EP #130

Is it Alcohol Use Disorder? Why Your Answer Matters

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In this episode of the Alcohol Minimalist podcast, Molly introduces a “more dry July challenge,” encouraging participants to add more alcohol-free days to their month, with the opportunity to win mindful drinking prizes. Molly discusses the importance of self-awareness in assessing one’s relationship with alcohol, cautioning against self-diagnosis and stressing the need for professional help in cases of physical dependence. The episode delves into the DSM-5 criteria for diagnosing alcohol use disorder, highlighting the evolving language and reduced stigma in the diagnostic process. Molly shares her personal journey, emphasizing the power of perspective shift and the role of anxiety in perpetuating drinking habits. The episode concludes with a call to action, encouraging listeners to make choices for a better life and assuring them of the possibility of transformation in their relationship with alcohol.

Hey, it’s Molly from alcohol minimalist. What do you do in this October? I would love to have you join me in my more sober October challenge. What do I mean by more sober October, it simply means that we’re going to add in more alcohol free days than you currently been doing, whether that’s one or two or 31. It’s up to you, you get to set your own goal and that’s why it’s more sober October. You can check it out and learn more at get got sunnyside.co/molly It’s totally free. I’ve got prizes, I’m going to be going live every week to announce the prize winners, and it’s just going to be an awesome event. So I would love to have you join me. You can learn more at get.sunnyside.co/molly and you can get registered today. Welcome to the alcohol minimalist podcast. I’m your host Molly watts. If you want to change your drinking habits and create a peaceful relationship with alcohol, you’re in the right place. This podcast explores the strategies I use to overcome a lifetime of family alcohol abuse, more than 30 years of anxiety and worry about my own drinking and what felt like an unbreakable daily drinking habit. Becoming an alcohol minimalist means removing excess alcohol from your life. So it doesn’t remove you from life. It means being able to take alcohol or leave it without feeling deprived. It means to live peacefully, being able to enjoy a glass of wine without feeling guilty and without needing to finish the bottle. With Science on our side will shatter your past patterns and eliminate your excuses. Changing your relationship with alcohol is possible. I’m here to help you do it. Let’s start now. Well hello and welcome or welcome back to the alcohol minimalist podcast. With me your host Molly Watts coming to you from my friends. It is still a perfect Oregon right now. It is really so beautiful. So gorgeous. So perfectly warm, a little bit of a breeze. I am no complaining all love, all love for Oregon right now. Hey, it is the last episode here in June it is releasing on June 28. And I want to kick it off by reminding you that if you are listening to this episode in real time, and if you have not already signed up to join me in my more dry July challenge than I want you to do it now go to get got sunnyside.co/molly and you’ll get to try Sunnyside the mindful drinking app for free for 60 days and without a credit card required. And here’s what more dry means. Okay, it just means that you’re adding in more alcohol free days than you typically would have in a month. So for me, I have committed to 70% alcohol free days in 2023. And part of that includes 25 alcohol free days in July. Typically in a 31 day month, I would have 20 alcohol free days. So my more dry July is that I’m bumping up to 25. Whatever more looks like for you is awesome. And there’s prizes. If you sign up and complete the challenge you will be entered into a drawing for $250 worth of mindful drinking prizes from sunny side. Also a chance to win a 24 pack of moment, a drink that I’m going to be talking about later this month with the founder of that company. And even if you’re already a Sunnyside member by the way, you can still participate in the challenge. Now you won’t get the 60 days free, but you will be eligible for the prizes. So jump on in the water’s fine. And prioritize your alcohol free days for July. Go to get.sunnyside.co/molly. That’s get.sunnyside.co/molly to get registered. All right, do it now. on to this week’s show, which I might tell you beforehand here sounds a little heavy for an early summer episode. And certainly right before I’m getting set to do this more dry July challenge. But I’ve been seeing posts and comments from people in groups that I support. And these programs typically support mindful drinking or moderation. And it seems like there’s people posting who are unsure if they are in the right place. When they’re posting in these groups. They’re wondering if they are quote unquote, addicted to a point that they are a lost cause, or that they are just too extreme of a case. And it got me thinking that I have never really done a full episode on alcohol use disorder. Even though I share resources from