Alcohol: Relationship between Stress and Drinking
Guest: Dr. Sarah Book – Psychiatry & Behavioral Sciences
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Sarah Book who is a psychiatrist at the Center for Drug and Alcohol Programs. Welcome to our show.
Dr. Sarah Book: Thank you.
Dr. Linda Austin: Dr. Book, you do some very interesting research on the relationship between stress and drinking. What is that relationship?
Dr. Sarah Book: Not only does stress make an individual more likely to drink, perhaps, but drinking can make stress worse over time.
Dr. Linda Austin: You know, a very typical patient I see, as a psychiatrist, is, let’s say, a businessman in his 50s who has always been a moderate social drinker, but over the years, it increases. What does your research show about why people under stress drink more, and then how that increases their stress?
Dr. Sarah Book: Alcohol helps stress. When you are stressed, and you drink, alcohol makes you feel better. But, over time, alcohol actually makes stress worse. And what I mean is, when you take a drink, you feel better. Very quickly, you start to feel more calm. But we know, not only from research that we do with people, but also research that we do in the laboratory, that, over time, alcohol use makes what we would call your baseline level of stress or anxiety go up. So even though you take a drink and your anxiety immediately goes down, overall, throughout the day, for example, your anxiety is going to be higher than it otherwise would have been if you hadn’t been using that coping mechanism.
Dr. Linda Austin: And you’ve been able to show that even in laboratory animals?
Dr. Sarah Book: That’s correct.
Dr. Linda Austin: So, in other words, there are, for example, elevations of stress hormones?
Dr. Sarah Book: That’s correct. There are different kinds of stress hormones that we can look at. Although, when you go to your doctor with either an anxiety problem or an alcohol problem, they’re really not likely to start looking at your blood to see what kind of stress you’re having. They’re going to talk to you and ask you about how you’re feeling and how you are coping with certain situations under stress.
Dr. Linda Austin: But what you’re saying makes so much sense, that alcohol wouldn’t be a problem if it didn’t help in some way.
Dr. Sarah Book: That’s correct. And, also, because it helps so quickly. One of the things, when we look at behaviors that might not be so good for us but we do them repeatedly anyway is, how much time does it take? When you have that behavior, if you immediately feel better, that behavior is something that you’re going to be more likely to repeat than, let’s say, if you have a behavior, for example, dieting, it’s difficult to diet if it’s going to take you a month to lose a couple of pounds. But when you take a drink, it immediately changes the way you feel. And that’s very reinforcing.
Dr. Linda Austin: So, somebody listening to this, I’m sure, is thinking, gosh, you know, I have a glass of wine at night pretty frequently. Is that amount small enough to make your baseline level of stress go up?
Dr. Sarah Book: There are lots of different researchers that look at the effects of alcohol. There are people who look at the effect of alcohol on stress, the effect of alcohol on the liver, the effect of alcohol on the heart, the effect of alcohol on the bone marrow. And one really interesting thing that comes out of all of that work, even though those people are not talking to each other, is there seems to be a common agreement as to the dose of alcohol that’s required to have those kinds of ill effects from alcohol.
Dr. Linda Austin: And what is that dose?
Dr. Sarah Book: Recently, the National Institutes of Health has recommended that if you are, for example, a woman, you should not drink more than four drinks per occasion, or seven drinks a week. If you’re a man, you shouldn’t drink more than five drinks per occasion, or 14 drinks per week.
Dr. Linda Austin: It’s wonderful to hear such black and white guidelines because, you know, for years, we’ve talked in terms, is someone an alcoholic or are they not, and people can so easily get into that argument, well, I’m not an alcoholic because I can stop anytime, etc., etc.
Dr. Sarah Book: Or, I don’t drink everyday. Oftentimes patients come to me and say, “I’m not an alcoholic. I only drink on the weekends.”
Dr. Linda Austin: But now it sounds like there is good data to say if you’re drinking more than seven drinks a week, as woman, or 14 drinks a week, as a man, you’re drinking too much.
Dr. Sarah Book: Correct. The other interesting thing, when you’re comparing genders, is that, if you’re looking at problems related to alcohol, women who drink these amounts that we’re talking about, seven drinks or more a week, are going to have alcohol-related problems much quicker, almost half the time that men will.
Dr. Linda Austin: Dr. Sarah Book, thank you very much.
Dr. Sarah Book: Thank you, Linda.
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