Episode 2: Champagne on the Brain
Robbie Shaw:
This is Champagne Problems, where we come together to explore the gray areas of drinking. This is a judgment-free zone where we can all take a look at how we make decisions about our relationship with alcohol.
We're back in the studio for another episode we're calling Champagne on the Brain. Today's topic is very critical to the mission of this podcast, and what we're going to do here is find out more about what's happening to our bodies and brains while under the influence of alcohol.
Sam Hampson:
I think about drinking a lot. I think there's so much that goes into this weighing, "Do I drink? Do I not drink?" There was a point in my life where I removed alcohol based on the fact that it was not compatible with optimal performance in the things that I wanted in my life. Then there was a point where I decided to invite it back in and that had to come with a lot of energy of just weighing, "Do I drink tonight? Do I not drink tonight? What does that look like? What kind of preventative measures am I going to have to put in place? What hangover cure am I going to have to drink before I go to bed?"
One of my first thoughts that I have is like, "How worth it is it to have this glass of wine or this fruity drink?" or whatever, and know that I usually get breakouts after drinking. So I'm looking at all the different health-associated things and you guys, it's a toxin. It is a neurotoxin you're putting in your body and you're putting it in your brain.
But the other things I think about, I think I'm just a person that needs a minimum of eight hours of sleep. The reality of what alcohol does is it interrupts and even prevents REM sleep, so I'm not getting those restful sleep cycles that I really need during those eight hours. So, yes, it may turn my racing thoughts off. It's going to shut that off and I'm going to be able to go to sleep faster, but I will not get the same quality sleep. I will likely wake up way more times that night and even the sleep I do get, it's not as restful. So another piece that I put into the equation, how much do I care about my eight hours?
The last piece was probably when I was on different medications where this mattered, but the idea that I don’t even like to take ibuprofen when I have a headache, but I'm willing to drink a glass of wine is freaking stupid. It's stupid and it's flat out incongruent to be like I really believe in overall wellness and I don't want to put these things in my body to include anti-depressants or painkillers or all these things, and then also consume alcohol. It's just incongruent.
The other thing to consider with this is if you are on an antidepressant, a sleep medication, anti-anxiety medication, or literally any other medication that is designed to do something as far as chemical or adrenal release in your body, you are likely canceling out or compounding the effects of that medication when you consume alcohol.
No one talks about it. But when I'm going through the equation in my head, is it worth the calories, the breakouts? Is it worth my eight hours of sleep? And what impact does this have on the effects of the medications that I'm supposed to be taking for said symptoms? Those are all places that I have to go when I'm being really honest with myself about what I'm doing, which is just chemically putting a neurotoxin on my brain.
Robbie Shaw:
You're not living in a wellness standard and, obviously alcohol, if that is involved, it's a depressant. It does these things to your body after it gives you what you're looking for out of it and we don't really make the connection. I think we could make the connection. I think we almost ignorantly avoid the connection because the reward of alcohol is so powerful and so effective that we are willing to deal with the crap that comes with it. That was my problem.
How Does Alcohol Affect Our Bodies?
Sam Hampson:
And yet the conversation that we have for our listeners is much more of like, "What do I need to be worried about as someone who drinks two glasses of wine a week? What happens on my body, on my brain when I'm putting alcohol in there?" and can we just talk about that because we don't.
Patrick Balsley:
Yeah. So I think it's really important that we have this piece and we have somebody to inform us of exactly what's happening to our brain when this stuff is ingested into our bodies.
So on today's episode, we have Dr. Steve Scanlan. Steve has been a friend of mine for several years now, and we've worked in different capacities together over the course of my professional career. I thought he would be the perfect guest today for Champagne on the Brain. Dr. Scanlan owns Palm Beach Outpatient Detox in Boca Raton, Florida. He is double Board-certified in General Psychiatry and Addiction Medicine, and he is a good man.
We want to start with you just giving us your most absorbable version of how alcohol works on the brain.
Dr. Steve Scanlan:
Well, that's a pretty good way to put it, absorbable. That's how it starts. You drink it and then it gets absorbed in your GI tract. That takes about 5 to 10 minutes, and that's when you start to feel it. It works in a lot of different ways, but it immediately causes the limbic area of your brain to start releasing dopamine that leads to euphoria, and that's what you feel in the beginning. It also has an effect on two main neurotransmitters, GABA, which is inhibitory, and glutamate, which is excitatory. It activates the GABA, which inhibits activity and it blocks glutamate, which is excited for activity. So you're not thinking about as much stuff and you get more relaxed and carefree. As you drink more, it has an effect on other areas. Obviously, in higher amounts, that can be dangerous.
Patrick Balsley:
I think that's one of the major cultural effects and why it has been so acceptable in our culture for so long.
Robbie Shaw:
Because it's so enjoyable.
Dr. Steve Scanlan:
It's classified as a depressant, but sometimes people want to block out some of the noise of the world and it can help people relax. There's a line that can be crossed where there can start to be some negative consequences. They always say on TV, “use responsibly,” and that's the big thing.
