Alcohol: Joie de Vivre, Vice, or Villian

The current opioid epidemic ensued because opioids have been widely prescribed by physicians who were told that “pain” was the 5^th vital sign, in addition to temperature, pulse, blood pressure and respiratory rate, and was being undertreated. Chronic pain had been undertreated; however, physicians were lead to believe that opioids were the most effective choice to treat pain and had less addiction issues than previously thought. Obviously, this misinformation, largely promoted by the pharmaceutical industry for profit, has had a disastrous effect on our country.

The idea to use a medication with a low therapeutic index (ratio of therapeutic effect to harmful effect) for the general population; however, is not a new phenomenon. In the 18^th century morphine was considered a cure for multiple ailments and in the early 19^th century even methamphetamines, cocaine and tobacco were advocated by physicians for health benefits. Given this recurring theme, perhaps we should be more mindful of another indulgence that we posit as being low risk and a lifestyle enhancement more than the drug it really is.

Alcohol in moderation is touted as something beneficial and especially red wine has been deemed a “heart healthy” beverage. The problem with alcohol; however, is determining how much is “moderate intake” and how much is “healthy”. Many of us tend to drink more than 3-5 per week if we’re women or 5-7 per week if we’re men, which are rather arbitrarily designated amount of “acceptable” alcohol use. The Center for Disease Control and Prevention (CDCP) says that heavy alcohol consumption is more than 15 per week for men and more than 7 per week for women and binge drinking is considered more than 5 drinks per session for men or 4 for women. It would not be reckless to say that in the Bay Area this consumption is more typical rather than the outlier number that indicates a potential alcoholism problem.

The real questions to consider regarding alcohol use are, “How does it affect your life? and “Why do you drink?” If the answer to either has negative connotations, a change of habit is a good course to take. Many experts believe that there is a grey zone and hazy continuum between acceptable use and an alcoholism disorder that may rapidly shift in the wrong direction depending on life circumstances. Alcohol affects the brain in some of the same ways as opioids: endorphin and dopamine release cause feelings of euphoria and activate the reward center of the brain which can predispose us to addiction. More consistent use over longer periods of time causes increased tolerance and the need for greater intake to get that same “buzz”, just like opioids. Excessive alcohol use isolates people and reduces motivation, productivity and ambition to do other things and adversely affects all of the organ systems. The definition of addiction is the irrational use despite harm. It’s a good idea to intermittently take inventory of how alcohol use may be affecting our lives.

Alcohol is the most acceptable recreational drug and I’m certainly not advocating for the return of prohibition. I once described the effect of it on me as analogous to a mini vacation. Although Shakespeare wasn’t talking about alcohol, when he wrote “Can one desire too much of a good thing?” the answer is still yes. A good friend of mine once said, “I enjoy wine so much that I don’t want to lose the privilege of being able to drink it.” She made the decision to conscientiously cut back on her drinking in order to avoid falling off of the proverbial cliff into alcoholism and forced abstinence. We should all follow her example and use other non-addictive activities to achieve the same feel good results. Endorphins are released with music, exercise, eating chocolate or hot peppers, having sex, pleasant social interactions, aroma therapy and acupuncture. The bottom line is that we’re all looking for ways to feel good and optimistic about our lives. The best way to achieve that is by changing our mindset away from using artificial aids such as pills or alcohol and towards engaging in more natural healthy social activities and interactions that allow us to participate with the world rather than avoid it.