Stress has been shown to contribute to increased alcohol use among drinkers. And right now, we’re all stressed – especially women, who are dealing with online school, child care, career concerns, and financial worries, just to name a few. But, are Americans really drinking more during the pandemic? The answer isn’t so clear. What is clear is that alcohol use has been increasing over the years for women but not for men. And, when we use alcohol as a way to cope with stress, it negatively affects our mental and physical health, our relationships, and our overall wellbeing. Dr. Aaron White is the Senior Scientific Advisor to the Director at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH). He’s a biological psychologist who has studied the effects of alcohol and other drugs on the brain for 25 years. Dr. White shares tips to make it easier to deal with or reduce the motivation to drink as a way to cope with life during a pandemic. He also discusses trends in Americans’ alcohol use over the last century, the impacts of alcohol on our health, and the benefits of cutting back – even if it’s just for one “Dry January” out of the year.
Listen to this episode to learn:
For more information, visit https://www.niaaa.nih.gov/.
Evaluating your relationship with alcohol
Intro: Welcome to the Equal Parts podcast, brought to you by Care@Work.
Emily Paisner: Being a working parent is hard, and sometimes when life is stressful and overwhelming, people turn to alcohol to cope. This episode is part of an ongoing series on caring for yourself. We're with Dr. Aaron White, a biological psychologist who has been studying the effects of alcohol and other drugs on the brain for 25 years. Currently, he's the senior science advisor to the director at the National Institute on Alcohol Abuse and Alcoholism, which is part of the National Institutes of Health.
Aaron and I talked about the differences between men and women and their alcohol use, how the pandemic has impacted our drinking habits, and tips for cutting back. Have a listen. Aaron, welcome to Equal Parts. Thank you so much for joining us today.
Aaron White: My pleasure.
Emily Paisner: Can you briefly tell us a little bit about the work and the research you do at NIH?
Aaron White: Sure. I work at the National Institute on Alcohol Abuse and Alcoholism, and we focus on alcohol and public health. We track alcohol use throughout the country and study harms related to that. We fund a lot of research. I think we're the largest funder of alcohol-related research on the planet. We pretty much do all things alcohol.
Emily Paisner: Since the pandemic started, we're all at home. Sometimes having a drink at the end of the day or even during the day for some people is an outlet. Are Americans drinking more or less now than we used to?
Aaron White: We're drinking more, in general. If we look at the amount of alcohol that we consume as a country, it's been inching up over the years, over the last 20 years or so. I think it's increased about 10%, but there's a more complex story underneath those data. In general, we're drinking more, but not everybody is drinking more. What's very interesting is the trends that contribute to that overall increase in drinking. Certainly, the pandemic has thrown a wrench in a lot of people's plans to drink less.
Some people are drinking more now. Certainly, some people are drinking less. We're still learning the impact of this pandemic on alcohol consumption. In general, there's lots of reasons to be concerned. Wherever you see big increases in stress, you tend to see increases in alcohol use along with that. Certainly, we are experiencing a lot of extra stress as a nation.
Emily Paisner: Can you talk about the differences in alcohol use between men and women?
Aaron White: Over the last 100 years or so, there's been a progressive narrowing in levels of alcohol consumption between men and women. 100 years ago, men were much more likely to drink and to get drunk than women. Over that last century, those gaps have narrowed, and in some cases, disappeared, and in some cases, reversed. For instance, for the first time, we assume in history, young females are now more likely to drink and report being drunk than young males, even among young adults, college students, for instance.
What used to be very large gaps in alcohol use between male and female college students are now gone and have reversed with female students telling us that they're more likely to drink and to report being drunk than males. Young adults who don't go to college, that gap still exists where males are drinking more than females, but not by much. This is a narrowing that has really been happening for a century, but we're finally at the point where those gaps are gone.
Unfortunately, we're also learning that the impact of alcohol on women's health is different than it is on men's health. Women seem to be more likely to develop certain health issues related to drinking, like breast cancer. When they do develop health complications of alcohol, like liver disease, it tends to progress faster than it does for men. It has a bigger impact on life expectancy in women than men. It's a bad combination. Increases in alcohol use among females combined with greater knowledge of the health impact of that alcohol use.
Emily Paisner: Why do you think women are drinking more? You mentioned college age, women are drinking more than men and older women as well. Why do you think this is?
Aaron White: I think there's a few things happening. One is that we strive for equality. For women, that has meant joining the workforce in greater numbers, taking on roles that 100 years ago were ascribed more to males. It's the added income, the opportunity to purchase alcohol, that's certainly part of what's been happening. In addition, there's a more insidious aspect to this that has to do with stress and coping. Women have more opportunities than they did a hundred years ago, but all of the same responsibilities. For instance, just because a woman joins the workforce doesn't mean that she spends less time child-rearing or cleaning the house. The data tell us that women still end up doing far more of those responsibilities than men.
Emily Paisner: Yes. We've talked about that a lot on our podcasts.