the NIA, A A in the show notes on every episode about how to the self diagnosing tool. And I’ve never really dove into what it means to have alcohol use disorder and when and why it matters if you identify as someone who has severe alcohol use disorder. Now, a brief disclaimer here. This podcast in general, not just this episode, is not intended to treat or diagnose alcohol use disorder. I am not a doctor, nor do I play one on this podcast, I do share scientific information and resources that are available for anyone to find and use as self diagnosing tools. My familiarity with alcohol use disorder comes from growing up with an alcoholic parent. But as my own drinking habits became more ingrained, and my anxiety around my own drinking increased, I absolutely used these criteria to help me to help reassure me, because I would separate myself from my mother. And therefore I didn’t really need to change anything, which is a little bit of what we’re going to talk about later here in the episode. For those of you wondering if how much you’re drinking is too much, or is a problem or put you into the quote unquote, addiction category? I think it’s important to note that within the diagnostic criteria for alcohol use disorder, there is not any discussion on amounts of alcohol, that define having alcohol use disorder. And that’s because everyone’s individual metabolic response to alcohol is, of course, different. We’ve talked about that numerous times on the podcast, and there is no one size fits all answer as to is how much I’m drinking a problem. We compare ourselves to what others are drinking, right? We do it all the time. It’s absolutely pointless. But we all do it to kind of calibrate, right? If I’m not drinking more or faster than the people around me that I’m okay. Or if my friend drinks more than me, and she doesn’t think she has a problem, then clearly, I don’t have a drinking problem. Or even to the extent that we’ll look over there and say, Hey, that guy is drinking a lot more than me. So he clearly has a problem. I don’t, right. None of this is useful, but we definitely do it. Now, let’s get technical for a minute. What the naa does tell us with regard to quantity and developing alcohol use disorder is this alcohol misuse, which includes binge drinking and heavy alcohol use, over time increases the risk of developing alcohol use disorder. And they do have qualifications for binge drinking and heavy drinking. Binge drinking, as defined by the N i a. And as a reminder, the N i A stands for the National Institute on Alcoholism and Alcohol abuse. And it defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration, the BAC to 0.08% or 0.08 grams of alcohol per deciliter or more. Okay, that’s what a binge is. And this typically happens if a woman has four or more drinks or a man has five or more drinks within about two hours. All right, so that’s what’s considered a binge four or more drinks for women five or more drinks for a guy in to about two hours. But again, they say about two hours they use the word about because it depends. It depends on your weight depends on how much you’ve eaten, it depends on how rested you are. It depends on whether you’re hot or cold. All of that. We’ve talked about that numerous times on the podcast. Heavy alcohol use, which we’ve talked about also is defined by the NIA a as or min anything consuming more than four drinks on any one day or more than 14 drinks per week. And for women consuming more than three drinks on any day or more than seven drinks per week. That is considered heavy alcohol use. If over time you miss use alcohol either by binge drinking or and or sustaining heavy alcohol use. You are at higher risk for developing alcohol use disorder. And here’s the definition of what alcohol use disorder is and this is straight from the NIA A’s website. Alcohol Use Disorder is a medical condition characterized by an impaired ability to stop or control alcohol use, despite adverse social, occupational, or health consequences. It encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the colloquial term alcoholism, considered a brain disorder. Alcohol Use Disorder can be mild, moderate, or severe, lasting changes in the brain caused by alcohol misuse, perpetuate alcohol use disorder, and make individuals vulnerable to relapse. The good news is that no matter how severe the problem may seem, evidence based treatment with behavioral therapies, mutual support groups, and or medications can help people with a UD achieve and maintain recovery. So you cannot just look at the amount you’re drinking to determine if you have alcohol use disorder. And more importantly, determining if you have alcohol use disorder really matters if and only if that’s a that’s a math term. Do you remember if and only if the IFF. Okay, if and only if, and this is of course, just my opinion. You are someone who has developed physical dependence on alcohol, that’s when it really matters that you determine whether or not you have alcohol use disorder. It is an important distinction because if you try to jump into a more dry July challenge, like mine, or anything else where you’re going to go alcohol