Selected Podcast
Alcohol Abuse Disorder-What You Need To Know
Dr. Donnie Sansom discusses alcohol use, what are the underlying causes that create this disorder and how do we address them.
Featuring:
Learn more about Donnie Sansom, DO
Donnie Sansom, DO
Donald Sansom, DO received his Bachelor of Science from Northern Arizona University in 1987, and his Doctor of Osteopathy degree from A.T. Still University (Kirksville Campus) in 1991. He completed an internship in internal medicine at the Jewish Hospital of Cincinnati and, subsequently, completed his residency in anesthesiology at the University of Cincinnati in 1995, spending his last year serving as elected Chief Resident.Learn more about Donnie Sansom, DO
Transcription:
Scott Webb: For those suffering from alcohol abuse and addiction, nearly 40% have at least one lifetime psychiatric diagnosis and more than 20% have another drug use disorder. Let's find out what we need to know about alcohol use disorder from Dr. Donnie Sansom, Associate Medical Director and Director of Addictions at Sierra Tucson. This is Let's Talk Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number one best addiction treatment centers, 2020 in Arizona by Newsweek. I'm Scott Webb. Doctor, thanks so much for joining me today. What's currently happening around the country with regards to alcohol consumption?
Dr. Sansom: I think that the most prominent issue, of course, in all of our lives has been the COVID pandemic. You just can't get away from it. And I had this little mental experiment I played with myself when this thing started earlier in the year, I thought, well, how long is it going to be before we see the effects of this in our patients? And it really didn't take long. I would say by March, I was hearing it by April. Everybody had a COVID-19 story that was coming in. And with respect to alcohol, what we saw was that, you know, during that timeframe, when there were more of the hard lockdowns throughout the country, a lot of the bars and restaurants closed, so people switched to online sales and, you know, the market analysis was, Hey, you know, maybe they're making up for the loss of a bar drinker who stops in occasionally and has one or two, like with a meal. You know, a restaurant drinker I might say.
And that doesn't seem to be what it really is because we know there's good data that just shows that the 50% of all the alcohol in the country is consumed by the top 10% of the drinkers. And so what's gone on is that sales have gone up with companies like Drizzly and other online marketing sources that have just skyrocketed. These were up like, you know, 460 plus percent during eight week periods in March and April timeframe and new buyer accounts were accounting for upwards of 1500%. So it was a real shift in the market, but it does seem to show. And I think that our vantage point at Sierra Tucson is that it shows that these individuals are drinking heavily and it's playing out in the lives of the patients that are coming in. So I think that the bottom line is the heavy drinkers are drinking more and we have reason to believe everybody's drinking just a little bit more.
Host: Yeah, unfortunately that sounds right. And you mentioned the ease with which we can all have alcohol delivered to our homes. And I think one of the questions that comes up is when does it become too much? You know, how do we know that our alcohol consumption has become a problem? And really what are the risks when it does?
Dr. Sansom: Yeah. Another great question. And I think the thing is you ask 10 people, they're going to give you 10 different answers, right. And everybody thinks the other guy or other gal has a problem. You, but we do have some definitions that I think help. And they're not that complicated. So kind of depends on whether you're a man or a woman. And the reason is there's differences in body habitus. There's difference in enzymes, there are differences in total body water. So man can drink a little bit more than a woman, and it is not problematic for him because of the way the alcohol is handled in the body. So for a man, if we see, if you're drinking five or more drinks at a setting, more than five times in a month, we call that binge drinking. And for a woman, that magic number is four. Four or more drinks for a woman at a sitting.
And then the other issue is, you know, we'll ask our patients, well, how many drinks in a week do you consume? And for a man, if they're drinking more than 14 drinks in a week, that's considered problem drinking. And for a woman it's seven. So, you know, a lot of my patients are kind of surprised by that. They say, Oh, well, gosh, you know, that doesn't seem like that much. And you know, everybody else I know is drinking. And again, the top 10%, and then certainly down to the next 10 and 30%, the top deciles are consuming most of the alcohol in America. It doesn't mean that other people don't drink, but that's where you're seeing people who are drinking at that rate. And again, I would just add with that as kind of a dovetail issue is that a drink is one 12 ounce beer, a five ounce pour of wine or a shot of hard liquor, that's one and a half ounces.
