What Alcohol Does to Your Body: Harvard’s Dr. Sarah Wakeman With the Medical Facts You Need to Know

1. 0:00 – 5:05

   Intro

   1. MRMel Robbins0:00

      Do you even know what's happening in your body and your brain when you consume alcohol? I don't.

   2. SWDr. Sarah Wakeman0:06

      It impacts our behavior, our sleep, our mood, and many other parts of our body system.

   3. MRMel Robbins0:11

      When a lot of people make a cocktail at home, it's like glug, glug, glug, glug, glug, and there's three shots right there.

   4. SWDr. Sarah Wakeman0:16

      Higher risk drinking would be if you're having more than 10 ounces of hard alcohol a week or 35 ounces of wine (bell dings) in a week.

   5. MRMel Robbins0:22

      We reach for the alcohol at night, but we don't really understand what's happening and how it's actually impacting your experience of your life day-to-day. Hey, it's your friend, Mel. I am so glad that you're here, and whether you're listening today for yourself or because someone that you love shared this episode with you, I wanna welcome you to the Mel Robbins Podcast family. It's a real honor to just spend some time with you today, and I also wanted to acknowledge you for something. You know, you could be listening or watching a bazillion things right now, but you chose to spend your time listening to something that can help you create a better life, and I just think that's so cool. And today's episode in particular is not only gonna help you do that, it could change your life or the life of someone that you love. Today on the show, you and I are getting a masterclass from one of the world's most respected and renowned experts on alcohol and its impact on your body, your brain, and your life. I am really excited that you're here with me today, and I've been looking forward to this conversation for a long time, and I'm gonna tell you why. Because I've been focused recently on getting super intentional about creating healthier habits, particularly around exercising more and taking better care of my brain, and the more that I do that, the more I've been questioning my relationship to alcohol. Maybe you've been questioning your relationship with it too. I mean, if you kinda think about it, here you are eating all this healthy food and exercising and taking your supplements and trying to learn and grow, and then you basically end the day, if you're like me, by washing down a High Noon or a glass of wine or a gin and tonic. If you put it in that context, it's kinda dumb. And I don't know if you've ever been in this situation where you go to see your primary doctor and they ask you that question, "So, how many drinks do you have a week?" (gulps) (laughs) I, I can't be the only one that has lied to their primary care doctor before because you suddenly know that the number's a little higher than it should be. I mean, I've been in that situation, and the more that I find out about alcohol, and I'm talking the facts, the more I'm thinking, "I gotta do something about it." I have questions. Is there any health benefit to drinking? Is there any amount of alcohol that you can drink that's actually healthy for you? Is the only answer that's available don't drink anything at all? Alcohol is constantly marketed to you and me. It's like the thing that you need to have a great weekend, you gotta have it for a tailgate, you need it for every celebration, it's what you grab when you wanna wind down at night. Do you even know what's happening in your body and your brain when you consume alcohol? I don't. Do you know how it interferes with the medications that you're taking? And here's how I wanted to approach this today. I don't wanna lecture you. I want you and I to feel empowered with facts because when you feel empowered, when you understand something at a deeper level, don't you feel more motivated and, like, really capable of making better choices for yourself? Of course you do. And one more thing I wanted to point out to you. If you're worried about somebody in your life and they're drinking, this episode is a world-class resource for you. Just share it with them, because if you haven't been able to get through to them about how concerned you are, I guarantee you our expert today will make them rethink their relationship with alcohol. Dr. Sarah Wakeman is here, and she is one of the most renowned medical experts in the entire world. She's gonna break down how alcohol impacts your health, your body, and your mind. Dr. Wakeman is the senior medical director of substance use disorder at Harvard's Mass General Brigham, which has been ranked as the number one research hospital in the entire world. After studying at Brown University, Dr. Wakeman did her residency at Mass General, which is the best program in the country, where she was also the chief resident, which means she was the number one medical resident in her class. She is an associate professor of medicine at Harvard Medical School and the program director of Mass General Addiction Medicine Fellowship, and she squeezed us into her extraordinarily busy schedule, and she is here today in our studios in Boston to spend time with you and give you and your loved ones the facts, the science, and the research so that you and the people that you love can make an informed decision about the role that alcohol plays in your life. So please help me welcome Dr. Wakeman to the Mel Robbins Podcast.

   6. SWDr. Sarah Wakeman4:54

      I'm so excited to be here. Thanks for having me.

   7. MRMel Robbins4:56

      Well, thank you for taking the time out, because I know you have an unbelievably busy schedule, so let's just jump right into it. So, Dr. Wakeman, can you

2. 5:05 – 5:45

   What is alcohol and what does it do when we drink it?

   1. MRMel Robbins5:05

      explain what even is alcohol and how does it affect our bodies?

   2. SWDr. Sarah Wakeman5:10

      Sure. So alcohol is a molecule. It's a water-soluble molecule that is readily absorbed in your body through your stomach and your small intestine when you drink it, and it affects all different parts of your body and body systems, in particular your brain, which is why we feel the effects of alcohol pretty soon after you start drinking. And we can talk through what those effects are, but it impacts our behavior, our sleep, our mood, and many other parts of our body system.

   3. MRMel Robbins5:35

      You, uh, talked about alcohol as a molecule. That sounds very science-y to me. (laughs) So what kind of molecule is it? Like, is it, you know, like

3. 5:45 – 6:18

   How is alcohol formed in the first place?

   1. MRMel Robbins5:45

      is it a poison? Is it, like, could, could you explain more about the makeup of what it actually is?

   2. SWDr. Sarah Wakeman5:50

      Yeah, so I mean, the way alcohol that we drink happens is through a process called fermentation.

   3. MRMel Robbins5:55

      Mm-hmm.

   4. SWDr. Sarah Wakeman5:55

      So, um, something that has sugar, like grape juice, or if you think about, um, beer, you know, barley or potatoes or other, um, often starches are fermented, and in that transformation process, they form an alco- they form an alcohol molecule that then has a different effect on our body. Alcohol's found in all sorts of different things. So obviously, it's intentionally made through fermentation to ingest, but we also

4. 6:18 – 7:50

   Wait. Alcohol that we drink is the same as WHAT?

   1. SWDr. Sarah Wakeman6:18

      use it in cleaning products or, like, rubbing alcohol or mouthwash, um, hand sanitizer. So there are alcohols all around us and used for many different things.

   2. MRMel Robbins6:28

      Huh. Well, when you say the category cleaning, hand sanitizer, rubbing alcohol, thinking about uses in a hospital, and then I put that in the same...... almost family, as something you would ingest in a cocktail. Is it the same molecule?

   3. SWDr. Sarah Wakeman6:46

      It is. And in fact, some of m- my patients with the most severe forms of alcohol use disorder will drink hand sanitizer or rubbing alcohol or mouthwash if they can't get regular alcohol, which tells you really the power of addiction once someone gets to that level of severity. But it's the same molecule with the same effect.

   4. MRMel Robbins7:04

      I just already had something that I learned that is ... I- I- if, if you're watching us on YouTube, you can, you can see that my mouth is agape. I don't know why I never connected the dots on that, that it is actually the same chemical.

   5. SWDr. Sarah Wakeman7:19

      Exactly. The actual alcohol molecule that we think of in a fancy, you know, cosmopolitan, is not different from what's in rubbing alcohol, let's say.

   6. MRMel Robbins7:27

      I never knew that. Like, I think that's an- an indication of just how much we engage in it and don't really think about what we're doing.

