What Alcohol Does to Your Body: Harvard’s Dr. Sarah Wakeman With the Medical Facts You Need to Know

Mel Robbins: Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast. I am so glad that you're here. Whether you're listening today for yourself or because someone that you love shared this episode with you, I want to welcome you to the Mel Robbins Podcast family. It's a real honor to spend some time with you today.

Mel Robbins: I also want to acknowledge you for something. You could be listening or watching a bazillion things right now, but you chose to spend your time listening to something that can help you create a better life. I just think that's so cool. Today's episode in particular is not only going to help you do that, it could change your life or the life of someone that you love.

Mel Robbins: Today on the show, you and I are getting a masterclass from one of the world's most respected and renowned experts on alcohol and its impact on your body, your brain, and your life. I am really excited that you're here with me today. I've been looking forward to this conversation for a long time, and I'm going to tell you why.

Mel Robbins: I've been focused recently on getting super intentional about creating healthier habits, particularly around exercising more and taking better care of my brain. The more that I do that, the more I've been questioning my relationship to alcohol. Maybe you've been questioning your relationship with it too. If you think about it, here you are eating all this healthy food, exercising, taking your supplements, trying to learn and grow. And then you basically end the day, if you're like me, by washing down a High Noon or a glass of wine or a gin and tonic. In that context, it's kind of dumb.

Mel Robbins: I don't know if you've ever been in this situation where you go to see your primary doctor and they ask you, "So how many drinks do you have a week?" I can't be the only one that has lied to their primary care doctor before, because you suddenly know that the number is a little higher than it should be. I've been in that situation. The more that I find out about alcohol—and I'm talking the facts—the more I'm thinking, I've got to do something about it.

Mel Robbins: I have questions. Is there any health benefit to drinking? Is there any amount of alcohol that you can drink that's actually healthy for you? Is the only answer that's available, don't drink anything at all? Alcohol is constantly marketed to you and me. It's the thing you need to have a great weekend, you need it for a tailgate, you need it for every celebration, it's what you grab when you want to wind down at night. But do you even know what's happening in your body and your brain when you consume alcohol? I don't. Do you know how it interferes with the medications that you're taking?

Mel Robbins: Here's how I want to approach this today. I don't want to lecture you. I want you and I to feel empowered with facts. When you feel empowered, when you understand something at a deeper level, don't you feel more motivated and capable of making better choices for yourself? Of course you do.

Mel Robbins: One more thing I wanted to point out. If you're worried about somebody in your life and they're drinking, this episode is a world-class resource for you. Just share it with them. If you haven't been able to get through to them about how concerned you are, I guarantee you our expert today will make them rethink their relationship with alcohol.

Mel Robbins: Dr. Sarah Wakeman is here, and she is one of the most renowned medical experts in the entire world. She's going to break down how alcohol impacts your health, your body, and your mind. Dr. Wakeman is the Senior Medical Director of Substance Use Disorder at Harvard's Mass General Brigham, which has been ranked as the number one research hospital in the entire world. After studying at Brown University, Dr. Wakeman did her residency at Mass General, the best program in the country, where she was also the chief resident—the number one medical resident in her class. She is an associate professor of medicine at Harvard Medical School and the program director of Mass General Addiction Medicine Fellowship.

Mel Robbins: She squeezed us into her extraordinarily busy schedule, and she is here today in our studios in Boston to spend time with you and give you and your loved ones the facts, the science, and the research so that you and the people that you love can make an informed decision about the role that alcohol plays in your life. So please help me welcome Dr. Wakeman to the Mel Robbins Podcast.

Dr. Sarah Wakeman: I'm so excited to be here. Thanks for having me.

Mel Robbins: Well, thank you for taking the time out because I know you have an unbelievably busy schedule. Let's just jump right into it. Dr. Wakeman, can you explain what even is alcohol and how does it affect our bodies?

Dr. Sarah Wakeman: Sure. Alcohol is a molecule. It's a water-soluble molecule that is readily absorbed in your body through your stomach and your small intestine when you drink it. It affects all different parts of your body and body systems, in particular your brain, which is why we feel the effects of alcohol pretty soon after you start drinking. We can talk through what those effects are, but it impacts our behavior, our sleep, our mood, and many other parts of our body system.

Mel Robbins: You talked about alcohol as a molecule. That sounds very science-y to me. What kind of molecule is it? Is it a poison? Could you explain more about the makeup of what it actually is?

Dr. Sarah Wakeman: Yes. The way alcohol that we drink happens is through a process called fermentation. Something that has sugar, like grape juice, or you think about beer—barley or potatoes or other often starches—are fermented. In that transformation process, they form an alcohol molecule that then has a different effect on our body. Alcohol is found in all sorts of different things. Obviously it's intentionally made through fermentation to ingest, but we also use it in cleaning products, rubbing alcohol, mouthwash, hand sanitizer. There are alcohols all around us used for many different things.

Mel Robbins: When you say the category cleaning, hand sanitizer, rubbing alcohol—thinking about uses in a hospital—and then I put that in the same family as something you would ingest in a cocktail. Is it the same molecule?

Dr. Sarah Wakeman: It is. In fact, some of my patients with the most severe forms of alcohol use disorder will drink hand sanitizer or rubbing alcohol or mouthwash if they can't get regular alcohol, which tells you the power of addiction once someone gets to that level of severity. But it's the same molecule, the same effect.

Mel Robbins: I just learned something. If you're watching us on YouTube, you can see that my mouth is agape. I don't know why I never connected the dots on that—that it is actually the same chemical.

Dr. Sarah Wakeman: Exactly. The actual alcohol molecule that we think of in a fancy cosmopolitan is not different from what's in rubbing alcohol.

Mel Robbins: I never knew that. I think that's an indication of just how much we engage in it and don't really think about what we're doing.

