if someone is drinking in moderation, not a big deal, but it's not something where you would ever counsel a patient to start drinking in order to reduce their risk of heart disease, just because that risk of cancer is there and that may outweigh it, especially for people who are more prone to cancer with their genetics.

So, yeah, you've got the immediate effects. You've got the long-term effects. It certainly can have its impacts, and again, something we see, I think, full range of that in the ER from the people with the injuries to the bleeding and cancer and all those sorts of things.

Scot: It impacts your sleep too. People don't sleep as well. A lot of times, people do drink to sleep. But I've talked to physicians that say that the research actually shows that you might think you're sleeping, but you're actually sleeping lighter or you have disturbed sleep. And, of course, that's one of our core four, so you're not getting as good a night's sleep.

And there are just kind of a lot of impacts. For me personally, when I was probably drinking more than I should, I started having digestive issues. I just was always miserable in my stomach. It wasn't as soon as I stopped, but within probably three, four months after really cutting back, that all improved for me.

So if you're experiencing some of those things and maybe you might be drinking a little more than you should, to me, that was almost worth it to give up a couple of beers to feel a little better. I hate stomach issues.

Troy: Yeah, the acid reflux. That's a common issue.

Scot: So a little bit later in the season, we're going to have somebody on the show who has had a journey with alcoholism, has gone through some of these steps. And we hope that having that individual on the show will perhaps help some other people through their story perhaps recognize a situation in their life that maybe you have time to turn around. You can turn this sort of thing around.

Is there anything else you want to add to this episode, Troy?

Troy: One thing it may be worth mentioning, too, Scot, we talked about the CAGE questionnaire. That's obviously such a quick test we can do. Let's say we talked about the CAGE questionnaire and you thought about, "Maybe two of those four I could answer yes to." Then you may ask, "Well, that's a pretty quick test. Is there anything more detailed I could go through, like a questionnaire, to see is there an issue?"

There's something called the Audit questionnaire, and you just search for that and you can find it online. But that goes through in more detail about getting into exactly how many drinks you have per week, like you mentioned, Scot, how many you have at once, getting into the whole binge drinking thing.

And some of those CAGE questions, it kind of goes through some of those again as part of it, but it's a 10-question questionnaire. And that really then breaks things down by a score to say, "Are you a medium risk? Are you a high risk? Are you at a point where addiction is likely?"

So it's an additional questionnaire. We don't need to go through all the questions on it, but I think that can be helpful as the next step to potentially see, "Is there an issue that I should get some help for, or where are things right now?"

Scot: And then if somebody decides that it is an issue, you've mentioned you've had people come to you in the ER. Is there perhaps a better place to go if it's not an emergent condition that you need to get rid of your dependency on alcohol?

Troy: Yeah, for sure. I think there are certainly lots of community resources. Alcoholics Anonymous being certainly something everyone has heard about if you are at a point where you say, "Hey, I've got an issue. I need to get help." That's a wonderful resource and I think something that's been proven over many years to be effective in terms of helping people.

If you're looking for inpatient treatment where you need inpatient detoxification and you need medically-assisted treatment to be able to just reduce your drinking or cut off from drinking, that's something you can talk to your doctor about. I think, regardless, I'd talk to your doctor. They can help set those things up for you. There are many community resources available for that as well.

In some people, it's just the sort of thing where they just reach a point and they just say, "I need help, and I need it now. I need to make this happen, and I don't have time to wait on that." We see those individuals in the ER on a regular basis. You can come in. We can talk to you about options. In some cases, we admit people to the hospital for this, if they are in withdrawal and they have severe symptoms. I'd say I admit people for this. It's a weekly thing for me where I'm admitting patients for this.

So wherever you are, like I said, there are community resources, all the way to going to the ER, coming in, seeing us, trying to get the help you need.

With any substance use disorder, I think the important thing is just reaching out for the help. And I think that's the hardest part, is taking that initial step. But if you can reach out to family and say, "Hey, I've got an issue. I need help," I think it's a huge thing just to be able to do that. And then you take it from there and you'll get the help you need as long as you just keep pushing forward.

Scot: All right. It's time for a brand new segment on the show on "Who Cares About Men's Health." We've got our nutrition expert, Thunder Jalili, in the studio to answer some nutrition myths. He's going to tell us whether our nutrition myths are truth or if they are going to get Thunder Debunked. What do you think?

Thunder: I like that, Thunder Debunked.

Troy: Can we call it Thunderstruck?

Thunder: Whoa.

Scot: Well, Thunderstruck . . .

Troy: Thunder will strike them down, strike down the myths. I like that.

Thunder: AC/DC may come after us for copyright infringement. But I'm willing to take the risk.

Scot: That's why I want Thunder debunked. I didn't want that to happen. I don't need an AC/DC lawsuit.

Troy: Because I know AC/DC listens to this podcast.

Scot: And I also know Troy wanted to call it Nutrition Myths Jalilied, but I told him that seemed weird.

