All About the NIAAA with Dr. George Koob
In this episode, host Molly Watts engages in a conversation with Dr. George Koop from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to shed light on the complexities of alcohol consumption and its impact on health and well-being. Dr. Koop discusses the critical issues surrounding alcohol, emphasizing the importance of staying within the dietary guidelines when drinking. He addresses the misconceptions about alcohol, especially in the context of stress relief and anxiety, explaining how excessive drinking can worsen negative emotional states. Dr. Koop delves into the scientific aspects, detailing neurotransmitter responses and stress-related factors. He also highlights the connection between alcohol and respiratory illnesses, particularly in the context of the COVID-19 pandemic. The episode stresses the importance of education and awareness, promoting the NIAAA’s resources, such as the “Rethinking Drinking” website and the “NIHAA Treatment Navigator,” as valuable tools for individuals seeking to change their relationship with alcohol.
Welcome to the alcohol minimalist podcast. I am 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 used 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. I am your host Molly Watts coming to you from an absolutely epic, gorgeous Oregon. It has been absolutely outstanding this week and it is Sunday, February 13. Super Bowl Sunday it is spectacular here again. So today I am recording this introduction. But truth be told I am not give him the episode that I thought I was going to be doing this week. I have told you that this month, we are going to be focusing on emotional well being emotional maturity, emotional resilience. And I recorded this podcast interview with Dr. George QUB from the National Institute on Alcohol Abuse and Alcoholism this last week, and I was planning on not distributing it until March after this month long focus. But truth be told, life just happened and I am not where I want to be with the next episode in terms of this emotional stuff. So I’m going to push that to next week. I’m going to go ahead and share this week even though it’s in February and even though it’s an emotional wellbeing week, you’re going to get to hear my conversation with Dr. George Qube. Let me tell you a little bit about Dr. Koop. He is an internationally recognized expert on alcohol and stress and the neurobiology of alcohol and drug addiction. He is the director of the National Institute on Alcohol Abuse and Alcoholism, where he provides leadership in the national effort to reduce the public health burden associated with alcohol misuse. As Nia, a director, Dr. Koop oversees a broad portfolio of alcohol research, ranging from basic science to epidemiology, diagnostics, prevention and treatment. I think you are going to love hearing from him. We had a great conversation just about the NAA, and how we can get you know, get the word out in terms of correcting all the misinformation that’s there around alcohol and also just letting people know that the naa is there as a resource, whether or not you are concerned about whether you have alcohol use disorder, or whether you just aren’t, we’re someone like me who wanted to understand the science of alcohol. The naa is really at the forefront of all the research that’s happening on alcohol. And really, he and I agree 100%, the safest amount of alcohol is zero. But if you’re going to include alcohol in your life, you want to do it in a minimal way, and you want to be making mindful decisions about it. So while we aren’t talking about emotional well being in this episode, not so much. I know that he comes from that background, and I think you will really enjoy this conversation. Next week. I will be back with the episode that is supposed to be coming right now. And that is is drama, driving your drinking, I think you’re really going to love it. Stay tuned, and it will be here on Wednesday, February 23 Instead of Wednesday, February 16. Today you’re hearing from Dr. George QUB. Enjoy the show. Good morning. Dr. Koop, thank you so much for taking the time to talk with me today. I know you are very busy. So I deeply appreciate you sharing your expertise and some of the fine research that’s going on with the NIH a I just gave a brief introduction about who you are. And the NIH a but thank you again for taking the time to talk with me today. You’re most welcome, Molly. It’s a pleasure. Yeah, absolutely. So I think that people don’t have a very good clear understanding of the mission of the NIA and when I looked it up, one of the things that struck me was understanding the impact of alcohol on human health and well being. So, when we talk about alcohol, and I talk about this a lot on the podcast, because there’s a lot of headlines out there, that can be kind of contradictory, or they seem contradictory, like we hear, it’s good for us, it’s bad for us. You know, tell me from the inside, you know, from the, from the scientists that you are in, from the background of the NIH a talk to me about what you the message that you want to deliver around alcohol. Alcohol is used by a large proportion of our population somewhere around 70%. And it’s used typically as a social lubricant. You know, it’s used in situations where people want to interact with other people. And it’s been used like that for centuries. And, and there’s absolutely on face value, nothing wrong with that, if you stay within the dietary guidelines that are recommended by the US Department of Agriculture, and those are, you know, one drink a day for, for women and two drinks a day for men, but when you get beyond that level of drinking, alcohol becomes a toxin. Flat out, you know, causes harm to about 200 Different and potentially, to under different conditions. Half of liver disease, now, deaths in this country are caused by alcohol. And so you know, I can, I can go on about all the things from pancreatitis to, to, you know, gastrointestinal bleeds that are caused by excessive drinking, but, you know, I think people have to