Check Up & Choices with Director Dr. Reid Hester, Ph.D
In Episode 20 of “Breaking the Bottle Legacy”, Molly introduces her guest, Dr. Reid Hester, who oversees research projects at CheckUp and Choices, an online program for those concerned about alcohol or drug use. The conversation delves into the scientific aspects of alcohol consumption, addressing the potential benefits of moderate drinking and its impact on sleep. Dr. Hester emphasizes the importance of understanding one’s triggers and urges, providing strategies to manage and reduce their intensity. The discussion also explores the continuum of alcohol-related issues, challenging the traditional disease model of recovery and advocating for a more nuanced approach. Molly and Dr. Hester discuss moderation strategies, including those offered by CheckUp and Choices and Smart Recovery, emphasizing empowerment and individual responsibility in changing one’s relationship with alcohol.
You’re listening to break in the bottle legacy with Molly watts, Episode 20. Hi, I’m Molly, after a lifetime living under the influence of family alcohol abuse, spending more than 30 years worrying about alcohol and my own drinking, believing I had an unbreakable daily drinking habit, I changed my relationship with alcohol forever. If you want to change your drinking habits than breaking the bottle legacy is for you. My goal is to help you create a peaceful relationship with alcohol, past, present, and future. Each week all focus on real science and using your own brain to change your relationship with alcohol. Nothing has gone wrong, you’re not broken, you’re not sick. It’s not your genes. And creating peace is possible. I’m here to help you do it. Let’s start now. Well, hello, and welcome or welcome back to breaking the bottle legacy with me your host, Molly watts, coming to you from an absolutely glorious Oregon today. I’m telling you folks, you’re going to get tired of hearing me say it if these sunny days continue because it’s just beautiful in Oregon during this time of year and I really encourage a trip to the Pacific Northwest if you haven’t already been here. Today on the podcast, I am absolutely thrilled to be speaking to Dr. Reed Hester PhD, who is the co founder of checkups and checkup and choices. And the director and Senior Scientist of its research division. Dr. Hester currently oversees research projects, as well as ensuring the scientific accuracy of all their product related materials. checkup and choices is a group of online programs for people with concerns about their alcohol and or drug use. And each program has evidence of effectiveness. And they are guided self help programs that use state of the art technology to help people decide whether to change and then how to be successful at it. So it’s a great resource. Of course, I will link all of that in my show notes. And Dr. Hester just has a long history of research. He’s been working in the field for over 40 years, published more than 60 papers, books, book chapters, and he’s really this is just a part of the mission of his life. He is unfortunately, I’m teasing. He is a graduate of his PhD from Washington State University. He also has a degree from the University of Washington. So as an avid University of Oregon duck, he and I had to give each other a little bit of a hard time. That’s why I said unfortunate, just teasing, folks. Dr. Hester was kind enough to lend me his time and I was very appreciative. I think you will really enjoy my conversation with Dr. Reed Hester. Hello, Reed, thank you so much for joining me, I really appreciate you taking the time to be on breaking the bottle legacy with me. Well, thanks for having me. Absolutely. I’ve just given kind of a shortened abbreviated version of your credentials, which are a lot and many. And so I really appreciate you taking the time to talk with me more about the science of alcohol and especially as it applies to people who are trying to moderate alcohol. I get a lot of questions from people about, like, what’s true about alcohol? Is it good for me? Is it bad for me? Give me your scientific and tenured researched answer to is there any benefit to drinking alcohol? Well, you know, this has been a topic of discussion and debate for decades now. Right. Yeah, field. And, you know, people obviously come to with their own biases. My take is that there’s zero benefits from heavy drinking or binge drinking and lots of downsides to that with respect to moderate drinking, the picture is more mixed. You know, some studies have shown a positive benefits, while others conclude from their data that the long term health benefits are just not worth it. So clearly, we know that alcohol has a condition inhibit people can loosen people up, help them adjust their attitude, elevate their mood, reduce anxiety, and it is effective in small doses. And that’s the key is in small doses. When you get above a blood alcohol concentration of about point O five, those benefits start waning and going the other direction to end up with a suit because Alcohol is a depressant. Right. And it also can ingen heavy drinking in particular can engender a lot of anxiety the next day. Yeah, yeah. I actually talked about that quite a bit on the podcast, I’ve done a lot of research on that myself, and experienced a lot of that myself as well. And it’s very, especially in the last couple of years as I greatly reduced the amount that I was drinking on a regular basis, then the pronounced the, the experience of that anxiety, post drinking became very pronounced even with just a few drinks. I was very aware of it. And so I’m really glad to hear you say that, because I actually think