Troy: I didn't, but I like it.

Scot: Thunder Debunked, Thunderstruck, it sounded so much better. We're going to give you a nutrition . . . something that you might find on the internet, and you're going to tell us whether it's truth, or if it's going to get Thunder Debunked. And I hope most of them get Thunder Debunked because that's fun.

Weight loss. Oftentimes, it's been said if you're trying to lose weight, it's just a simple equation of calories in versus calories out. So if you eat fewer calories than you expend, then you're going to lose weight. Is that truth, or is that myth going to be Thunder Debunked?

Thunder: I think that is going on the road to being Thunder Debunked. In the last few years, there's been a lot of work done in this area called time-restricted feeding. What that's been showing . . . and it started with animal models and it's gone to humans too, but it basically shows if you consume your calories in a short amount of time and have a long fasting period for a 24-hour cycle, you don't really gain weight.

And what's really interesting, especially in some of the animal studies, is it kind of doesn't matter what they feed these animals. They can eat a high-fat diet or things that usually make animals gain weight, and they still control their weight as long as they eat their food in a short period of time. So in the 24-hour cycle, give them 8 hours or 10 hours of eating, and then 14 to 16 hours of not eating.

That's why I think the calories in equals calories out is a little too simplistic now.

Scot: All right. Weight loss is just really calories in, calories out, that has been Thunder Debunked. Troy, will you do me a favor?

Troy: Thunder Debunked.

Scot: Will you do the honors of singing, "You've been Thunder Debunked?"

Troy: I think you already did it.

Scot: All right. Weight loss, is it really just calories in, calories out? That nutrition advice has just been Thunder Debunked.

Troy: Thunder Debunked.

Scot: "Just Going To Leave This Here." It might have something to do with health. It might be something totally random. Troy, why don't you go ahead and start "Just Going To Leave This Here"?

Troy: You're putting me on the spot again, Scot. I have to . . .

Scot: I'll take it. That's fine.

Troy: I'm going to let you . . . Scot, it's time for "Just Going To Leave This Here." How about you start us off today?

Scot: All right. Just Going To Leave This Here. So a couple of episodes ago, I was talking about how I wanted to look into exercising with kettlebells. I also mentioned my frustration that, because of COVID-19, home health equipment whether it's new or used, is becoming very scarce, kettlebells being one of those things. I contacted numerous people in the want ads, went to numerous exercise stores, "Nope, don't have them. Don't have them." Finally got my hands on some kettlebells.

Troy: Nice. You finally found them.

Scot: It was like doing a deal, man. It was like doing the seediest deal you've seen on any movie or TV show. I met a guy in a parking lot at a Walgreens in Bountiful. He popped his trunk. We did a quick per-pound price negotiation. By the way, kind of the going rate for kettlebells, $1.50 to $2 a pound. If you're paying more than that, they better be competition-level kettlebells, like really good quality ones . . .

Troy: Good to know.

Scot: . . . or you just really want them badly. I got my kettlebells for $1.10 a pound from the guy in the Walgreens parking lot.

Troy: Oh, he cut you a deal.

Scot: Yeah, cut me a deal. I don't know if he's just giving me that first kettlebell taste hoping I come back a little bit later.

Troy: He probably is like, "He'll get stronger and he'll need more. This will not be enough kettlebell for this man."

Scot: Anyway, I put them in my car, and I drove home, and they've sat in my garage since.

Troy: I was just hoping the next step in this story was that you did go back for more kettlebells.

Scot: No. I've messed around with them a little bit. I've got a routine I want to start. I just haven't quite gotten to it. Things have just been crazy. It's kind of that familiar story, isn't it, Troy? We go into our health things with the best intentions and sometimes we're just not ready for it.

Troy: And look at that effort you put forth. I mean, you met a random stranger in a parking lot.

Scot: Yeah, I did.

Troy: You did that. But at least you have the kettlebells now.

Scot: I do.

Troy: So you're ready to move forward.

Scot: And every once in a while I'll go out to the garage and I'll look at one of them . . .

Troy: You're like, "Man, that looks heavy."

Scot: I'll pick it up and I'll swing it around, try to lift it over my head. I want to have somebody on the show that's done kettlebells before that maybe can give me some pointers or tips. Everywhere I read said 35 pounds is kind of where a guy that's just beginning should start. I don't know how that's possible. But hopefully, we'll have a guest on later. In the meantime, I'm . . .

Troy: Scot, I know a guy. I guarantee he will talk to us about kettlebells.

Scot: All right. Well . . .

Troy: We've got to get that guy on.

Scot: The drug parallels continue with the kettlebell.

Troy: Scot, I'm just going to leave this here. I'm not using kettlebells, but something I am using . . . do you do whiten your teeth? Do you use the whitening strips or anything like that?

Scot: I do not whiten my teeth. No.