   7. SWDr. Sarah Wakeman7:39

      Absolutely. I mean, that ... It is so socialized, and a part of culture, and a part of celebrations and events that I think it just feels like a part of life.

   8. MRMel Robbins7:48

      Are there negative impacts

5. 7:50 – 9:58

   Are there negative impacts to having a drink every night?

   1. MRMel Robbins7:50

      to having, like, a beer or a glass of wine every night? I mean, how does that impact you?

   2. SWDr. Sarah Wakeman7:55

      Yeah, so this is probably the most fascinating area of research, where things have changed and gone back and forth over many decades of science, and it's actually a somewhat tricky question to answer, which is why I think there have been very confusing sometimes and conflicting studies about this. Um, so if you wanna try to understand what is the impact of low-risk drinking, moderate-risk drinking, higher-risk drinking, you have to figure out, how do you study that? So you would need to follow a population over time to see what happens and then you need to figure out, how do we isolate the effect of alcohol? And so early on, there were lots of studies showing that low-risk drinking or moderate-risk drinking were actually healthy.

   3. MRMel Robbins8:30

      I think I remember something about, like, a glass of red wine is really good for you, the antioxidants. I don't know if that's the red wine lobby telling us that.

   4. SWDr. Sarah Wakeman8:38

      Yeah. One criticism of those, um, studies showing that low-risk drinking is healthy is that the group that is often used as sort of the comparison group are people that don't drink at all, but it turns out that many people who don't drink at all may not be drinking because they have chronic health problems-

   5. MRMel Robbins8:53

      Mm-hmm.

   6. SWDr. Sarah Wakeman8:53

      ... or because they actually used to have an alcohol use disorder and they're now in remission or recovery, and they may have health consequences that are leading to higher mortality compared to people who are drinking at a low-risk or infrequent level. So a lot of the newer studies have actually used infrequent drinkers as the sort of control group or the comparison group, and I think that's really helpful to understand the data that way. Um, there was a really big study actually this year that looked at hundreds of thousands of people that had been surveyed since the 1990s all the way through the mid, um, 2000 and teens, and did a really elegant job of trying to answer this question. And the things they did differently than other studies is first they controlled for other healthy behaviors, lifestyle behaviors, chronic conditions-

   7. MRMel Robbins9:35

      Mm-hmm.

   8. SWDr. Sarah Wakeman9:36

      ... 'cause one question is a person who's drinking a glass of wine a day, maybe they're also running every day and, you know, doing other sort of health-promoting behaviors, and maybe that person who's chosen not to drink at all has lung cancer and that's the reason (laughs) they're not drinking. And so they actually controlled for all of that, and they did see that in the low-risk category, there seemed to be a slight decrease in mortality, and it was not true for cancer.

6. 9:58 – 10:40

   Know THIS about alcohol, especially if cancer runs in your family.

   1. SWDr. Sarah Wakeman9:58

      So any amount of alcohol is associated with an increased cancer risk, and that's a really important thing to know, especially if someone has a personal family history of cancer. Breast cancer is one that's strongly associated with alcohol use-

   2. MRMel Robbins10:10

      Wow.

   3. SWDr. Sarah Wakeman10:10

      ... and so factoring that in as you're making your decisions about alcohol is really important.

   4. MRMel Robbins10:15

      Um, what is it about the molecule of alcohol that increases your risk for cancer?

   5. SWDr. Sarah Wakeman10:23

      You know, it's different for every type of cancer, and I think we're- we're just starting to understand this. Um, if you take breast cancer, their things that seem to increase hormone levels are often associated with a risk of cancer, so I think that's an area of active research to understand why alcohol and breast cancer in particular are so closely linked.

7. 10:40 – 12:45

   What alcohol does to your liver, and how you can change that.

   1. SWDr. Sarah Wakeman10:40

      Other types of cancer, it's a little more clear. They tend to be cancers of the liver or the gut that are strongly associated with alcohol, and that makes sense if you think of alcohol as a potential poison going into your gut, being metabolized by your liver, causing changes there. That's an area that we do see a lot of cancer risks.

   2. MRMel Robbins10:57

      Can you talk about what you're seeing as it relates to alcohol and liver failure, or just how it's impacting people's livers?

   3. SWDr. Sarah Wakeman11:07

      Yeah. So one of the main health harms from alcohol, especially heavy alcohol use, is liver damage. And so what we see happen is this progression where the first thing that happens is inflammation of the liver, and when your liver gets inflamed, you start getting fat deposit in the liver. So the first kind of step is what we sometimes call fatty liver, so it's fat deposition in your liver. Um, that actually can totally reverse if you stop drinking or you make changes, um, and that's the amazing thing with the liver. It's a really regenerative organ, so you could cut 80% of someone's liver out and they would be okay, but there is a point where you cross a threshold where you can no longer repair the damage, and that's when you get to a stage called cirrhosis. So from fat deposition, then you start getting scarring. Your body lays down all this scar tissue because of the chronic inflammation in your liver, and when your liver becomes so scarred that it's really stiff and- and starts not functioning well, that's cirrhosis. And we often used to think of cirrhosis as something that happened to people, like, decades down the road.

   4. MRMel Robbins12:03

      Yeah.

   5. SWDr. Sarah Wakeman12:03

      I'm seeing people in their early 30s with cirrhosis in the hospital.

   6. MRMel Robbins12:07

      What?

   7. SWDr. Sarah Wakeman12:07

      And I think those are, like, some of the most heartbreaking cases 'cause people thought ... Like, this wasn't on their bingo card. They did not even think this was a concern. Um, you know, they were drinking heavily, they thought it was so- their social circle was doing the same thing, um, and then all of a sudden they're in their late 20s, early 30s in the hospital in liver failure, um, and, you know, there's very little we can do at that point other than an organ transplant, which is a huge deal and not something that's accessible to everyone.

   8. MRMel Robbins12:33

      Is this something that you're seeing happening-... increase at a younger and younger age?

   9. SWDr. Sarah Wakeman12:37

      Yeah, and there's actually a lot of studies showing this. So between, you know, 2010 and 2020, there's been a significant increase

8. 12:45 – 12:50

   How does alcohol impact your kidneys?

   1. SWDr. Sarah Wakeman12:45

      in alcohol-related liver failure, especially amongst women and younger and younger people.

9. 12:50 – 13:50

   This recent event increased alcohol use in the U.S.

   1. SWDr. Sarah Wakeman12:50

      And even just after the onset of COVID, we saw somewhere around a 25% increase in alcohol-related death after the onset of the pandemic. So, the pandemic was hard for many reasons, but it certainly increased alcohol use across the country, and with that, liver disease and liver failure.

   2. MRMel Robbins13:05

      Wow. How does alcohol impact the kidneys?

   3. SWDr. Sarah Wakeman13:10

      So alcohol, one of the main effects that people have probably experienced is it makes your kidneys less sensitive to a hormone your body produces, um, called ADH or antidiuretic hormone, and so you pee more. So if anyone's ever noticed that when they drink, they sort of pee a lot more.

   4. MRMel Robbins13:26

      And it's not because you're hydrated, 'cause that's what I thought is why-

   5. SWDr. Sarah Wakeman13:28

      Yeah.

   6. MRMel Robbins13:28

      ... you pee more is 'cause, "Oh, I just have more liquid in me." But it's actually because it's blocking a hormone?

   7. SWDr. Sarah Wakeman13:34

      Exactly. So, even irrespective of how much volume you've drank, you pee more because of this blocking of the effect of a normal hormone function in your kidney, and so that can lead to dehydration, which is one of the many reasons you feel really crummy the next day, because you get dehydrated from drinking.

