Maggie McKay (Host): Alcohol addiction is something that affects so many people and it can be a lifetime struggle. So today we'll learn more about it and how to get help with Dr. Michael Radeos, Addiction Specialist and Program Director at Flushing Hospital Medical Center. Welcome to Flushing Hospital Med Talk, a podcast from Flushing Hospital Medical Center.

I'm Maggie McKay. Welcome, Dr. Radeos. Thank you so much for making the time to be here today.

Michael Radeos, MD, MPH, FASAM: Oh, thanks for having me, Maggie.

Host: So let's just start with what is alcohol addiction or alcohol use disorder?

Michael Radeos, MD, MPH, FASAM: Well, alcohol use disorder can be thought of like any of the other substances or any of the other addictions. For example, we've heard a lot about the opioid epidemic, so people who use opioids like heroin, fentanyl, etc. are said to have opioid use disorder. If the substance is alcohol, it becomes alcohol use disorder.

And what's interesting is you don't have to look at substances any different than you look at, for example, another substance, tobacco, or other things like gambling, for example, shopping, eating; all these things can become use disorders or addictions. And when it becomes an addiction, you know it because most people, let's say, might be able to have a drink or a glass of wine with dinner, so using is not a problem. And there's then the next three steps. The second step is tolerance, where it takes more of the substance to get you where you're trying to get to. Then you have the physical dependence, which means that if you use, let's say you have too much to drink one night, you wake up with a hangover, now you have a physical dependence.

And if you get to the point where it's affecting your life, your job, your marriage, any of those things, when it starts interfering with the function of your life; that's when you know you have an addiction or a serious use disorder.

Host: And what makes alcohol addictive?

Michael Radeos, MD, MPH, FASAM: It's an interesting question. I think most of the substances that we think about, they do something to you. So they relax you, they give you pleasure, and to really oversimplify it, the brain has these things called neurotransmitters. They're chemicals in the brain that literally spike when you feel something good.

So let's say you're a child and you get a good report card in school and your mom or dad takes you to the ice cream shop and get you an ice cream. You'll get what's called a dopamine spike and it means you feel really good. And it also means that you start putting two and two together and realizing that, Hey, if I get another good report card in another month or so, I might get another ice cream.

It all boils down to that basic principle, something that makes you feel good, that makes you want to keep taking it. In the situation of alcohol, opioids, and the others, you seem to have to keep taking more and more in order to try to relive that first experience, that first time. And in some of these substances, the sky's the limit, and it'll keep you coming until it really starts affecting your life.

Host: And you touched on it a little bit, but what is considered excessive drinking?

Michael Radeos, MD, MPH, FASAM: It's different for men and women. So, basically, if you're into the equity lens, it's not quite fair. So, a man can have up to let's say, four drinks a day, a woman, three. Over a week, a man can have 14 drinks and a woman has maybe ten. Now, the thing is, a lot of it has to do with body size. So guys tend to be larger than ladies, so we have the chance to drink a little bit more.

But, there is kind of a quick way of remembering this. A standard drink is different depending on what it is you're drinking. So a standard drink would be like a 12 ounce beer, or if you're thinking a malt liquor or hard seltzer, it's 8 to 10 ounces, that's a standard drink. For wine, it becomes 5 ounces. If you're drinking fortified wines, it's three to four ounces. If you're drinking a cordial or a liqueur, two to three ounces. And if you're drinking a shot, whiskey, brandy, cognac, vodka, it's only one and a half ounces. So you really need to keep that in mind to know when you're pushing the limits. And one more thing to add to that, it changes. So as you start developing a use disorder and you drink more, and you develop a tolerance, which means it takes more of the substance to get you where you're going, you may be able to handle more, but that can also be a warning sign.

Host: And what are the causes and the risks when it comes to alcohol use disorder?

Michael Radeos, MD, MPH, FASAM: One of the big ones is genetic. So it appears that if you have a parent or a grandparent that was someone with alcohol use disorder, you are already halfway there. And the genetics affect you, not just in the fact that you had a parent, let's say, that uses, or a grandparent, but it also affects you in the way that your genetics hit your metabolism.