Troy: Okay. Well, I found something I kind of like. I don't like the whitening strips just because those feel kind of gooey on my teeth. It's kind of a weird feeling. And I'd read some stuff online about using charcoal. I know this sounds weird. Have you ever heard about using charcoal on your teeth, like brushing your teeth with charcoal?

Scot: No. That sounds like something that we're going to debunk in a future episode.

Troy: It probably is. We need to get a dentist on here. I want to get a dentist on here just to ask all these dental questions to. But according to the internet, it works great. And I can tell you it's one of those things that looks really gross. It's like this powdered charcoal. I don't know what the source of the charcoal is, but it's purified, whatever. I'll just buy it online. You just brush your teeth with charcoal and your teeth look really gross, like your mouth is all . . . there's just black stuff all over it and all charcoal-y looking. Then you just wash your mouth out and your teeth look whiter.

So there may be someone out there listening who is like, "That is just the stupidest thing I've ever heard," like some medical professional or dentist, and is like, "Okay . . ." So let me know, contact us at hello@thescoperadio.com to let us know if I'm a total idiot for using charcoal to whiten my teeth. I think it works. It seems to be working. I've been using it for a few months. I'm happy with it so far. But maybe I'm totally off base here.

Scot: All right. So, as a medical professional, you're not recommending it. You are actually soliciting to find out if it's a good idea or not.

Troy: I will say I am not a dentist. When I use charcoal . . . this is interesting. We use charcoal for certain types of drug overdoses. We actually have the patients drink the charcoal, it goes in their stomach, and then it will bind to these things. They may have overdosed on pills. So we do use charcoal. That's the only time I've used charcoal.

And usually when they drink this stuff, it makes their mouth kind of look all black and all that just from the charcoal on their lips. That's how I look after I brush my teeth with charcoal. It's kind of weird stuff. I don't know. I think that's the idea. It's supposed to kind of bind to the stuff on your teeth and whiten them. Again, I'm curious. This is more a curiosity, but yeah.

Scot: I will reach out. We'll get a dentist on the show. We'll talk about that . . .

Troy: We need a dentist. We really do.

Scot: . . . and get the rest of your dental questions as well.

Troy: Yeah. We've never had a dentist. So I'm going to ask him about charcoal.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of our podcast. Troy, you get to start today. What do you want to say at the end of this podcast?

Troy: Hey, I want to say thanks for listening. Be sure and subscribe anywhere you get your podcast. If you like us, give us five stars. Tell your friends about us. You can reach out to us at hello@thescoperadio.com.

Scot: You can also go to facebook.com/WhoCaresMensHealth. And we have a brand new listener line you can leave a message at. You can leave your name or you don't have to. You can say you're John Smith. You can ask a question, leave a comment, tell Troy that he needs to get it together with the charcoal and brushing his . . . use toothpaste like normal people do.

Troy: Please. Hey, I use toothpaste too, just to clarify. I do use toothpaste. Anyway . . .

Scot: 601-55SCOPE. That's 601-55SCOPE. Thanks for listening. And together, Troy . . .

Together: Thanks for caring about men's health.

Scot: That's hard to do when you're not face-to-face and online, isn't it?

Troy: I tried to screw it up just to mess with you.

Coronavirus pandemic, social isolation, not enough social isolation, economic uncertainty. That's enough to make you want to drink. But let's not.

It's after 5:00 p.m. somewhere in the world, and it's been a long day of being cooped up with kids in the house or nobody in the house. Maybe it's the time for a glass of wine. Alcohol distributors reported a 50% increase in the sales of alcohol from one week in March of the coronavirus compared to a week the same year ago. Home delivery of alcohol has increased dramatically, and one report notes a 300% increase in alcohol sales in March compared to January. Well, maybe, in January, people were practicing Dry January, a common New Year's resolution to avoid alcohol for the month of January. And the rebound sales and corona alcohol hoarding made that bump. Of course, it could have been just sales of high proof alcohol to clean the kitchen counters. Maybe people were stocking up for social distancing.

There's some evidence that, after the big surge in alcohol sales in March, there's been a return to normal in April. But probably, that doesn't explain it all. Our lives are stressful, and we may self-medicate with alcohol to deal with the stresses of our lives. Also, women may use alcohol to self-medicate our depression and anxiety, both of which are more common in women than men and more prevalent in times of social and economic distress. The stresses of too many people stuck together in the house or apartment, the stress of trying to get the kids to do just a little schoolwork, the stress of being alone, the worries about job layoffs and cutbacks that affect men and women.

It's true that some women use alcohol to relieve stress. It's pretty effective actually. Alcohol is a downer, so alcohol is a sedative. If you are all wound up and your heart's beating and you're stressed out, alcohol can definitely make those symptoms of stress go down. The problem is alcohol interferes with your ability to make good decisions, and that's a problem, particularly if you're stressed. Alcohol increases the risk of conflict and domestic violence. And after all that, alcohol interferes with your sleep. It may make you sleepy originally, but it inhibits REM sleep. So often, people wake up at 3:00 or 2:00 at night, and they can't get back to sleep. or they stay awake with their heart beating.