10. 13:50 – 15:15

    Does alcohol damage your gut microbiome and does it matter?

    1. MRMel Robbins13:50

       What about the gut microbiome? We're learning so much about the importance of healthy gut. How does alcohol impact that?

    2. SWDr. Sarah Wakeman13:58

       Yeah, so, um, alcohol, I think there's growing research on how it impacts the microbiome. Um, certainly, again, at heavy levels, it seems to harm the microbiome, and we see this in patients with liver disease, but also just the impact of alcohol itself. The kind of two main things it does, one is it creates, um, more leakage in your gut. So people may have heard of kind of leaky gut. Um, you know, your- the walls of your intestine become more porous so that, um, so that things that aren't meant to come i- out of your intestine do and can actually cross the br- blood-brain barrier. So this whole idea of kind of the brain-gut axis is a really growing area of, of, um, research and knowledge. Um, so alcohol can do that. It can also change the makeup of your microbiome itself, um, as can high fat, high sugar, white flour, sort of the Western diet. Um, but there's now a lot of studies showing that- that some of the modifiable things, if you wanna im- improve your gut health, are decreasing your alcohol consumption and steering away from that kind of Western diet of high fat, high sugar, high carb.

    3. MRMel Robbins14:57

       You know, I'm sitting here listening to you and I'm thinking, "Why the hell do I even drink this stuff?"

    4. SWDr. Sarah Wakeman15:02

       Yeah, I think it is important to understand sort of what are the risks that we often don't talk about and assume that this is, you know, a harmless thing that's just a part of life. My personal perspective is that every health behavior exists on a spectrum-

11. 15:15 – 18:15

    Ask yourself these 3 questions to assess the role alcohol plays in your life.

    1. SWDr. Sarah Wakeman15:15

    2. MRMel Robbins15:15

       Mm-hmm.

    3. SWDr. Sarah Wakeman15:15

       ... and it's really understa- uh, important to understand sort of, what is that spectrum, where do I fall, and then what are my personal health goals? And actually stopping to sort of think, "How does alcohol fit in my life? Like, what do I like about it? What do I not like about it? What am I worried about it? What is this amount of alcohol doing to my health?"

    4. MRMel Robbins15:31

       Is there any health benefit to drinking alcohol?

    5. SWDr. Sarah Wakeman15:35

       My opinion is that we shouldn't be thinking of it as a health benefit, so I would never as a doctor say to a patient, "I think you should start drinking a glass of wine a day for your health."

    6. MRMel Robbins15:43

       (laughs) It's true.

    7. SWDr. Sarah Wakeman15:44

       We used to... People used to say that. You know, again, this idea of a glass of red wine is healthy. Um, I think that framing is wrong. I think that doesn't mean that you can't drink any alcohol, and we should talk through that. But thinking of it as a health-promoting behavior is probably not the best way to frame it. Now, there are many things we do in life that the safest thing would be to do none of it.

    8. MRMel Robbins16:04

       Right.

    9. SWDr. Sarah Wakeman16:04

       So if your goal is to have zero risk, you should probably never drive your car, never go skiing, you know, never fly in an airplane, never eat bacon, never go out in the sun, and people aren't gonna live that way. So I think it's really important to understand sort of what are the risks, how does this fit into my overall life, and when should I be concerned, and how can I actually make changes to decrease those risks? So if you're finding that you are really stressed in your life and you're reaching to alcohol as a stress reliever, it's probably not gonna be a healthy way of coping with that-

    10. MRMel Robbins16:31

        Mm-hmm.

    11. SWDr. Sarah Wakeman16:31

        ... and may lead to longer term problems. And especially if you're trying to live a life where you're being more mindful or more present or present for your kids or your partner or, you know, you're trying to get in shape and you wanna wake up in the morning to exercise, if you're drinking every night you're probably gonna feel not refreshed in the morning, you're gonna notice that, you know, you don't have the same exercise capacity. So I think just figuring out sort of how this ritual, alcohol, what role it plays in your life. And it doesn't have to be that you stop drinking entirely, and I think that's a really important message, 'cause that may not be the goal for people. But if you are feeling like, "Maybe this is causing some problems to me, maybe this is actually counterproductive to my other health goals," making some changes, cutting back, taking a break, those are all really healthy ways that you can start to really explore your relationship with alcohol.

    12. MRMel Robbins17:16

        Y- you know, I love the fact that you are a specialist in addiction and you have a very realistic approach, because I do agree with you that it does feel like it's either you're all in or you're all out. I think for a lot of people, it is scary to feel like there's only one option, which is you either drink or you don't. And for many people, not drinking at all is the, the absolute empowering option. But I love what you're saying, which is you need to wake up and understand what your motivators are and what you actually care about in this moment in your life. And if you care about producing more at work or being more present or reaching your potential, you gotta look at the role that alcohol is playing in your life.

    13. SWDr. Sarah Wakeman18:06

        Yep.

    14. MRMel Robbins18:07

        So from a medical perspective, how much drinking is too much drinking?

    15. SWDr. Sarah Wakeman18:12

        Yeah, so from a research standpoint, higher

12. 18:15 – 19:15

    How much drinking is too much, from a medical perspective?

    1. SWDr. Sarah Wakeman18:15

       risk drinking would be if you're having more than 10 ounces of hard alcohol a week or 35 ounces of wine in a week for a woman or for anyone over 65. So above that, we start seeing health risks like increased risk of dementia, impact on your liver, your digestive tract, and other serious conditions.

    2. MRMel Robbins18:31

       Uh, you know, I'm just sitting here thinking about you as a physician and a researcher, and how I think a lot of us lie to our doctors about how much we're actually drinking, and that we're not even aware of what the serving size truly is, because when a lot of people make a cocktail at home, it's like glug, glug, glug, glug, glug, and there's three shots right there.

    3. SWDr. Sarah Wakeman18:51

       Yeah.

    4. MRMel Robbins18:52

       Or you've had a number of big glasses of wine, which basically mean you have had all seven glasses of wine in one night-

    5. SWDr. Sarah Wakeman18:59

       Yeah.

    6. MRMel Robbins18:59

       ... and thinking, "Oh, oh, I've just had a couple glasses." But I bet as you are seeing somebody get a scan, there's probably times where you're like, "Yeah, that's somebody that has, is a very heavy drinker, 'cause I can see it on the brain."

    7. SWDr. Sarah Wakeman19:13

       Yeah, and I think there's so many important points buried

13. 19:15 – 20:45

    Here’s why many people don’t share their alcohol habits with doctors.

    1. SWDr. Sarah Wakeman19:15

       in that. So first, we all lie. I tell my dentist I floss every day.

    2. MRMel Robbins19:18

       (laughs)

    3. SWDr. Sarah Wakeman19:18

       I don't. We want people to like us and approve of us, so I sort of expect people will lie to me, especially if they don't know me.

    4. MRMel Robbins19:24

       Right.

    5. SWDr. Sarah Wakeman19:24

       And for most people, because of the tremendous stigma around substance use disorder, um, there's a lot of shame and worry. For many people, their experience has not been that good things happen to them when they share that they're having a problem with alcohol or other drugs.

    6. MRMel Robbins19:38

       Mm-hmm.

