Holiday Harmony: Balancing Tradition and Well-being

Amy Stark, M.D., an addiction psychiatrist with Texas Tech Physicians, discusses the challenges of maintaining sobriety during the holidays. She emphasizes the importance of non-alcoholic options at parties and suggests strategies for those struggling with addiction, such as bringing their own non-alcoholic drinks and using visual cues like holding a drink to deter pressure. Dr. Stark highlights the impact of alcohol on the brain's decision-making processes and the differences in alcohol tolerance between men and women. She also stresses the importance of community support and professional help for those seeking to quit or cut back on alcohol use, cautioning against abrupt cessation due to potential withdrawal risks.

Transcript

Melissa Whitfield  0:09 
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and to stay healthy with help from evidence based advice from our physicians, health care providers and researchers. Maybe it's cold outside, but you do need to mind what's in your drink, especially if you're either abstaining from or watching your alcohol intake. These next few months are a challenging time for people who struggle with addiction. Dr Amy Stark, an addiction psychiatrist at Texas Tech Physicians, tells us that alcohol often plays a central role in how we connect with others during the holidays, it also can exacerbate existing mental health issues for some. In this episode, Dr Stark gives us those recommendations as to how to still socialize and connect with others, even if we choose not to drink. She also gives us suggestions for hosts or party planners to keep in mind when it comes to serving beverages, above all, don't drink and drive.

Melissa Whitfield  1:28 
Dr Stark, welcome to our podcast.

Dr. Amy Stark  1:30 
Thank you for having me.

Melissa Whitfield  1:32 
Can you tell us a little bit about yourself, your expertise and what you do at the Health Sciences Center?

Dr. Amy Stark  1:37 
Sure. So I have been back at Texas Tech with School of Medicine in Amarillo since 2018 and that was coming back home, because I did graduate from Tech for medical school. I escaped for a bit and did my training in general psychiatry at the Mayo Clinic, and then I did a fellowship in addiction psychiatry at Yale, before coming back to the HSC as faculty. So now I wear a number of hats. I am the Regional Department Chair of Psychiatry. I'm the clerkship director for Psychiatry on the Amarillo campus, and I still have a full clinic where I see people with all kinds of psychiatric and substance use issues.

Melissa Whitfield  2:16 
Well, thank you again very much for coming on our podcast. It seems like you're very busy, but thank you for taking time to talk to us about struggling with addiction and this time of year. What is it about this time of year that makes it a challenging time for those who struggle with addiction?

Dr. Amy Stark  2:32 
Yeah, the holidays can be tough for for a lot of people, but particularly folks who have, you know, pre existing substance use issues or psychiatric issues, or both. It can be even though so many of us think about the holidays as a time to come together and celebrate, it can also be a very isolating time for a lot of people, and that's an easy trigger, an easy reminder for people to lean into coping strategies that maybe aren't the healthiest. It's also, as I'm sure everyone listening is aware a really stressful time. There's so much to do during the holidays. We're trying to wrap up everything at work. At the end of the year, we're trying to plan perfect family get togethers and make sure that everything's just right under the tree for our kiddos. So there's, you know, the stress of being picture perfect, feeling isolated, and just all of those feelings coming together can be a trigger for people to reach for a substance in a way that isn't healthy. And on top of it, just the increased number of festivities. We all know that Tis the season to eat, drink and be merry. So just the increased availability of alcohol at every single social event really makes it a little bit scary of a time for someone who's really trying to maintain their sobriety.

Melissa Whitfield  3:53 
What are some of the things party planners can keep in mind when making plans to celebrate, including midnight toast. I mean, I know people have been getting together since probably Halloween, so we have Halloween, Thanksgiving, birthdays, other celebrations. What do we do for those parties?

Dr. Amy Stark  4:12 
I think there's a couple really easy things that people hosting can do to help accommodate all their guests, including people who may want to drink less, or people who don't want to drink at all, and the first thing is just making sure you have non alcoholic options available. Water, sodas, tea, anything? And making it an easy option, and not that someone has to go and seek it out, because the only thing available is beer, liquor and wine. The other thing that I think comes from a well meaning place at parties is when a host or a friend is always let me top off your drink. Let me fill you up. Let me get you a drink. And I think if we could encourage people to switch to Can I get you something to drink? Or if someone says no. People trying to be really respectful around that. Or, you know, meeting that, that answer of, no, I don't want an alcoholic drink with what else can I get you? As opposed to, oh, come on. And that, that well meaning peer pressure that does happen at the holidays.