realize that when it’s used, you know, within the dietary guidelines, okay. But even there’s, some people shouldn’t be drinking at all. So, you know, women who are pregnant women who are thinking about getting pregnant individuals who maybe have a history in their family of alcohol use disorder of Asian Americans who were have a, you know, the aldehyde dehydrogenase allele that is not very active means that when they drink, they get a huge surge in acid aldehyde, which is a carcinogen and also causes the flush reaction that they tried to drink past that they have a tenfold higher likelihood of esophageal cancer, alcohol, you know, in, in excess is rare, you know, contributes to about 5% of cancer in this country. That’s a, that’s a fact that even your local physician probably doesn’t know about. And we’ve been working with the National Cancer Institute on that issue. So, you know, I can go on and on. But, you know, I think it’s safe to say that, you know, if you choose to drink, stay within the dietary guidelines, but otherwise, you know, and there’s really no absolute safe amount of alcohol, for breast cancer in women, you know, even one drink a day conveys epidemiologically, you know, overall a large population and conveys you know, some increased risk for breast cancer. So, ya know, I talked about that all the time. I always I say that very clearly the science shows or, you know, the recommendations are the safest amount there is no, it just as you said, No, technically safe amount, the safest amount is zero. So if you want to get really, you know, fundamentally honest about it, that is, but if you are going to drink, you definitely want to stick to those low risk limits, folks, they’re always in the show notes here, I always have them there it is, you know, and you said, one drink per day for women, two drinks a day for men, those are standard drinks you if you don’t know what that is, you can also visit the NIA A’s website for some information on what a standard drink actually looks like. Because I think there’s some there’s confusion there, too, especially with the way that people you know, pour drinks in restaurants and with our fascination with craft beers, it’s a lot. There’s a lot of, there’s a lot of information that people need to be aware of if they’re going to include alcohol in their lives. Yeah, absolutely. And, you know, a standard drink is usually five ounces of wine, 1.5 ounces of distilled liquor in a 40 40% range, like, like a bourbon or a or a Scotch gin. And, you know, 12 ounces of beer, but we’re not talking about beer that has a concentration of 20% Alcohol we’re talking about be around 5% alcohol and and so, you know, there’s that cartoon, where are they? Well, I’m only having one glass of wine, the glass of wine is the size of your head. You know, so, you know, I all of this information, by the way that we’re discussing for everyone and I’m assuming you tell people is in rethinking drinking, which is something you can use your search engine and it’ll come up. Yeah, part of our website. Yeah, absolutely rethinking drinking is one of the things I wanted to, to definitely hit on with you. Because I really appreciate the Rethinking drinking website, I will link that in the show notes, folks, especially the the PDF there, because it provides evidence based information. And I really, you know, I really love the focus on science. I talk about science a lot here as well. And one of the things that I like about that so much is because, and tell me you’re just kind of your thoughts on this. But, you know, the sober curious movement, I can’t say that I, you know, there’s, that’s great that people are exploring options to not have alcohol in their lives. And I certainly want to encourage, like I said, everyone to either stick to low risk limits, or if you are finding it difficult to stick to low risk limits, then alcohol free may be the best choice. What I appreciate so much about rethinking drinking is it’s very non judgmental, and it’s very much designed to educate people. And so that’s one of my concerns with the sober curious moment is because it’s kind of coming back to this angle where there’s something morally wrong with you, if you can’t, you know, if you’re not handling alcohol appropriately. And one of the things that I appreciate too, about the NA Nia is that focus on taking things back from this moral story of alcohol and moving it into a science realm to things that are evidence based. Tell me more about rethinking drinking. And also I know the NIA has launched a new project with these short tech videos. Right. Well, I, I agree with everything you just said. The, you know, the the advantage from our perspective of sober curious and, and dry October dry January is, is very simply that it allows you to, you know, reevaluate your relationship with alcohol. Yeah, we don’t care whether you go absent or don’t go absent, we you know, but the fact that you stopped for a while and then listen to your bio, I think that’s the critical issue, listen to your body, if you feel better, when you’re not drinking, your body is trying to tell you something. And I think it’s, that’s an easy way of looking at those, those movements. You know, rethinking drinking was to do exactly what you said, provide evidence based information. And I see that, in fact, is our mission. In AAA, which is to provide evidence based information about alcohol related problems, alcohol use disorder, and to help improve diagnosis, prevention and treatment of alcohol related problems. And, you know, we are the largest funder of alcohol research in the world. And so I consider us a world a US of course, resource. And you know, I think, you know, I hopefully, the information we put out, well will help a lot of people, the two other well, they’re multiple other pieces of information may mean getting out another one for those individuals who, who have a relative or they themselves are or a friend who’s maybe suffering from alcohol use disorder, we have the NI AAA treatment Navigator, and there you can find out what