Whether or not to drink is a personal choice. How much to drink and when to drink is a personal responsibility. Adolescents under 21 should never drink. You should never drink if you're driving. You should never drink if you're taking prescription drugs that interact with alcohol, particularly antidepressants, anxiety medications, or narcotics. You should never drink if you're pregnant. And you should never drink if you're not in a safe place socially. Home should be a safe place socially. However, in these days of everyone at home, out of school, maybe out of work, interactions can rise and tensions can rise. This makes home not a safe place to drink alcohol.

Now, I'm a fan of numbers, so let's do the numbers. Heavy drinking is more than seven servings of alcohol a week. A serving is the 12-ounce bottle of beer or a one 5-ounce glass of wine or 1.5 ounces of spirits. Alcohol abuse is a pattern that's harmful to the drinker or others. Alcoholism is a disease marked by a compulsion to drink, inability to stop drinking once it started, and the need to consume more alcohol to get the same effect, to get high or to get relaxed, and this is called tolerance. Alcoholics may also suffer alcohol withdrawal symptoms, like nausea or shaking or anxiety.

So what do you do? Honestly, look at your alcohol consumption count. Count them up. Is it more than five a week? Is it more than seven a week? How big is your glass of wine? Wine is often women's drink of choice, and a very large glass of red wine is often found in the hands of our favorite TV heroines. Ask yourself why you're drinking. Are you drinking to treat your stress, your depression, your boredom, your anxiety? Are you being encouraged to drink by a manipulative partner? If yes to those questions above, dial it down or get help to deal with why you're drinking. And you probably don't need those calories. Those TV ladies are never seen eating food anyway, so I guess they can get away with the calories.

Is it okay to drink to relieve stress? Probably not on a regular basis. In fact, in times of social and economic stress, we need to be on the top of our games to handle what is happening at home.

Also, the World Health Organization has specifically warned about alcohol use during the COVID-19 pandemic. The WHO's regional office for Europe recommended governments restrict access to alcohol and "any relaxation of regulations or their enforcement should be avoided." More than three million people die every year from alcohol, the WHO said. Adding that alcohol consumption during an emergency, and that's right now, can exacerbate health vulnerabilities, risk-taking behavior, mental health issues, and violence.

Now, social distancing can be particularly stressful for men and women who are in recovery from alcohol abuse. The social systems, including Alcoholics Anonymous, that help people do the very hard work day to day to stay sober, are difficult to find in these corona days. Having meetings with your therapist or your AA group on Zoom can be helpful, but the physical presence of another calm, caring human and human touch are missing. Virtual support and meetings can be helpful, but some people are not tech-savvy, and some people don't have internet. Some people will not be able to pay for their very expensive internet connection. And libraries, which have been a haven for some, are closed. It can be really hard for people who are struggling economically and struggling with alcohol abuse and addiction. For many, their work was a source of meaning and financial security and social support to get through the days. And not having work or being furloughed or being told to stay home and being socially isolated is hard.

If you're struggling with alcohol abuse in these times, try to reach out virtually, a telephone call, a tweet, a something to people who can help. If you're not struggling with alcohol abuse, try to reach out. There are people who need that call. So all of you out there, stay safe, stay calm, stay sober. And thanks for joining us on The Scope.

This information was accurate at the time of publication. Due to the changing nature of the COVID-19 pandemic, some information may have changed since the original publication date.

Interviewer: You have somebody in your life who is entering the alcohol recovery process or is in recovery and you want to be supportive but some of the things you say might actually be harmful.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: We're talking with Dr. Jason Hunziker, psychiatrist at the University of Utah. Dr. Hunziker, people who are recovering from alcohol addiction, it's a really hard process and they need all the support they can get.

Dr. Hunziker: The choice to go into recovery is a big deal for everyone who does it. It's a very difficult process and it does take a lot of support not only internally but from people in the environment and from systems that help people enter the recovery process. We do have to be careful however what we say to people as they are getting ready to enter that process and as they are in that process so that we can motivate them to stay sober and make this big change in their life.

Some of the things I recommend that we don't say are things like, "Hey you can have just one, and it's not going to hurt anything." That clearly is not going to be helpful to somebody who is telling you that their life has been destroyed by alcohol. That's sets you up for failure in your process and in your program and so that's something that should be avoided.

Interviewer: So what are some other things that people say sometimes that you think are supportive but really aren't?

Dr. Hunziker: Somebody is in the program and you think you're being supportive by visiting them and then you say, "You know I'm glad you're doing this right now. It's a good time for you to do this but one day you're going to be able to drink again."

Interviewer: Really? They say that?

Dr. Hunziker: Yes, and again that is not something that is helpful at all to maintain the sobriety that they're looking for. When you stop, you still have the addiction. You just choose now not to use. And I use the word choose pretty lightly because if it was that easy to quit, everybody would just quit. So they make the decision to everyday get up in the morning and realize that they're not going to use and then go through that day not using even though they still have some cravings, they still have some desires and they still fight that impulse to go get some alcohol.