I’ve said exactly those things before. So I’m glad that I’m doing it. I’m saying it correctly, there’s plenty of evidence that it interferes with your sleep, too. Yeah, yeah. And the research on sleep, it is increasingly click clear that it is important part of both physical as well as mental health. People who are not getting quality sleep, are putting themselves at a significant disadvantage. Yeah, I actually just interviewed a well known sleep doctor and had this very conversation because sleep deprivation is so prevalent in the society today. And there’s a lot of misconception from people who drink that they believe that they have to have a drink to get to sleep. Like that’s literally something they’re thinking. And the science is just not there. It’s it does help you it. It what I what I learned from him is that it will get you to sleep faster, but it puts you It disrupts your sleep patterns for the rest of the night. Exactly. And so yeah, and that’s just detrimental in so many ways. I mean, I was dumbfounded by how much sleep deprivation can infect it? Well, it affects your longevity. I mean, it’s like it’s it affects everything. So it really is something that people need to be concerned with. I appreciate you saying that the that with alcohol. You know, it’s very small amounts. Right. And I actually have been using the phrase around here, I’d say that I’m an alcohol minimalist, because I do. I think that that’s really the kind of the mindset we have to take because it’s really, there isn’t ever a time and in fact, the the NI a guidelines for drinking, they say that are for drinking, that’s not going to be causing you. disorder. So risk drinking low risk. Thank you. Thank you that women no more than three drinks in a day, but no more than seven drinks in a week. And men no more than four in a day and no more than 14 in a week. But three drinks in a day is you know, for people that are drinking on a regular basis that can they can get to three drinks pretty easily, especially if they’re not if they’re not aware of the alcohol content in the drinks that they’re drinking. Exactly. Exactly. You know, a Long Island Iced Tea has four standard drinks, but right most recipes, right? Yeah, that’s not that’s that’s exactly. And that’s not you know, a lot of people are thinking I’m only having one drink, but they’re not they’re having for from the get go. Know that there was a great cartoon. I don’t know if you remember Hagar the old cartoon, Viking. And I can’t find the cartoon anymore. But he had huge hands and he’d say, tell the bartender, you know, let me have a whiskey and just have spin, pour two fingers. And he brings across his tumbler with two huge fingers are filled with whiskey. Yeah, kind of the same theory. Right? Right. So now you know, the event. That’s where the advantage of beer and wine come in. And that beers is typically in 12 ounce cans or bottles, typically is about 5% alcohol, although the, you know, the craft brewery can can go up substantially from there. We actually have a list on our website of that you can search by alcohol content. And it’ll tell you, you know, what, what the various levels of alcoholic and and that’s that’s required on alcohol on wine and liquor, but not on beer. Mm hmm. Yeah. And that’s a really interesting thing that you brought up, because I actually have talked about that too, because I’m an IPA drinker by choice. So, and IPAs can range anywhere from 7% on up to 10% 11%, which is, which is you know, which really is theirs. So a 12 ounce can of beer is no longer just doesn’t count as a single as a standard drink. You have to pay attention to that. And I don’t want to make it in let’s talk about that a little bit. Because I I say to people, I have created a peaceful relationship with alcohol. And we talk about having a healthy relationship or what healthy drinking looks like. We don’t want to drive people crazy with all these rules and you know, paying attention but that’s where I think the whole mindset of being minimalist are really understanding that you’re just not going to be drinking that much. If you want No include alcohol into your life in a healthy way. Correct? It’s just and, you know, a healthy relationship involves not only drinking moderately but not in response to negative emotions, right? Anxiety, depression, worry. Because as a as a alcohol is potent at briefly helping those so rewards your drinking. But it also tends to then affect your judgment. So as you drink more, you’re less able to say, you know, I should really cut this out because it’s not doing me good. Right people remember the initial positive benefits? Yeah. So small doses that are not taken in response to negative emotions is probably the healthiest sort of relationship you can have. Yeah, yeah, absolutely. And I talk about that a lot, too, is just the not buffering away or numbing away your emotions, because so many people get wrapped up into that, especially what for me what started as a habit of just kind of taking the edge off every day, right, that kind of thing, then it quickly, it quickly evolved into drinking more and more, especially when I was having a negative, you know, a negative emotion day. And so that’s, it’s just really the only way to have any type of healthy if you can call it healthy. Because it’s, of course, you know, I say it, I know you would agree the healthiest amount of alcohol for anybody is probably zero, period. I mean, there’s just really no two ways about that. But if you’re going to include alcohol in your life, you want to do it in the healthiest way possible. I want to talk to you a little bit about the disease model for alcoholism. Oh, goodness, oh, if