Alcohol in the news. Should we or shouldn’t we?

The cost of avoiding emotional pain.

Feb 06, 2023

Brian Lynch, M.D., Chicagor your health.

In medicine, our job is to work towards an ideal. Yet it occurs to me that that is a rather new orientation for Medicine. Medicine is still, mainly, a reactionary endeavor. Something goes wrong and we try to fix it.

Decades ago I thought that prevention should be at the forefront of the practice of medicine. A moment's thought shows that’s been an involving and moving target.

40 years ago medical schools were teaching that you just need to eat a varied balanced diet. What exactly what that was we didn’t know.

Now, of course, there is constant instruction about the prevention of disease in terms of diet, exercise, and sleep, unfortunately much more in the media than the exam room.

These are ideals. How do we implement them? Can people implement them? What are the psychological impediments to implementing them?

Several examples of what I am speaking: When jogging was all the rage I was becoming more interested in the psychological aspects of medicine and I quickly realized that jogging has an enormous amount to do with your personality and, of course, your life situation. A big influence in not being gung ho and recommending that was my self-knowledge that at the time I didn’t even want to walk around the block.

To begin with when we speak of these things it’s all well and good that they are ideals and we are coming to these conclusions but for the vast majority of the population much of it is unattainable. You may know all of it, all of the right things to do but on the other hand, you work the night shift. or you get up at 4 AM to go to work albeit it your a night person. Or you are a musician that stays up three nights a week until 4 AM entertaining. And the reader can fill in the blanks for their life.

I realized I couldn’t suggest to a single mother with four kids and 50 pounds overweight that she jog 2 miles a day.

That is one angle to think about these things as far as life circumstances and the limitations put on us by that external world. Then there is the internal affective world, the emotional world.

Another example from my clinical experience is smoking.

I will say more in a minute but any substance use legal or illegal, moderate or immoderate has to do with some kind of self-medication. Smoking is self-medicating. It starts as a medication for being comfortable in social situations or treating distress and or shame for more familial or biological problems. It ends up being very much an avoidance of withdrawal symptoms albeit the psychological problems are still there.

In Illinois, several years ago, public smoking was banned. During the follow-up to that and after I never heard a discussion about the fact that people were medicating themselves by smoking and what would happen if you take away that medication?

Years later I have heard nothing about that.

There is, I suppose, a subconscious universal idea that the reason people smoke, or drink is simply to feel better. But it’s a difficult thing to wrap your head around and that is: OK feel better, does that mean that they were feeling bad? Now, I think the perception is that you were feeling good, and you want to feel better than you were. Yes, you were already feeling good. Now you want to get “high”. This is a natural thought but it comes from ignorance. It is avoiding thinking about deep issues, it is a lack of empathy, a lack of understanding of why people do things.

I wondered OK, you stop public smoking and raise the cost of a pack of cigarettes to $15. There is a dramatic decrease in smoking. Expenditures on healthcare for smoking-related issues go down. What I am saying is do we even think of the consequences, the negative consequences, of people quitting smoking? Does drinking go up? Does domestic violence go up?

I remember a person who had quit smoking. A person that was very frugal and poor and who took care of his mother. Several times he had come in and complained about still not having any money. And I was wondering if there is something that is compensating for the lack of cigarettes. And I didn’t have to ask him or it was like just before I was going to ask him he said: “doc I know what’s wrong I’m gambling more!” He was spending the money he saved on lottery tickets.

Spending money on gambling is exactly equivalent to the energy produced in processing the unpleasant emotional states that he was treating with nicotine. He is now treating it with the thrill of buying a lottery ticket and hoping to win.

I’m providing a link to an article about the statistics concerning drinking.

So, we are only supposed to drink at a maximum of two drinks a week. Yet we can attribute at least 100,000 deaths per year in the United States to drinking. and 25% of people admit to binge drinking (five or more drinks at one sitting) in the last month. In my experience I think that these numbers are substantially underreported. This all points to some kind of disconnect in the community.

Recently, I’ve come across statistics showing that it is quite likely that 36 % of doctors and lawyers have an issue with alcohol.

The overall idea is that our lifestyle and living arrangements in this country are not the best. There is a ton of discussion about sleep. I suppose it is in the news and on the radar one, because we know so much more about it now but two, because we aren’t getting enough sleep. Many lectures on sleep start with the idea or start with the fact that we aren’t getting enough sleep.

I always try to go to the root causes. What is driving everything. Which highlights another problem and that is we tend to isolate activities as such as we focus on alcohol as if it is isolated, an isolated problem. OK, we have to focus on things, we have something called channel capacity. We can only focus on one issue at a time. And we want to improve how we handle that issue. But we should give some thought to how it interacts with society in general and how it is similar to other issues and driven by root causes that manifest themselves in a myriad of ways.

But let’s say some specific things about alcohol and the basic reasons for its existence.

There’s probably not a culture in history that has not discovered alcohol.

Its mind-altering properties are legend and have been celebrated from the beginning.

What does alcohol do? It is processing unpleasant emotions that have been backed up. Shame in particular but also anger,fear, and distress.

But you say I only use it socially. It is a great social drink. It’s only the other guy. Or a joke among doctors is an alcoholic is someone that drinks more than I do.

But even the occasional cocktail is doing something. It is managing your affect, and your emotion. A teacher of mine says that it lyses shame. To lyice is a term from biochemistry and it means “to cut”, chemical cuts another. Alcohol lyses shame.

My favorite way of describing this is that if you walk into a cocktail party with an open bar or a cash bar, it doesn’t matter, but then an open bar will get things going quicker. If you would record the decibel level in the room over 90 minutes what would you experience? I believe by 90 minutes you will have to raise your voice in a crowded room to be heard in a conversation.

Shame means the uncomfortable feeling you have when walking in the room: am I smart enough, will l I have anything to say or are my clothes all right, and what if so and so is here?

Am I being negative here? Am I being nihilistic?

I hope I’m being realistic. I hope I’m pointing out that everything is connected to everything else. Pick your poison, everyone is managing their emotional turmoil in different ways. Domestic violence, school shootings, opiate overdoses, exercise addiction, and shopping addiction, all of them are some kind of self-medication. It is to say we are human. We try to fit into a complex and difficult and dangerous world. In ancient times much of this process was taken care of by the tribe and ritual. We have less and less of that. i think we tend to think about these things as “the other” , I assure you they are not the other they are just the tip of the iceberg. We have met the enemy and it is us.

My point is do what you can to improve your life and improve your health. Try not to beat yourself up as that only leads to some kind of further self-medicating. Monitor yourself for problems such as my patient that turned to gambling after he quit smoking and spent all his money anyway.

What is your internal environment telling you and what can you do about it? That will get to the root of the storm.Unfortunately, that’s a lifelong process.

Drinking, smoking, and all other forms of avoidance of pain are not going to go away.

It sounds nihilistic but what I’m trying is to also to avoid shaming and humiliating people who look at the high standards Medicine is setting and think to themselves that they are a failure because they can’t keep up with those standards. It’s medicine's job and I’m glad prevention is more emphasized now. It must needs do this but needs always to be compassionate.

FACT SHEET ON ALCOHOL

Some important recent research on the biochemistry of drinking.

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