Host: So, when we talk about alcohol use disorder, what are the underlying causes besides COVID perhaps that can create this disorder and how do we address them?
Dr. Sansom: Alcohol use disorder is the term we now use for the listeners, what we used to call alcoholism or alcohol abuse. And it's just a less shaming and a little bit more defined thing to call it alcohol use disorder. And we break that down into mild, moderate, and severe. And so when we're diagnosing this and looking at who's at risk, you know, usually we'll go through a history and we'll talk about certain things. One of the things and it kind of hearkens back to the question you asked before is how can a person sort of assess, do you have a problem? And it's something that a screener in a therapists office or primary care doctor might use. And there's a lot of different questionnaires that work. One I like is called the cage. It's really easy to do C A G E it's an acronym. C have you ever felt the need to cut down on your drinking? A, have you ever felt annoyed by someone who's criticizing your drinking? G, do you feel guilty about your drinking? Or E, have you ever had an eye-opener, have you ever had to drink in the morning to get rid of the tremors of the shakes?
And it's simple, it's easy to use, and if you have a yes answer to two or more of those pretty significant for actually probably having alcohol use disorder. So that's one way that a person can screen it. And of course, if you come in to Sierra Tucson, we're going to look at some of the risk factors. We know that there's a genetic load. We call it. Genetics play a large factor in all kinds of substance use disorder, probably at least 50% of it. What does that mean? It doesn't mean like there's an on off switch and 50% of the people haven't and 50% don't, there's probably 30 or 40 different genes that are involved with substance use disorder. And, you know, some people have a variety of makeup that, you know, some will have a productivity, some will have a vulnerability, and it really depends on which genes you have. It's also coupled with early use because we know there's changes in the dopamine reward pathway and in the prefrontal cortex of adolescents when they use.
And there's repeated use, there's a peer group that you're living in living with, or your family of origin, or are they drinkers, is it normative? And so these things start to factor in to this repeated use and the brain begins to change. And we also know that there's a lot of other undercurrents to it, the background of trauma, developmental trauma, things that happen when we're young. PTSD, untreated ADHD has an astoundingly high association with substance use disorder, untreated or improperly treated. Anxiety, depression, bipolar disorder, all of these things factor in. So generally we have to sort of sort out the wheat from the chaff as it were in the history. And then we get a clearer picture about how did somebody come to this point? Why this repeat pattern, how did we get to this place where our brain really truly is becoming diseased? And we go back to the drink because it's more important than other things in this survival pathway. So a lot to that question, but that's how we do it here at Sierra Tucson.
Host: Yeah. And I do love the Sierra Tucson model, you know, mind, body, spirit, and you have such a great way of explaining all of this. It was a lot to unpack there and I jotted some things down for myself. I jotted caged down. I'd hadn't heard it expressed that way before, but that's really great and really great the work you guys do at Sierra Tucson. And I think I know the answer to this, but let me ask you, let me ask an expert. Can someone just stop drinking? Are there any risks to just, you know, going cold turkey, I guess, as they used to say?
Dr. Sansom: Yeah, great question. It's kind of a loaded answer. I'll give you this, that some people can, and they probably are just at a lower risk in terms of where they are in their hierarchy of the disease. How much are they mild, moderate or severe in terms of their alcohol use disorder? But I think it's very important for an individual to understand that for a person who's been drinking heavily for a period of time, the withdrawal from alcohol is exceptionally dangerous. Perhaps the most dangerous we deal with. Opioid withdrawal can be really a bear to get through and it feels awful, but most of the time that one won't take your life. I'm not going to say always, but most of the time. Alcohol, however is absolutely deadly person can go into seizures, withdrawal, seizures delirium tremens which is where the brain, essentially the patient manifests with delirious thoughts, thoughts that are untethered from reality.