Interviewer: Okay, what are some other things that people might say?

Dr. Hunziker: Other things people say when they don't realize you don't realize you're an alcoholic at all they'll say, "Wait a minute. I see you go to work every day. You have a job. You're still making money. How can you be an alcoholic?" They think that just because you can function that you're not an alcoholic. But that still does not mean that this does not interfere with other aspects of your life.

Some people will say when you've been in the process for a long time and you've been going to your recovery meetings and you haven't had a drink they'll say, "Aren't you done yet? I mean, you've been doing this for years, shouldn't you be cured already?" There's no cure. I mean the cure is to not drink and the only way to not drink is to get positive support and to be actively making sure that doesn't happen.

Interviewer: Okay, any other things that people might say they think are supportive to a recovering alcoholic but might not really be that supportive?

Dr. Hunziker: Well I think sometimes people want to down play or minimize the alcoholism in the other person's life and so they will say things like, "Well I eat food every day, that doesn't make me addict so how could you be an addict?"

Interviewer: Because those two things are so comparable.

Dr. Hunziker: Exactly, exactly. So clearly our words are very important when somebody has made the decision to go into recovery and we need to choose those words carefully. We don't shy away from having conversations but I don't think we want to interfere and actively seek out information about the alcoholism. If somebody wants to give it to us, great. Let's listen, let's be supportive but if you start asking a lot questions people feel like you're being intrusive and then when you're intrusive it sets them up for failure.

Interviewer: So what are the words and the conversations that you can say to recovering or you should be saying to a recovering alcoholic?

Dr. Hunziker: It's not so much what you say all the time but some of the things that you do. Be available so if they call you in the middle of the night you don't say, "Oh, you're just drunk again" or " Oh, here it goes again." You're supportive, you're available, and you're encouraging them to use you as a support system so they don't go drink. Other things, you stay positive. Keep giving them encouragement all the time because it is a difficult process.

I mean you could imagine if you had to give up something you really enjoyed doing even if you didn't really think it was causing you that much problems. So you want to make sure that you're positive and they get encouraged by you so they will continue to fight the addiction.

Interviewer: So say you know someone who is thinking, who is considering the recovery process, what can you say to them to kind of motivate them to enter it?

Dr. Hunziker: You know I think normally what you want to do is have them think about how this helps them or doesn't help them. If you can say to them, "Okay, let's make a list of how alcohol helps you in your life, and then let's make a list of how alcohol hurts your."

Interviewer: Doesn't help you in your life.

Dr. Hunziker: Exactly, exactly.

Interviewer: Pros and cons.

Dr. Hunziker: And then people can look at that and then you can provide motivation based on the positive feature say, "Look what you can... You want these, you want that, you want this. The only way to get that is to be sober and if you can be sober, good things are going to come."

Interviewer: So any final thoughts that you have about recovering alcoholics, what you should and shouldn't be saying?

Dr. Hunziker: The only thought I have is that if somebody comes to you and says, "I'm contemplating stopping my drug use or my alcohol use." Please refer them to somebody who has a knowledge of recovery, has a knowledge of treatment, their primary care doctor, Alcoholics Anonymous, Al-Anon, somewhere that they can get that process moved from contemplation to full active recovery.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: March 12, 2019
originally published: November 5, 2014

The teenage brain on booze. What do we know about it? How is it different from adult brains on alcohol and what's the problem?

Most states have laws restricting the sale of alcohol to people under the age of 21. These laws have been in existence for much longer than our knowledge about the worrisome affect of alcohol on the developing adolescent brain and we know that many adolescents get around the laws and drink alcohol at parties or privately and usually to excess. Adolescents who break the law by drinking alcohol rarely just have one social beer, so what's the problem? What do we know now about the brain development that makes us even more worried about adolescents and alcohol?

Adolescence is a time of transition physically, socially, and emotionally. There are two critical times in brain development after birth. One is about age 2 to 3 and the other is at adolescence. During adolescence the brain undergoes major remodeling involving the formation of new connections between nerve cells.

These changes affect the processes involved in planning and decision making and impulse control, voluntary movement, memory and speech. Alcohol appears to have different affects on the brain of adolescents than on adults. Adolescence has a greater affect on memory center in the brain in adolescence than adults. In animal studies this affect seems permanent. Adolescents also have an underdeveloped part of the brain that helps with decision making and impulse control and risk assessment, something every parent teacher and cop knows. In animal studies the ability of this part of the brain to develop is impaired by alcohol. A fancy term for this is neurodevelopmental dysmaturation and that fancy term means that the adolescent brain exposed to binge drinking a common practice among under age drinkers, that brain may not mature normally. This impairment may actually accelerate the use of alcohol in adolescence and predict its use and abuse in later life.