you all could see him. He’s covering his face and shaking his head. Because yeah, I know, right. So I really do want to I want to hear your perspective on it. Because I know I have my own opinions on it. I didn’t go into it in great detail with you. But my mother battled alcoholism for her whole life. And she she ended up succumbing to that, but not until her at after her 80th birthday. So she was really hardcore. Tell me about your take on the disease model of alcoholism? Well, you know, my longtime co author and colleague, Bill Miller and I wrote a book chapter, that was an introduction to a handbook of alcoholism treatment approaches that we first published back in the 90s. And then, I think the last edition was in 2003. And in each of those, we started off with a chapter that talked about the various models that describe the phenomenon of alcohol misuse, and heavy drinking and dependence. And, excuse me, first, let me step back and say that the term alcoholism isn’t hasn’t been used in the medical field for decades now, right. And we’ve even gotten away from the notion of abuse versus dependence, because that there’s a very large gray area in between the two of those, it’s now considered alcohol use disorder, which is much less stigmatizing to get back to the to the models, how you think about the phenomenon of alcohol misuse really has a big impact on what you do about it. If you consider a disease, then you’re looking for medications to treat it, right? If it’s a moral failing, then you’re considering then you’re looking to the clergy to help you with it. If it’s a psychosocial phenomenon, that has biological components, as well as genetic components, then you need to take a much broader perspective. They call bio psycho social, big word, but it has a biological component. It has a psychological component and as a social component. And that’s really the the model which is most inclusive, and best describes how we can productively can think about alcohol issues. Yeah, I love that. You mentioned in that description. And I’m glad you did, because we’re going there. Genetics as being a component. So give me your, your impression or your decisions or your research on the alcoholic gene. Is there such a thing? And if so, good, perfect. answer is no. Good. I’m so glad we’ve worked for decades. I’m so glad again, we aligned on that. So, you know, I I’ve always come come down on it and said, Well, if there is something that’s genetically if you’re genetically predisposed, it does not mean you’re predestined and predetermined with alcohol and nurture, nurture and society to destiny. Yeah, exactly. And I truly believe Even I believed this about my mother too. And her father was an alcoholic. And so you know, you somebody could make an argument, right that there was some sort of genetic link between all of us. But what I think about, for a lot of people that develop alcohol use disorder, people that did develop a physical dependence on it, which my mother was definitively physically dependent on alcohol. But she didn’t start out that way. And she started out by same thing, drinking and then drinking to numb emotions, drinking as a solution to get away from whatever she was feeling. And so I really believe that people have to focus on the why that they’re drinking in the first place. Tackle the thoughts that they’re having that are creating whatever feelings they’re feeling that they’re trying to get away from, when they drink. Does that is what give me your thoughts on that. Yeah, I mean, in evidence based protocols for helping people change their drinking, there, one aspect of that is to identify triggers to drinking or overdrinking. And one aspect of those triggers are negative emotional states. Hunger, anger, depression, anxiety, you name it. Right? Where was I going with that? Okay, we were talking about the about just the I was saying that I think that people, the the whys behind people start to why they start to drink in the first place is what they need to tackle as opposed to, yeah, and really, the triggers get to that, because, you know, people who have been, who have a long standing habit of drinking too much drinking heavily, then they have an idea that, you know, Friday, five o’clock, you know, if their cousin comes over, if they’re upset with our spouse, they have an idea of what their triggers are. And what we’ve tried to do is to help them identify those triggers. And then help them to consider the ways to deal with those triggers. without drinking without over drinking. That is really a key component of making change in the way that you have a relationship with alcohol. So is a trigger and an urge the same thing triggers, produce can produce urges and cravings, okay. Okay. You look at the clock and say, Gosh, it’s it’s quarter five. And you know, that thought come around five o’clock, that’s when you typically have your first drink, noticing the time there’s going gets a trigger. And that trigger can trigger an urge, or in a more extreme sense of a craving. The cool things about urges and cravings is that they can’t hurt you. Right? Right. They can make you uncomfortable, but they can’t hurt you. And really important thing is that they fluctuate over time. And there are a variety of things you can do to reduce the intensity, duration, and an impact of urges and cravings. Yeah, that’s kind of what I was, I talk about allowing urges, and not trying to resist and fight against them, not trying to ignore them, distract yourself. I mean, these are strategies that you can employ. But once you really begin to understand that an urge cannot, you know, they can’t hurt you. They