Dr. Sarah Wakeman: Absolutely. It is so socialized and a part of culture and a part of celebrations and events that it just feels like a part of life.

Mel Robbins: Are there negative impacts to having a beer or a glass of wine every night? How does that impact you?

Dr. Sarah Wakeman: This is probably the most fascinating area of research where things have changed and gone back and forth over many decades of science. It's actually a somewhat tricky question to answer, which is why there have been confusing and sometimes conflicting studies about this. To understand the impact of low-risk drinking, moderate-risk drinking, higher-risk drinking, you have to figure out how to study that. You need to follow a population over time to see what happens, and then you need to figure out how to isolate the effect of alcohol.

Dr. Sarah Wakeman: Early on, there were lots of studies showing that low-risk drinking or moderate drinking were actually healthy.

Mel Robbins: I think I remember something about a glass of red wine being really good for you. The antioxidants. I don't know if that's the red wine lobby telling us that.

Dr. Sarah Wakeman: One criticism of those studies showing that low-risk drinking is healthy is that the group often used as the comparison group are people that don't drink at all. But it turns out that many people who don't drink at all may not be drinking because they have chronic health problems or because they used to have an alcohol use disorder and are now in remission or recovery. They may have health consequences leading to higher mortality compared to people who are drinking at a low-risk or infrequent level.

Dr. Sarah Wakeman: A lot of the newer studies have actually used infrequent drinkers as the control group or the comparison group. That's really helpful to understand the data that way. There was a really big study this year that looked at hundreds of thousands of people surveyed since the 1990s through the mid-2000s and teens, and did an elegant job of trying to answer this question. The things they did differently is first, they controlled for other healthy behaviors, lifestyle behaviors, and chronic conditions. Because one question is: a person who's drinking a glass of wine a day—maybe they're also running every day and doing other health-promoting behaviors. And maybe that person who's chosen not to drink at all has lung cancer, and that's the reason they're not drinking. They controlled for all of that.

Dr. Sarah Wakeman: They did see that in the low-risk category, there seemed to be a slight decrease in mortality. But it was not true for cancer. Any amount of alcohol is associated with an increased cancer risk. That's a really important thing to know, especially if someone has a personal or family history of cancer. Breast cancer is one that's strongly associated with alcohol use. Factoring that in as you're making your decisions about alcohol is really important.

Mel Robbins: What is it about the molecule of alcohol that increases your risk for cancer?

Dr. Sarah Wakeman: It's different for every type of cancer. I think we're just starting to understand this. For breast cancer, things that seem to increase hormone levels are often associated with a risk of cancer. That's an area of active research to understand why alcohol and breast cancer in particular are so closely linked. Other types of cancer are a little more clear. They tend to be cancers of the liver or the gut that are strongly associated with alcohol. That makes sense if you think of alcohol as a potential poison going into your gut, being metabolized by your liver, causing changes there. That's an area where we do see a lot of cancer risk.

Mel Robbins: Can you talk about what you're seeing as it relates to alcohol and liver failure, or just how it's impacting people's livers?

Dr. Sarah Wakeman: One of the main health harms from alcohol, especially heavy alcohol use, is liver damage. What we see happen is a progression. The first thing that happens is inflammation of the liver. When your liver gets inflamed, you start getting fat deposits in the liver. The first step is what we sometimes call fatty liver—fat deposition in your liver. That actually can totally reverse if you stop drinking or make changes. That's the amazing thing with the liver—it's a really regenerative organ. You could cut 80% of someone's liver out and they would be okay.

Dr. Sarah Wakeman: But there is a point where you cross the threshold where you can no longer repair the damage. That's when you get to a stage called cirrhosis. From fat deposition, you start getting scarring. Your body lays down all this scar tissue because of the chronic inflammation in your liver. When your liver becomes so scarred that it's really stiff and starts not functioning well, that's cirrhosis. We used to think of cirrhosis as something that happened to people decades down the road. I'm seeing people in their early thirties with cirrhosis in the hospital. Those are some of the most heartbreaking cases because people thought this wasn't on their bingo card. They didn't even think this was a concern. They were drinking heavily, they thought their social circle was doing the same thing. Then all of a sudden they're in their late twenties, early thirties in the hospital with liver failure. There's very little we can do at that point other than an organ transplant, which is a huge deal and not something that's accessible to everyone.

Mel Robbins: Is this something that you're seeing increase at a younger and younger age?

Dr. Sarah Wakeman: Yes. There are a lot of studies showing this. Between 2010 and 2020, there's been a significant increase in alcohol-related liver failure, especially amongst women and younger and younger people. Even just after the onset of COVID, we saw somewhere around a 25% increase in alcohol-related death after the onset of the pandemic. The pandemic was hard for many reasons, but it certainly increased alcohol use across the country and with that, liver disease and liver failure.

Mel Robbins: Wow. How does alcohol impact the kidneys?

Dr. Sarah Wakeman: One of the main effects that people have probably experienced is it makes your kidneys less sensitive to a hormone your body produces called ADH, or antidiuretic hormone. So you pee more. If anyone's ever noticed that when they drink, they pee a lot more—it's not because you're hydrated. That's what I thought—oh, I just have more liquid in me—but it's actually because it's blocking a hormone.

Mel Robbins: Exactly.

Dr. Sarah Wakeman: Even irrespective of how much volume you've drunk, you pee more because of this blocking of the effect of a normal hormone function in your kidney. That can lead to dehydration, which is one of the many reasons you feel really crummy the next day.

Mel Robbins: What about the gut microbiome? We're learning so much about the importance of healthy gut. How does alcohol impact that?