    7. SWDr. Sarah Wakeman19:38

       And so as a doctor, I feel like it's on me to earn someone's trust, and also to educate them. I mean, there's nothing more heartbreaking to me than when I see someone, you know, in the terminal stages of liver failure, for example, from alcohol, and no one has told them beforehand, like, what the risks are, that this is go- that this could happen, what sort of lower-risk drinking looks like. They've often never had that conversation. So we'll see people in their 30s come in, they literally die during that hospital admission, and you look back and they had touchpoints with doctors. They maybe were drinking heavily, and no one stopped to sort of talk to them about it. And I think that is a real testament to f- how, in the medical system, for so long, we have seen substance use and addiction as something separate from the rest of healthcare, as sort of not our job, or-

    8. MRMel Robbins20:23

       Mm-hmm.

    9. SWDr. Sarah Wakeman20:23

       ... a behavioral issue, or a moral issue, or a willpower issue. But this is a health condition like any other, and I think, um, the medical system and doctors need to get comfortable talking to patients about it, asking them the right questions, giving them the right education, and partnering with people around making healthy changes.

    10. MRMel Robbins20:40

        When you sit with somebody that comes into, um, your practice, how do

14. 20:45 – 25:20

    7 questions to ask if you or someone you love has a problem.

    1. MRMel Robbins20:45

       you help them figure out their relationship with alcohol? Like, what are a list of symptoms that you would say, "These are all indications that this could be a problem"?

    2. SWDr. Sarah Wakeman20:59

       Yeah, that's a great question. So I'll run through kind of the checklist that I'm thinking when I'm talking to someone about alcohol. So first, um, you know, understanding how much they're drinking, just the general quantity and how frequently is important as sort of a proxy for what their risk might be. But then the really important questions are, um, are they drinking more than they want to? So are they, they may have set an intention for themselves, and they're finding they're actually always drinking more, or spending more time on drinking or recovering from drinking than they intended. Have they tried to make changes and not been able to? So have you tried to cut back or tried to stop and you actually weren't able to? That's a really important sign that you may have lost control of your drinking. Are you drinking despite the fact that people in your life are worried about it, or your spouse has expressed concern, or it's impacting your work or your ability to function in roles that matter to you? Are you drinking despite the fact that it actually makes you more anxious, or it's worsening your mental or physical health in some way? And then we often think about craving, which is sort of a strong psychological urge to want to drink, so that, like, you can't get the idea of having a drink out of your mind. That's something that we can see with alcohol use disorder. And then there are two physical symptoms, which is that idea of, like, do you need to drink more to get the same effect? So do you need to drink four drinks now, whereas before, one or two would give you that effect? And do you feel sick if you stop drinking? So that's sort of the checklist we run through, and I think really gets at those kind of general areas of losing control, using compulsively, using despite consequences, and then craving.

    3. MRMel Robbins22:16

       That was so helpful. And one of the things that really resonated with me is that you've tried to quit, you drink more than you want, you feel anxious, and yet you continue to do it, and you're in this cycle of wishing you could get control over this, and yet feeling like you can't. And yet, if you, you know, aren't stumbling around at night, or you feel like I am able to, like, carry on a conversation, I'm not blacking out, I'm not getting behind the wheel of a car, there's this assumption that it is under control. But I love how you just defined it, because you're m- you're making us really look at ourselves, and ask ourselves the honest question, which, "Is it really?" And even just that question, "Are you drinking more than you want to be drinking?" If you answer that question honestly, and whether you're listening right now for yourself or you're listening for somebody that you love that you're concerned about, this is an amazing starting point, because we're not bickering about how much you're drinking. We're not bickering about your behavior. We're, we're really talking about the honest answer to, what is your relationship to it, and do you actually have control over your ability to use it or not use it? And that is powerful. Now, Dr. Wakeman, where I wanna pivot to next is I'm starting to see this picture where, as a researcher and a renowned expert on this topic, that you are talking about kind of the big risks that can happen. I wanna focus a little bit on amplifying the day-to-day impact-

    4. SWDr. Sarah Wakeman23:50

       Mm-hmm.

    5. MRMel Robbins23:51

       ... that most of us are not present to.

    6. SWDr. Sarah Wakeman23:54

       Yeah.

    7. MRMel Robbins23:55

       That we reach for the alcohol at night because, at least in my own experience, it's like an easy lever to pull to say to my brain, "We're no longer working." This is the, the thing that I do as my ritual to move into the evening, to have a glass of wine. But we don't really understand what's happening and how it's actually impacting your experience of your life day to day. I wanna take a quick pause so we can hear a word from our sponsors, and I also wanna remind you that if you're worried about somebody, send them this episode right now as you're listening to our sponsors, because oftentimes they can't hear it from you. But hearing it from somebody like Dr. Wakeman, who has such a balanced approach and is a renowned expert on this topic...It might actually just be the thing that gets somebody to wake up and wanna do better. So I'll be waiting for you after a short word from our sponsors. Thank you for sharing this with anybody who needs to hear it, and I'll see you right after the break. Welcome back. I'm Mel Robbins, and I'm so glad you're here. Thank you, thank you for sharing this episode with absolutely anybody in your life that you believe needs to hear this. You and I are spending time today with Harvard's Dr. Sarah Wakeman. So Dr. Wakeman, can you explain to us what are some of the other day-to-day things that people experience when they drink that they might not realize is related to drinking?

    8. SWDr. Sarah Wakeman25:16

       Yeah, it's a great question. So one really common thing is worsened acid reflux. So if

15. 25:20 – 26:10

    Physical symptoms of alcohol overuse.

    1. SWDr. Sarah Wakeman25:20

       you have heartburn, that's strongly associated with alcohol, which actually relaxes the part of your esophagus that allows acid to come back up. So oftentimes, people are struggling with terrible heartburn and they don't realize that those two glasses of wine are probably having a direct impact on that. Other things, we know that alcohol can make you dehydrated, so you may notice that your skin changes. It impacts how you sleep, so you may feel less rested when you wake up in the morning or wake up in the middle of the night and not be able to fall back asleep. So lots of little sort of day-to-day ways that alcohol may be impacting your health and your experience.

    2. MRMel Robbins25:51

       What are some of the benefits that you would experience almost immediately if you quit drinking entirely or you cut way back? What kind of health benefit would you experience in your day-to-day life?

    3. SWDr. Sarah Wakeman26:04

       Yeah, you'll see a lot of really quick things. So one, you'll sleep better and feel more restored. You may lose weight. There's a lot

16. 26:10 – 27:05

    7 benefits you’ll see pretty quickly once you stop drinking.

    1. SWDr. Sarah Wakeman26:10

       of calories in alcohol, so if your goal is to lose weight, you're drinking a ton of liquid calories, so you may find that that's better. You may find that your exercise capacity goes up 'cause you're resting more and you're not having hangovers and you're able to exercise in a way that feels different. You may find that you're less irritable and more present for your loved ones, that your mood is actually better over time. Your skin might look better. You're less dehydrated. Your hormones are more regulated, so you may have less acne. So all of those benefits you can often see in a very short time, and that can be reinforcing as you decide what you want your long-term goals to look like to really see what life is like with less or without alcohol.

    2. MRMel Robbins26:44

       How does alcohol impact the range of women's hormones from estrogen to progesterone to, to s-, like all of it? How does it impact your hormones?

    3. SWDr. Sarah Wakeman26:55

       Yeah, this is, I think, an area of growing research and understanding, and I think people are really interested in sort of drinking during menopause as well and what, you know, what are the, what, what to think about

17. 27:05 – 28:50

    How does drinking make menopause worse?

    1. SWDr. Sarah Wakeman27:05

       all of that. Um, a couple things. I think many of the symptoms that people experience during menopause, like hot flashes, will be made worse by any amount of alcohol.

