Ashlee Williams, MD: Whether it's to shake off a stressful day or to calm nerves in a social situation, many people turn to alcohol or marijuana to unwind. But what starts as a simple way to relax can eventually take a toll on your mood, disrupt your sleep, and make managing stress harder. Welcome to The Healthier You Podcast.

I'm Dr. Ashlee Williams, and today I'm joined by Dr. Jessica Reddy, a Board Certified Psychiatrist here at Kaiser Permanente. Together, we'll explore how regular use of substances like alcohol and cannabis can quietly undermine your health and wellbeing, and we'll share practical steps to help you regain balance.

Dr. Reddy, thank you so much for joining us.

Jessica Reddy, MD: Thank you for having me.

Ashlee Williams, MD: Dr. Reddy, it's common to use alcohol or cannabis to unwind, reduce stress, or help with sleep. So how does regular use of these, negatively impact mood, anxiety or even physical health?

Jessica Reddy, MD: I think this is a really, really important topic, Dr. Williams, so I'm very glad that we're covering it here. I first want to say that alcohol and cannabis or marijuana, this is like you said, is very, very common and a lot of my patients kind of look to these substances as ways to help cope with everyday life stressors and oftentimes mood disorders and other psychiatric conditions.

So really start from a place of compassion because more often than not, these are people who are just trying to survive essentially. It's really just trying to get through hard times. And alcohol and marijuana are, are widely available. And, can be marketed as things that kind of actually help with certain things like anxiety. What, I really like to explain to people is that for both of these substances, both alcohol and cannabis, people can certainly develop addiction and physiologic dependency too. And what does that look like? So, alcohol and cannabis are used for stress relief.

A lot of the times people are self-medicating for insomnia, sleep difficulties. But what I like to tell patients is whatever effects that the substance is being used for, the withdrawal will be the opposite of that. You know, what comes up must come down. And so say for example, we're drinking at night and that helps us calm down and helps us sleep. Well the next morning you know, you have to go to work, et cetera.

You're sort of putting your body in, in mini withdrawal periods. It might not be life-threatening, so severe that this withdrawal is life-threatening, but we're still feeling the effects. So what that would look like is maybe increased anxiety, jitteriness, irritability. Difficulty with frustration tolerance, for example. And we know that both alcohol and marijuana can affect sleep quality. We know this through sleep studies, that it can interfere with the sleep architecture. Therefore even if it might help people fall asleep, it's actually impairing sleep in the long run.

And then studies are demonstrating that cannabis, especially long-term use, is associated with cognitive issues, including impaired memory and attention, as well as can increase the risk of anxiety, depression and mood disorders. And this is, you know, I want to kind of contrast this to oftentimes patients are getting cannabis from dispensaries that are marketing the substances as actually, medicines to combat these very things that actually, this substance can make worse.

Host: I think a big question is how? How do these substances create a cycle of dependence and addiction?

Jessica Reddy, MD: So this really goes back to, if we think about it simply, we're animals and when we're put in uncomfortable or painful situations, whether that be physical pain or emotional pain, seeking something to help cope, and getting relief from that pain, it now starts to enact this cycle of reward system.

So this involves the neurotransmitter dopamine in the brain. And, you know, the more that we tap into this cycle, the more what we call dependent or addicted one's body and brains can be to pretty much anything. But yes, these in particular.

Host: What are some signs that someone's habit may actually be a problem?

Jessica Reddy, MD: This is a really interesting question because, I really like to think about how the habit or the use is affecting their functionality and their ability to live their life in their social and employment, recreational obligations and activities, and really prevent patients from living the life that they want to live.

 I use this point to demonstrate this importance of functional impairment and that somebody who's drinking maybe one, two glasses of wine per week, might experience, given their physiology and their brains, they might experience cognitive issues or difficulty with focus or feel just generally unwell physically or mentally after just having one or two glasses of wine.

I would argue that that could be a problem, right? Even though that the number of, the actual number of drinks is low; as long as it's interfering with one's ability to live the life that they want to live, that's when we want to look into it.