Dr. Sarah Wakeman: There is growing research on how it impacts the microbiome. Again, at heavy levels, it seems to harm the microbiome. We see this in patients with liver disease, but also just the impact of alcohol itself. The two main things it does: one, it creates more leakage in your gut. People may have heard of "leaky gut." The walls of your intestine become more porous so that things that aren't meant to come out of your intestine do, and can actually cross the blood-brain barrier. This whole idea of the brain-gut axis is a really growing area of research and knowledge. Alcohol can do that.

Dr. Sarah Wakeman: It can also change the makeup of your microbiome itself, as can high fat, high sugar, white flour—the Western diet. There are now a lot of studies showing that some of the modifiable things, if you want to improve your gut health, are decreasing your alcohol consumption and steering away from that kind of Western diet of high fat, high sugar, high carb.

Mel Robbins: I'm sitting here listening to you and I'm thinking, why the hell do I even drink this stuff?

Dr. Sarah Wakeman: I think it is important to understand the risks that we often don't talk about and assume that this is a harmless thing that's just a part of life. My personal perspective is that every health behavior exists on a spectrum. It's really important to understand what that spectrum is, where do I fall, and what are my personal health goals. Actually stopping to think: how does alcohol fit in my life? What do I like about it? What do I not like about it? What am I worried about? What is this amount of alcohol doing to my health?

Mel Robbins: Is there any health benefit to drinking alcohol?

Dr. Sarah Wakeman: My opinion is that we shouldn't be thinking of it as a health benefit. I would never, as a doctor, say to a patient, "I think you should start drinking a glass of wine a day for your health." We used to—people used to say that, again, this idea of a glass of red wine being healthy. I think that framing is wrong. That doesn't mean that you can't drink any alcohol, and we should talk through that. But thinking of it as a health-promoting behavior is probably not the best way to frame it.

Dr. Sarah Wakeman: There are many things we do in life where the safest thing would be to do none of it. If your goal is to have zero risk, you should probably never drive your car, never go skiing, never fly in an airplane, never eat bacon, never go out in the sun. People aren't going to live that way. So it's really important to understand the risks, how this fits into your overall life, when you should be concerned, and how you can make changes to decrease those risks.

Dr. Sarah Wakeman: If you find that you are really stressed in your life and you're reaching for alcohol as a stress reliever, it's probably not going to be a healthy way of coping and may lead to longer-term problems. Especially if you're trying to live a life where you're being more mindful, more present for your kids or your partner, or you're trying to get in shape and want to wake up in the morning to exercise. If you're drinking every night, you're probably going to feel not refreshed in the morning, and you'll notice you don't have the same exercise capacity.

Dr. Sarah Wakeman: I think just figuring out what role this ritual alcohol plays in your life—and it doesn't have to be that you stop drinking entirely. That's a really important message, because that may not be the goal for people. But if you are feeling like this is causing some problems, maybe this is actually counterproductive to your other health goals, making some changes, cutting back, taking a break—those are all really healthy ways that you can start to explore your relationship with alcohol.

Mel Robbins: I love the fact that you are a specialist in addiction and you have a very realistic approach. I do agree with you that it feels like it's either you're all in or you're all out. For a lot of people, it is scary to feel like there's only one option—you either drink or you don't. For many people, not drinking at all is the absolute empowering option. But I love what you're saying, which is you need to wake up and understand what your motivators are and what you actually care about in this moment in your life. If you care about producing more at work, being more present, or reaching your potential, you've got to look at the role that alcohol is playing in your life.

Dr. Sarah Wakeman: From a medical perspective, how much drinking is too much drinking? From a research standpoint, high-risk drinking would be if you're having more than 10 ounces of hard alcohol a week or 35 ounces of wine in a week for a woman or for anyone over 65. Above that, we start seeing health risks like increased risk of dementia, impact on your liver, your digestive tract, and other serious conditions.

Mel Robbins: I'm sitting here thinking about you as a physician and a researcher. I think a lot of us lie to our doctors about how much we're actually drinking, and we're not even aware of what the serving size truly is. When a lot of people make a cocktail at home, it's like glug, glug, glug, glug, glug, and there's three shots right there.

Dr. Sarah Wakeman: Or you've had a number of big glasses of wine, which basically means you have had all seven glasses of wine in one night, thinking, "Oh, I've just had a couple glasses."

Mel Robbins: I bet as you are seeing somebody get a scan, there are probably times where you're like, "Yeah, that's somebody who is a very heavy drinker because I can see it on the brain."

Dr. Sarah Wakeman: There are so many important points buried in that. First, we all lie. I tell my dentist I floss every day. I don't. We want people to like us and approve of us. I sort of expect people will lie to me, especially if they don't know me. For most people, because of the tremendous stigma around substance use disorder, there's a lot of shame and worry. Their experience has not been that good things happen to them when they share that they're having a problem with alcohol or other drugs.

Dr. Sarah Wakeman: As a doctor, I feel like it's on me to earn someone's trust and also to educate them. There's nothing more heartbreaking to me than when I see someone in the terminal stages of liver failure from alcohol, and no one has told them beforehand what the risks are, that this could happen, what lower-risk drinking looks like. They've often never had that conversation. We'll see people in their 30s come in, they literally die during that hospital admission. You look back and they had touch points with doctors. They maybe were drinking heavily and no one stopped to talk to them about it.

Dr. Sarah Wakeman: I think that is a real testament to how in the medical system for so long, we have seen substance use and addiction as something separate from the rest of healthcare—as not our job, or a behavioral issue, or a moral issue, or a willpower issue. But this is a health condition like any other. I think the medical system and doctors need to get comfortable talking to patients about it, asking them the right questions, giving them the right education, and partnering with people around making healthy changes.

Mel Robbins: When you sit with somebody that comes into your practice, how do you help them figure out their relationship with alcohol? What are a list of symptoms that you would say, "These are all indications that this could be a problem?"