    2. MRMel Robbins27:12

       Really?

    3. SWDr. Sarah Wakeman27:13

       Yes. Because alcohol dilates your blood vessels. So you may have experienced if you drink a couple glass of wine, you actually feel flushed-

    4. MRMel Robbins27:19

       Yes.

    5. SWDr. Sarah Wakeman27:19

       ... and feel warm. Well, it's just gonna amplify the experience you're having during hot flashes. So if you're trying to not have hot flashes, drinking is gonna be your enemy in that 'cause it's just gonna make that worse. Same things like sleep disturbance are really common in menopause, mood changes, and alcohol may impact all of those. And it can be a tough cycle 'cause you may be drinking because your mood's actually low and you're having a hard time falling asleep, but then alcohol's actually running counterproductive and making those symptoms worse over the long haul.

    6. MRMel Robbins27:43

       Let's talk a little bit about sleep because-

    7. SWDr. Sarah Wakeman27:46

       Yeah.

    8. MRMel Robbins27:46

       ... doesn't alcohol impact your sleep in a very negative way?

    9. SWDr. Sarah Wakeman27:50

       Yeah, and people may be surprised to hear that 'cause it makes you fall asleep quicker.

    10. MRMel Robbins27:53

        Yes.

    11. SWDr. Sarah Wakeman27:53

        So often people are like, "Oh, alcohol helps me sleep 'cause I fall asleep so quickly." But when we think about sleep architecture, there's different cycles to sleep. People are probably familiar with, like, REM sleep is that deep, um, you know, rapid eye movement sleep. But there's different cycles that your body, your brain naturally cycles through in the night, and the balance of those cycles is really important to get restorative sleep, which is when your body rests and heals. And what alcohol does is it changes the makeup of those cycles, so you go more quickly into deep sleep and you have less time in dif-, in sort of the normal phases of sleep. And so your sleep architecture is disrupted and you don't get that same restful sleep. So you may wake up at 2:00 in the morning, you know, after you've fallen asleep really quickly, but then you wake up and can't fall back asleep. Or you may wake up in the morning and just feel not refreshed even though you were completely, you know, asleep very deeply because your brain is not having the time to restore itself the way that it needs to.

    12. MRMel Robbins28:44

        I have another question, Dr. Wakeman. Can you walk us through what's happening in your body in terms of what we call a hangover?

18. 28:50 – 29:00

    Think alcohol makes you sleep better? This is what actually happens.

    1. MRMel Robbins28:50

       So you've had your night out, you've had a bit of alcohol, right? And you wake up. What, what, what is a hangover,

19. 29:00 – 32:15

    What’s a hangover and what happens in your body?

    1. MRMel Robbins29:00

       and what is actually happening in the body as you withdraw from the alcohol?

    2. SWDr. Sarah Wakeman29:04

       Yeah. Hangover is fascinating, and there, I think people are still trying to understand exactly what is going on. Sort of loosely defined, what we refer to as hangover often is a, is a sort of constellation of symptoms that include headache, um, feeling anxious, often actually having diminished sort of, um, exercise tolerance, so your, um, you can't, you don't have the same aerobic capacity that you did before, um, feeling irritable. Those are all sort of symptoms of hangover that people have probably experienced. There is an older school of thought that actually it was mild alcohol withdrawal.

    3. MRMel Robbins29:35

       Hmm.

    4. SWDr. Sarah Wakeman29:35

       So withdrawal is when you're drinking so much that when you stop drinking, you actually get symptoms. Seems like that is likely not the case. The constellation of symptoms is quite different. And so the thinking is that it's a combination of really two things. One is dehydration. Um, so we already talked about how alcohol make you, um, you know, make you pee more, and so you get dehydrated. And then the other is actually byproducts from the drink that you're drinking itself, either the, the sort of breakdown products of alcohol or there are certain types of liquors and drinks that have, um, other types of molecules, congeners, that, um, can build up and make you feel even crummier. So for example, clear alcohol tends to cause less of a hangover than dark alcohol, and that's probably because of the other substances that are in it. But it's really sort of toxic byproducts and dehydration, if I were to sum it up, of what's causing a hangover.

    5. MRMel Robbins30:22

       Why is anxiety one of the biggest...... kind of symptoms of a hangover and alcohol withdrawal?

    6. SWDr. Sarah Wakeman30:30

       Yeah. It's probably the effect of these byproducts that then, you know, are still impacting your, the way your body functions, your brain, and it takes a long time for your body to excrete them. Um, and so we can see, see just feeling that really anxious, restless kind of gross feeling afterwards.

    7. MRMel Robbins30:44

       Does, um, alcohol impact cortisol or any of the other kind of hormones that are in your brain that are playing a part in anxiety?

    8. SWDr. Sarah Wakeman30:53

       Yeah, it does, especially over time. And so what we see when people have drinking, have been drinking over a long time is actually your body starts to adjust, 'cause our bodies are very adaptable. So if your body's used to having three or four drinks every night, your body's gonna start to accommodate to that. And so what we see is actually changes in the brain. So you see changes in the amount of receptors you have, the amount of hormones you have, your dopamine levels, your stress hormone levels. Um, so your brain is actually adapting to the effects of alcohol. So one thing you may see is that you actually don't get the same effect. So it used to be that two glasses of wine made you feel a certain way and now you need three or four to s- feel the-

    9. MRMel Robbins31:28

       Hmm.

    10. SWDr. Sarah Wakeman31:29

        ... same way. That's a concept called tolerance, that your body is adapting to having that alcohol around all the time and your brain's actually changing. The reverse of that is if all of a sudden you stop drinking, you're gonna feel all out of sorts. You're gonna feel shaky, you may have a headache, you may feel anxious, you may feel nauseous. Um, and that's because your body's gotten so adapted to always having alcohol on board that it takes time actually for those changes to reset.

    11. MRMel Robbins31:52

        When you really stop and think about the roller coaster you're putting your brain and your hormones and your body through, like it does make you pause, and that's kinda, that's what I wanted to do with this conversation is to make you stop and think about what's actually happening-

    12. SWDr. Sarah Wakeman32:09

        Yeah.

    13. MRMel Robbins32:10

        ... and the reasons why you reach for it. Can you talk a little bit about, um, for

20. 32:15 – 33:30

    This is how alcohol increases anxiety and depression.

    1. MRMel Robbins32:15

       anybody that's taking prescription drugs for anxiety or depression the impact that alcohol can have?

    2. SWDr. Sarah Wakeman32:21

       Yeah. There's a couple really important things to know. First, alcohol itself can cause depression and anxiety. So if you are, even though you feel like in the moment it's helping relieve symptoms, there's actually something called a substance-induced mood disorder where you can get, you can look f- all the world like you have depression and it's actually caused by using alcohol heavily over time. So you may, if you're drinking heavily, you may actually be running, you know, working again at cross purposes with your efforts to try to manage your depression or anxiety. The other thing is there are some types of medications that are really dangerous when they're mixed with alcohol, and anxiety medications in particular, especially any medication that also has sort of a slowing down effect. So some people take medicines in a class called benzodiazepines, so things like Xanax or Klonopin or Ativan. Those when mixed with alcohol have sort of a combination effect that can actually slow down your breathing, could cause an overdose, could make you very sick, could make you more sort of impaired sooner. Um, so really important to not mix those medications with alcohol.

    3. MRMel Robbins33:22

       Wow. How does alcohol compromise your memory?