free, you need to proceed with extreme caution and seek professional help before you try to abstain if you’ve developed a physical dependence on alcohol. Now, I will reiterate that this show is not intended to treat severe alcohol use disorder. And if you have developed physical symptoms of withdrawal when you are not drinking, eg shakiness, nausea, sweating, racing heart, and this is not just a one off hangover, but happens regularly, then you may need medical support to safely detox off alcohol. So yes, if you are physically dependent on alcohol, it’s certainly absolutely imperative to figure out that that is the case, before jumping into a challenge like more dry July, or dry weary or simply cutting yourself off cold turkey, which might seem like what you want to do or what you need to do, right. But if you’ve developed a physical dependence on alcohol stopping drinking is, while it is true that stopping drinking is what you need to do, you will probably need to do it under the care of medical professionals, because withdrawal symptoms can be life threatening for someone who is severely physically addicted. Now, we have talked about previously on the podcast, the study done by the Substance Abuse and Mental Health Services Administration, that and the CDC that basically said that, even amongst obsessive drinkers, even people who are misusing alcohol, nine out of 10 of us are not physically dependent. And I’ve brought that up many times on the show. I just, I don’t want to say that. And I also want you to be aware that if you have developed those physical symptoms and need to go through any sort of any type of medical detox, it’s important. So don’t just jump into any type of abstinence based program or abstinence challenge or your own cold turkey thinking and do that. If that’s that’s the case. And if we can agree that really this is the only time it’s necessary, like life or death to classify your alcohol use, I think it’s useful to also understand the guidelines that the NIA has established because alcohol use disorder is progressive. You can’t take you don’t take your first drink, right and immediately experience mild alcohol use disorder. It happens over time and with repetition and as you potentially build tolerance and the amount of alcohol you drink increases. And then you can find yourself if you are honest with yourself when you use the self diagnosing tools to move from no disorder right at the beginning, no disorder to mild to moderate and ultimately, potentially, to severe alcohol use disorder. I think it’s imperative to help people understand that alcohol use disorder is progressive and we definitely We need to pay attention to how alcohol is impacting our lives. What I also believe is that some of us, me included, hold on to definitions as a way of alleviating the ever present anxiety that we may have around our drinking. For me in that heightened anxiety moment, I used the criteria to reassure myself that I didn’t have a real problem with alcohol. But of course, my reality was a state of constant anxiety that was perpetuated by my daily drinking habit that far exceeded low risk limits and would be I definition classified as heavy drinking. You all know I’m a science girl and that is why I am so proud of my partnership with Sunnyside. Sunnyside has great data based on their user experience and they also have great science techniques behind what drives the program in the first place. Users of Sunnyside in their first 30 days experience on average a 29% reduction in drinks. They avoid 1500 calories and they’ve saved over $50 each month. This is because there is science behind the program. Sunnyside helps you reach your goals and stick with them long term by focusing on three scientifically proven superpowers. One is pre commitment, you intentionally make a plan ahead of time and we talk about making a plan all the time here on the podcast. Number two is conscious interference. And you’ll learn that the habit of tracking each drink helps you decide about it. Number three is positivity. We know this is not easy sometimes right? And we all need a little boost. I tried to be a boost and Sunnyside is a great boost via text message or email to keep you motivated. So if you haven’t already checked it out, I invite you www.sunnyside.co/molly To get started on a free 15 day trial today. All right, let’s look at these criteria that health professionals use. And I want to say health care professionals use criteria from the diagnostic and statistical manual of mental disorders. The fifth edition that’s the DSM five, to assess whether a person has a UD and to determine the severity if the disorder is present. I’ve long been familiar with the diagnosing tools for AUD. But the DSM five was only published in 2013. Prior to that, the DSM four had been published in 1994. And it had two major areas of diagnoses for alcohol. They were alcohol abuse and alcohol dependence. And it was the DSM four that I was most familiar with through navigating my mother’s alcoholism. And the nuances of the DSM five that came out in 2013. were somewhat lost on me probably because of my history with her. As I’ve said here