Dr. Sarah Wakeman: That's a great question. I'll run through the checklist that I'm thinking when I'm talking to someone about alcohol. First, understanding how much they're drinking—the general quantity and how frequently—is important as a proxy for what their risk might be. But then the really important questions are: Are they drinking more than they want to? They may have set an intention for themselves and they're finding they're always drinking more or spending more time on drinking or recovering from drinking than they intended.

Dr. Sarah Wakeman: Have they tried to make changes and not been able to? If you tried to cut back or tried to stop and you actually weren't able to, that's a really important sign that you may have lost control of your drinking. Are you drinking despite the fact that people in your life are worried about it, or your spouse has expressed concern, or it's impacting your work or your ability to function in roles that matter to you? Are you drinking despite the fact that it actually makes you more anxious or it's worsening your mental or physical health in some way?

Dr. Sarah Wakeman: We often think about craving, which is a strong psychological urge to want to drink—like you can't get the idea of having a drink out of your mind. That's something we can see with alcohol use disorder. Then there are two physical symptoms: the idea that you need to drink more to get the same effect—you need to drink four drinks now whereas before one or two would give you that effect—and do you feel sick if you stop drinking? That's the checklist we run through. It really gets at those general areas of losing control, using compulsively, using despite consequences, and craving.

Mel Robbins: That was so helpful. One of the things that really resonated with me is that you've tried to quit, you drink more than you want, you feel anxious, and yet you continue to do it. You're in this cycle of wishing you could get control over this and yet feeling like you can't. If you aren't stumbling around at night, or you feel like you are able to carry on a conversation, you're not getting behind the wheel of a car—there's this assumption that it is under control. But I love how you just defined it, because you're making us really look at ourselves and ask ourselves the honest question: is it really?

Mel Robbins: Even just that question—"Are you drinking more than you want to be drinking?"—if you answer that question honestly, whether you're listening right now for yourself or for somebody that you love that you're concerned about, this is an amazing starting point. We're not bickering about how much you're drinking. We're not bickering about your behavior. We're really talking about the honest answer to what is your relationship to it, and do you actually have control over your ability to use it or not use it. That is powerful.

Mel Robbins: Dr. Wakeman, where I want to pivot to next is this: as a researcher and renowned expert on this topic, you're talking about the big risks that can happen. I want to focus a little bit on amplifying the day-to-day impact that most of us are not present to. We reach for the alcohol at night because, at least in my own experience, it's an easy lever to pull to say to my brain, "We're no longer working." This is the thing that I do as my ritual to move into the evening, to have a glass of wine. But we don't really understand what's happening and how it's actually impacting your experience of your life day to day.

Mel Robbins: I want to take a quick pause so we can hear a word from our sponsors. I also want to remind you that if you're worried about somebody, send them this episode right now as you're listening to our sponsors. Oftentimes they can't hear it from you, but hearing it from somebody like Dr. Wakeman, who has such a balanced approach and is a renowned expert on this topic, might actually be the thing that gets somebody to wake up and want to do better. I'll be waiting for you after a short word from our sponsors. Thank you for sharing this with anybody who needs to hear it. I'll see you right after the break.

[Sponsor break]

Mel Robbins: Welcome back. I'm Mel Robbins, and I'm so glad you're here. Thank you for sharing this episode with absolutely anybody in your life that you believe needs to hear this. You and I are spending time today with Harvard's Dr. Sarah Wakeman.

Mel Robbins: Dr. Wakeman, can you explain to us what are some of the other day-to-day things that people experience when they drink that they might not realize is related to drinking?

Dr. Sarah Wakeman: It's a great question. One really common thing is worsened acid reflux. If you have heartburn, that's strongly associated with alcohol, which actually relaxes the part of your esophagus that allows acid to come back up. Oftentimes people are struggling with terrible heartburn and they don't realize that those two glasses of wine are probably having a direct impact on that.

Dr. Sarah Wakeman: Other things—we know that alcohol can make you dehydrated. You may notice that your skin changes. It impacts how you sleep. You may feel less rested when you wake up in the morning, or wake up in the middle of the night and not be able to fall back asleep. There are lots of little day-to-day ways that alcohol may be impacting your health and your experience.

Mel Robbins: What are some of the benefits that you would experience almost immediately if you quit drinking entirely or cut way back? What kind of health benefit would you experience in your day-to-day life?

Dr. Sarah Wakeman: You'll see a lot of really quick things. You'll sleep better and feel more restored. You may lose weight—there are a lot of calories in alcohol. If your goal is to lose weight and you're drinking a ton of liquid calories, you may find that's better. You may find that your exercise capacity goes up because you're resting more, you're not having hangovers, and you're able to exercise in a way that feels different. You may find that you're less irritable and more present for your loved ones, that your mood is actually better over time. Your skin might look better—you're less dehydrated. Your hormones are more regulated, so you may have less acne. All of those benefits you can often see in a very short time, and that can be reinforcing as you decide what you want your long-term goals to look like—to really see what life is like with less or without alcohol.

Mel Robbins: How does alcohol impact the range of women's hormones, from estrogen to progesterone, all of it? How does it impact your hormones?

Dr. Sarah Wakeman: This is an area of growing research and understanding. I think people are really interested in drinking during menopause as well, and what to think about all of that. A couple of things: many of the symptoms that people experience during menopause, like hot flashes, will be made worse by any amount of alcohol.

Mel Robbins: Really?

Dr. Sarah Wakeman: Yes, because alcohol dilates your blood vessels. So you may have experienced if you drink a couple glasses of wine, you actually feel flushed and warm. Well, it's just going to amplify the experience you're having during hot flashes. So if you're trying to not have hot flashes, drinking is going to be your enemy in that because it's just going to make that worse. Same things like sleep disturbance are really common in menopause. Mood changes and alcohol may impact all of those. And it can be a tough cycle because you may be drinking because your mood is actually low and you're having a hard time falling asleep, but then alcohol is actually running counterproductive and making those symptoms worse over the long haul.