Forty-seven percent of those who began drinking alcohol before the age of 14 become alcohol dependent at some time in their lives compared to 9% of those who wait until at least age 21. The correlation holds even when genetic risks for alcoholism are taken into account. Binge drinking we find as four drinks in one period of time for women and five for men, is common in adolescence and at the same time the same amount of alcohol adolescents are less likely than adults to suffer the side effects of binge drinking; sleepiness, nausea and vomiting and staggering. And the adolescence memory is worse on the same amount of alcohol than adults and it may be impaired for weeks after.

Think about the weekend binge drinking common on college campuses and high school parties and the affect on memory in the following weeks. And for women...girls really, the affect of alcohol and sexual decision making can have devastating long term affects. Having sex without protection against sexually transmitted diseases, having sex without protection against pregnancy and having sex without their permission and all of the above. And for boys and girls with car keys, drinking which is usually to excess isn't usually perceived by the drinker who gets in the car unaware of how impaired they are.

So the laws against underage drinking are even smarter than we know and our adolescents are no smarter than we think they are. They're under social pressures to drink. They're treating anxiety and depression with alcohol and if they're in an environment where there is illegal underage drinking they're not under the social stigma against getting drunk that is in place with most adult drinking.

So what to do? Support the police in enforcing the laws about underage drinking. Two, remember the adolescent brain is still developing until age 25; four years after adolescents can drink legally. Three, know who your kids are with, where they are and where's the responsible adult, that would be someone over 25 and preferably over 30. Four, be very careful in investigating the culture of the dorms and fraternities and sororities that your adolescents choose to join. Five, if you're an adolescent and listening to this, aren't you wise or did your mother make you do it. You are not invulnerable. You don't look cool when you drink. You just don't look very smart.

updated: February 18, 2020
originally published: October 30, 2014

Interviewer: I think most of us at one time or another may have joked that, "We're addicted to chocolate," or, "I'm addicted to that TV show," but those addictions aren't real addictions. We're going to examine addictions next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Elizabeth Howell is with the University of Utah Hospital. Let's talk about addiction for a second. Now everybody jokes about, "I'm addicted to chocolate." That's not really addiction, is it?

Dr. Howell: Not really. I mean, some of the same brain processes are involved, but chocolate doesn't usually cause people to lose their family and their house and their life. It's a compulsion maybe to eat chocolate . . .

Interviewer: Sure.

Dr. Howell: . . . but it's not something that's going to kill you.

Interviewer: So let's talk about true addictions. I was doing a little bit of reading, and it just really was strange to me that if somebody is truly addicted, they can't look out for their own well being, they can't make decent decisions, because a lot of times people, you'll hear them say, "Well, wow, why didn't they just make a better choice than doing drugs?" But they really don't have that ability, if I understand correctly. Is that accurate?

Dr. Howell: Well, yeah. You have some choices about some things, but I think the main thing to remember is that when you're actively addicted, and you're using drugs or alcohol or both, that your brain is not working right. I mean, it's not the same as having a brain that is sort of firing on all cylinders at the same time.

Interviewer: Yeah. Is it the actual addiction, or is it the drugs, or a combination of both?

Dr. Howell: Both, really.

Interviewer: All right.

Dr. Howell: So the drugs actually, they alter how you perceive the world and how you see things, but they also do something that's very important, which is they activate the process in the brain, which is the addiction process, that really distorts how people think. So in Pennsylvania, there's kind of an epidemic of people mixing fentanyl, which is a very potent opioid, with heroin, and a lot of overdose deaths have happened because of that. And if you're someone in the public, you'll say, "Wow, that's really scary. If I were a heroin addict, I wouldn't be using anything right now . . .

Interviewer: Yeah, sure.

Dr. Howell: . . . because I'd be afraid I'd kill myself."

Interviewer: Yeah.

Dr. Howell: But if you're a real active addict, what you think is, "How did they get the good stuff?"

Interviewer: Really, that's the thought process?

Dr. Howell: That is the thought process.

Interviewer: And they want that.

Dr. Howell: And they want that, because they want something that is so good that it might kill them, and that is the insanity, as they say in the 12-step programs, of the addiction. The insanity of the disease is that your thinking is very distorted.

Interviewer: And that's how they frame in the head, "I want something so good it'll kill me?"

Dr. Howell: Well, it could be, yeah.

Interviewer: Wow.

Dr. Howell: You could get to that point.

Interviewer: So inside the brain, let's say somebody just has an addiction, but they're not currently using.

Dr. Howell: Right.

Interviewer: Is their brain a little different than somebody without that predisposition towards an addiction?

Dr. Howell: There are probably some differences in the brains of people before they ever start using. In the twin studies that have been done using alcoholic families, and alcohol is the easiest thing to study compared to other drugs, if a child was born to an alcoholic father and adopted into a non-alcoholic home, they still had a much higher risk of becoming alcoholic. The highest risk was a child of an alcoholic biological father adopted into an alcoholic home. So the nurture part, the environment, did play a certain role, but by far the biggest risk for addiction is genetic.

