Selected Podcast
Alcohol Awareness
Elise Wessol DO discusses alcohol awareness. She examines the epidemiology of this global issue and the normalization of binge drinking and alcohol use in society. She shares the important health risks of alcohol use from the WHO and NIAAA guidelines and she offers the latest treatment options available, which have been grossly underutilized.
Featuring:
Elise Wessol, DO
Elise Wessol, DO is an Addiction Medicine physician.
Transcription:
Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole, and today we're discussing alcohol awareness. Joining me is Dr. Elise Wessol. She's an Addiction Medicine Specialist with the Carle Foundation Hospital. Dr. Wessol, it's a pleasure to have you join us today. How has COVID potentially caused a rise in addiction and substance use disorders in the last year? Data's shown that there's been this increase in substance abuse as a way of coping with the stress of the pandemic. So, Dr. Wessol talk to us about this intersection of substance use disorder and COVID-19.
Elise Wessol, DO (Guest): Yes, you're absolutely right. With the advent of the COVID-19 pandemic, there has been uncertainty about the future, lost income and work, social isolation, and this leads to loneliness, anxiety, depression, and then coupled with alcohol use or substance use, these conditions often worsen and we have seen a unprecedented rise in opioid overdoses as well as alcohol use disorder diagnoses. Furthermore, we have seen a rise in alcohol liver disease in young women, which are supercharged by the pandemic.
Host: That is so interesting. So, let's talk first about some of the more important health risks of alcohol use. Can you speak to the World Health Organization and the National Institute on Alcohol Abuse and Alcoholism, those guidelines, and what do they say about these health risks and really how much we should be or should not be using?
Dr. Wessol: According to WHO guidelines, there is no safe level of alcohol use. Any alcohol use can increase the risk for various cancers, for heart disease and also to mental health conditions like depression and anxiety. The NIAAA recommends that for all women and then men greater than 65 years old, they should drink no more than three drinks per occasion. And for men less than 65 years old, no more than four drinks per occasion. And then no more than 14 per week for men, less than 65 years old and no more than seven per week for women and men greater than 65 years old. So, those are the national guidelines. Any more than that is considered binge type drinking.
And alcohol is the leading risk factor for premature mortality and disability among those aged 15 to 49 years old. Disadvantaged and displaced populations have much higher rates of alcohol related deaths and hospitalization as well. Additionally, alcohol contributes to around 20% of ED visits and 22% of overdose deaths related to prescription opioids. So, we know that alcohol contributes to a very high rate of mortality and morbidity in our population.
Host: Isn't that's so interesting what we're seeing today? And as we're talking about this, Dr. Wessol, speak about the normalization of binge drinking and alcohol use in society. What we see happening at colleges and really everywhere. And since the pandemic, I mean, it's certainly is more prevalent as you've already said. So, tell us how we've normalized that. And if you have any theories or opinions on what we can do to change that mindset.
Dr. Wessol: Yeah, so binge alcohol use is normalized in college campuses, around the nation and young people particularly do not give much thought about the consequences of binge type alcohol use. And as we've seen in the news, there are deaths related to alcohol use and hazing in the Greek life on college campuses. And then outside of college, we see alcohol used in commercials and TV shows and marketing campaigns on how alcohol is used for celebrations, for coping, for self-medicating. And so, it can be a normalized part of a person's culture. We need to more readily discuss and openly discuss alcohol use with our patients. And then that can lead to more conversations about alcohol use may be affecting a person's health, especially contributing to blood pressure, heart disease, and diabetes, just to name a few. And then also if a patient's alcohol misuse is identified or they are identified to have an alcohol use disorder, treatment can be initiated.
Host: to talk about that. But for other providers, and even for parents listening out there, it is so important. What you mentioned about talking about this and talking to your patients, and as a parent with kids in college, this is a conversation that I had numerous times, so many times about binge drinking and the scary dangers of it and what we're seeing at the colleges. So, thank you for talking about that. Now let's talk about some of the treatment options available at the Carle Foundation Hospital, which have really been grossly under utilized, right? Dr. Wessol, how can we get more people to look into them? And what would you like other providers in the community to know about steering their patients towards these programs?