And in addition to that, with that confusion and confabulation and the delirious thinking, there's a risk of seizures, there is a risk of decreased level of consciousness. Usually the patient those patients have a very volatile cardiovascular system, high blood pressure, high heart rate, and it's life threatening. Those patients will end up in the intensive care unit. That's not the majority of patients who withdraw, but it is a high enough number that we just don't know where people are on that pathway. Seizures are common and electrolyte abnormalities, the hyper dynamic state of the high blood pressure tachycardia, and an older person with underlying cardiac issues that can be dangerous. So alcohol withdrawal is nothing to be trifled with and probably should be best done under the care of doctors and nurses at a medical detox unit.
Host: I feel like we could talk for much longer today than we have, but as we wrap things up here today, doctor, what advice can you share with listeners about alcohol use disorder, or if it hasn't quite gone that far for some of them, how can they best deal with COVID-19 with drinking more perhaps than they normally do? What's your best advice?
Dr. Sansom: Yeah, that's a really, really good wrap up question because I think that if there's a commonality that I see in my patients here at Sierra Tucson, it's that people feel hopeless and they feel that they isolate and they're starting to hide the drink. Maybe a spouse is on their case or they're hiding it from work or their kids or whatever. And so we pull ourselves into a secret place and it's very difficult to reach out for help. Help is available in a lot of different places. Obviously at Sierra Tucson, we have people that take phone calls 24/7, there are other centers just calling an AA meeting for many people, that's a big help. Talking with your therapist, talking with your primary care physician, having an honest talk about how much you're drinking. There are a lot of different ways that people can reach out.
That is no small thing. What I just said. Most people absolutely don't want to do that. I hear that over and over and over. So I think it's important just to know that you're not alone. You're not isolated help is available. We certainly see that all the time here at Sierra Tucson and help people unpack that loneliness. And then I guess just the last thing is during this period of uncertainty and fear and stress and isolation that we're experiencing worldwide, it's important to remember just that, that we're all interconnected, that we still need to get self care, whether it's getting out, going for a walk, having some period of time where it's just, you can just maybe get away from being in the house all the time. And the mindfulness, because this stress level is a very important piece to all the increased alcohol use that we're seeing. So people need to find ways to manage their stress and to reach out and stay connected.
Host: That is a great way to end and great advice. And I just love Sierra Tucson, the expertise, the compassion, yes, there are many places that people can go, but especially Sierra Tucson, the Sierra Tucson model, and just the comfort, the care, the compassion is really just unmatched. And I really appreciate your time today, doctor and you stay well.
Dr. Sansom: Thank you.
Host: Call (800) 842-4487 or go to Sierratucson.com for more information. Sierra Tucson, where change begins. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. Thanks for listening.
Scott Webb: For those suffering from alcohol abuse and addiction, nearly 40% have at least one lifetime psychiatric diagnosis and more than 20% have another drug use disorder. Let's find out what we need to know about alcohol use disorder from Dr. Donnie Sansom, Associate Medical Director and Director of Addictions at Sierra Tucson. This is Let's Talk Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number one best addiction treatment centers, 2020 in Arizona by Newsweek. I'm Scott Webb. Doctor, thanks so much for joining me today. What's currently happening around the country with regards to alcohol consumption?
Dr. Sansom: I think that the most prominent issue, of course, in all of our lives has been the COVID pandemic. You just can't get away from it. And I had this little mental experiment I played with myself when this thing started earlier in the year, I thought, well, how long is it going to be before we see the effects of this in our patients? And it really didn't take long. I would say by March, I was hearing it by April. Everybody had a COVID-19 story that was coming in. And with respect to alcohol, what we saw was that, you know, during that timeframe, when there were more of the hard lockdowns throughout the country, a lot of the bars and restaurants closed, so people switched to online sales and, you know, the market analysis was, Hey, you know, maybe they're making up for the loss of a bar drinker who stops in occasionally and has one or two, like with a meal. You know, a restaurant drinker I might say.
And that doesn't seem to be what it really is because we know there's good data that just shows that the 50% of all the alcohol in the country is consumed by the top 10% of the drinkers. And so what's gone on is that sales have gone up with companies like Drizzly and other online marketing sources that have just skyrocketed. These were up like, you know, 460 plus percent during eight week periods in March and April timeframe and new buyer accounts were accounting for upwards of 1500%. So it was a real shift in the market, but it does seem to show. And I think that our vantage point at Sierra Tucson is that it shows that these individuals are drinking heavily and it's playing out in the lives of the patients that are coming in. So I think that the bottom line is the heavy drinkers are drinking more and we have reason to believe everybody's drinking just a little bit more.