can’t, it’s just, it’s a feeling. And if you really just allow it, and you witness it, and one of the great things about the human brain is our ability to step outside ourselves, and, and look at what we’re doing, you know, observe our own behavior. And so that whole idea that I think that you wrote about it, in an article, I think I talked to you briefly about studying the urge about just understanding that that urge process is something that evolves over time, and that you can have control over and, and literally allow it to think yourself through it kind of, yeah, we have written a blog post about that on our website, check voices.com. And what you’re talking, what you’re describing there is a very helpful and appropriate strategy, but it’s also a more advanced strategy for people who have much stronger urges and cravings. is better for them to start off with the simpler ones, simpler strategies of distracting themselves delaying deferring for five minutes or 10 minutes of doing something more productive, you know, more engaging than sitting around thinking about your desire to have a drink. Right? And coming back to that then say, well, how does that now is? It was a six now it’s maybe a three. Yeah, it was eight now it’s five. Yeah. And then engaging in other strategies? Yes, the study allowing the urge to happen, and just kind of writing it because it doesn’t. It’s not a constant. It’s not a constant phenomenon. It waxes in Wayne’s talking about urge surfing, where you you’re going to be on the top of the wave, you’re going to write it down. And as you write it down, the wave lessens this impact you but you’re still moving along. So it comes in waves. If you’re just sitting out there on your surfboard, the waves the swells rise and fall ball. So I appreciate this is just a great conversation. I could keep talking to you all day about all this stuff. One thing I want to touch on before we end our conversation is your thoughts on whether or not it’s true, I say that we know that in certain 12 Step programs, they will tell you that you’re powerless, and that alcohol holds all the power. And I full heartedly do not believe that I believe that people do have the power to control their relationship with alcohol. It does require intentional behavior to inquire requires learning requires a lot of steps. It can require discipline, but I the vast majority of people who are not physically dependent on alcohol, I believe they have the ability to do this with with resources to create that relationship that they want with alcohol. Your thoughts? Yes, that’s absolutely true. We also know that the stronger the level of severity of your alcohol use disorder, the more likely you are to be successful getting rid of the alcohol related problems or minimizing them is by abstaining. Right. And interestingly, if we look at long term outcomes from moderation training protocols, we find that a fair good size percentage of folks who are successful at cutting back in there drinking eventually stopped entirely just because it is not, it’s no longer a big deal to write. Right, you can take it or leave it, right. And that’s what yeah, that’s what I’ve always said I wanted is I wanted, that’s what I wanted to create for myself, that’s what I have done is I wanted to never have to worry about alcohol anymore. I didn’t want to think about it. I didn’t want it to be I want it to be a non issue, just like that, take it or leave it. And so I do believe that people can get there. One of the great resources, and we will link this, of course, in the show notes is checkups and choices. And that’s you stock up. Yeah, check. Yeah, well, yes, I checkups and choices.com. We will definitely link that in the show notes. Tell me a little bit about the program and the association with moderation management. You know, I was on the board of moderation mat board of directors for a moderation management for many years until last 10 or 15 years ago when I just, you know, had too many other things. And it’s always been an organization that has struggled, because people get it, people, you know, can learn the skills to moderate and cut back and then they leave. And so they have always been kind of a struggling organization. And we have supported them with when they send referrals to us from that. But perhaps the most encouraging and uplifting, mutual support group I have ever run into is smart recovery. Yeah. And well, smart recovery has been abstinence focused. It’s shifting away from that a little more now. And say, whatever, you know, whenever whenever you get to what’s what’s stopping for you is what’s important. Because moderate drinking means stopping after two or three drinks. abstaining means stopping after zero drinks. Right. Right. And it’s my understanding that in the support meetings now that if someone says, Well, you know, I did pretty well, I only had two drinks last night, people don’t jump on for her. They’re supportive and saying, Well, great. What What strategies did you use to, you know, essentially, control yourself? Right. And it is the most upbeat, encouraging, and supportive group of people in recovery I’ve ever run into. Nice. Yeah, I love I actually, I’ve been in the field for 40 years now. Right? I appreciate that. Because I actually look smart was a part of the the information that I gathered while I was taking, you know, in developing what I was doing, and I agree with you in terms of especially because they employ a lot of cognitive behavioral therapy in terms of their steps for recovery. And they do put the power into your own your own hands as opposed to some other, you know, system or deity or whatever else