Dr. Wessol: Absolutely. So, yes, there are three FDA approved medications for the treatment of alcohol use disorder. There is no standardized addiction medicine training and our education systems, medical school residencies. And so that is beginning to change. But for that reason, that is part of why these medications and treatment for substance use disorder is grossly under utilized. So, most people are familiar with Antabuse or disulfiram which is the medication that if patients were to drink on it, they do become violently ill. The really the big hitters for the treatment of alcohol use disorder are naltrexone and acamprosate, which help to reduce cravings for alcohol and help maintain abstinence.
Naltrexone, additionally has been shown to decrease the number of drinks per drinking occasion. So, if a patient's goal isn't abstinence from alcohol, it can decrease from heavy use to low moderate use. And so these are the medications that we try to put patients on and they can be prescribed by any primary care provider without any additional licensing or DEA training and not just by addiction medicine providers.
Host: So, what would you like physicians in general to do, to help their patients who are struggling with substance use disorders at this time? Tell us how the Carle Foundation Hospital, what they're doing to ensure the continuity of care for addiction services during this pandemic. Kind of wrap it up for us with your best advice for other providers about getting their patients to look into these options and really, how the Carle Foundation Hospital is helping with the addiction problem during these times.
Dr. Wessol: Yeah, absolutely. So, firstly, we did start an inpatient consult service. So, we are connecting with patients who are acutely hospitalized as primarily or secondarily due to their substance use. And so that is a way to engage them in conversation about their substance use and perhaps initiate treatment as well as connect to outpatient care. Secondly, approaching a patient with curiosity and empathy to help develop a conversation that the patient is not feeling stigmatized or judged because of their substance use will help them be honest with their providers and then you'll get the best information to help them with their substance use and then discuss treatment options.
So, I think the first and foremost thing providers can do is approach patients with empathy regarding their substance use, with nonjudgmental attitudes and tones, and that can help facilitate conversations. The patient's more comfortable with discussing their substance use, and that can lead to the next steps of intervening and connecting to treatment.
Host: Such an important message at this time. Thank you so much, Dr. Wessol for joining us today. For a listing of Carle providers and to view Carle sponsored educational activities, please visit our website at carleconnect.com for more information. That concludes this episode of Expert Insights with the Carle Foundation Hospital. We hope the information gained will be applicable to your work and life. And if you found this podcast informative, please share on your social channels and be sure to check out all the other interesting podcasts in our library. I'm Melanie Cole.
Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole, and today we're discussing alcohol awareness. Joining me is Dr. Elise Wessol. She's an Addiction Medicine Specialist with the Carle Foundation Hospital. Dr. Wessol, it's a pleasure to have you join us today. How has COVID potentially caused a rise in addiction and substance use disorders in the last year? Data's shown that there's been this increase in substance abuse as a way of coping with the stress of the pandemic. So, Dr. Wessol talk to us about this intersection of substance use disorder and COVID-19.
Elise Wessol, DO (Guest): Yes, you're absolutely right. With the advent of the COVID-19 pandemic, there has been uncertainty about the future, lost income and work, social isolation, and this leads to loneliness, anxiety, depression, and then coupled with alcohol use or substance use, these conditions often worsen and we have seen a unprecedented rise in opioid overdoses as well as alcohol use disorder diagnoses. Furthermore, we have seen a rise in alcohol liver disease in young women, which are supercharged by the pandemic.
Host: That is so interesting. So, let's talk first about some of the more important health risks of alcohol use. Can you speak to the World Health Organization and the National Institute on Alcohol Abuse and Alcoholism, those guidelines, and what do they say about these health risks and really how much we should be or should not be using?
Dr. Wessol: According to WHO guidelines, there is no safe level of alcohol use. Any alcohol use can increase the risk for various cancers, for heart disease and also to mental health conditions like depression and anxiety. The NIAAA recommends that for all women and then men greater than 65 years old, they should drink no more than three drinks per occasion. And for men less than 65 years old, no more than four drinks per occasion. And then no more than 14 per week for men, less than 65 years old and no more than seven per week for women and men greater than 65 years old. So, those are the national guidelines. Any more than that is considered binge type drinking.
And alcohol is the leading risk factor for premature mortality and disability among those aged 15 to 49 years old. Disadvantaged and displaced populations have much higher rates of alcohol related deaths and hospitalization as well. Additionally, alcohol contributes to around 20% of ED visits and 22% of overdose deaths related to prescription opioids. So, we know that alcohol contributes to a very high rate of mortality and morbidity in our population.