Host: Yeah, unfortunately that sounds right. And you mentioned the ease with which we can all have alcohol delivered to our homes. And I think one of the questions that comes up is when does it become too much? You know, how do we know that our alcohol consumption has become a problem? And really what are the risks when it does?
Dr. Sansom: Yeah. Another great question. And I think the thing is you ask 10 people, they're going to give you 10 different answers, right. And everybody thinks the other guy or other gal has a problem. You, but we do have some definitions that I think help. And they're not that complicated. So kind of depends on whether you're a man or a woman. And the reason is there's differences in body habitus. There's difference in enzymes, there are differences in total body water. So man can drink a little bit more than a woman, and it is not problematic for him because of the way the alcohol is handled in the body. So for a man, if we see, if you're drinking five or more drinks at a setting, more than five times in a month, we call that binge drinking. And for a woman, that magic number is four. Four or more drinks for a woman at a sitting.
And then the other issue is, you know, we'll ask our patients, well, how many drinks in a week do you consume? And for a man, if they're drinking more than 14 drinks in a week, that's considered problem drinking. And for a woman it's seven. So, you know, a lot of my patients are kind of surprised by that. They say, Oh, well, gosh, you know, that doesn't seem like that much. And you know, everybody else I know is drinking. And again, the top 10%, and then certainly down to the next 10 and 30%, the top deciles are consuming most of the alcohol in America. It doesn't mean that other people don't drink, but that's where you're seeing people who are drinking at that rate. And again, I would just add with that as kind of a dovetail issue is that a drink is one 12 ounce beer, a five ounce pour of wine or a shot of hard liquor, that's one and a half ounces.
Host: So, when we talk about alcohol use disorder, what are the underlying causes besides COVID perhaps that can create this disorder and how do we address them?
Dr. Sansom: Alcohol use disorder is the term we now use for the listeners, what we used to call alcoholism or alcohol abuse. And it's just a less shaming and a little bit more defined thing to call it alcohol use disorder. And we break that down into mild, moderate, and severe. And so when we're diagnosing this and looking at who's at risk, you know, usually we'll go through a history and we'll talk about certain things. One of the things and it kind of hearkens back to the question you asked before is how can a person sort of assess, do you have a problem? And it's something that a screener in a therapists office or primary care doctor might use. And there's a lot of different questionnaires that work. One I like is called the cage. It's really easy to do C A G E it's an acronym. C have you ever felt the need to cut down on your drinking? A, have you ever felt annoyed by someone who's criticizing your drinking? G, do you feel guilty about your drinking? Or E, have you ever had an eye-opener, have you ever had to drink in the morning to get rid of the tremors of the shakes?
And it's simple, it's easy to use, and if you have a yes answer to two or more of those pretty significant for actually probably having alcohol use disorder. So that's one way that a person can screen it. And of course, if you come in to Sierra Tucson, we're going to look at some of the risk factors. We know that there's a genetic load. We call it. Genetics play a large factor in all kinds of substance use disorder, probably at least 50% of it. What does that mean? It doesn't mean like there's an on off switch and 50% of the people haven't and 50% don't, there's probably 30 or 40 different genes that are involved with substance use disorder. And, you know, some people have a variety of makeup that, you know, some will have a productivity, some will have a vulnerability, and it really depends on which genes you have. It's also coupled with early use because we know there's changes in the dopamine reward pathway and in the prefrontal cortex of adolescents when they use.
And there's repeated use, there's a peer group that you're living in living with, or your family of origin, or are they drinkers, is it normative? And so these things start to factor in to this repeated use and the brain begins to change. And we also know that there's a lot of other undercurrents to it, the background of trauma, developmental trauma, things that happen when we're young. PTSD, untreated ADHD has an astoundingly high association with substance use disorder, untreated or improperly treated. Anxiety, depression, bipolar disorder, all of these things factor in. So generally we have to sort of sort out the wheat from the chaff as it were in the history. And then we get a clearer picture about how did somebody come to this point? Why this repeat pattern, how did we get to this place where our brain really truly is becoming diseased? And we go back to the drink because it's more important than other things in this survival pathway. So a lot to that question, but that's how we do it here at Sierra Tucson.