exactly is an alcohol use disorder. And you can find out what are the range and, and spectrum of treatments because alcohol use disorder is a spectrum disorder, you can have a mild, moderate or severe version, the severe version is what we used to call you know, substance dependence on alcohol or alcohol addiction or or alcoholic, we don’t tend to use the term alcoholic anymore. To try and just remove the negative kind of is to some people, you know, not ever and then, you know, I think treatment navigator also has a locator in it. I no not think and the locator, you can type in your zip code. And it’s a Psychology Today locator and Substance Abuse Mental Health Services Administration, locator, and you can find a treatment facility in your area. And maybe it isn’t what you get by just contacting them, they can refer you to other to other, you know, treatment facilities. And then the short takes are again, as you mentioned them that that’s just an effort by us to define terms that people don’t really get. And it’s not their fault, because they’re confusing, like blackout blackout is not losing consciousness blackout is simply where you don’t remember what transpired while you were drinking. And at some level, that’s pretty serious. Yeah. And you know, it’s like a gap in the tape. Think of it that way a gap in your memory tape. And so you don’t you know, you’d be dancing on the table with the boss’s significant other and not know about it, and everybody’s smirking at you the next day you come into the office and that, in fact, is a blackout. Right? But you can take it and make it a lot more serious when you think about other kinds of interactions. So, yeah, I think another one of the short texts is on binge drinking. And I really appreciated that too, because that’s something that I share quite often here as well, because, according to the NIA for women have binges considered anything more than three drinks in one day, and for men, anything more than four. And I know there’s a lot of people that wouldn’t that don’t think that that’s a binge, you know, in their own mind. They don’t see themselves like they go out on a weekend night, they’re having four drinks, five drinks, they don’t see that as a binge when it is in fact, by definition. That is what it is. Yeah, no, and we see drinking way pass binges in young people, we call it extreme binge drinking, I mean, and, you know, what often happens is individuals start drinking and and then you start to forget how many drinks you’ve had. And then the, the drinks don’t do for you what the first drink did, right? That’s there’s a, it’s a famous, it’s got a name, even. But that’s the simple version of that is tolerance. And we show tolerance to alcohol within one setting of drinking. And that’s something again, that people don’t realize very rapidly, your brain and body adapt to any insult and alcohol in some level is an insult. Or as I used to teach undergraduates at the University of California, San Diego. You know, there’s no free ride in the brain when it comes to drugs. So whatever you do, when when you take a psychotropic drug of any kind, when you take a drug that affects brain function, the brain reacts to that. Change the chemistry, and the chemistry has to change back in an opposite way. It’s a good way of thinking of it. Yeah. What what goes I talk about that a lot here on the on the podcast, because I’m a very big fan of neuroscience and neuro chemistry and understanding that in the brain, especially when it comes to alcohol, because I didn’t you know, I used to tell myself stories about how I needed to drink to relieve stress and anxiety. And the, the truth of the matter is, from a neuro chemical standpoint, if you drink beyond even eat well, any amount, but especially if you’re drinking beyond one drink, the counterbalance what your brain does to try to counterbalance that depressant action is to throw out a lot of neuro cameras, chemistry and neurotransmitters that are going to spike your feelings of anxiety after the fact as the alcohol is dissipating, bring your system. So it’s not you know, it isn’t true that alcohol helps you relieve stress and anxiety in the long run, especially if you’re drinking more than just one drink. So I, I love that conversation. And I thank you for bringing up also the SH s Ah s a, I can’t say it all. So substance abuse, mental health and Services Administration in 2014. And that was shortly after you came to the NI A, you did a study in collaboration with them that showed that nine out of 10 excessive drinkers were not physically dependent on alcohol. And it’s my belief that alcohol use disorder is progressive. And you talked about that about it being a spectrum disorder. And before people develop a physical dependence, they often develop a psychological dependence. But I believe personally that it can be rewired, if they become more aware of that, and they can actually change their their belief system around alcohol. As a neuroscientist, someone that has studied the brain as well. Do you believe that people can create new neural pathways and rewire their habits around alcohol? If they haven’t crossed that threshold to physical dependence? The answer is yes. Even if they’ve crossed the threshold of physical dependence, the answer’s yes with one, one slight change. We don’t we don’t grow new neurons in our adult brains, except possibly in the hippocampus. And even that’s a bit country reversal with with humans, but what we do is strengthen circuits that maybe weren’t activated in the past and utilized and so my example would be and this has been shown in individuals with with alcohol use disorder is that if you go abstinent and and you are going into treatment, whatever it is, it could be, you’re doing it on your own, and your brain starts to recover. What starts to recover is like, you know, driving on on i 95, on the east coast, is is the way a person might get from A to B in some cognitive task. Who doesn’t have a history of AUD, but a person who had even severe AUD still can get from Aden. Do that