before on the show, and in my book, it was when I actually lost the alcoholic label that I was able to shift my perspective on my own drinking habits, which is why I think many other people get stuck too. If we are simply trying to avoid the label of alcohol use disorder, we miss the opportunity for changing our relationship with alcohol sooner and avoiding years of anxiety and struggle like I did. I’m not going to go into the DSM four at length, or this episode would be really long. But here’s what the NIA says were the differences between the DSM four which basically was published in 1994, and so covered to 2013. And then the DSM five, which came out in 2013. And sidenote, if you’re looking it up on googling it, in 2000, the DSM four was revised. So the DSM four TR was published in 2000. Nothing substantial changed for alcohol use disorder. And last sidenote, the DSM is not just for alcohol use disorder, the diagnostic and statistical manual of mental disorders. The DSM, is the handbook used by healthcare professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. So it’s much bigger and much broader than just alcohol use disorder. But I think it’s where we classify alcohol use disorder. Here’s what happened. Here’s the big differences between the DSM four and the DSM five. Right. So the DSM four there was changes in the disorder terminology. The DSM four described two distinct disorders. One was alcohol abuse and one was alcohol dependence, and had specific criteria for each. The DSM five integrates Those two disorders, alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder with mild, moderate and severe sub classifications. Alright, so we went from two different disorders, alcohol abuse and alcohol dependence to one big disorder, alcohol use disorder with sub classifications mild, moderate and severe. There were also differences changes in the diagnostic thresholds. Under the DSM for the diagnostic criteria for abuse and dependence were distinct. Anyone meeting one or more of the abuse criteria within a 12 month period would receive the abuse diagnosis. And anyone with three or more of the dependence criteria during a 12 month period would receive a dependence diagnosis. Under the DSM five, it’s different anyone meeting any two of the 11 criteria during a 12 month period would receive a diagnosis of a UD, the severity of a UD, mild, moderate or severe is based on the number of criteria met. All right. And again, we’re not going to go backwards into the DSM four, but we will go diving into the DSM five here in a minute. The other part is that it removed legal problems as a criteria that was actually a criteria in the DSM four. Right, so easy to separate yourself out if you had never had a legal problem. And the DSM five eliminated that. It also added a criteria, the DSM five added craving as a criteria for alcohol use diagnosis, I mean alcohol use disorder diagnosis. And that was not included in the DSM four, it updated some of the language and really that was a big move to remove some of the stigma. And again, moving away from alcohol abuse and alcohol dependence to just alcohol use disorder was it was the hope was that it would remove some of the stigma so that people would, would look into getting help or changing earlier on. Alright, so now that we’ve given a little history of the DSM, let’s look at these criteria specifically. And again, sir, the severity is based on the number of criteria a person meets based on their symptoms, self described, right? Mild alcohol use disorder is two to three criteria, moderate is four to five, and severe is six or more. And a health care provider might ask the following questions to assess a person’s symptoms. And this is what you can ask yourself, what I want you to notice. First off is that these things require us to be honest with ourselves, alright, if you’re not willing to be honest with yourself, I always I say, with my folks all the time, it’s data over drama, right, we got to have the data, we cannot change what we cannot see, we have to be honest with ourselves. Number two, I want you to notice that these focus on the results that you have in your life, if we look at this from a lens of the behavior map results cycle, the results, at the end of right to the behavior map results cycle, if you haven’t, if you’re not familiar with that, folks go back and find it in the various episodes. But it’s my work when I talk about the circumstances of our lives. Lead are the data that they’re the input, and we have thoughts, feelings and actions which create the results that we have in our life. So I want you to look at it from that lens. When you’re looking at these diagnostic criteria. They focus on the results you have in your life in terms of job relationships, school family. And we should also notice that within this there is an attempt to address this the signs of physical dependence without the stigma or the label of dependence and abuse. So here are these questions. Have you in the past year, one had times when you ended up drinking more or longer than you intended? Now, I’m sure many of us can say yes to that, right. I certainly could have when I