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Bob Lewis (Host): And welcome once again to our series with the experts and doctors from Summa Health, talking about various health issues that are concerning our community every single month here on WNIR. April is Alcohol Awareness Month. It's a chance to raise awareness and understanding of alcohol use disorder and the very serious health consequences associated with excessive alcohol consumption.

Joining us today on the program from Summa Health is Dr. Aly Zewail. He's a psychiatrist. specializing in Addiction Medicine at Summa Health. He's going to talk about what we should know about alcohol use disorder, including the signs, symptoms, treatment options, and how to support any loved ones we have struggling with alcohol use disorder. First of all, Dr. Zewail, thank you very much for being with us here this afternoon.

Dr. Aly Zewail: Well, thanks for having me.

Host: Now, tell us about alcohol use disorder. How is that now defined?

Dr. Aly Zewail: Well, basically, alcohol use disorder is like a medical condition that's characterized by unhealthy pattern of alcohol consumption. In simple terms, like people will continue to consume alcohol despite of harmful consequences. So, you know, alcohol is an extremely addictive substance that can trigger release of chemical substance in the brain and alter the structure of the brain in some people that are prone to the substance use disorder. And that will lead to the harmful consequences and they cannot stop despite they know that they are harming their own life and the loved ones around.

Host: Now, who is at risk for alcohol use disorder?

Dr. Aly Zewail: Well, actually, it's all age groups. We can start with the young adults that are still in college, and it will have a negative impact on them because their brain is still developing, it's still in the progress; also, the midlife adults, like the one that go through the stress of life, parenthood, employment; and even older folks with age-related illnesses with mental problems. Gender, in the past, the males used to be more than females, but this ratio has changed lately. They're almost equal. There's also genetic risks that influence. If someone has high incidence of alcohol use or substance use in the family, probably he has a higher risk of developing a substance use disorder. If there is a baseline mental illness, it can cause different forms of substance use disorder like anxiety, depression. People tend to numb their feelings if they have PTSD, if they have been exposed to trauma or there's a stressor in life.

Host: What are some of the choices that people might make that would increase their risk for alcohol use disorder?

Dr. Aly Zewail: Well, basically, their brain is prone to perceive alcohol different than normal people, so the risk that can put them in this alcohol use disorder is early consumption, if they are having mental illnesses that are not treated. As I said before, like if they have a childhood trauma, PTSD, if they are exposed to, you know, peer pressure, like in college, that kind of stuff, that can increase the risk and make them more exposed to be affected with substance use disorder.

Host: Now, how can we tell if somebody has alcohol use disorder or an addiction versus somebody who just enjoys drinking?

Dr. Aly Zewail: Well, the simple term is that they're going to continue drinking despite of harmful stuff happening to them. But the things that a family or a loved one might notice, like failing to fulfill obligations at home, work, or school. There's going to be new financial issues, it wasn't there in the past. There's going to be relationship problems. They're going to be withdrawn from the loved ones, they want to stay by themselves. They're going to lose interest in their favorite activities and hobbies. They wanted to sleep more. They are eating less, and sometimes they're eating even more. There's going to be memory issues. There's going to be poor concentration. They're going to do a wrong decision that's like a normal person would think this is the logic. So, they start making bad decisions that used to be logical to them in the past. If they have a mental illness like depression and anxiety, the loved one will notice that it's going to get worse and their depression is going to be worse, their anxiety is going to be more acting up. They're going to have more panic attacks, that kind of stuff.

Host: Now, how can you support a loved one who's suffering from this kind of addiction?

Dr. Aly Zewail: Well, if your loved one has a problem, we suspect they have a problem, the best thing to do is to find a time that you can talk to them without distraction for both of you. And you have to use something called motivational interview skills. First of all, you have to emphasize that you're concerned about that person's health and well-being, without judgment, without blaming, without arguing. And you have to stick to some facts about treatment, like telling that he or she is not going to be alone during that journey of treatment. And always use open-ended question and listen and acknowledge their feelings. Show respect for their point-of-view. And focus on what we should do, not what we shouldn't do.

