My first COVID vacation last year was spectacular, except that I barely remember 3 days of it because I was drinking to the point of amnesia.
I am a physician from a multigenerational family of alcoholics, and I never wanted to struggle with alcohol use disorder (AUD). Instead, I discovered that I could avoid feelings of discomfort by overworking, achieving, and staying perpetually busy. Workaholism became my drug of choice. As an adult, I worked obsessively from Sunday evening to Friday afternoon. By Friday at 6 p.m. I would think “I just want to turn my brain off,” pour myself a glass of wine, and unwind.
By the time I was an exhausted mid-career physician, drinking on Friday intensified and bled through into Saturday night. As I recovered Sunday morning, I would have overwhelming hangover anxiety, persistent worry, and self-criticism. Then I would numb with overworking until the next weekend, living in a continuous cycle of muting my feelings with work and alcohol.
Everyone I knew was overdrinking. Every social engagement with my high-achieving, workaholic friends was lubricated with cocktails. When I was intermittently sober, I was the exception to the rule of social engagement. Of note, 12.9% of male physicians and 21.4% of female physicians struggle with AUD or dependence.
From the outside, I did not appear to have a problem with alcohol. I only drank 2 days per week. I did “dry January” several times. In fact, I was alcohol-free for the first 6 months of 2020. My marriage was happy. I was a good mom. Alcohol did not impact my work responsibilities. I had no real consequences for my drinking.
But quietly, shamefully, I worried.
I was terrified that I was really an alcoholic in denial. As an actual doctor, I would google “How do I know if I’m an alcoholic?” I would see that I did not meet the criteria for substance use disorder (SUD) and rationalize that I was overthinking. The problem was the more I restricted my drinking, the more intense my Friday nights became. I privately worried about the blackouts in my 40s that I rarely had in my 30s.
On Nov. 3, 2021, the day I came back from Mexico, my worry was unavoidable. The quiet whisper that I should get curious about sobriety became a roar. To be clear, there was no rock bottom in Mexico. I didn’t come back with a crazy tattoo or a sexually transmitted infection. I simply decided “I can’t do this anymore.”
Enough is a decision — not an amount.
Ninety percent of alcohol overusers do not meet the criteria for SUD. Gray drinking is the zone between tee-totaling and SUD, characterized by the worry about one’s alcohol overuse. It increases one’s likelihood of SUD and sounds like this:
- You don’t have a drinking problem, but a problem with your drinking
- Silent worry, regret, or shame about drinking
- Drinking between two extremes — not every day, but you don’t have an “off” switch
- You can stop, but it’s hard to stay stopped
- Your drinking doesn’t look problematic to others
- No “rock bottom”
- Memory gaps when you drink
- Worsening anxiety or depression after drinking
Alcohol use, from tee-totaling to dependence, is a spectrum. For years, I was more afraid of an alcohol dependence diagnosis than the real impact alcohol made in my life. Ultimately, where I fell in that spectrum was irrelevant. The cost of drinking far outweighed the perceived benefits, and it was time to let it go.
Newly sober, I found skills to fundamentally address the urge to turn off my brain at 6 p.m. on Friday. Coaching and therapy were and continue to be extremely helpful. Identifying a compelling “Why;” learning to tolerate and not respond to urges; finding alternative ways to have fun and relax; connecting with friends who are less reliant on alcohol; addressing my burnout and anxiety; and speaking openly about my shame and worry have been part of my continued sobriety.
Nov. 3, 2021, was the last day I drank alcohol. By sheer serendipity, that is my brother’s sobriety date from 3 years prior. For me, that date is more than just a coincidence — it is an affirmation that I was right to consider sobriety.
If you would have asked me last year ‘Do you ever worry about your drinking?,’ I would have given you a long explanation of how I was fine. Similarly, if your answer is anything more than ‘No,’ it is worth getting curious about your relationship with alcohol. Consider a period of time away from alcohol, and see what you learn – the degree of your desire for alcohol will be very clear without it. There are many resources for support. You never know what hangs in the balance of choosing a period (or lifetime) of sobriety.
Kara Pepper, MD, is an internal medicine physician.
This post appeared on KevinMD.
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