Mel Robbins: Let's talk a little bit about sleep because doesn't alcohol impact your sleep in a very negative way?

Dr. Sarah Wakeman: Yeah. And people may be surprised to hear that because it makes you fall asleep quicker. So often people are like, "Oh, alcohol helps me sleep because I fall asleep so quickly." But when we think about sleep architecture, there are different cycles to sleep. People are probably familiar with REM sleep, that deep, rapid eye movement sleep. But there are different cycles that your body and brain naturally cycle through in the night. The balance of those cycles is really important to get restorative sleep, which is when your body rests and heals. What alcohol does is it changes the makeup of those cycles. So you go more quickly into deep sleep and you have less time in the normal phases of sleep. Your sleep architecture is disrupted and you don't get that same restful sleep. So you may wake up at two in the morning after you've fallen asleep really quickly, but then you wake up and can't fall back asleep. Or you may wake up in the morning and just feel not refreshed, even though you were completely asleep very deeply, because your brain is not having the time to restore itself the way that it needs to.

Mel Robbins: I have another question for you, Dr. Wakeman. Can you walk us through what's happening in your body in terms of what we call a hangover? So you've had your night out, you've had a bit of alcohol, and you wake up. What is a hangover and what is actually happening in the body as you withdraw from the alcohol?

Dr. Sarah Wakeman: Yeah, hangover is fascinating. And I think people are still trying to understand exactly what is going on. Loosely defined, what we refer to as hangover is a constellation of symptoms that include headache, feeling anxious, often having diminished exercise tolerance. So you don't have the same aerobic capacity that you did before, feeling irritable. Those are all symptoms of hangover that people have probably experienced. There's an older school of thought that it was mild alcohol withdrawal. Withdrawal is when you are drinking so much that when you stop drinking, you actually get symptoms. It seems like that is likely not the case. The constellation of symptoms is quite different. The thinking now is that it's a combination of really two things. One is dehydration. We already talked about how alcohol makes you pee more, so you get dehydrated. The other is actually byproducts from the drink itself. Either the breakdown products of alcohol, or certain types of liquors and drinks that have other types of molecules, congeners, that can build up and make you feel even crummier. For example, clear alcohol tends to cause less of a hangover than dark alcohol, and that's probably because of the other substances that are in it. But if I were to sum it up, it's really toxic byproducts and dehydration that are causing a hangover.

Mel Robbins: Why is anxiety one of the biggest symptoms of a hangover and alcohol withdrawal?

Dr. Sarah Wakeman: Yeah, it's probably the effect of these byproducts that are still impacting the way your body functions, your brain, and it takes a long time for your body to excrete them. So we can see that feeling really anxious, restless, gross feeling afterwards.

Mel Robbins: Does alcohol impact cortisol or any of the other hormones in your brain that are playing a part in anxiety?

Dr. Sarah Wakeman: Yeah, it does, especially over time. What we see when people have been drinking over a long time is that your body starts to adjust because our bodies are very adaptable. If your body is used to having three or four drinks every night, your body is going to start to accommodate to that. We see changes in the brain. You see changes in the amount of receptors you have, the amount of hormones you have, your dopamine levels, your stress hormone levels. Your brain is actually adapting to the effects of alcohol. So one thing you may see is that you actually don't get the same effect. It used to be that two glasses of wine made you feel a certain way and now you need three or four to feel the same way. That's a concept called tolerance, that your body is adapting to having that alcohol around all the time and your brain is actually changing. The reverse of that is if all of a sudden you stop drinking, you're going to feel all out of sorts. You're going to feel shaky. You may have a headache. You may feel anxious. You may feel nauseous. And that's because your body has gotten so adapted to always having alcohol on board that it takes time for those changes to reset.

Mel Robbins: Wow. When you really stop and think about the roller coaster you're putting your brain and your hormones and your body through, it does make you pause. And that's what I wanted to do with this conversation, is to make you stop and think about what's actually happening and the reasons why you reach for it. Can you talk a little bit about for anybody that's taking prescription drugs for anxiety or depression, the impact that alcohol can have?

Dr. Sarah Wakeman: Yeah, there are a couple of really important things to know. First, alcohol itself can cause depression and anxiety. So even though you feel like in the moment it's helping relieve symptoms, there's actually something called a substance-induced mood disorder where you can look all the world like you have depression and it's actually caused by using alcohol heavily over time. So if you're drinking heavily, you may actually be working at cross purposes with your efforts to manage your depression or anxiety. The other thing is there are some types of medications that are really dangerous when they mix with alcohol, and anxiety medications in particular, especially any medication that also has a slowing down effect. Some people take medicines in a class called benzodiazepines, things like Xanax or Klonopin or Ativan. Those, when mixed with alcohol, have a combination effect that can actually slow down your breathing, could cause an overdose, could make you very sick, could make you more impaired sooner. So it's really important to not mix those medications with alcohol.

Mel Robbins: How does alcohol compromise your memory?

Dr. Sarah Wakeman: So alcohol affects all parts of the brain, including the amygdala, which is an area that lays down memory. It has complicated actions in the brain. It increases more slowing down hormones, so we think of it as a depressant because it slows you down and relaxes you, and it decreases more excitatory neurotransmitters. In the short term, because your consciousness is being affected, you won't be making new memories. Over the long term, heavy alcohol use can actually cause dementia. It can cause severe memory problems. There's actually a unique condition that we only see with alcohol generally where the part of your brain that lays down new memories gets damaged and people get basically an amnesia syndrome where they can't make new memories. They can only remember things from the past, but they're unable to make any new memories. That's a very extreme example, but we see it in the hospital and it's really scary when it happens.