cognitive tasks and but they take the side roads, because the side roads now have been strengthened. It’s kind of like what the what you do for your, your knee when when you blow your anterior cruciate and, and you have to strengthen the muscles around you’re needed to function normally. And so we do that in our brains. And you’re absolutely correct. I mean, alcohol will, in a rising face the blood alcohol curve, you know, it will reduce your stress response. But as soon as the alcohol wears off the stress response in your brain, and there are neurotransmitters that we use, for our stress response, come back with a vengeance. And then every time you drink, you’re, in a sense, causing the problem that the drinking is supposed to be alleviating. Right, so you get into this vicious cycle that you’re trying to fix the problem with, with a drug that’s making the problem worse, as you pointed out, and these transmitters are, they got big names, but but they’re, you know, like corticotropin, releasing factor and dyne orphan and, and norepinephrine, these are transmitters that we need, okay, because we have to have a stress response, you step out in front of a car in New York City, or a taxi, and it’s bearing down on you either have to freeze and go back to the sidewalk, or you have to run across the street. And when you get across the street after evading being hit by a taxi. Against the light, you know, your brain is hot. All kinds of stress now you’ll you’ll find your heart’s pounding, your face is flushed, you suddenly, you know your brain is wide awake, and you can think of great new ideas. But I don’t recommend that for getting great new ideas. But anyway, you get the picture. Yeah, so we need those systems. But unfortunately, alcohol makes those systems chronically active. And, and that drives a lot of what we used to call alcohol dependence. And you’re right, it doesn’t have to be physical, it can be emotional. I don’t tend to use the word psychological dependence or physical dependence because the brain is physical. But you know, that get in to epistemology, what I what I really want to emphasize is that that negative emotional states are a major driver for excessive drinking, or been a major driver for excessive drinking during the pandemic, because all of us have been stressed in different ways. And they’re a major driver of relapse for individuals who do have an alcohol use disorder. Yeah, absolutely. In fact, I’ve just spent the whole month I will have spent the whole month of February, talking about emotional maturity, emotional resilience, emotional well being because just as that exactly as you said, the the vast majority of people who develop alcohol use disorder issues are doing that because they’re, they have a negative emotional state. And so we need to, we need to figure out how to, you know, handle our emotions in a better way. Because alcohol doesn’t really help alcohol doesn’t solve the problems. Yeah, one other point, you can get there multiple ways you can be traumatized as a child, you could you can live through a pandemic, but you can drink a lot, and just drinking a lot drives the same systems. And I think a lot of people don’t understand that piece. Yeah, absolutely. And I’m so glad that you brought up the COVID Locked 19 lockdown, because obviously, as we know, that has been an ongoing issue here, in not only in the United States. But of course, across the world. For the last two years, we’ve seen such an increase in alcohol use. And I just want to, to reiterate what you said in terms of it’s not only not effective for reducing stress and anxiety, but it also isn’t very good for our immune system either. No, I mean, the four ways that alcohol can interact with the pandemic, and we’ve already talked about two of them. And the other two are, you know, acute respiratory distress syndrome is exacerbated by alcohol without a virus that attacks the lungs. And then you have a virus that is producing the same thing when you’re in the hospital, which is acute respiratory distress syndrome. And so you know, we have a number of research grants out there right now trying to find out if there’s a more direct interaction, but it certainly could be an indirect interaction via the immune system. And then of course, the disinhibition which we’ve talked about, indirectly, you know, people doing things in crowded rooms with poor ventilation and then taking the masks off because they’re drinking and then you know, getting loud and boisterous and you know, that kind of shouting is clear. Have you been demonstrated to be contributing to spread a virus in a crowded environment? So those are the four areas, you know that alcohol interfaces with the pandemic directly? Yeah. Awesome. That Yes. And so I’m sure there’s I can’t, there are, as you said, more research out there right now, right, that’s gone going for figuring out these issues with COVID. And it because I don’t think COVID We would love to say it’s going away soon. But I just think that it’s going to be around for a while. So we probably need to figure out how to handle that on an ongoing basis. Dr. Cube, I know you have another talking engagement to get to. So I just appreciate you taking the time today, I will share all of these links in the show notes folks on where you can get more information on the NIH a and all of its resources, because at your core, at its core, it really is an educational piece for anyone who is trying to change their relationship with alcohol. And that’s really what I what I talk about all the time. We want you to be healthy. We want you to be safe, as safe as possible if you’re going to include it. And so, Dr. George Koop, I just appreciate you taking the time to talk with us today. Thank you, Molly. And if you have any further questions, feel free to send them to our team. And you know, we want to ever do this again. I’m happy to answer questions from people. So absolutely, that would be wonderful. I appreciate that. Thank you have a great day. Thanks a lot. 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