So people that metabolize alcohol slowly, for example, they might metabolize to something that makes them sick. It's called aldehyde. So if you turn alcohol into aldehyde, but you can't get rid of the aldehyde, you may never develop a use disorder because every time you drink, you metabolize into something that makes you sick. It also affects your immune system. And that means you can get more sick than your partner that's not a drinker or your brother and sister, let's say that's not a drinker. So from the genetic point of view, there is that initial strike against you if you have that genetic makeup.

Host: So let's say you have that genetic makeup, does that mean you're more susceptible to be addicted to other things, not just alcohol, say drugs or whatever?

Michael Radeos, MD, MPH, FASAM: That's a good question. And to the extent that I understand it, it probably does. Like we say an addictive personality type. But a lot of the reasons why the addictions seem to I'm going to have a foothold is when you look at the genome, so all of your genetic makeup, all of your chromosomes and your genes; there are certain genes that have more than one type for that gene. And depending on the type of gene that might make you more susceptible in terms of the dopamine spike that you get, in terms of the way that you metabolize it. And the other thing that's very hard to separate from the genes and your environment is whether or not you are looking at, let's say, twins, let's say one twin grew up with the biologic parents, the other twin maybe went to live with foster parents somewhere, and then you can actually look at the environment and see whether by being in different places, how much does the genetics kick in versus how much does your surroundings kick in?

Host: Dr. Radeos, when it comes to alcohol use disorder, what are the symptoms?

Michael Radeos, MD, MPH, FASAM: Well, there's a questionnaire called the audit, which is A-U-D-I-T and a couple of questions here will kind of give you a sense of what, let's say an interviewer or a counselor would be looking for. So I'll just run through some of the questions, just to give you a sense.

How often do you drink alcohol containing beverages during the day? How many drinks containing alcohol do you have when you are drinking? How often do you have six or more drinks on occasion? How have you or someone else been injured as a result of your drinking? So, it's kind of a slow process. So for example, I'll give it in a way that most people listening will understand.

Let's say you go to a Christmas party or a holiday party, whatever, and you're not used to drinking. And then you have a few drinks and you get into a certain frame of mind. At that point you may say, okay, that was interesting, but I'm not going to do that again. Other people will say, okay, I want to go back and get that feeling again. And then you end up drinking more and more. And as I mentioned earlier, up to four drinks a day for a male, three drinks a day for a female maximum, you start getting into a process where you may end up doing binge drinking, you may drink and drive, you may end up missing work, so it's a slow process where it just goes from bad to worse. And as I mentioned, when it becomes an addiction, it's when it starts really affecting your health, for example, drinking and driving, your relationships, your job, because you end up not being able to make it to work, or your work suffers, your productivity suffers, etc.

Host: And when it comes to your health, what are the complications?

Michael Radeos, MD, MPH, FASAM: Now, that's a real deep question. There are so many ways. For example, in terms of risks of drinking, let me just start off by saying, alcohol related deaths in the United States, that's over 140,000 a year. And emergency department visits between 2006 and 2014 increased 47%. Alcohol, even in overdose deaths, plays a part in 17.4%. So, the other way of looking at it, is it affects different parts of your body as well. So, for example, it can affect, in the earliest stages, if the mom drinks, the baby may end up with a fetal alcohol spectrum disorder, which affects the baby's health, it affects its mental capabilities, cognitive functioning, et cetera.

And it's not clear how much alcohol it's going to take to create fetal alcohol spectrum disorder. So once again, if you know you're pregnant, if you're trying to get pregnant, the ideal thing is not to drink at all because we just don't know how much is enough to hurt the fetus.

Host: And when should you see a doctor?

Michael Radeos, MD, MPH, FASAM: I would say, interestingly, you probably should have a primary care provider. So, with a primary care provider, you may want to have them such that they screen you. So, a good primary care physician should be screening their patients, and there's all different types of instruments that they can use to ask the questions.

For example, they should be asking about integrative medicines, complementary medications, and also find out, you know, are you drinking, and if you're drinking, are you drinking more than one drink a day, let's say at dinner. And if the answer is yes, then you can go to something like the audit questionnaire and really look at the scores of these questionnaires and that can give you a good sense of how much at risk the person is for problem drinking.