Melissa Whitfield  5:16 
Well, speaking of peer pressure, what are some tips for those who are struggling with addiction, to stay in recovery when they're you know, facing those questions.

Dr. Amy Stark  5:26 
Absolutely, the first thing that I think is so important is to trust yourself to feel confident enough to say no in those situations. I've got patients that will bring their own bottles of water to parties, and there's no problem with that. If you, if you don't think that there's going to be a sober option, a non alcoholic option, feel free to, you know, bring or just ask for the mixer. Can I just have the soda can I just have the orange juice? That way you do have something, but it's not easy for everyone to say, no. There are a lot of people who struggle with that. And so as much as I can sit here all day and say, be confident in yourself, be confident in your answer of, I don't want to partake tonight, that's much easier said than done. So if it is a difficult situation that you find yourself in, and you've got those well meaning friends who want to top off your drink or bring you a drink. One of the little tricks that I have found that works quite often is having a drink in hand. If you're at a party that is using those red party cups, as long as you have a red party cup in hand, it really doesn't matter what's in it. People will assume that you're partaking. If you're at a party that has actual glassware, same situation applies. Get whatever drink that you're going to get, water, juice, a soda, but make sure that you get a lime or a lemon on the edge of that glass. If there's a garnish on it, people will assume that you're partaking, and that will really cut down on the number of times that people will come up to you and say, can I get you a drink? Why aren't you drinking?

Melissa Whitfield  7:07 
Some of us might think that maybe one more drink won't hurt, and then find ourselves drinking more. Why is it that some people seem to tolerate alcohol more than others?

Dr. Amy Stark  7:17 
Yeah, that's a really good question, and when we think about addiction, it's really nature and nurture and not either of them. There are a lot of different things that come to play together when we think about someone's individual risk for developing problems with substances like alcohol. That's why you may have a girlfriend who's able to get a mimosa once a month at brunch, and it's no problem, and she doesn't think about it again until the next monthly next monthly brunch and someone else, where one drink is a really slippery slope that leads them right back into active addiction. So there is a lot of individual risk and protective factors that come to play. But I think another part of your question is, once we start drinking, why is it harder to say, I've had to buy two drinks that I said I was gonna have. I'm done now. Why do we kind of say, well, we'll have one more until we have one more, and it just snowballs. And part of that is, you know, the effect that alcohol has on our brain, and in particular our prefrontal cortex, which is the part of our brain that helps us problem solve and make good decisions. And when we're drinking, that good judgment that we have starts to get overridden by the pleasure parts of our brain, the parts of our brain that are reward seeking, that want that instant gratification. And so once you've had one or two, even if we had planned to say, I'm having one or two drinks at this party and then I'm done that control, that ability to stick to that plan, is gonna be a little bit more challenged just by having alcohol on board.

Melissa Whitfield  9:02 
And there are also differences between men and women, right?

Dr. Amy Stark  9:06 
there are absolutely and oh my gosh, we could have a whole other podcast on this. So depending on you know, the size of your body and how old you are, and what other medical problems you may or may not have, what medications you might be taking, that all has an impact on how our body processes alcohol. And so you know, a man in his early 20s is going to process alcohol very, very differently than a woman in her 70s. And so we have to take that into consideration too, and that, you know, even if you're the same age as someone at the table as you you may not be able to drink the same amount and experience the same effects, because our bodies do have all of these different processes and situations that come to the table when we're thinking about how alcohol is processed.

Melissa Whitfield  9:57 
So we're getting ready to go to a party or an event, does drinking on a full stomach or alternating drinks with water or drinking black coffee help decrease the effects of alcohol?