Alcohol’s Impact on Physical Health
Patrick Balsley:
What are some of the ways that our general health is affected by alcohol use? Like even for the mild to moderate drinker, like in terms of sleep, nutrition…
Robbie Shaw:
Mental health.
Sam Hampson:
You mentioned the GI tract. I'm imagining esophagus, everywhere.
Dr. Steve Scanlan:
Well, it's a neurotoxin, so that's where you start. You're taking in a neurotoxin. There are other forms of alcohol that are much more toxic than ethyl alcohol, which is what we use. But every time you take in alcohol as a neurotoxin, it will kill some brain cells. I mean, we have a lot of them, but over time it's a cumulative effect. Continued use can cause atrophy of the cortex.
Patrick Balsley:
Tell us about that.
Dr. Steve Scanlan:
Well, the cortex is your main brain part, and atrophy means that it shrinks. But the cerebellum, that's for movement and motion. People that drink chronically end up having a lot of trouble with their balance over time. With alcohol though it develops slowly. That's where it can also affect the hippocampus, where we create memories. So people that are drinking moderately or higher will start to see some issues with memory. I know most people have a binge drinking episode at least once in their life and remember how everything's kind of hazy the next day.
It also decreases REM sleep. That's the restful sleep. So when you're drinking, you're not going to get very good quality sleep. There's liver damage because the liver has to get rid of the alcohol, and then the esophagus; you can have reflux and gastritis.
Alcohol’s Impact on Mental Health
Dr. Steve Scanlan:
Then the mental health effects is where I was always the most worried because you have to ask yourself if you're using it to self-medicate or to deal with anxiety because of loneliness or isolation?
I always look at it like if I drink today it's like a credit card. There could be something I want to buy and I could buy it right now with a credit card, but eventually I'm going to have to pay it back. Having just even a few drinks takes some dopamine and serotonin and we get to enjoy it right now. But that dopamine and serotonin was for the next day. That was the stores that you were supposed to have for your brain. So people wake up the next day and they don't have as much dopamine or serotonin, and they're more anxious and they're more irritable. It's like, "I want to have all my dopamine and serotonin for the next day."
That was something that was there for me. I wasn't thinking about the physical symptoms when I stopped drinking, but it is a good thing and you feel so much better. It was more on the emotional stuff and the trouble. Even if you look at moderation management, you're expected to stop drinking completely for 30 days. A lot of people can't do that, but some people can, and I think that really opens up where you are on the spectrum.
The Genetics of Addiction
Robbie Shaw:
You often hear about people who get to that level where it is somewhat of a severe addiction, and then you often hear you can never really go back to drinking manageably. Why is that?
Dr. Steve Scanlan:
I don't have an exact answer for that, so I can just throw out a hypothesis. Addiction is genetic and you inherit it. It has to be activated. I think a certain amount of use, especially with the dopamine activation for a period of time, has to go on. It's like a pickle can't go back to being a cucumber. So that's why it's important, when someone's looking at this, like, "Oh, maybe I have a problem with alcohol. I need to cut down." There's people that have addiction genetics, and then there are other people who don't. Those who don’t would be able to find moderation with changes.
Sam Hampson:
From your perspective, is there such a thing as a healthy relationship to alcohol or with alcohol?
Dr. Steve Scanlan:
Yeah, I think there can be. Someone who definitely doesn't drink every day, and when they drink they don't go over a certain amount, they're definitely not going to be over the legal limit to drive ever. I mean, occasionally, there might be some binge drinking, but that might be just for certain holidays or certain times. Also, the person who's not drinking to control their emotions or because of stress, someone who has emotional sobriety. Someone who's using it socially and responsibly, I think those numbers are good from the Institute; for women, not going over more than seven drinks a week; or for men, over 14. That's a pretty good benchmark for pretty healthy.
Sam Hampson:
Yeah, and you mentioned some of those other factors that make it unhealthy; the intent, like what is my emotional intent with consuming this? Is it to turn on the GABA, turn off the glutamate? Like, what am I really doing? Is it to be able to escape or medicate something? Or, is it to enhance the experience I'm already intent on having like, "I'm going to dinner with friends and I'm going to add alcohol to it," and I can take it or leave it. It's not, "To be able to have dinner with friends I have to have a glass of wine first."
Common Misunderstandings and Myths About Alcohol
Patrick Balsley:
Are there any other myths that you feel like should be addressed or misunderstandings that are more common than others?
Dr. Steve Scanlan:
Well, I know there is a report where the big thing about the red wine or a little bit of alcohol was almost healthy from a cardiovascular standpoint. No, I don't think that helped anything too much.
Sam Hampson:
For sure. I saw a meme the other day that was like if one glass of wine is good for making you happy, how good a bottle is? It's still circulating.
Dr. Steve Scanlan:
I think a lot of people come to me and they say, "I just think if I stopped, like I have only so many friends and so much of my social life is about drinking, and a lot of things revolve around it," or I have someone who's single and they're like, "I don't know how I could even go out on a date or meet someone new without being able to drink." A lot of people don't think they would ever be able to have fun again if they're not drinking. Those are truly myths. I always tell people, "You remember when you were a kid and you didn't have to have alcohol or anything to have fun and you could just enjoy it?" Obviously, speaking to someone who haven't had a drink in, I guess, 17 years, I mean, you do really learn how to have fun. That helps dispel. There's a lot of noise in someone's head.