Interviewer: Does the brain physically get rewired because of addiction?

Dr. Howell: I don't know if it gets completely rewired, but there are certain genes that are turned on or off, depending on the different genes, when you start using.

Interviewer: Okay.

Dr. Howell: And, like you say, they're kind of laying there dormant.

Interviewer: Sure.

Dr. Howell: It's like a room with the lights off, but when you turn the lights on . . .

Interviewer: By taking a drink or doing a drug.

Dr. Howell: . . . right, then certain genes could be turned on or turned off. And the way that this happens, it's not like the first time you ever use that all the changes that happen, by the time you've been using for 20 years, are there. They happen over a period of time and in sort of wave of different changes in the brain, different parts of the brain, different systems of the brain, and it's quite complicated. I don't know if you would call it rewiring, but it's definitely a re-engineering of the brain.

Interviewer: So we've talked a lot about addiction. I want to talk for a moment now, and kind of wrap this up with, if somebody is a loved one of somebody who is addicted, help them be in the mindset of the addicted person so they can better help them.

Dr. Howell: I would try to imagine it as thinking of something that you feel like you have to have for life, like it's something that you need to survive. And when you're in the throes of addiction, the person who's addicted really feels as if that is the most important thing in life, that it is actually more important than food, or their children, or whatever, and that the drive to use is so strong that their behavior seems insane, because it is. Because what you can't control is the craving and the mental obsession and the compulsion. Now people obviously get into recovery, and they stop using, so we could get into this is it really a disease, can you really control it sort of debate, but what you can't control is what your brain is telling you. That's like saying if you're diabetic, I will not let my blood sugar go up.

Interviewer: Yeah.

Dr. Howell: You can do as much as you possibly can to keep your blood sugar from going up, but you can't always control that, because that's a physiologic process that is independent. And that's what the addiction is. Once it gets started, it's an independent physiologic process that can be managed, but it can't be just gotten rid of or controlled.

Interviewer: Or cured.

Dr. Howell: Or cured, yeah.

Interviewer: It's always there.

Dr. Howell: Right.

Interviewer: So what could somebody do to help that person? Because I don't think this is a do-it-yourself sort of a thing.

Dr. Howell: No, not really. And what we tell family members first is get informed and find out what you need to know about addiction and take care of yourself, because many times a person comes in for addiction treatment, their family has been trying to help them, but they've been doing it sort of in a backwards way. They're well-meaning, but they've been kind of enabling the person. They've been covering up for them. They've been bailing them out of jail. They've been doing this and that. And so you don't want to do that.
People need to experience the consequences of their addiction, and sometimes it's the only thing that will wake them up, because your brain is all changed, it's not working right, and you need a big wake-up call, and sometimes that needs to be letting people "hit bottom." Where you don't want somebody to hit bottom is if they're in danger of dying and hitting bottom, but if they're going to go to jail, or whatever, then I would let that play out, and then have a plan that, "Okay, we'll help you get out of jail," if that's what's happening, "if you will go to treatment."
There are some medications that can help, although we don't have enough, and then there are also many psychological, psychosocial treatments that include psychotherapy and changing behavior, more behavioral therapy, going to 12-step meetings, or some kind of support group.
The other thing you have to make sure of is that anything else that is involved that may be impacting the addiction is being treated. So if someone's depressed, they have post-traumatic stress disorder, or they're bipolar, or whatever, some sort of mental illness or mental disorder gets treated appropriately without addicting medications.

Interviewer: Yeah.

Dr. Howell: Yeah, because that's where I see a lot of people getting into trouble, is they have anxiety, so they're put on something else, like a benzodiazepine that's addicting, like Xanax or one of the others, and that's only going to make the problem worse. And the other thing that you need to do is make sure that besides that you're treating the psychiatric or mental problems, that you're also treating any physical problems that are going on. Somebody could have hyperthyroidism or something that could be triggering them to drink.

Interviewer: Sure.

Dr. Howell: I mean, there are a number of things. So the physical and the mental you want to take care of, and make sure that whatever treatment program you're looking at has the ability to check for those things and treat them, if appropriate.

Announcer: We're you're daily dose of science, conversation, medicine. This is The Scope. The University of Utah Health Sciences Radio.

Interviewer: Sixty-six percent of Americans say they occasionally drink, and that number is increasing. Are we drinking too much, too little, just the right amount? How does this all affect your mental health? That's coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're here with Dr. Jason Hunziker, psychiatrist at the University of Utah Hospital. Dr. Hunziker, the first question is mental health and alcohol addiction. Is there a connection between the two?

Dr. Jason Hunziker: Clearly. There's clearly a connection. Unfortunately, it's a complex connection, and there are several different theories on how this happens. Is it the alcohol changing neurotransmitters in you brain that causes the mental health? Were you already depressed and anxious, so you started drinking as a way to fix your anxiety and your depression? Did the alcohol and the depression start at the same time? Is it mixed that way? It's really hard to know in most people which came first and what the connection is, but we do know that mixing the two is not healthy for you.