There are other things that we look into including whether or not these substances might be causing physical signs of dependency, withdrawal symptoms, neglecting responsibilities or avoiding obligations, in the effort to either seek the substance or use it. And then having, you know, having to have more than before in order to get the same effect, which is what is called tolerance.

So those are some signs that we might be entering a zone of problematic use.

Host: Are there any risk factors that make someone more prone to developing a substance abuse problem?

Jessica Reddy, MD: I always like to go back to, you know, the person who's in pain. Somebody who is going through stress or emotional pain and, and that being sort of an impetus to use or to drink. It's a coping mechanism. It's something that we call maladaptive coping mechanism because it can have these really profound negative consequences, in the long term or even in the short term without getting at the root cause of the pain. But we've got people who have co-occurring disorders such as depression or anxiety, any anxiety disorders or PTSD or any type of phobia. As well as physical conditions, coping with chronic physical issues. Oftentimes we'll have patients who are drawn to substances to help cope. And then of course there, you know, the big area of research is the genetic contribution of developing addictions. Why somebody could participate in drug use and somebody else have the same amount, but then one of them develops an addiction versus the other. There's definitely a genetic contribution.

Host: So some things that we don't have control over. Do you have any tips or strategies for anyone listening who wants to quit or cut back on using a particular substance?

Jessica Reddy, MD: What I really try to start with is discovering, just being, you know, I really try to be curious about, what are we, if anything, are we trying to self-medicate? And really understand, okay, like what are those stressors or what are those factors that are bringing somebody back to use and drink?

 And really addressing those first and foremost. Second of all, really identifying the factors that continued use, is affecting or negatively affecting one's life because, if we get very clear about how the use is creating problems or impairing one's ability to live a life worth living, those are where we will start to develop a motivation to heal and to change, right? Because we want to identify what damage is it causing in one's life? And then start there to help make it better. Another thing is identifying other ways to cope. Oftentimes patients, who use substances to help cope, don't have other coping mechanisms.

So, whether that be exercise or, you know, calling family or, trying a new hobby or going and spending some time in nature, having encouraging the development of other maybe novel or unfamiliar at first ways to help cope in the face of emotional pain, can be really helpful.

Host: As a psychiatrist, when would you recommend that someone seek professional help? And can you talk a little bit about what treatment options are available?

Jessica Reddy, MD: Yeah. I think that I would say I have a low threshold to seek professional help. If you feel like, A, that there are things in your life that you need help coping with, and B, that maybe you're otherwise using substances to do so. If, it's starting to impair your life and you're starting to live a life that is not consistent with what your dreams are.

I think that there's a lot of stigma against identifying as somebody who has a substance use problem. But like anything in medicine, we're not thinking about binary. You know, it's, nothing is binary in medicine, and biology, and that, you know, just because somebody is seeking help because they're a little bit concerned that there may be, you know, their use is interfering with their life in whatever way, doesn't make them a bad person or any sort of judgment or label. And that seeking help early and developing alternative coping mechanisms early can only help in the long run and actually help cure and heal the stressors and the distress that might be facilitating or causing somebody to drink or use in the first place.

Host: So true, and I think it's so important to keep having these conversations so that we can help take away the stigma. Well, thank you so much for this insight, Dr. Reddy. Here are some takeaways from today's episode.

One. Substance use disorder is a mental health condition that disrupts brain function and daily life. Two. Regular use of alcohol or cannabis can worsen mood, anxiety, sleep, and overall health over time. Three. Dependence develops gradually, often leading to withdrawal symptoms and needing more of the substance to feel normal.

Four. Red flags include cravings, neglecting responsibilities, withdrawal symptoms, and continued use despite harm. And five. Early help, healthy coping strategies and professional support can make recovery possible. For more expert advice, please visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast.

If you found this episode helpful, don't forget to subscribe and share it with others. Thank you, and from all of us at Kaiser Permanente, be well.