Then, also, some of the myths. I treat a lot of professionals. Because I'm outpatient, a lot of people are coming in, they're doing well at work. They've never been arrested, they're being good to their family, and they're still being responsible. They're high functioning. But even though they are high functioning and a lot of things are going well, the alcohol can have negative consequences. So there's a lot of myths. Every person has to sit with themselves and say, "What are my rationalizations, my justification, my minimizations that I do with my drinking?" I think that's important to go over.
Sam Hampson:
Just being so scared of letting go of that relationship, that grief and loss around alcohol use if you're in consideration of removing it from your diet or from your intake.
Dr. Steve Scanlan:
I also have people that come for general psychiatry, so it's not all people that are having some huge issue with alcohol. I have some people that said, "Ah, maybe I could cut down," and there are just so many benefits you'll see by decreasing or even taking a break for a little bit and reflecting. If alcohol is playing some role, when you take it away, you have to look at, "How am I going to replace this void?" There are healthier ways to get reward like exercise or diet where you can get pleasure, but you're not having to drink to change the way you feel. You can be in charge of how you feel, but that takes work. Alcohol is easier and it is instantly gratifying.
Improving Your Relationship with Alcohol
Patrick Balsley:
Where do you suggest, if I wanted to stop drinking or take a look at my drinking, where would you suggest I start?
Dr. Steve Scanlan:
I’m talking about the people that might be able to get back into a healthy relationship with alcohol again versus people that would not be able to do that. I've just asked a lot of people in my treatment experience, "Just could you stop for 30 days and then evaluate. Take that break." A lot of people are able to do that, and then there are a lot who cannot, but that's a really good benchmark. Be honest. Take a break for 30 days.
Patrick Balsley:
Not only stop drinking for 30 days, but give yourself the chance to add some of these other holistic lifestyle choices into the mix so you can start to see some of the positive benefits that they can provide in place of that.
Getting Past the Alcohol Culture in America
Dr. Steve Scanlan:
You look at the American way with things like, "Do you want to fix it now or do you want to fix it right?" Everyone's always looking for the quick fix. It's something that develops over time and you didn't get to this spot where you're having an issue with alcohol in a week. So it's like it takes some time. You may have some setbacks, but you just don't give up.
A lot of treatment out there is fear-based and that's not how it should be. So like I said, I'm going to get a month and see how I feel. Then I remember putting it into three months, six months, and then I was like, "You know what? I want to get a year and then I'll decide." In a year, I was like, "This is the best I've ever felt in my life, the happiest, and I've never gotten so much done," and it's like, "Now I'm in charge of how I feel."
It is nice to have more autonomy with all your feelings. Even if you're someone who does take medication. Say you take an SSRI for anxiety or depression. So if you have more serotonin in the synapses, it can help with depression or anxiety. But if you're stealing the next day's serotonin from drinking and then it's the next morning and you're like, "Oh, okay, well, I'm going to take my Prozac for my anxiety." If there's not that much serotonin to block the reuptake of, then the medication is not even going to work.
Robbie Shaw:
Well, it speaks to the normalization of alcohol consumption in our society that puts a blinder on people to not look at that. I mean, it seems so obvious for us who are in this world, but to people who aren't, it's like, "Well, I'll look at everything, but what I've done for 20 years. We're not going to look at alcohol." Absolutely not going to look at that because that's what everybody does and that's what we will always do, but let's look at everything else. What concerns you the most about the normalization of alcohol in our society?
Dr. Steve Scanlan:
People start to use it before they learn how to deal with problems on their own. It's like the alcohol is thrown in there and that's an easier way. I wish there was a little bit more explanation of it and how it acts before someone gets introduced to it.
Patrick Balsley:
Often, it reverts back to coping strategies, coping tools, coping mechanisms. When alcohol is so normalized, and I can speak from experience, early on in my life that's what I figured out was the easiest way to cope with things I was struggling with, and it just became part of my makeup. My developing brain developed with the tool of alcohol, and so I knew no other way. It was just inevitable that it was going to become problematic due to my unhealthy coping skills.
Robbie Shaw:
What do you think the main drivers are of the alcohol normalization in our society?
Dr. Steve Scanlan:
I mean, I guess advertising and media and sex, the pressure of life and wanting to fit in, and with everything going so social media now, I feel like there's even more pressure.
I liked that you're doing this podcast because even those last two questions and talking about normalization, it's something that I haven't really thought about that much or heard other people talk about. That's why I'm glad you're talking about something like this. There's been lots of people trying to do this and you don't want to do it alone.
Robbie Shaw:
The information and opinions shared on this podcast are solely those of the hosts and guests and not a substitute for medical advice. If you feel like you may need professional help, here are some resources. For the Substance Abuse and Mental Health Services Administration hotline, call 1-800-662-4357, or visit samhsa.gov. For listeners in the Charlotte, North Carolina community, visit dilworthcenter.org or call 704-372-6969. Or visit theblanchardinstitute.com or call 704-288-1097.