Host: Now, what type of professional help is available for alcohol use disorder?

Dr. Aly Zewail: In my hospital, we have a lot of help with that. We provide for the loved ones that are struggling with addiction. Fortunately, we have a whole program starting from the emergency department. It's called the First Aid Program. It's 24/7 where the patient or the person that's suffering from substance use disorder will go to the emergency department, which is open 24/7. They initiate the addiction treatment. We have one in Akron, Barberton, Green, Wadsworth Emergency Department 24 hours a day.

At this first visit, the providers will treat the withdrawal symptoms if they're going with the withdrawals. If they have cravings, they can initiate medication that helps with cravings, and they're going to set them up with one of our addictionologists. If they feel that the patients will need to be inside of our facility for detox for their own safety, we have our detox unit, which I'm proud to say it's the first detox unit in the United States that was built by Dr. Bob Smith, the co-founder of Alcoholic Anonymous and Sister Ignatia, and that was at St. Thomas in 1939. So, we had the first detox unit in the country. We have 14 beds, like private rooms. We have very qualified medical staff on the detox unit, specialized social worker that works with each patient according to their needs. And we try to formulate the treatment process during the detox and after treatment, what we need to do.

And as outpatient, we have a clinic called Medication-Assisted Treatment Clinic, which offers all the medications that helps with cravings for alcohol, opiates, methamphetamines, including monthly shots for all that. And also, in our new building, behavioral health building, we have a dual diagnosis unit for patients that have mental illness and, at the same time, they have substance use disorder on the sixth floor here at the hospital. So, we cover all the bases from the emergency department until the inpatient rehab.

Host: So, you have a lot of options for levels of treatment for alcohol abuse disorder, but how do you work with people to determine which level of treatment they might need?

Dr. Aly Zewail: Well, for our program, I would say, like, for example, our outpatient program, we do something called intake or initial assessment, which helps us to understand their history of addiction, identify their challenges or current mental health disorders. And we tailor each patient to gear them toward the right way of treatment. If serious harm is at stake, we'll recommend higher levels like detox. We can recommend during that assessment either medication-assisted treatment. We can give an appointment with one of our specialists, addictionologist, to take care of them on the long run. So, it all depends on this intake or assessment during the initial visit.

Host: Once again, we're talking to Dr. Aly Zewail, who is a psychiatrist specializing in Addiction Medicine at Summa Health. We're talking about alcohol use disorder, as this is April, Alcohol Awareness Month. Now, Dr. Zewail, can you talk to us about the recovery journey? How long does that go, and what's it like?

Dr. Aly Zewail: Well, the recovery journey takes time. People have to understand that they didn't become addicts just overnight. So, of course, it took many years to be suffering from substance use disorder, and so does the recovery process. The recovery journey takes time, relapse is often a part of recovery. I would try to explain to them that we're going to try not to, for them, to relapse, of course, but it is part of recovery. The statistics shows that, sadly, the relapse is 80% and the total recovery is 20%. We're trying to minimize that. But we try to explain to them the risks. What would trigger their relapse? We're trying to explain to them there's going to be something called mental relapse before their physical relapse. Their brain is going to try to trick them a few days before their physical relapse. So, we're trying to make them acquainted with all the circumstances to minimize the relapse. And we're trying also to minimize the taboo of relapse. We understand that this can happen. We shouldn't be embarrassed. The most important thing is that you try again and start again.

Host: How common is it again for people to relapse after this kind of treatment?

Dr. Aly Zewail: It is pretty common. As I said, like in the common population, it's 80%. The last 20 percent, there's a probability of recovery. Certain groups, like professionals, like physicians, lawyers, those kind of professionals, it's the opposite. The relapse is 20% and the recovery is 80% and it has to do because their agencies, like medical board, like the other boards, they keep an eye and they let them go through IOP. They make them follow up with addictionologist, make them treat their mental health at the same time. That's why their relapse is way less than common population. We're trying to implement that vision in our facility here by incorporating the IOP, addictionologist, mental health treatment at the same time.