    4. SWDr. Sarah Wakeman33:26

       So alcohol affects all parts of the brain including the amygdala,

21. 33:30 – 37:45

    Keep forgetting names and important information?

    1. SWDr. Sarah Wakeman33:30

       which is an area that lays down memory. Um, and it, you know, has complicated actions in the brain, so it increases sort of, um, more slowing down hormones. So we think of it as a depressant, um, because it sort of slows you down and relaxes you, um, and it decreases more exciter, excitatory neurotransmitters. Um, in the short term because your sort of, your consciousness is being affected, you won't be making new memories. Over the long term, heavy alcohol use can actually cause dementia. It can cause severe memory problems. There's actually a, a unique condition that we only see with alcohol generally where the part of your brain that lays down new memories gets damaged and people, um, get basically an amnesia syndrome where they can't make new memories, so they can only remember things from the past but they're unable to make any new memories. And that's a very extreme example, but we see it in the hospital and it's really scary when it happens.

    2. MRMel Robbins34:24

       What do you see when you look at a brain where somebody's been a heavy drinker versus somebody that's occasional or very light?

    3. SWDr. Sarah Wakeman34:31

       We actually see brain damage on people who've had chronic heavy alcohol use over many years. So if you, um, take a picture of the brain, like with a CAT scan or with an MRI, um, what we describe it as is volume loss. So normally you want to see a big, healthy, robust brain, and as you age and with types of dementia one thing that we see is the brain starts to shrink. So, like, the actual functional parts of the brain are smaller. We see that process accelerated with heavy alcohol use. So often take, uh, someone who's in their 50s who really shouldn't have volume loss of their brain at that age, but if they've been using alcohol at a very heavy amount for a long time, we'll often see their brain looks like a much older brain, um, because of that shrinking. And then there are very extreme examples like this rare memory condition where we literally see that part of the brain almost die, like you can see it light up that it's been, um, severely impacted.

    4. MRMel Robbins35:19

       That's scary.

    5. SWDr. Sarah Wakeman35:20

       It is really scary.

    6. MRMel Robbins35:22

       Um, we have so many listeners around the world who flooded us with questions when we told them that you were gonna be here, and a lot of them are about how to deal with somebody that they love and they're drinking.

    7. SWDr. Sarah Wakeman35:36

       Yeah.

    8. MRMel Robbins35:37

       And so I really want to hear your advice about what specific things you should do and what mistakes we need to avoid when there's somebody in our lives that we're concerned about. Like, how do you approach this? What's the best way to bring it up? What is the worst? And by the way, I want to remind you that if you're thinking about somebody in your life, while the sponsors are talking to you, please share this episode. Let Dr. Wakeman talk to your loved one. It could be a life-changing gift for them to hear this. So thank you in advance for being generous with sharing this with people that you love. And I'll be waiting for you with Dr. Wakeman after a short break. Welcome back. I'm Mel Robbins and you and I are here today with Harvard's Dr. Sarah Wakeman. Dr. Wakeman, I'd love to get your counsel on what you would recommend to somebody if your spouse doesn't think they have a drinking problem but it's a problem for you.

    9. SWDr. Sarah Wakeman36:30

       Yeah, I think these are such important questions, and, um, one of the greatest tragedies to me around substance use disorder is often family members and the general public have been fed the wrong thing to do, and so I think it's a great thing to talk about. First, it's important to define sort of what is an alcohol use disorder 'cause that's sort of what we're getting at. Um, you know, there's- there's heavy drinking where we're worried about the long-term health effects, and then there is where alcohol's become a problem in your life, and really the definition of an alcohol use disorder is losing control over your drinking, compulsive use of alcohol, and using despite consequences. So, if you are continuing to drink despite the fact that your partner has shared that they're really worried about you, or you've started to have problems at work 'cause you're calling out sick, or, um, you're continuing to drink despite health problems related to it, so your doctor says, "You know what? Your liver tests are elevated. You really need to cut back on drinking," and you continue to drink, those are all signs that alcohol's started to play a different role in your life. About 15% of the population will have an alcohol use disorder in their life, so this is a very common health condition, more common than many other conditions we see. The great news is that it's entirely treatable. Most people will get well. I think we often have in our minds that this is like a terrible, stigmatizing, recalcitrant condition that no one ever gets better from. That is not true, and, um, that notion that this, you know,

22. 37:45 – 38:50

    What to do and NOT do when talking to someone about alcohol.

    1. SWDr. Sarah Wakeman37:45

       is something to feel hopeless about I think drives a lot of the stigma and shame. There is good treatment out there. People will get well, but they do need care and they need support. So, I think the first thing you can do if you're a loved one is just share your worries, not in a way that blames the person, not in a way that's judgmental, but in a loving way just like you would about anything else with someone's health, that this is what you've observed, this is why you're worried. Explore what the person thinks, and that becomes really important, because when it comes to addiction, it really doesn't matter at all why I think someone should make changes to their alcohol use. The only thing th- that matters is they think their life will get better in some way. And so, really starting to sort of untangle what are this person's goals and how is alcohol getting in the way of them reaching it, that becomes the work, and a partner can be a wonderful mirror for that. "You know, I know you're working towards a promotion at work, and you mentioned that you had to call it sick twice this week and your boss is frustrated at you. What do you think about that?" So, really exploring it, and ultimately you're sort of empowering the person to feel like they can make a change and that you're supporting them, but you're not forcing it on them, which is often what people feel, you know, caught up in- in having to do.

    2. MRMel Robbins38:47

       What is the mistake that you see people making?

    3. SWDr. Sarah Wakeman38:49

       I

23. 38:50 – 42:00

    Why a tough love approach doesn’t work for alcoholics.

    1. SWDr. Sarah Wakeman38:50

       think people have heard these notions of, like, tough love, enabling, hitting bottom. Those are probably the biggest fallacies. So, for people who aren't familiar with those concepts, the idea that tough love is that, like, you really should make things hard on a person, that- that if- if sort of consequences pile up, the person will ultimately get better.

    2. MRMel Robbins39:06

       Mm-hmm.

    3. SWDr. Sarah Wakeman39:07

       Enabling is the idea if that you're kind or caring to someone, that you're actually hurting them in some way, and hitting bottom is this idea that people have to just fall so far and get- get some- suffer some terrible consequence before they make a change. Those are all really problematic concepts for a couple reasons. So, first of all, the definition of alcohol use disorder is not being able to stop despite bad things happening to you, and many people are drinking 'cause it's a powerful coping mechanism, and some of the things that put you at risk for an alcohol use disorder are traumatic life experiences, untreated anxiety and depression, not feeling good about yourself. So, having the only people that you sort of love and trust in your life try to cut you down to size and tell you that you're doing something terrible and set some ultimatum is actually not gonna help you get well. None of us make hard changes when we feel threatened or sort of punished or not supported. We do it when we feel loved and safe and have hope that our life could be better. And so, as a loved one, that's probably the greatest gift you can give to the person. Now, it's complicated because you're impacted by their behavior.

    4. MRMel Robbins40:03

       Yes.

    5. SWDr. Sarah Wakeman40:03

       So, it's very easy as a provider, one of the things I love about doing this work, 'cause I've been on the other side and had family members and it's a different experience, as a doctor, like, whether or not my patient continues to drink doesn't impact me personally. I can just be their partner, their champion, work with them. For families, there are times where the behavior becomes so unsafe that people have to keep themselves safe and set boundaries, and that's okay. I think the, um, distinction there is that, uh, it's not doing it for the person's benefit, so if you kick someone out of your house, it's not gonna necessarily help them get better, but there may come a time and a place where people need to do that for their own emotional safety or well-being.