that might be out there. They really do. uplift the individual. So I appreciate that. Absolutely. And they they’re using empirically supported protocols that are adapted for use in mutual support groups, right. And we actually I collaborated with them when we developed our checkup and choices protocol staining. And, and I’ve known Tom Horvath for decades now, and he was one of the original, he and a few others to Gerstein, and, and Hank, Rob, some of the original developers, and they’re all, you know, very empirically oriented Cognitive Behavior therapists and psychiatrists. The one thing that I want to talk to you and I, like I said, Well, we’ll we will wrap up, I promise, the, the thing that I, that I, that I struggle with, with smart recovery is that is the word recovery. Because I think there’s a lot of people that like myself included, who I would have never wanted to say that I was in recovery, needed recovery, anything like that. I in fact, anybody from the outside would have never known that I had a quote that I was drinking as much as I was, or that I was wracked with anxiety about it because of my alcoholic upbringing, right? I sat around worrying, and Googling and looking all the time, like is this, you know, am I meeting the qualifications for alcohol use disorder. And I never, I never allowed myself but I, but still, I would have never, my mother was an alcoholic. So I had a very clear picture of what that looked like to me. And so I would have never sought recovery. And that’s one of the things that I am wanting to make sure that people hear and understand, especially for like smart, which is a fantastic program. People, you don’t have to be at rock bottom, and you don’t have to be, you know, struggling mightily. There is there is room for improvement for many of us, in our relationship with alcohol. And many people are drinking more than they probably should be much more than those guidelines, those low risk guidelines that we talked about. And these support groups, whether it’s smart moderation management, wherever it may be, can help you improve that relationship with alcohol. Yeah, let me just say that, it’s really unfortunate that recovery is a legacy of the old disease model, call ism. Your, if you’re an alcoholic, you need to get into recovery. Right. And that that’s most unfortunate, because it does, it can prevent people from you know, even looking at it or considering it. And, you know, I always like to encourage people to think about drinking and alcohol problems, it’s on a continuum. You can drink a little, you can drink a lot, you can have few alcohol problems, you can have a ton of alcohol problems, have minimal health, bent health consequences that can kill you. So it’s not like pregnancy. Right? It’s like hypertension, right? And just because you’re taking a medication to control your hypertension and losing weight, so that it’s under control, doesn’t mean that you’re in recovery. But you’re dealing with life as it comes to you. Yeah, no, I agree. And I think I’ve talked to, you know, Dr. David Nutt of UK expert, I know, you know, him the notion of just knowing just like, you know, your, your blood pressure, just like you know, your, you know, these these basic health things, you should also know how much you’re drinking. I mean, it’s kind of that that way, you should keep it in a mindful way to be as healthy about it as possible. And it isn’t like you’re in for anyone. Now, there are people that you know, when you develop a physical dependence on alcohol, there are different protocols, different steps, different things that need to happen, but that you’re still eventually going to have to deal with the psychological addiction and the psychological dependence on alcohol as well. And physical addiction is fairly rare, right? If you look at the overall spectrum, it’s very rare. I initially started working in inpatient rehab hospital for alcohol. And those people were severely dependent. I mean, you know, their detox was days long to get them weaned off alcohol, because it can it can kill you, you know, start, certainly when you’re drinking a quart a day. Yeah. But that’s a pretty small, small portion of the people who are concerned about their drinking. Right. Right. I think there’s I think there’s more people should be concerned about their drinking than just those people that are physically dependent because that yes, exactly those people it’s really is. I think the statistic is less than 10%. It’s it’s narrow, and a lot of people who think they have a dependence on alcohol are probably not physically dependent, but they are most likely psychologically dependent and that is the key. So, Dr. Reed Hester, I appreciate you taking the time today so much, I will link everything in my show notes, your books and the checkups and choices.com and anything else that you would like to add as we are leaving? No, you know, I just want to encourage people to to consider that they can and make changes in their in their lives and their relationship to alcohol. And the best way to do that is to start taking a look at it and considering what their options are. Yeah. program in the first place. Yeah. And it’s never too late. I’m too late. I’m a person that was had a 30 plus year, daily drinking habits. So I’m here to tell people you can do it. Five. Exactly. Dr. Hester, your adult thank you so much. I appreciate it. And be well, you too. Thank you for listening to breaking the bottle legacy. This podcast is dedicated to helping you change your drinking habits and to create a peaceful relationship with alcohol. Take something that 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