Episode: 258

What Happens to Your Body and Mind When You Stop Drinking Alcohol

an Encore Episode

Today, you’re getting a masterclass about what alcohol does to your body, brain, and health.

AUDIO ONLY: Most Watched Clips are based on the original episode.

One of the most renowned and respected experts on alcohol is here to give you the latest research and science of how alcohol impacts your life.

She’s going to give you facts and help you be informed about the decisions you are making when it comes to your mental, physical, and emotional health when it comes to alcohol consumption.

Joining Mel today is Harvard’s Dr. Sarah Wakeman, MD. Dr. Wakeman is Senior Medical Director of Substance Use Disorder at Mass General Brigham, an Associate Professor of Medicine at Harvard Medical School, and the Program Director of Mass General Substance Use Addiction Services.

She’s here to answer:

How much is TOO much alcohol?

What amount of alcohol is okay in a healthy life?

What happens to your brain when you drink?

And how do you help someone you love who you think drinks too much?

By the time you finish listening, you’ll have the latest research so that you make the most informed decisions about the role alcohol plays in your life.

This is an encore episode with new and exciting insights from Mel at the top.

Get a copy of Mel’s new book, The Let Them Theory here.

If you liked this episode, your next listen should be this one: Harvard Psychologist Shares 6 Words That Will Change Your Family

Connect with Mel:

This is an encore episode with new and exciting insights from Mel at the top of the episode that is packed with tools, tips, and scripts to reprogram your mind for more positive thinking

Listen on:

It is never too late.

Dr. Sarah Wakeman, MD

Featured Clips

Transcript

Mel Robbins (00:00:00):

So Dr. Wakeman, can you explain what even is alcohol and how does it affect our bodies?

Dr. Sarah Wakeman (00:00:07):

Sure. So 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. And 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. And 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 (00:00:31):

You talked about alcohol as a molecule, that sounds very sciencey to me. So 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 (00:00:46):

Yeah, so I mean the way alcohol that we drink happens is through a process called fermentation. So something that has sugar like grape juice or if you think about beer, barley or potatoes or other, often starches are fermented and 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, so obviously it's intentionally made through fermentation to ingest, but we also use it in cleaning products or like rubbing alcohol or mouthwash hand sanitizer. So there are alcohols all around us and used for many different things. Well, when you say

Mel Robbins (00:01:26):

The category, cleaning, hand sanitizer, rubbing alcohol, thinking about uses in a hospital, and then I put that in the same almost family as something you would ingest in a cocktail. Is it the same

Dr. Sarah Wakeman (00:01:41):

Molecule? It is, and 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 really the power of addiction once someone gets to that level of severity. But it's the same molecule with the same effect.

Mel Robbins (00:02:00):

I just already had something that I learned that is if you're watching us on YouTube, you can see that my mouth is a gap. I don't know why I never connected the dots on that, that it is actually the same chemical.

Dr. Sarah Wakeman (00:02:16):

Exactly. The actual alcohol molecule that we think of in a fancy cosmopolitan is not different from what's in rubbing alcohol, let's say.

Mel Robbins (00:02:24):

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 (00:02:35):

Absolutely. It is so socialized and a part of culture and a part of celebrations and events that I think it just feels like a part of life.

Mel Robbins (00:02:45):

Are there negative impacts to having a beer or a glass of wine every night? I mean, how does that impact you?

Dr. Sarah Wakeman (00:02:51):

Yeah, so this is probably the most fascinating area of research where things have changed and gone back and forth over many decades of science and it's actually a somewhat tricky question to answer, which is why I think there've been very confusing sometimes in conflicting studies about this. So if you want to try to understand what is the impact of low risk drinking, moderate risk drinking, higher risk drinking, you have to figure out how do you study that. So you need to follow population over time to see what happens, and then you need to figure out how do we isolate the effect of alcohol. And so early on there were lots of studies showing that low risk drinking or moderate risk drinking were actually healthy.

Mel Robbins (00:03:27):

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

Dr. Sarah Wakeman (00:03:35):

One criticism of those studies showing that low risk drinking is healthy, is that the group that is often used as sort of 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 actually used to have an alcohol use disorder and they're now in remission or recovery and they may have health consequences that are leading to higher mortality compared to people who are drinking at a low risk or infrequent level. So a lot of the newer studies have actually used infrequent drinkers as the sort of control group or the comparison group. And I think that's really helpful to understand the data that way. There is a really big study actually this year that looked at hundreds of thousands of people that had been surveyed since the 1990s all the way through the mid 2000 and teens and did a really elegant job of trying to answer this question. And the things they did differently than other studies is first they controlled for other healthy behaviors, lifestyle behaviors, chronic conditions,

(00:04:32):

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 sort of 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. And so they actually controlled for all of that. And they did see that in the low risk category there seemed to be a slight decrease in mortality and it was not true for cancer. So any amount of alcohol is associated with an increased cancer risk. And that's a really important thing to know, especially if someone has a personal family history of cancer. Breast cancer is one that's strongly associated with alcohol use. And so factoring that in as you're making your decisions about alcohol is really

Mel Robbins (00:05:10):

Important. What is it about the molecule of alcohol that increases your risk for cancer?