Host: So treatments, what treatments are available?

Michael Radeos, MD, MPH, FASAM: So the first thing I think is important is who should go to treatment. So for example, a lot of people will go in and out of emergency departments because my other lifetime specialty has been emergency medicine. And a lot of people who do emergency medicine, and I went through that phase too, it's avoidance.

You have somebody coming in because of drug use or alcohol use, and it's not the kind of patient you look forward to seeing, although that may be the patient you can do the most to change their trajectory in life. So the first step is, before the patient even thinks that they need help, hopefully they have a significant other that can actually try to convince them to go for help. So you may only get a chance, you may only get a crack at that patient when they come into the emergency department, at which time, if you're lucky, they may listen to you, if you don't give them the so called bums rush to get them out of the emergency department. You can hold on to them and have a counselor speak to them, and do what's called a warm handoff so that the counselor gets them to talk to another counselor from an outside facility that might be able to see them on an outpatient basis.

Or if they really seem to have problems, we can have them speak to a counselor that can then direct them to a detox center so they can start the process of trying to divest themselves from the substance that's starting to take over their lives.

Host: So you mentioned the ER and let's say you can't get your spouse or friend or family member into the ER to seek help. Where else can people find help?

Michael Radeos, MD, MPH, FASAM: That's a good question because not only is it the patient that comes to the emergency department that might be hesitant, even when you do approach him, but the only reason I would go with somebody with an alcohol use disorder to the emergency department primarily is if they do show signs of getting really sick.

So, I'll give you an example. A young woman came in with her father to the emergency department not that long ago. And he seemed fine, very pleasant man. And his young daughter was sitting, the wife had passed about a year earlier. So the young woman was really having to take care of this father with alcohol use disorder.

And she mentioned that he fell frequently. So I examined him. I really didn't find anything in the examination, but because of the fact that he had alcohol use disorder, I was concerned he might've injured his head with one of his falls. And I sent him for a CAT scan and sure enough, he had what's called a subdural hematoma.

I had to transfer him to a neurosurgical treatment unit. So the danger of somebody who's just not acting right that's drinking, that's a really good reason to bring them to the emergency department. And hopefully the emergency department will not just deal with the injury or the medical complication, but also be able to direct them into treatment.

If you don't go to the emergency department, for example, if you go to the SAMHSA website, that's S-A-M-H-S-A. That's the Substance Abuse and Mental Health Service Administration. So S A M H S A.gov. They have something called a treatment finder, in which case you can put in your zip code and it'll find areas around you where you can actually call up and tell them that you and your spouse, for example, or you and your family member whoever needs help, and they can give you an amazing list of options.

Host: I noticed you call it alcohol use disorder. Do they not say alcoholism anymore?

Michael Radeos, MD, MPH, FASAM: No, a lot of what we use for how we label and mention things can be stigmatizing. So, for example, you know, in the old days, they would have, and even William Burroughs, who suffered from opioid use disorder, wrote a book called Junkie, but you're not going to go around and say, excuse me, are you a junkie?

You're going to say do you have opioid use disorder? And the other thing is, when you say addict, what's interesting about that is, even though a person might be addicted to a substance, you don't go to a person with a diabetes and call them an insulinist or something like that. Right. You basically say you have a disease called diabetes and you use multiple medications.

One of them is insulin. So it's more like you're treating the patient like a problem in and of themselves, whereas they have a problem that's a medical issue. It's a substance use disorder.

Host: Thank you so much for sharing this information on alcohol addiction. A topic that, like we said, so many people are affected by, even if they don't have it, people in their family, their friends. We appreciate your time.

Michael Radeos, MD, MPH, FASAM: Well, thank you for having me, Maggie. Have a great day.

Host: Again, that's Dr. Michael Radeos. For more information about alcohol addiction or to schedule an appointment with an addiction specialist, please call Flushing Hospital's Reflections Treatment Program at 718-670-5078 . All content on this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.

Please consult a medical professional before adopting any of the suggestions discussed on this podcast. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is Flushing Hospital MedTalk, a podcast from Flushing Hospital Medical Center.