Host: Now, with the rest of society, there's a lot of stigma around somebody who relapses back into alcoholism. Can you talk to us about that and how you help your patients handle that?

Dr. Aly Zewail: Yeah. I mean, there's always this understanding that any substance use disorder is not a choice. It's a medical condition. And for the wiring of the brain in people whose substance use is definitely different than other people. We try to explain to the patient that it's a disease like diabetes, like congestive heart failure, that needs to be treated. We're trying also to explain to them that, based on the risk factor, there's a lot of medical treatment. We don't use that term alcoholic. We use substance use disorder. And that we were teaching also, we're teaching medical students, we're teaching physicians that this is a disease that needs to be treated. And the stigma actually has lessened year after year. So, patients understand that, and physicians have noticed that too.

Host: Now, once somebody has completed treatment, what are some of the tips for how to best support them now that they are in the recovery phase?

Dr. Aly Zewail: Well, do not be complacent. If you feel comfortable, that's what your brain is trying to trick you that you are like on the safe side right now. No, you have to continue to meet with your medical professional. If you're attending 12 step meetings, you have to continue that. If you don't believe in AA meetings, the religious part, there's non-religious 12-step meetings, but you need to stay in those kind of support groups.

After finishing the IOP, we offer something called relapse prevention or aftercare, which is only once a week after finishing the whole intensive outpatient therapy, just to keep them in the loop. We, as I said, continue with the addictionologist. We monitor our patients at least every three months. We make sure that they and their family, they're still progressing. And we always tell them, do not get in a mindset that you can beat addiction alone. You have to continue to engage with support group therapy, and even when your sobriety is under control.

Host: Is it ever possible for somebody who has suffered from alcohol use disorder to ever going back to be able to have an alcoholic drink once in a while and not slip back into the addiction?

Dr. Aly Zewail: No, no, no. If you have substance use disorder, definitely you cannot do that. As I mentioned before, the wiring of the brain is totally different than the other population. There's nothing called just one drink that you can drink normally. Sadly, the reward center in the brain is wired differently, which means once he takes one drink again, he's going to lose the control over his frontal lobe, which is the executive function of his brain. And he's going to start using his midbrain, which is like a basic instinct without logic. So, we try to explain to them in simple terms that he cannot even have one drink in the future, or else he's going to go back and remember the bad consequences. It always happens even with one drink.

Host: Now, of course, Akron, as you mentioned earlier, doctor, your service goes back to 1939, with the opening of the first detox center here in Akron as part of the founding of Alcoholics Anonymous. Now, Alcoholics Anonymous, you talked about them as a support group. Now, you know, do you see that they're one of the better support groups, or do you really need somebody more than that, a qualified doctor and professionals to work with you, in addition to AA, to keep somebody on the road to recovery?

Dr. Aly Zewail: Well, 12-step meetings are incorporating part of cognitive therapy. And it's a great program, don't get me wrong. But you cannot just depend on 12-step meetings without having a professional help in a way that we understand the physiology of the disease. We know what works for that person is not going to work for that person. We basically tailor each treatment plan according to the circumstances. If a person stopped drinking because they had childhood trauma or PTSD, it's treated differently than a person that's just like to drink just to get high. So, there are some people that they just drink, because they like to numb their feelings. Others, they just like to drink to get high. Each one of those groups have different kind of medication, different approach in treatment.

Host: Now, I know there are listeners that are wondering, you know, if they, you know, have a problem with this. Is there a certain number of drinks or amount of alcohol that one uses on a daily or regular basis that is like a warning sign that you may be more than just a social drinker, you may have an actual problem?