Interviewer: What do you mean by mixing the two?

Dr. Jason Hunziker: If you're depressed, you're already putting yourself in a position, particularly if you're not getting treatment, that you have a hard time taking care of yourself. Getting out of bed is a struggle, trying to get to work, and if you have kids, taking care of your children, it's very difficult.
Then, you throw alcohol on top of that which is in and of itself a central nervous system depressant. The alcohol actually makes you more depressed. It makes it harder for you to function. You lose time at work. You have marital problems, relationship issues with your children. It can lead to more trouble taking care of yourself and lead to childhood abuse and neglect.

Interviewer: It's almost like the chicken and the egg thing. You don't really know if it's a mental thing first or if it's an addiction first, right?

Dr. Jason Hunziker: That's correct. It's really hard to know for a lot of people, and when we evaluate people who come in with alcohol and mood disorder we have to take some time to figure out were they already depressed first or did the alcohol come first and that's what caused the depression.

Interviewer: Is that important in the treatment, to know which one came first?

Dr. Jason Hunziker: It's definitely important in the way we diagnose the illness. Often, we don't diagnose depression or anxiety if we feel like the alcohol was the direct cause of that. Often, what we see is people have been depressed unknowingly for a long time and then picked up the alcohol as a way to kind of medicate that, and it didn't work.

Interviewer: I mentioned earlier that we both talked about how alcohol has become such a normal part in American society, American life. It's like a part of your day. Is that normal? Is that healthy? What's going on there?

Dr. Jason Hunziker: Again, healthy, probably not...

Interviewer: Not even the red wine?

Dr. Jason Hunziker: There is some evidence that red wine can be healthy if you drink it in the five ounce or less per night and that's all you have. The problem with most people is...

Interviewer: That's not all they have.

Dr. Jason Hunziker: ...that's not all they have. In fact, a study that came out recently from the CDC shows that 38 million Americans say they drink too much.

Interviewer: Really, they admit that?

Dr. Jason Hunziker: They admit it, and these are people who aren't considered alcohol dependent.

Interviewer: How do you treat that? Can you treat it, or is it classified as a mental illness at that point?

Dr. Jason Hunziker: It is, and in the new DSM-V it's called the substance use disorder.

Interviewer: Okay.

Dr. Jason Hunziker: Yes, there is treatment for it. First and foremost, you need to make sure if you've been drinking too much that you talk to your medical doctor. Alcohol detoxification can be tricky and at times deadly and needs to be monitored closely just to get you through that initial phase of getting the alcohol out of your body.
The detox part, believe it or not, is the easy part to this process. Staying off of alcohol is when it becomes very difficult, because if you go back and drink one drink it is never enough for you and you will start drinking again and again and again. Then, it leads to all those problems that brought you in in the first place.
We do have treatment. There are inpatient programs where you can go stay for 30 to 90 days, learn all about addiction, learn what to watch for, make sure that you stay sober. There's AA, which is free meetings all over the town. Every hour somewhere there's a meeting with great support system to help you stay sober. There's intensive outpatient programs that are available for people to go to which are four days a week at night time when most people are drinking, so it keeps people from using alcohol.
The reason alcohol is so important is that it doesn't just affect your life.

Interviewer: Right.

Dr. Jason Hunziker: It can affect everyone around you. When you're addicted to alcohol often you do drink by yourself, because you don't want people to see how much you're drinking. You'll start drinking at work. You'll drink in your car. You'll drink while you go grocery shopping. You'll drink Listerine and mouthwash and Nyquil just to get the alcohol out of it?

Interviewer: Really? Oh, so it's...

Dr. Jason Hunziker: It leads to all kinds of medical complications.

Interviewer: What are some of those medical complications that you just mentioned?

Dr. Jason Hunziker: Some of the medical complications can be liver failure.

Interviewer: Of course.

Dr. Jason Hunziker: Alcohol can also lead to hypertension. It can lead to problems with respiratory drive and respiration. Then, of course, the family issues that come from alcohol can be devastating. You're causing yourself issues, the depression, the anxiety. That can bleed over as anger and frustration to your significant other and your children, which then gets perpetrated later again in life by your kids.

Interviewer: Any final thoughts?

Dr. Jason Hunziker: I think that if you or someone you know or love or care about you think has an alcohol problem, please approach them about that. Tell them why you're concerned and what the concern is. Get them to their doctor where they can get some more resources. There are plenty of things online that you can pull up and say hey, this is where I can go get treatment.
If nothing else, go to an AA meeting. They're everywhere all the time. Everybody has an hour that they can go sit. Even if you're intoxicated, go sit in the meeting and hear what these people say about sobriety and how they can help you get sober so you can improve your life and the life of everyone around you.

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