Aaron White: Yes, and where you see single-parent households, you tend to see women at the head of those households. It's a combination of just overall societal changes, but certainly, the stress and strain of all of those obligations seems to be contributing as well. That is really where the concern is, how much are women drinking? Another part is, why are women drinking more?
Emily Paisner: I feel like every year someone comes out with another study about a certain type of alcohol being good for you. A lot of times it's red wine. Is there a type of alcohol that is better for us than another?
Aaron White: I wish that there were a particular type of alcohol that was healthy or healthier. It turns out that--
Emily Paisner: I'm sure that a lot of people wish that.
Aaron White: It turns out every type of alcoholic beverage, the intoxicant is the alcohol. The alcohol stays the same. The damage that the beverage does to the body comes from the alcohol. Whether it's a beer, a shot, or a glass of wine, if it has the same amount of alcohol, it carries the same amount of risk to health. In studies looking at the health of wine drinkers compared to say, spirit drinkers, many of these studies find that wine drinkers tend to be healthier overall, but it doesn't really appear to have anything to do with the wine. There's not enough stuff in the wine that could convey health benefits. There's nothing magical that happens in the process of fermenting grapes into wine that makes wine healthier. It turns out that people who drink wine tend to, as a whole, engage in healthier lifestyles, and so they may be healthier than your typical beer drinker, but it's not because of the wine itself.
Emily Paisner: That's interesting. Do you have any tips that might make it easier to deal with or help to reduce this motivation to drink, to help cope right now?
Aaron White: It's important that we all try to stay connected to people we care about in some way. Everybody is tired of Zoom calls, but if that's the only way we have to stay connected, we should use that. There's some simple tricks that are always valuable in trying to cope with stress. One of them is to try to identify something positive to look forward to, even if it's as simple as a meal or a TV show you like. Little things right now that can help get you through a day by focusing on something positive. Something happens in the brain when you start focusing on positive things that orients you toward thinking about things in a positive light.
The other thing is it's helpful to just ask yourself some questions. If you find that you're drinking more to cope with all of this, try to be a little more mindful about that. When you pour your glass of wine, ask yourself, "Why am I doing this? What am I hoping to get from it? Did I get it? What's another way that I could get this without the wine or without the shots or whatever it happens to be?" Alcohol is effective at temporarily reducing our discomfort. We like to talk about the buzz the drugs give people, but it's when we use substances to cope that we really put ourselves on a dangerous path.
If you use alcohol because it dampens your anxiety, there's diminishing returns here. It might work initially, but it's not going to keep working and it's not going to solve the problem. Each time you drink, you get a little less relief, and when the alcohol wears off, you get a little more increase in discomfort. If you repeat that cycle over and over again, you develop what we call tolerance, and when you stop drinking, you feel pretty miserable. It's just not a sustainable solution to the challenges we're facing now.
Emily Paisner: How can we look at our relationship with alcohol?
Aaron White: It involves simply trying to hold the alcohol in your mind at arm's length and look at it rather than just drink it [chuckles]. To think, "What am I doing? Why am I doing this? What do I like about it?" You might find that you just like it. You like that glass of wine or that shot and that you like the little bit of relaxation you get and the warm euphoria, and that for you that's okay. You're not avoiding life. You're not trying to escape. You're not relying on it, but you might find that, actually, you're using it to lean on more than you're comfortable with. You're using it to cope with stress and anxiety. It helps you get to sleep.
The problem is that alcohol tends to disrupt the same things that we think it's helping us with. In other words, it tends to make anxiety worse over time. It makes depression worse over time. It makes us sleepy and it might anesthetize you, but it actually disrupts sleep and reduces the quality of sleep that you get. I think looking at one's relationship with alcohol simply involves stepping back and asking ourselves questions about why we drink? When we drink? What it is that we are seeking from the alcohol? Then, more importantly, what can we do to get those things without the alcohol? For some people, that might not require that you stop drinking. It may require that you just cut back and some nights you do something else to relax.
Emily Paisner: We hear a lot about that, specifically at the beginning of the year when people are trying to cut back and change some of their bad habits that they're trying to readjust. You hear about 'Dry January'. Can you share some of the benefits around what taking a break from alcohol can do?
Aaron White: Sure. Keep in mind that most of the research on what happens when people take a break from alcohol involves people who choose to do this. They choose to take a break. They have the expectation of benefit, but when people take a break, it's very common for them to say after a month, they sleep better, they lose some weight. People often report that-- this is not very scientific, but their skin looks healthier, fewer wrinkles and smaller bags under their eyes.
The liver actually, even in people who drink moderately, where you're probably not doing enough to damage the liver, the liver still shows some indication of improvement in function and health, just by taking a break for a month even from moderate consumption. Then, people save money. I think the most important upside is it's a great way to take a closer look at your relationship with this substance that many of us use. Some people decide at the end of that month that they're going to go back to drinking. It's common for people to go back but drink less than they did before.