Dr. Sarah Wakeman (00:05:20):

It's different for every type of cancer, and I think we're just starting to understand this. If you take breast cancer there, things that seem to increase hormone levels are often associated with a risk of cancer. So I think that's an area of active research to understand why alcohol and breast cancer in particular are so closely linked. Other types of cancer, it's a little more clear. They tend to be cancers of the liver or the gut that are strongly associated with alcohol. And 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 that we do see a lot of cancer risks.

Mel Robbins (00:05:54):

Can you talk about what you are seeing as relates to alcohol and liver failure or just how it's impacting people's livers?

Dr. Sarah Wakeman (00:06:04):

Yeah, so one of the main health harms from alcohol, especially heavy alcohol use is liver damage. And so what we see happen is this progression where the first thing that happens is inflammation of the liver. And when your liver gets inflamed, you start getting fat deposit in the liver. So the first kind of step is what we sometimes call fatty liver. So it's fat deposition in your liver that actually can totally reverse if you stop drinking or you make changes. And that's the amazing thing with the liver. It's a really regenerative organ. So you could cut 80% of someone's liver out and they would be okay, but there is a point where you cross a threshold where you can no longer repair the damage, and that's when you get to a stage called cirrhosis. So from fat deposition then you start getting scarring, your body lays down all this scar tissue because of the chronic inflammation in your liver.

(00:06:49):

And when your liver becomes so scarred that it's really stiff and starts not functioning well, that's cirrhosis. And we often used to think of cirrhosis as something that happened to people like decades down the road. I'm seeing people in their early thirties with cirrhosis in the hospital, and I think those are some of the most heartbreaking cases because people thought this wasn't on their bingo card, they did not even think this was a concern. They were drinking heavily, they thought their social circle was doing the same thing and then all of a sudden they're in their late twenties, early thirties in the hospital in liver failure. And 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 (00:07:29):

Is this something that you're seeing happening increase at a younger and younger age?

Dr. Sarah Wakeman (00:07:34):

And there's actually a lot of studies showing this. So between 2010 and 2020, there's been a significant increase in alcohol related liver failure, especially amongst women and younger and younger people. And even just after the onset of covid, we saw somewhere around a 25% increase in alcohol related death after the onset of the pandemic. So 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 (00:08:02):

Wow. How does alcohol impact the kidneys?

Dr. Sarah Wakeman (00:08:07):

So alcohol, one of the main effects that people have probably experienced is it makes your kidneys less sensitive to a hormone your body produces called a DH or antidiuretic current hormone. And so you pee more. So if anyone's ever noticed that when they drink, they sort of pee a lot more

Mel Robbins (00:08:22):

And it's not because you're hydrated. What I thought is why you pee more is because, oh, I just have more liquid in me, but it's actually because it's blocking a hormone.

Dr. Sarah Wakeman (00:08:30):

Exactly. So even irrespective of how much volume you've drank, you pee more because of this blocking of the effect of a normal hormone function in your kidney. And so that can lead to dehydration, which is one of the many reasons you feel really crummy the next day because you get dehydrated from drinking.

Mel Robbins (00:08:46):

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

Dr. Sarah Wakeman (00:08:55):

Yeah, so alcohol, I think there's growing research on how it impacts the microbiome. Certainly again at heavy levels it seems to harm the microbiome and we see this in patients with liver disease, but also just the impact of alcohol itself. The kind of two main things it does. One is it creates more leakage in your gut. So 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. So this whole idea of the brain gut access is a really growing area of research and knowledge. So alcohol can do that. It can also change the makeup of your microbiome itself as can high fat, high sugar, white flour, sort of the western diet. But there's 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 (00:09:53):

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

Dr. Sarah Wakeman (00:09:58):

Yeah, I think it is important to understand what are 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 and it's really important to understand what is that spectrum, where do I fall? And then what are my personal health goals? And 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 it? What is this amount of alcohol doing to my health? Is

Mel Robbins (00:10:28):

There any

Dr. Sarah Wakeman (00:10:29):

Health benefit to drinking alcohol? My opinion is that we shouldn't be thinking of it as a health benefit.

Dr. Sarah Wakeman (00:10:35):

So 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. That's true. People used to say that again, this idea of a glass of red wine is healthy. I think that framing is wrong. I think 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. Now, there are many things we do in life that the safest thing would be to do none of it. So 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, and people aren't going to live that way.