    6. MRMel Robbins40:40

       Mm. Mm.

    7. SWDr. Sarah Wakeman40:41

       Um, but for that human being, to help someone get well, and this is where earlier conversations are so important, is to really sort of love and support them and- and work together on it, and make sure they find access to good treatment, which is out there and available.

    8. MRMel Robbins40:53

       I wanna kind of just hover on this point, that if somebody's reaching for alcohol and it's become a coping mechanism for dealing with stress or dealing with a, like, uh, health issue or mental health issue or whatever, insecurity, it's terrifying to give up the coping mechanism.

    9. SWDr. Sarah Wakeman41:12

       Yeah.

    10. MRMel Robbins41:13

        And what do you see when it comes to that psychology of you're somebody whose family is like, "You have a problem and we're worried about you," and yet it keeps on going? Like, how does shame or that fear that you have of, "Well, I can't actually get through if I don't have the alcohol," or, "I... It's just easier," and, "Wh- what's the problem with having a glass of wine or two a night?"

    11. SWDr. Sarah Wakeman41:42

        Yeah. So many important pieces in there. I think there's so much stigma in our society about alcohol use disorder and substance use disorder, um, and people, rightfully so, feel really ashamed and secretive, and sometimes long after they've started to worry about themselves, they're scared to tell anyone else because they think someone will judge them

24. 42:00 – 44:25

    Why most people avoid seeking help with their relationship to alcohol.

    1. SWDr. Sarah Wakeman42:00

       or treat them poorly. And that stigma and fear of bad treatment or judgment actually keeps people from seeking help for a long time. I think the other really important piece is that when you're removing something that has played a powerful role in someone's life, you need to fill up those spaces with other things.

    2. MRMel Robbins42:16

       Mm.

    3. SWDr. Sarah Wakeman42:16

       I think our sort of Puritan roots as a society is we have this idea that, like, you're doing something bad, you need to just pull yourselves up by your bootstraps and knock it off and white-knuckle it, and- and in fact, like, it should be hard, you know? That's often our sort of, these ideas of tough love and hitting bottom is like, "Well, you're- you're, like, have done something bad and you, uh, you know, you don't have willpower, so we're gonna make it tough on you," when in fact, like, the broader concept is why would someone make changes and how is their life gonna get better and how do we make it easy to make a change? And so, if you think about any change you made in your life, if you set yourself up for success, you're gonna be far more likely to be able to make that change. So, if you're suffering from trauma, depression, anxiety, you're not gonna be able to just stop drinking without help. You need help.... treating the anxiety, depression, trauma, and also treatment for the alcohol use disorder. That's not because you're weak, that's not a failing, and if you're not able to sort of meet your goals with whatever intervention and support you're getting, that's a sign that that support is not enough for you. So, really shifting from this idea that the person is failing to thinking, like, the system-

    4. MRMel Robbins43:19

       Mm-hmm.

    5. SWDr. Sarah Wakeman43:19

       ... the treatment, the resources are failing, and how do we adjust that instead of blaming the human being who's suffering.

    6. MRMel Robbins43:25

       I just wanna thank you. I think it's very refreshing because so much that you listen to on this topic is, "Don't drink," and I kind of expected, Dr. Wakeman, you to come in here and just take your fist and slam it on the counter and talk about the lives ruined from alcohol, and, you know, you might have that experience in your family as you're listening to us, but what she's saying is you have to understand how somebody is feeling and what's actually gonna work to get them to want to see that something else is possible for them. So Dr. Wakeman, I- I have another question for you. A lot of parents writing in about college-aged kids and binge drinking and 20-somethings, uh, that are also drinking too much. Do you have any, like, scripts or lead-in sentences to even broach this topic? Because I feel like most of us don't know how to even bring it up.

    7. SWDr. Sarah Wakeman44:19

       Yeah, I think ideally it starts young. Like, ideally you're having these conversations very early on with kids in a pragmatic,

25. 44:25 – 45:40

    What’s the most effective way to talk to your kids about drug use?

    1. SWDr. Sarah Wakeman44:25

       not in a scare tactic way. So we know that things like DARE, you know, this, like, "I'm gonna scare you into this is what alcohol and drugs do to your brain," actually f- kids use more drugs after seeing that sort of stuff.

    2. MRMel Robbins44:34

       (laughs)

    3. SWDr. Sarah Wakeman44:34

       It's not helpful. Kids see right through adults when they're sort of all or nothing about things. So, having these nuanced conversations about, like, "You're gonna be around friends who are drinking really heavy. What do you think about that? What's been your experience? What are some of the worries you might have about that?" And talking about the very practical risks that are not necessarily, like liver failure or addiction, which are not gonna be resonant for a 19-year-old, but, you know, hav- getting into a situation that doesn't feel safe, you know, getting into a sexually vulnerable position with someone, doing something that you don't wanna do, missing class the next day. So talking about sort of relevant personalized issues that may come up for that kid, and then importantly, making the pers- that your child feel safe talking to you. You know, you want them to feel comfortable coming to you about small things so that they'll come to you about big things, and so you can share all of this in a way that doesn't feel judgmental, doesn't feel accusatory, really opens the door to ongoing conversations instead of making someone feel sort of, you know, like they're being blamed or judged by their parent.

    4. MRMel Robbins45:28

       So for somebody that's never even broached this-

    5. SWDr. Sarah Wakeman45:30

       Mm-hmm.

    6. MRMel Robbins45:31

       ... and alcohol is in the family, like, this is a thing that's really triggering for all of us, is there a way to break down the conversation

26. 45:40 – 47:00

    The 5 most important things to communicate to someone you love.

    1. MRMel Robbins45:40

       just so that the person listening can, can take from us, or, you know, take from this conversation, "All right. I'm going to express my feelings, then I'm gonna ask them about theirs"? Because most people get really defensive-

    2. SWDr. Sarah Wakeman45:55

       Yeah.

    3. MRMel Robbins45:55

       ... when you talk about this, and then that just shuts down the conversation.

    4. SWDr. Sarah Wakeman45:58

       Totally. Um, well first of all, it is not too late. You have not failed. We- it- none of us are perfect in this. These are hard conversations, and we haven't learned how to do it. Um, so it is never too late. It doesn't matter how many times you've ignored it or had a, you know, an unproductive conversation. Um, I think in that moment, probably the most important things you can communicate are, "I love you. I'm worried about you. I'm here for you. I know that treatment works. This is how I can support you." So, like many things, you're sort of talking about yourself, you're talking about your care and concern, you're rooting everything in how much you love this person, and you're offering to be a partner in helping them find support and treatment. And it may not happen that day. It usually doesn't. So often, the journey to recovery is a circuitous journey of a thousand small steps. It's very rarely that dramatic leap we see on TV. And so to not give up hope and to know that those small moments of kindness and support actually are progress and are part of the person's journey to ultimately getting well.

    5. MRMel Robbins46:54

       Um, if you're the one that really just wants to cut back...

    6. SWDr. Sarah Wakeman46:59

       So if you're listening

27. 47:00 – 49:40

    The 3 important first steps when you’re the one who wants to quit.

    1. SWDr. Sarah Wakeman47:00

       and you wanna cut back on alcohol use, I think first figure out your why.

    2. MRMel Robbins47:03

       How do you help them figure out their why as it relates to their relationship with alcohol?