Some people just decide that they're better off without it. Regardless, the exercise of stepping back and thinking about your relationship with alcohol, that's, I think, where the real value is. I will say there is something very important to mention about this. For people who drink heavily, you're drinking to intoxication regularly, it can actually be deadly to stop drinking abruptly. It's something that if you're going to take a break from alcohol, you should ask yourself whether there's a chance that you have been drinking heavily enough that you could go into full-on withdrawal.
There's probably about 850 people a year who die from alcohol withdrawal, according to death certificates, and a couple hundred thousand show up in emergency departments for alcohol withdrawal. It's no joke. People can become very dependent on this, and then go through serious withdrawal. For people who are moderate drinkers, it's a good exercise and see how you feel. You may decide that you don't want to go back after you take a break.
Emily Paisner: You mentioned college kids and adolescents earlier, and it's a big topic for likely a lot of parents who are listening right now. Can you tell us a little bit more about the research that you're seeing in underage drinking?
Aaron White: Among adolescents and early young adults, like 18 to 25, there's actually been a decline in alcohol use, a fairly big decline in alcohol use, particularly among our teenagers over the last 20 years.
Emily Paisner: That's promising.
Aaron White: It is promising in a way. Alcohol use, including binge drinking, have dropped in half just over the past 20 years.
Emily Paisner: I feel like there's a but coming.
Aaron White: Yes, there is a but. The first one is that most of that decline has occurred for males, not for females. Whatever is driving the decrease in alcohol use, it's affecting young males more than young females and we don't understand why. The other thing is our kids are socializing a lot less. Alcohol tends to be a social drug. Some of the decrease might not reflect a lack of or a change in interest in alcohol among young people. It may just reflect a change in how our young people spend their time. I will say that is positive news that there are declines, first of all, but one of our concerns is that the percentage of young people that tell us they drink alone, particularly girls, has gone up a lot.
I think it's something like 10% of adolescent girls now tell us the last time they drank, they drank by themselves. We know that anxiety and depression are skyrocketing for our kids. Our concern is that while we have these overall declines in alcohol use among young people, that we could still end up with an increase in problems related to alcohol among young people, because those who are drinking tend to be more likely to drink alone now. We suspect, although we don't know, that they're more likely to drink to try to cope with this big increase in stress and anxiety.
Among our 18- to 25-year-olds, 30% of them now reach criteria for a mental illness in the past year. That's almost one in three 18- to 25-year-olds has a mental illness in the United States. That has doubled just in the last 10 years or so.
Emily Paisner: Now, that's a sobering number.
Aaron White: Oh, it's very concerning. Suicidality, suicide attempts, major depression, all of those things are going up at a very alarming rate among our young people.
Emily Paisner: How as parents can we have constructive conversations with our kids about alcohol, and how can we model good behavior for them when it comes to drinking responsibly?
Aaron White: As parents, our behaviors are on full display for our kids, as we're all stuck at home together. This is a very challenging time. It's also a very important time to try to model healthy coping. The best thing we can teach our kids right now is how to deal with this pandemic and all of the stress it brings in healthy ways, because our kids are paying attention, even if they don't know they're paying attention. They learn by seeing how we handle situations.
That also means that if we're drinking more, our kids are going to see that and the message they'll get is that that's how adults cope. I don't think there's ever a time when it's too early to start talking to kids about alcohol. You can explain these things to kids in grade school, what alcohol is, why people drink it, why kids can't drink it and why adults sometimes do. I think that we should have these conversations, but it's the modeling that probably has a bigger impact than even the conversations that we have.
Emily Paisner: I think it would be great if we can leave our listeners with some resources that you may be able to recommend for those who are listening and thinking about cutting back or even stopping drinking altogether.
Aaron White: My institute, NIAAA, has two resources that I think are very valuable. One of them is called Rethinking Drinking and you can find that just by googling "Rethinking Drinking." What Rethinking Drinking is, is a website that allows you to explore your drinking, go through the clinical criteria for an alcohol use problem and see how your drinking fits into that framework. There are tips on there for how to cut back, a lot of information about how much alcohol is in different types of drinks.
Importantly, if you go through those steps and you find that maybe you're drinking more than is healthy for you, then it links to another resource, which is called the Treatment Navigator. What the Treatment Navigator does is helps you find help. That could be, particularly now, online meetings, but there are still plenty of resources available to get help if you decide that you want to change your relationship with alcohol.
Emily Paisner: Aaron, thank you so much. I think those resources will be really helpful for people. I know I've learned a lot today and I'm sure our listeners have, too. Thank you so much for joining us.
Aaron White: Oh, my pleasure. Thank you for having me.
Outro: Thanks for listening to this episode of Equal Parts. See you next time.
Emily Paisner: Wait, before you go, I just want to tell you a little bit about Care@Work by care.com. They work with some of the world's largest companies to offer family care benefits to their employees. If you're one of the lucky ones who already has care benefits at work, use them. If you don't, ask for them. It's a real lifesaver. To learn more, visit care.com/careatwork. Again, that's care.com/careatwork.