Host: Yeah. And I do love the Sierra Tucson model, you know, mind, body, spirit, and you have such a great way of explaining all of this. It was a lot to unpack there and I jotted some things down for myself. I jotted caged down. I'd hadn't heard it expressed that way before, but that's really great and really great the work you guys do at Sierra Tucson. And I think I know the answer to this, but let me ask you, let me ask an expert. Can someone just stop drinking? Are there any risks to just, you know, going cold turkey, I guess, as they used to say?
Dr. Sansom: Yeah, great question. It's kind of a loaded answer. I'll give you this, that some people can, and they probably are just at a lower risk in terms of where they are in their hierarchy of the disease. How much are they mild, moderate or severe in terms of their alcohol use disorder? But I think it's very important for an individual to understand that for a person who's been drinking heavily for a period of time, the withdrawal from alcohol is exceptionally dangerous. Perhaps the most dangerous we deal with. Opioid withdrawal can be really a bear to get through and it feels awful, but most of the time that one won't take your life. I'm not going to say always, but most of the time. Alcohol, however is absolutely deadly person can go into seizures, withdrawal, seizures delirium tremens which is where the brain, essentially the patient manifests with delirious thoughts, thoughts that are untethered from reality.
And in addition to that, with that confusion and confabulation and the delirious thinking, there's a risk of seizures, there is a risk of decreased level of consciousness. Usually the patient those patients have a very volatile cardiovascular system, high blood pressure, high heart rate, and it's life threatening. Those patients will end up in the intensive care unit. That's not the majority of patients who withdraw, but it is a high enough number that we just don't know where people are on that pathway. Seizures are common and electrolyte abnormalities, the hyper dynamic state of the high blood pressure tachycardia, and an older person with underlying cardiac issues that can be dangerous. So alcohol withdrawal is nothing to be trifled with and probably should be best done under the care of doctors and nurses at a medical detox unit.
Host: I feel like we could talk for much longer today than we have, but as we wrap things up here today, doctor, what advice can you share with listeners about alcohol use disorder, or if it hasn't quite gone that far for some of them, how can they best deal with COVID-19 with drinking more perhaps than they normally do? What's your best advice?
Dr. Sansom: Yeah, that's a really, really good wrap up question because I think that if there's a commonality that I see in my patients here at Sierra Tucson, it's that people feel hopeless and they feel that they isolate and they're starting to hide the drink. Maybe a spouse is on their case or they're hiding it from work or their kids or whatever. And so we pull ourselves into a secret place and it's very difficult to reach out for help. Help is available in a lot of different places. Obviously at Sierra Tucson, we have people that take phone calls 24/7, there are other centers just calling an AA meeting for many people, that's a big help. Talking with your therapist, talking with your primary care physician, having an honest talk about how much you're drinking. There are a lot of different ways that people can reach out.
That is no small thing. What I just said. Most people absolutely don't want to do that. I hear that over and over and over. So I think it's important just to know that you're not alone. You're not isolated help is available. We certainly see that all the time here at Sierra Tucson and help people unpack that loneliness. And then I guess just the last thing is during this period of uncertainty and fear and stress and isolation that we're experiencing worldwide, it's important to remember just that, that we're all interconnected, that we still need to get self care, whether it's getting out, going for a walk, having some period of time where it's just, you can just maybe get away from being in the house all the time. And the mindfulness, because this stress level is a very important piece to all the increased alcohol use that we're seeing. So people need to find ways to manage their stress and to reach out and stay connected.
Host: That is a great way to end and great advice. And I just love Sierra Tucson, the expertise, the compassion, yes, there are many places that people can go, but especially Sierra Tucson, the Sierra Tucson model, and just the comfort, the care, the compassion is really just unmatched. And I really appreciate your time today, doctor and you stay well.
Dr. Sansom: Thank you.
Host: Call (800) 842-4487 or go to Sierratucson.com for more information. Sierra Tucson, where change begins. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. Thanks for listening.