    3. SWDr. Sarah Wakeman47:08

       Yeah, I think understanding first how alcohol fits in your life, and so people can do this at home by just keeping a drinking diary. So even just jotting down on your phone or in a notebook when you wanna have a drink, sort of what activities you associate with drinking, what, you know, when you do have a drink, how many drinks you have over what time periods. It's sort of like keeping a food journal where it actually just makes you more mindful of like, "Oh, I'm, like, triggered to wanna snack on this thing because I'm feeling really upset about this fight I just had." You can identify that with alcohol too. Like you mentioned this earlier, "I'm really stressed out at the end of the day and so I come home and wanna reach for a glass of wine." Um, understanding sort of how alcohol fits in your life is an important first step, and then figuring out what are the goals you're working on right now, and that could change over time. But again, if your goal is something related to fitness or wellness or health, you may find after learning more about alcohol and the role it plays in your life that actually you wanna change how much you're drinking, um, and so then you have your why. My why is I'm, you know, training for a marathon and I've found that when I drink I have a hard time waking up and going for my long runs, and so I'm only gonna drink on this day and I'm gonna keep it to this amount. So it's very specific, and that's important for behavior change. If you make this broad sort of general goal of, "I'm never gonna drink again 'cause alcohol's bad,"-

    4. MRMel Robbins48:17

       (laughs) Yeah.

    5. SWDr. Sarah Wakeman48:17

       ... you're probably not gonna do it 'cause that's hard and it's- doesn't really relate to you as a human. So as much as you can make it specific, measurable, time-bound, so it's like, "The next three weeks I'm gonna try this and then I'm gonna reassess," um, that makes it much easier to actually make change and stick to it over time.

    6. MRMel Robbins48:34

       Well, that's great advice 'cause I feel like so many of us have had that experience where you go to a big wedding and you're like, "That's it, I'm never drinking again. I d- can't do this to myself." And three days later, you're going out for somebody's engagement and now you're like, "Ah, I should just have a glass of wine," and you're back in it.

    7. SWDr. Sarah Wakeman48:50

       Yeah.

    8. MRMel Robbins48:50

       And so I- I think getting very clear about what are your goals, and I'm willing to bet if you write down your goals, that you're gonna see that alcohol-... is not helping any of them.

    9. SWDr. Sarah Wakeman49:03

       Exactly. And there's lots of tips out there, but you wanna make it as easy as possible for yourself. So if your goal is to cut back on drinking, you don't wanna have a week where you're packed with going out to happy hour with people. You wanna really set yourself up for success, so organize your social activities around non-drinking activities. Come up with a plan if you're gonna be in a situation where you would normally drink, that you're gonna have a glass of club soda in your hand the minute you walk in the door, you're gonna have a friend who knows that you're working on this who's gonna be your partner. Setting those intentions and those ideas and tools and tricks ahead of time will make it way easier for you to ultimately reach that goal of cutting back.

    10. MRMel Robbins49:35

        If you don't feel supported by your family or your partner or friends,

28. 49:40 – 51:40

    How can you get the support you need?

    1. MRMel Robbins49:40

       what advice do you have for people to nego- to navigate that?

    2. SWDr. Sarah Wakeman49:44

       Great question. I think first, letting people know about your intention, so sharing what your goal is is really important 'cause people can't support you if they don't know. And if you've always drank a certain way with your partner or friends and all of a sudden you're not, they're not, they're gonna be like, "What's going on?"

    3. MRMel Robbins49:57

       Mm-hmm.

    4. SWDr. Sarah Wakeman49:58

       Whereas if you say to them, "Hey, guys, I know you love me and support me. I wanna share with you that my new goal is to, you know, not drink more than one drink a day or only drink on Friday and no more than two drinks," or whatever, or, "Not drink at all, and this is my why. I'm doing this because I'm worried about myself," or, "I'm doing this because, you know, it feels counterproductive to my health and I really want your support, and this is how you can support me." So then you're really framing it as they get to be a partner with you. You're not criticizing their drinking, 'cause often people feel then like, "Oh, I'm a little self-conscious. This person's gonna be judging me, or they think I'm bad." You're just asking for their help. And so maybe that looks like instead of meeting for drinks, you meet to go to a yoga class, or you meet to go for a run, or, um, you know, you let the person know why you're gonna be or- ordering a soda water instead of a drink. And so you can be really concrete both for yourself in what those tools look like, but also for the people in your life, um, to signal to them how they can help support you. And sometimes people can't do that, and that happens whenever we make any big change.

    5. MRMel Robbins50:51

       Mm-hmm.

    6. SWDr. Sarah Wakeman50:51

       People may have experienced that if they decided to have a weight loss journey or change their life in some way, that there are people that really fit in our lives for certain points and that can't journey with you through that transformation, and that's sad. Um, but if you find that despite those conversations someone is actually destructive to the change that you wanna make and not supportive, then that may be a broader question about sort of the role of that relationship in your life.

    7. MRMel Robbins51:15

       I thought I knew a lot about this topic, and it just goes to show you, there is always something new you can learn. So I have another question, Dr. Wakeman. What is your message to someone who is struggling with their relationship to alcohol?

    8. SWDr. Sarah Wakeman51:28

       Yeah. I think I'd like to just talk for a moment about alcohol use disorder 'cause I think we've been covering sort of the health harms of alcohol use, either at a low risk level or moderate level or high level. For anyone who is struggling with alcohol use disorder

29. 51:40 – 53:52

    What to know if you have an alcohol use disorder.

    1. SWDr. Sarah Wakeman51:40

       or is worried they may be struggling with alcohol use disorder, treatment works. You will get well. Finding sort of a trusted healthcare provider that you can partner with is a part of that journey, but to really have hope. This is not a hopeless condition. It will not be with you forever. You will be in a place where you're free from this. And there are treatments that are out there and just getting those, much like you would for depression or diabetes or high blood pressure is the most important thing. And this is not an issue of shame or willpower or being bad. And, um, I hope that people will feel like they can come in and get the help that they need.

    2. MRMel Robbins52:11

       And for the person who had this conversation shared with them from a family member who's probably concerned about their drinking, what is your message to that person?

    3. SWDr. Sarah Wakeman52:22

       It can be really hard to hear this, especially in a society that still stigmatizes alcohol use and alcohol use disorder. I think take this as a message of love. Someone loves you. They're care- they care about you. They're sharing their worries, and they're there to support you. And they wanna be a part of this journey to help you live the best life you can possibly live in whatever way that means. And hopefully it will be a moment to pause and think and get the support you need to make some changes.

    4. MRMel Robbins52:47

       Well, Dr. Sarah Wakeman, thank you so much for being here with us today. Thank you for the work that you're doing. You really are changing and saving people's lives, and we appreciate the time and how much wisdom you poured into us.

    5. SWDr. Sarah Wakeman53:00

       Thank you, Mel, for having me. This was a true pleasure, and hopefully these words will reach people who are working to better their lives or are worried about someone they love.

    6. MRMel Robbins53:07

       And I wanna also just make sure that you listening, that in case nobody else tells you, that I tell you, that I love you and I believe in you. I'll talk to you in a few days. And to you, you're here with me on YouTube, I wanna be sure to tell you, I love you, I believe in you, and I believe in your ability to create a better life. And I hope everything that you learned today makes you feel empowered to do that. So please hit subscribe because that's one way that you can really support me in bringing you this content every single day. And I know you're thinking, "What's the next thing that I can watch, Mel?" Let me tell you. You're gonna wanna watch this, understanding yourself, the number one thing you need to do to live an authentic life.

Episode duration: 53:52