Host: Isn't that's so interesting what we're seeing today? And as we're talking about this, Dr. Wessol, speak about the normalization of binge drinking and alcohol use in society. What we see happening at colleges and really everywhere. And since the pandemic, I mean, it's certainly is more prevalent as you've already said. So, tell us how we've normalized that. And if you have any theories or opinions on what we can do to change that mindset.
Dr. Wessol: Yeah, so binge alcohol use is normalized in college campuses, around the nation and young people particularly do not give much thought about the consequences of binge type alcohol use. And as we've seen in the news, there are deaths related to alcohol use and hazing in the Greek life on college campuses. And then outside of college, we see alcohol used in commercials and TV shows and marketing campaigns on how alcohol is used for celebrations, for coping, for self-medicating. And so, it can be a normalized part of a person's culture. We need to more readily discuss and openly discuss alcohol use with our patients. And then that can lead to more conversations about alcohol use may be affecting a person's health, especially contributing to blood pressure, heart disease, and diabetes, just to name a few. And then also if a patient's alcohol misuse is identified or they are identified to have an alcohol use disorder, treatment can be initiated.
Host: to talk about that. But for other providers, and even for parents listening out there, it is so important. What you mentioned about talking about this and talking to your patients, and as a parent with kids in college, this is a conversation that I had numerous times, so many times about binge drinking and the scary dangers of it and what we're seeing at the colleges. So, thank you for talking about that. Now let's talk about some of the treatment options available at the Carle Foundation Hospital, which have really been grossly under utilized, right? Dr. Wessol, how can we get more people to look into them? And what would you like other providers in the community to know about steering their patients towards these programs?
Dr. Wessol: Absolutely. So, yes, there are three FDA approved medications for the treatment of alcohol use disorder. There is no standardized addiction medicine training and our education systems, medical school residencies. And so that is beginning to change. But for that reason, that is part of why these medications and treatment for substance use disorder is grossly under utilized. So, most people are familiar with Antabuse or disulfiram which is the medication that if patients were to drink on it, they do become violently ill. The really the big hitters for the treatment of alcohol use disorder are naltrexone and acamprosate, which help to reduce cravings for alcohol and help maintain abstinence.
Naltrexone, additionally has been shown to decrease the number of drinks per drinking occasion. So, if a patient's goal isn't abstinence from alcohol, it can decrease from heavy use to low moderate use. And so these are the medications that we try to put patients on and they can be prescribed by any primary care provider without any additional licensing or DEA training and not just by addiction medicine providers.
Host: So, what would you like physicians in general to do, to help their patients who are struggling with substance use disorders at this time? Tell us how the Carle Foundation Hospital, what they're doing to ensure the continuity of care for addiction services during this pandemic. Kind of wrap it up for us with your best advice for other providers about getting their patients to look into these options and really, how the Carle Foundation Hospital is helping with the addiction problem during these times.
Dr. Wessol: Yeah, absolutely. So, firstly, we did start an inpatient consult service. So, we are connecting with patients who are acutely hospitalized as primarily or secondarily due to their substance use. And so that is a way to engage them in conversation about their substance use and perhaps initiate treatment as well as connect to outpatient care. Secondly, approaching a patient with curiosity and empathy to help develop a conversation that the patient is not feeling stigmatized or judged because of their substance use will help them be honest with their providers and then you'll get the best information to help them with their substance use and then discuss treatment options.
So, I think the first and foremost thing providers can do is approach patients with empathy regarding their substance use, with nonjudgmental attitudes and tones, and that can help facilitate conversations. The patient's more comfortable with discussing their substance use, and that can lead to the next steps of intervening and connecting to treatment.
Host: Such an important message at this time. Thank you so much, Dr. Wessol for joining us today. For a listing of Carle providers and to view Carle sponsored educational activities, please visit our website at carleconnect.com for more information. That concludes this episode of Expert Insights with the Carle Foundation Hospital. We hope the information gained will be applicable to your work and life. And if you found this podcast informative, please share on your social channels and be sure to check out all the other interesting podcasts in our library. I'm Melanie Cole.