There’s nothing wrong with one or two drinks after work. Or is there?
As I write about substance abuse concerns for us physicians, I could have easily started with worst-case scenarios, or cautionary tales. Some of the risks of alcohol use have been known for decades, if not centuries. But what about moderate use? When does it become abuse?
With regular information and studies about the potential positive and negative effects of alcohol consumption, and with the credibility these studies frequently lack, it’s hard to give definite advice based on the “truth” of real science regarding many lifestyle choices, including alcohol consumption.
There has been a more public health-oriented model of assessing alcohol risk championed by Dr. Mark Willenbring, the former Director to the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The US government guidelines recommend men consume no more than 14 drinks a week (one drink is a beer, a glass of wine or an ounce of liquor), and women no more than 7 a week. This recommendation was primarily based on a study that associated longevity with alcohol consumption. There is minimal recent information to update these guidelines. The Mayo Clinic Report and the NIAAA website agrees with the government guidelines for ‘moderate alcohol use’, and describe risks which increase with heavier use. The Mayo report begins with noting the current mixed message of potential balance of benefits and risks of alcohol use but concludes that “no one should begin drinking or drink more on the basis of potential health benefits.”
This leaves us with an incomplete risk management assessment for the use of alcohol and we are left to acknowledge the decades old model of consequences. However, this framework does not even begin to address concerns associated with cannabis use (in the context of changing legality and standards), opiate use (legitimate prescribed use versus clearly abusive use), stimulant and benzodiazepine use (legitimate versus abusive), and the use of other potentially ‘addictive’ options.
So back to the question at hand.
Is there anything wrong with one or two drinks after your responsibilities have been taken care of for the day? Probably not—there is probably nothing significantly wrong with enjoying an evening cocktail, wine or beer, but when has the day really ended and your responsibilities been successfully addressed and taken care of? This rings true especially today with EMR’s, 24/7 communication and other responsibilities. One can only address this for themselves, with their family and loved ones and with colleagues who you share responsibilities.
There are simple warning signs of alcohol abuse: Poor sleep, feeling tired and slow in the morning (hangover), missing details, isolation, mood changes, irritability and lack of involvement, to name a few.
Weight changes, blood pressure elevation, heartburn, tremors, shakes, headaches (symptoms of withdrawal) and others overtly questioning you with concerns about your behavior and appearance. These signals often come before you have encountered problems with slurring words on a phone call, a colleague (or patient) smelling alcohol on your breath, or being late, or even missing work, from the hangover.
Stress management is a tricky business. Always has been. As the pace of our world continues to accelerate, and the constant electronic availability increases demands on us, stress management becomes more of a challenge. As the draw to reward ourselves with a drink after work increases, or the desire to relax with alcohol, or seek relief with the use of other drugs (either self-obtained or prescribed to us for symptoms of stress and anxiety), we can be slowly drawn into a self-absorbed world, away from healthy behaviors and rewards, such as spending time with others, exercise, hobbies, participating in activities of purpose and meaning or even involving ourselves with the variety of effective meditative and burnout strategies.
We must always behave as though the Board of Medicine is watching us, through the eyes and ears of the people we work and to ensure patient safety.
Physician Well Being Resources members can contact VITAL WorkLife to talk with a professional confidentially about their concerns before they become life-changing problems. You might also begin by accessing information and tools on the NIAAA website.
VITAL WorkLife offers support to help members manage stress and can also help members assess and define when stress has become a clinical issue (but is still solvable and fixable). In addition, VITAL WorkLife can help members understand when substance use is placing you or your loved ones (and your patients or perhaps your organization) at risk, and how to access resources to help yourself with any of these concerns. These VITAL WorkLife solutions include:
So help keep the drink at the end of the day a safe and enjoyable experience, and get your questions addressed before they become problems for you and the people you care about. Contact VITAL WorkLife online or at 877.731.3949 for more information.
Sources:
https://www.niaaa.nih.gov/
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/alcohol/art-20044551