Dr. Amy Stark  10:09 
I love those questions because they're good questions that mean that people are actively thinking about, how am I going to stay as safe and drink in a responsible way when I'm at this event, making sure that you do eat beforehand, that you've had something to eat can slow down a little bit the absorption of that alcohol. So it's always a good idea to have something in your stomach, or even to drink with a meal if you are going to be drinking, because it slows down the amount of consumption. Alternating with water is actually a fabulous idea. I always recommend that to people who are trying to think about how to drink responsibly around the holidays. One, it slows you down. It decreases the number of drinks that you're able to have over that period of time. And two, we all know that alcohol dehydrates us. That is the main driver for hangovers the next day, really is dehydration. And so making sure that we're alternating with water, it's going to decrease the total amount of alcohol that you're consuming over that period of time, just by slowing you down, but it'll also help your body to just feel better the next day. And as much as I love coffee, I hate to tell you that drinking a black coffee is not really going to help you sober up. What does help is time. It's just the passage of time your body processes alcohol at a consistent rate, and so there's not really anything that we can do to speed up that process once the alcohol has been injested, so making sure that you have enough time to to process that alcohol so that you are not intoxicated, certainly getting behind the wheel, ideally no alcohol, but making sure that enough time has passed since you have had a drink, and having a drink of coffee really isn't going to help them.

Melissa Whitfield  12:07 
This question is more, I guess, for year round, rather than just holidays. Because I was thinking back to when I was younger, and whenever I was at happy hour with friends and didn't feel like drinking, or if I had to go pick up my son afterwards, I would tell my friends that I was on on medication and couldn't drink, and they would just drop it. But can you give us other tips so we wouldn't have to flat out lie on how to respond when people ask why someone isn't drinking?

Dr. Amy Stark  12:34 
Absolutely and I think that kind of comes back to what we were talking about earlier, that even when we say, No, thanks, I'm not drinking, sometimes people still push the issue, and that's why we find ourselves in the situation of saying, Oh, I'm on a medication, or I'm trying to get pregnant, or I'm the designated driver, all of those things that we say that get people to stop pushing, even when our friends are well meaning that that pressure can can feel like a lot, but I think your answer, you know, hey, I'm on a medication. It's going to make me really sick if I drink. That's, that's a reasonable thing to say. I think that the best option. And I wish that we could all feel comfortable saying this is I'm not drinking tonight, and that people would just drop it. But that's not always the case. So the answer of, I'm on medications, I'm the designated driver. I'm not feeling great. I already have a headache. All of those things are appropriate to say if you're feeling pressured, but ideally, we get to a point, both as ourselves who may be consuming and trying to say no, thank you, and also as people hosting parties that were able to respect that No, thank you, that if someone says no, you know I'm not drinking tonight or I don't drink that, we just drop it. We just leave it.

Melissa Whitfield  13:57 
Is there anything else that you'd like to add?

Dr. Amy Stark  14:00 
I always have to talk about making sure that if you're questioning if your alcohol use is a problem, that there are people out there who can help you. We still live in a society where there's a lot of stigma around substance use and addiction, and what we know from looking at the science and working in this field is that people who have alcohol or drug problems, this is a medical problem. It's not a moral one, it's a medical one. And so if you were questioning, if you have an issue, and if you are struggling, if you're having a hard time quitting or cutting back, there are people who can help you talk to your doctors. There are medications that can help. There are therapies that can help. There is help out there. The other really important thing that we have to talk about every single time we talk about alcohol is if you are thinking about quitting, but you've been drinking heavily. Or for a really long time, it's important that you talk to a doctor and not just stop abruptly, because alcohol withdrawal can be very dangerous and even deadly. So if you want to quit or cut back, make sure that you've got backup, that you've got a team to help and support you while you're doing this. The final thing that I always have to talk about when I talk about alcohol is community. One of the most helpful things in recovery is having community, because recovery cannot happen in isolation. And so making sure that you've got a team of support people, whether that's family, friends, people at peer support meetings, your physicians, whoever it is that's in your corner to walk this journey with you, so that you've got someone to turn to when things feel hard and to also celebrate victories with that is such an important part of recovery. But I would just encourage anyone who's listening this and thinking, you know, maybe I should think about my my alcohol use. Come talk to your doctor. We want to help, and there is help out there people can and do recover.

Melissa Whitfield  16:10 
Dr Stark, thank you so much for coming on our podcast and talking to us about this and giving us all these wonderful, helpful tips. And certainly much to think about as we celebrate and celebrate with others.

Dr. Amy Stark  16:21 
Well, thank you so much for having me.

Melissa Whitfield  16:25 
Thank you for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams, Hope Caperton and me, Melissa Whitfield.