Mel Robbins: What do you see when you look at a brain where somebody has been a heavy drinker versus somebody that's occasional or very light?

Dr. Sarah Wakeman: We actually see brain damage in people who've had chronic heavy alcohol use over many years. If you take a picture of the brain with a CAT scan or an MRI, what we describe it as is volume loss. Normally you want to see a big, healthy, robust brain. As you age and with types of dementia, one thing we see is the brain starts to shrink. The actual functional parts of the brain are smaller. We see that process accelerated with heavy alcohol use. So often we'll take someone who's in their 50s who really shouldn't have volume loss of their brain at that age. But if they've been using alcohol at a very heavy amount for a long time, we'll often see their brain looks like a much older brain because of that shrinking. And then there are very extreme examples like this rare memory condition where we literally see that part of the brain almost die. You can see it light up that it's been severely impacted.

Mel Robbins: That's scary.

Dr. Sarah Wakeman: It is really scary.

Mel Robbins: We have so many listeners around the world who flooded us with questions when we told them that you were going to be here. A lot of them are about how to deal with somebody that they love and they're drinking. I really want to hear your advice about what specific things you should do and what mistakes we need to avoid when there's somebody in our lives that we're concerned about. How do you approach this? What's the best way to bring it up? What is the worst? And by the way, I want to remind you that if you're thinking about somebody in your life, while the sponsors are talking to you, please share this episode. Let Dr. Wakeman talk to your loved one. It could be a life-changing gift for them to hear this. So thank you in advance for being generous with sharing this with people that you love. And I'll be waiting for you with Dr. Wakeman after a short break.

[Break]

Mel Robbins: Welcome back. I'm Mel Robbins, and you and I are here today with Harvard's Dr. Sarah Wakeman. Dr. Wakeman, I'd love to get your counsel on what you would recommend to somebody if your spouse doesn't think they have a drinking problem, but it's a problem for you.

Dr. Sarah Wakeman: Yeah, I think these are such important questions. One of the greatest tragedies to me around substance use disorders is that often family members and the general public have been fed the wrong thing to do. So I think it's a great thing to talk about. First, it's important to define what is an alcohol use disorder, because that's what we're getting at. There's heavy drinking where we're worried about the long-term health effects, and then there is where alcohol has become a problem in your life. The definition of an alcohol use disorder is losing control over your drinking, compulsive use of alcohol, and using despite consequences. If you are continuing to drink despite the fact that your partner has shared that they're really worried about you, or you've started to have problems at work because you're calling out sick, or you're continuing to drink despite health problems related to it—your doctor says, "You know what, your liver tests are elevated, you really need to cut back on drinking," and you continue to drink—those are all signs that alcohol has started to play a different role in your life. About 15% of the population will have an alcohol use disorder in their life. This is a very common health condition, more common than many other conditions we see. The great news is that it's entirely treatable. Most people will get well. I think we often have in our minds that this is a terrible, stigmatizing, recalcitrant condition that no one ever gets better from. That is not true. That notion that this is something to feel hopeless about drives a lot of the stigma and shame. There is good treatment out there. People will get well, but they do need care and they need support.

I think the first thing you can do if you're a loved one is just share your worries, not in a way that blames the person, not in a way that's judgmental, but in a loving way, just like you would about anything else with someone's health. "This is what I've observed, this is why I'm worried." Explore what the person thinks. That becomes really important because when it comes to addiction, it really doesn't matter at all why I think someone should make changes to their alcohol use. The only thing that matters is they think their life will get better in some way. So really starting to untangle what are this person's goals and how is alcohol getting in the way of them reaching it—that becomes the work. A partner can be a wonderful mirror for that. "I know you're working towards a promotion at work and you mentioned that you had to call in sick twice this week and your boss is frustrated with you. What do you think about that?" So really exploring it. Ultimately, you're empowering the person to feel like they can make a change and that you're supporting them, but you're not forcing it on them, which is often what people feel caught up in having to do.

Mel Robbins: What is the mistake that you see people making?

Dr. Sarah Wakeman: I think people have heard these notions of tough love, enabling, hitting bottom. Those are probably the biggest fallacies. For people who aren't familiar with those concepts, the idea of tough love is that you really should make things hard on a person, that if consequences pile up, the person will ultimately get better. Enabling is the idea that if you're kind or caring to someone, you're actually hurting them in some way. And hitting bottom is this idea that people have to fall so far and suffer some terrible consequence before they make a change. Those are all really problematic concepts for a couple of reasons.

First of all, the definition of alcohol use disorder is not being able to stop despite bad things happening to you. Many people are drinking because it's a powerful coping mechanism. Some of the things that put you at risk for an alcohol use disorder are traumatic life experiences, untreated anxiety and depression, not feeling good about yourself. So having the only people that you love and trust in your life try to cut you down to size and tell you that you're doing something terrible and set some ultimatum is actually not going to help you get well. None of us make hard changes when we feel threatened or punished or not supported. We do it when we feel loved and safe and have hope that our life could be better. As a loved one, that's probably the greatest gift you can give to the person.

Now, it's complicated because you're impacted by their behavior. One of the things I love about doing this work is that I've been on the other side and had family members. It's a different experience as a doctor. Whether or not my patient continues to drink doesn't impact me personally. I can just be their partner, their champion, work with them. For families, there are times where the behavior becomes so unsafe that people have to keep themselves safe and set boundaries. And that's okay. I think the distinction there is that it's not doing it for the person's benefit. If you kick someone out of your house, it's not going to necessarily help them get better. But there may come a time and a place where people need to do that for their own emotional safety or well-being. But for that human being to help someone get well, this is where earlier conversations are so important—to really love and support them and work together on it and make sure they find access to good treatment, which is out there and available.