Dr. Aly Zewail: Yeah. It's like seven drinks a day. For male gender, it's going to be seven drinks a day or 14 drinks a week. For females, it's going to be three drinks a day or seven drinks a week. Anything more than that put them in the risk of having alcohol issues. Now, there's a difference between having a risk from the alcohol and there's a difference between having alcohol use disorder. You can drink only two drinks and you have alcohol use disorder. Again, those two drinks is going to mess up the wiring of your brain, and you're going to start do harmful decisions. So, the number of the drinks that I mentioned in the beginning, that puts you at risk of the harm of the alcohol itself, but doesn't mean that you're going to have substance use disorder. Substance use disorder can be with just one drink. And I just what I mentioned also, for males above 65, it's also going to be three drinks a day or six to seven a week max. Anything more than that will put them at risk of alcohol issues.

Host: Now, of course, in addition to the behavioral issues of alcohol use disorder, the physical problems that can come from the excessive use of alcohol are numerous. And many people are aware of many of them, but talk to us, doctor, about the specific medical conditions that can be either caused or aggravated.

Dr. Aly Zewail: Yeah. Alcohol-related problems continue to take a heavy toll on individuals, families, communities. Researchers estimated that each year, there are close to 180,000 alcohol-related deaths, making the alcohol a leading preventable cause of death in the United States. In addition, there are more than 200 different diseases and injury-related conditions that are associated with alcohol misuse. And it's different, again, from age to age, from race to race, from gender to gender, like elderly, for example, there's going to be an increased risk of falls. There's going to be memory problems. The liver, of course, it's not like a young individual liver. So, they're going to have faster exacerbation or acceleration of the liver disease. They're going to have sleep problems, they're going to have delirium, so it increases overall mortality.

In younger population, it can cause failures at work, and also it can cause marital problem due to like affecting the reproductive system. It can cause heart conditions. And in young adults, it can affect their brain like from 18 to 25. It can affect their academic achievement, especially at college age. So it affects basically every organ in the body. Because if you think about it, alcohol is a toxin. So, imagine you put that toxin in each cell of your body. So, if it's in the brain, it's going to affect the brain. If it's in the heart, it's going to affect the heart. Kidneys, it's going to affect the kidneys, muscles, and so on and so on.

Host: So, if alcohol is indeed the toxin that it appears to be, is there any safe amount of alcohol that somebody should drink and still have good health?

Dr. Aly Zewail: As I mentioned earlier, like if they consume less than like for males, for males 65 and under, it has to be less than seven drinks and seven drinks a day and 14 a week. For females, three a day and seven a week, that will lower the risk. But if what they're looking for, antioxidant-- in fact, they can get antioxidants from a lot of other sources. But we are talking here about people with substance use disorder. So with those people, not even one drink will help them. One drink will lead to 1,000 drinks and will lead to disaster in their life.

Host: Now, if somebody's listening right now and they're questioning whether or not they themselves or a loved one need to seek treatment, what would you say to them?

Dr. Aly Zewail: If they suspect that their loved ones has a substance use problem, then there is a high probability they do. So, they need to get in hold with a medical professional. During the interview, we had very extensive interview process. We try to figure out if they do meet the criteria for substance use disorder or not. And we usually encourage that the loved ones, spouses, parents, even the children of loved ones to come with them because, as I mentioned, it does not just affect the patient, it affects the family too. So, I'm sure that the loved one will have an anxiety issue. Sometimes they even have PTSD from what they went through with their loved one. So, I encourage that. If they suspect something is going on, there is something going on. So, they need to reach and get medical advice right away.

Host: Again, here in Akron, to learn more about Summa Health's Addiction Medicine Program, you can call toll-free 877-203-7396, that's 877-203-7396, or go to the website summahealth.org/addiction, summahealth.org/addiction. And again, Dr. Aly Zewail is a psychiatrist who specializes in Addiction Medicine at Summa Health. Thank you so much for talking with us this afternoon. And again, bless you for your work that you're doing with these people and the folks that are so plagued with this very common addiction in our society. So again, thank you so much for talking to us today.

Dr. Aly Zewail: Thanks for having me, Bob.

Host: I'm Bob Lewis.