was doing this when I can probably still do this now. If I’m really if I really want to get drinking more. Yeah, Were there times Yeah. More than once wanted to cut down or stopped drinking or try to but couldn’t. In the past year, have you spent a lot of time drinking, drinking, being sick from drinking or getting over other After Effects? To your experience a lot of hangovers. This is this is what you what you want to check in with yourself on. Have you wanted a drink so badly that you couldn’t think of anything else? There’s The question that’s addressing the cravings, right? Have you found that drinking or being sick from drinking often interfered with taking care of your home or family or caused job troubles or school problems? In the past year have you continued to drink even though it was causing trouble with your family or friends? In the past year, have you given up or cut back on activities you found important interesting or pleasurable, so you could drink? In the past year, have you more than once gotten into situations while or after drinking that increased your chances of getting hurt? such as driving, swimming using machinery, walking into a dangerous area or unsafe sexual behavior? In the past year, have you continued to drink even though it was making you feel depressed or anxious? or adding to another health problem? Have you continued to drink after having an alcohol related memory blackout? In the past year, have you needed to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect? And before? It’s a question around tolerance, right. And lastly, have you found that when the effects of alcohol were wearing off, you had withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, dysphoria, which is feeling uneasy or unhappy, malaise, a general sense of being unwell feeling low or a seizure, or sense things that we’re not there, any of these symptoms may be a cause for concern. And the more symptoms you have, the more urgent need for change is. Law, here’s what I think is most important that I never really got from the DSM four or the DSM five. As long as we try to keep problem drinking, as the wrong side of the line, and all other drinking as the right side of the line, we aren’t really seeing the forest for the trees. When I used alcoholism, or alcohol use disorder as the only problem I was trying to avoid, I still stayed stuck in a daily drinking habit that caused me unrelenting anxiety, both from a physical standpoint due to alcohol itself. And because I worried about the amount I was drinking, and the genetic path I believed I was following. When I realized that my daily drinking habit was the source of that constant anxiety, which I never really understood, until I learned the science of alcohol and the brain. That was when real change became possible. So I hope you get from me here that it matters if you have alcohol use disorder, if you are physically dependent, and you are considering taking a break from alcohol. But if you aren’t physically dependent, which I assume that 90% of you who are listening are not, because that’s just the average for all people. Then I don’t want you to allow the tools of the naa to keep you from becoming your best self. Because you see them as helping you to avoid your worst self. Ask yourself, if a life without worry, anxiety, frustration, fear, disappointment, regret, anger, about your drinking would be better than where you are right now. If the answer is yes, then it doesn’t matter if you’ve got alcohol use disorder or not. What matters is that you decide to take a step to make a choice to do just a little bit better today. And I hope that for those of you that are considering it, I hope you will check out my just start program. I’ve just got it launched this 30 Day mini program and I’m getting such great feedback, such great results. People are really getting the gist of my work because they’re listening to the book on audio. They’re starting to do the deeper dive in the worksheets. And again, it’s not going to change your relationship with alcohol in 30 days, but it will get you started. And that’s what’s possible. If you don’t wait until you decide that you got a real drinking problem that you really have mild, moderate or severe alcohol How to Use Disorder. If you ask yourself if a life without that negative feelings that you have about alcohol would be better than what you have right now, then it’s time to start working on your relationship with alcohol. You can check it out at Molly watts.com/start. Alright my friends, that is all I have for you this week. I would love to have you join me in the more dry July challenge. July is a common and I am super excited about it. So make it a great week everyone and I’ll see you next time. Thank you for listening to the alcohol minimalist podcast. This podcast is dedicated to helping you change your drinking habits and to create a peaceful relationship with alcohol. Use something you learned in today’s episode and apply it to your life this week. Transformation is possible you have the power to change your relationship with alcohol now, for more information, please visit me at www dot Molly watts.com