Mel Robbins: I want to kind of hover on this point. If somebody is reaching for alcohol and it's become a coping mechanism for dealing with stress or a health issue or mental health issue or whatever insecurity, it's terrifying to give up the coping mechanism. What do you see when it comes to that psychology of somebody whose family is like, "You have a problem and we're worried about you," and yet it keeps on going? How does shame or that fear that you have of "I can't get through if I don't have the alcohol" or "It's just easier" play in? And what's the problem with having a glass of wine or two a night?

Dr. Sarah Wakeman: So many important pieces in there. There's so much stigma in our society about alcohol use disorder and substance use disorder. People rightfully feel really ashamed and secretive. Sometimes long after they've started to worry about themselves, they're scared to tell anyone else because they think someone will judge them or treat them poorly. That stigma and fear of bad treatment or judgment actually keeps people from seeking help for a long time.

The other really important piece is that when you're removing something that has played a powerful role in someone's life, you need to fill up those spaces with other things. I think our Puritan roots as a society give us this idea that "You're doing something bad, you need to just pull yourself up by your bootstraps and knock it off and white-knuckle it." In fact, it should be hard. That's often our ideas of tough love and hitting bottom—"You've done something bad, you don't have willpower, so we're going to make it tough on you." When in fact, the broader concept is: Why would someone make changes? How is their life going to get better? And how do we make it easy to make a change?

If you think about any change you made in your life, if you set yourself up for success, you're going to be far more likely to be able to make that change. If you're suffering from trauma, depression, anxiety, you're not going to be able to just stop drinking without help. You need help treating the anxiety, depression, trauma, and also treatment for the alcohol use disorder. That's not because you're weak. That's not a failing. And if you're not able to meet your goals with whatever intervention and support you're getting, that's a sign that that support is not enough for you. So really shifting from this idea that the person is failing to thinking that the system, the treatment, the resources are failing. How do we adjust that instead of blaming the human being who's suffering?

Mel Robbins: I just want to thank you. I think it's very refreshing because so much that you listen to on this topic is "Don't drink." And I kind of expected you, Dr. Wakeman, to come in here and just take your fist and slam it on the counter and talk about the lives ruined from alcohol. And you might have that experience in your family as you're listening to us. But what she's saying is you have to understand how somebody is feeling and what's actually going to work to get them to want to see that something else is possible for them.

So, Dr. Wakeman, I have another question for you. A lot of parents are writing in about college-age kids and binge drinking and 20-somethings that are also drinking too much. Do you have any scripts or lead-in sentences to even broach this topic? Because I feel like most of us don't know how to even bring it up.

Dr. Sarah Wakeman: Yeah, I think ideally it starts young. Ideally you're having these conversations very early on with kids in a pragmatic way, not in a scare tactic way. We know that things like D.A.R.E.—"I'm going to scare you into this is what alcohol and drugs do to your brain"—actually, kids use more drugs after seeing that sort of stuff. It's not helpful. All kids see right through adults when they're all or nothing about things. So having these nuanced conversations: "You're going to be around friends who are drinking really heavy. What do you think about that? What's been your experience? What are some of the worries you might have about that?" And talking about the very practical risks that are not necessarily liver failure or addiction, which are not going to be resonant for a 19-year-old. But getting into a situation that doesn't feel safe, getting into a sexually vulnerable position with someone, doing something that you don't want to do, missing class the next day. So talking about relevant, personalized issues that may come up for that kid.

And then importantly, making your child feel safe talking to you. You want them to feel comfortable coming to you about small things so that they'll come to you about big things. You can share all of this in a way that doesn't feel judgmental, doesn't feel accusatory, really opens the door to ongoing conversations instead of making someone feel like they're being blamed or judged by their parent.

Mel Robbins: For somebody that's never even broached this and alcohol is in the family, this is a thing that's really triggering for all of us. Is there a way to break down the conversation so that the person listening can take from us, take from this conversation? All right, I'm going to express my feelings. Then I'm going to ask them about theirs, because most people get really defensive when you talk about this, and that just shuts down the conversation.

Dr. Sarah Wakeman: Totally. Well, first of all, it is not too late. You have not failed. None of us are perfect in this. These are hard conversations and we haven't learned how to do it. So it is never too late. It doesn't matter how many times you've ignored it or had an unproductive conversation. In that moment, probably the most important things you can communicate are: I love you. I'm worried about you. I'm here for you. I know that treatment works. This is how I can support you. So like many things, you're talking about yourself. You're talking about your care and concern. You're rooting everything in how much you love this person. And you're offering to be a partner in helping them find support and treatment. It may not happen that day. It usually doesn't. The journey to recovery is a circuitous journey of a thousand small steps. It's very rarely that dramatic leap we see on TV. So don't give up hope. Know that those small moments of kindness and support actually are progress and are part of the person's journey to ultimately getting well.

Mel Robbins: If you're the one that really just wants to cut back. So if you're listening and you want to cut back on alcohol use, I think first figure out your why. How do you help them figure out their why as it relates to their relationship with alcohol?

Dr. Sarah Wakeman: Yeah, I think understanding first how alcohol fits in your life. People can do this at home by just keeping a drinking diary. Even just jotting down on your phone or in a notebook when you want to have a drink, what activities you associate with drinking, when you do have a drink, how many drinks you have over what time periods. It's like keeping a food journal where it actually just makes you more mindful. "Oh, I'm triggered to want a snack because I'm feeling really upset about this fight I just had." You can identify that with alcohol too. Like you mentioned earlier, "I'm really stressed out at the end of the day, so I come home and want to reach for a glass of wine." Understanding how alcohol fits in your life is an important first step.

Then figuring out what are the goals you're working on right now. That could change over time. But if your goal is something related to fitness or wellness or health, you may find after learning more about alcohol and the role it plays in your life that you want to change how much you're drinking. Then you have your why. "My why is I'm training for a marathon and I found that when I drink, I have a hard time waking up and going for my long runs. So I'm only going to drink on this day and I'm going to keep it to this amount." It's very specific, and that's important for behavior change. If you make a broad, general goal like "I'm never going to drink again because alcohol is bad," you're probably not going to do it because that's hard and it doesn't really relate to you as a human. So as much as you can make it specific, measurable, time-bound. "For the next three weeks, I'm going to try this and then I'm going to reassess." That makes it much easier to actually make change and stick to it over time.

Mel Robbins: Well, it's great advice because I feel like so many of us have had that experience where you go to a big wedding and you're like, "That's it. I'm never drinking again. I can't do this to myself." And three days later, you're going out for somebody's engagement. And now you're like, "Ah, I should just have a glass of wine," and you're back in it. So I think getting very clear about what your goals are. And I'm willing to bet if you write down your goals, you're going to see that alcohol is not helping any of them.

Dr. Sarah Wakeman: Exactly. And there are lots of tips out there, but you want to make it as easy as possible for yourself. If your goal is to cut back on drinking, you don't want to have a week where you're packed with going out to happy hour with people. You want to really set yourself up for success. So organize your social activities around non-drinking activities. Come up with a plan if you're going to be in a situation where you would normally drink. Have a glass of club soda in your hand the minute you walk in the door. Have a friend who knows that you're working on this who's going to be your partner. Setting those intentions and those ideas and tools and tricks ahead of time will make it way easier for you to ultimately reach that goal of cutting back.

Mel Robbins: If you quit drinking and you don't feel supported by your family or your partner or friends, what advice do you have for people to navigate that?

Dr. Sarah Wakeman: Great question. I think first, letting people know about your intentions. Sharing what your goal is is really important because people can't support you if they don't know. If you've always drank a certain way with your partner or friends and all of a sudden you're not, they're going to be like, "What's going on?" Whereas if you say to them, "Hey guys, I know you love me and support me. I want to share with you that my new goal is to not drink more than one drink a day, or only drink on Friday and no more than two drinks, or not drink at all. This is my why. I'm doing this because I'm worried about myself. I'm doing this because it feels counterproductive to my health. And I really want your support. This is how you can support me." Then you're really framing it as they get to be a partner with you. You're not criticizing their drinking, because often people then feel self-conscious like, "Oh, this person is going to be judging me or they think I'm bad." You're just asking for their help. So maybe that looks like instead of meeting for drinks, you meet to go to yoga class or you meet to go for a run. You let the person know why you're going to be ordering a soda water instead of a drink. So you can be really concrete both for yourself and what those tools look like, but also for the people in your life to signal to them how they can help support you.

Sometimes people can't do that. That happens whenever we make any big change. People may have experienced that if they decided to have a weight loss journey or change their life in some way, there are people that fit in our lives for certain points and that can't journey with you through that transformation. And that's sad. But if you find that despite those conversations, someone is actually destructive to the change that you want to make and not supportive, then that may be a broader question about the role of that relationship in your life.

Mel Robbins: I thought I knew a lot about this topic, and it just goes to show you there is always something new you can learn. So I have another question, Dr. Wakeman. What is your message to someone who is struggling with their relationship to alcohol?

Dr. Sarah Wakeman: Yeah, I'd like to just talk for a moment about alcohol use disorder. I think we've been covering the health harms of alcohol use, either at a low-risk level or moderate level or high level. For anyone who is struggling with alcohol use disorder or is worried they may be struggling with alcohol use disorder, treatment works. You will get well. Finding a trusted healthcare provider that you can partner with is a part of that journey. But to really have hope, this is not a hopeless condition. It will not be with you forever. You will be in a place where you're free from this. There are treatments that are out there. Getting them, much like you would for depression or diabetes or high blood pressure, is the most important thing. This is not an issue of shame or willpower or being bad. I hope that people will feel like they can come in and get the help that they need.

Mel Robbins: And for the person who had this conversation shared with them from a family member who's probably concerned about their drinking, what is your message to that person?

Dr. Sarah Wakeman: It can be really hard to hear this, especially in a society that still stigmatizes alcohol use and alcohol use disorder. I think take this as a message of love. Someone loves you. They care about you. They're sharing their worries and they're there to support you. And they want to be a part of this journey to help you live the best life you can possibly live in whatever way that means. And hopefully it will be a moment to pause and thank and get the support you need to make some changes.

Mel Robbins: Well, Dr. Sarah Wakeman, thank you so much for being here with us today. Thank you for the work that you're doing. You really are changing and saving people's lives. And we appreciate the time and how much wisdom you poured into us.

Dr. Sarah Wakeman: Thank you, Mel, for having me. This is a true pleasure. And hopefully these words will reach people who are working to better their lives or worried about someone they love.

Mel Robbins: And I want to also just make sure that you're listening, that in case nobody else tells you that I tell you that I love you and I believe in you. I'll talk to you in a few days.

[Sound of a pause, then a shift in tone]

Mel Robbins: Okay, okay, great. Here we go. All right, coaches, Tracy, great, that's perfect, thank you. That's okay. Hydrate, baby. Like, it's true, but it makes you think, doesn't it? As a—oh, I'm like, I do not remember what the hell is going on today. What is happening? I don't know what's going on over here in the garbage. Goodbye. Look how emotionally agile I am. What I want you to really heat. Okay, hold on. Where was I going with that? Dr. Wakeman, can you tell me about the race? Lorde. I didn't. Is that okay? Okay. Holy cow. Awesome.

[Pause]

Mel Robbins: Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know, what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode. Stitcher.