(00:11:10):

So I think it's really important to understand what are the risks? How does this fit into my overall life and when should I be concerned and how can I actually make changes to decrease those risks? So if you're finding that you are really stressed in your life and you're reaching alcohol as a stress reliever, it's probably not going to be a healthy way of coping with that and may lead to longer term problems. And especially if you're trying to live a life where you're being more mindful or more present or present for your kids or your partner or you're trying to get in shape and you 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. You're going to notice it. You don't have the same exercise capacity. So I think just figuring out how this ritual alcohol, what role it plays in your life, and it doesn't have to be that you stop drinking entirely. And I think that's a really important message. That may not be the goal for people, but if you are feeling like maybe this is causing some problems to me, maybe this is actually counterproductive to my other health goals, making some changes, cutting back, taking a break, those are all really healthy ways that you can start to really explore your relationship with

Mel Robbins (00:12:12):

Alcohol. Yeah, I love the fact that you are a specialist in addiction and you have a very realistic approach because I do agree with you that it does feel like it's either you're all in or you're all out. I think for a lot of people it is scary to feel like there's only one option, which is you either drink or you don't. And 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. And if you care about producing more at work or being more present or reaching your potential, you got to look at the role that alcohol is playing in your life. So from a medical perspective, how much drinking is too much drinking?

Dr. Sarah Wakeman (00:13:09):

So from a research standpoint, higher 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. So above that, we start seeing health risks like increased risk of dementia, impact on your liver or your digestive tract and other serious conditions.

Mel Robbins (00:13:28):

I am just sitting here thinking about you as a physician and a researcher and how I think a lot of us lie to our doctors about how much we're actually drinking and that we're not even aware of what the serving size truly is. Because when a lot of people make a cocktail at home, it's like lug, lug lug lu lug, and there's three shots right there. Or you've had a number of big glasses of wine, which basically mean you have had all seven glasses of wine in one night and thinking, oh, oh, I've just had a couple glasses. But I bet as you are seeing somebody get a scan, there's probably times where you're like, yeah, that's somebody that is a very heavy drinker. I can see it on the brain.

Dr. Sarah Wakeman (00:14:10):

And I think there's so many important points buried in that. So 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. So I sort of expect people to lie to me, especially they don't know me.

Mel Robbins (00:14:21):

And

Dr. Sarah Wakeman (00:14:21):

For most people, because of the tremendous stigma around substance use disorder, there's a lot of shame and worry for many people, 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. And so as a doctor, I feel like it's on me to earn someone's trust and also to educate them. I mean, there's nothing more heartbreaking to me than when I see someone in the terminal stages of liver failure, for example, from alcohol. And no one has told them beforehand what the risks are that this could happen, what sort of lower risk drinking looks like. They've often never had that conversation. So we'll see people in their thirties come in, they literally die during that hospital admission and you look back and they had touch points with doctors, they maybe were drinking heavily and no one stopped to sort of talk to them about it. And 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 sort of not our job or

(00:15:20):

A behavioral issue or a moral issue or a willpower issue. But this is a health condition like any other. And 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 (00:15:36):

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 (00:15:55):

Yeah, that's a great question. So I'll run through the checklist and I'm thinking when I'm talking to someone about alcohol. So first, understanding how much they're drinking, just the general quantity and how frequently is important as sort of a proxy for what their risk might be. But then the really important questions, are they drinking more than they want to? So they may have set an intention for themselves and they're finding they're actually always drinking more or spending more time on drinking or recovering from drinking than they intended had they tried to make changes and not been able to. So 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?

(00:16:37):

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? And then we often think about craving, which is sort of a strong psychological urge to want to drink. So you can't get the idea of having a drink out of your mind. That's something that we can see with alcohol use disorder. And then there are two physical symptoms, which is that idea of do you need to drink more to get the same effects? Do 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? So that's sort of the checklist we run through and I think really gets at those kind of general areas of losing control, using compulsively, using despite consequences, and then craving

Mel Robbins (00:17:13):

That was so helpful. And 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 and you're in this cycle of wishing you could get control over this and yet feeling like you can't. And yet if you aren't stumbling around at night or you feel like I am able to carry on a conversation, I'm not blacking out, I'm 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, which is it really? And even just that question, are you drinking more than you want to be drinking? If you answer that question honestly, and whether you're listening right now for yourself or you're listening for somebody that you love, that you're concerned about, this is an amazing starting point because 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? And that is powerful. Now, Dr. Wakeman, where I want to pivot to next is I'm starting to see this picture where as a researcher and a renowned expert on this topic that you are talking about kind of the big risks that can happen. I want to focus a little bit on amplifying the day to day impact

(00:18:48):

That most of us are not present to,

(00:18:51):

That we reach for the alcohol at night because at least in my own experience, it's like an easy lever to pull to say to my brain, we're no longer working. This is the thing that I do is 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. I want to take a quick pause so we can hear a word from our sponsors, and 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, because 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, it might actually just be the thing that gets somebody to wake up and want to do better.

(00:19:38):

So 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, and I'll see you right after the break. Welcome back, I'm Mel Robbins, and I'm so glad you're here. Thank you. 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. So 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 (00:20:12):

Yeah, it's a great question. So one really common thing is worsened acid reflux. So 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. So oftentimes people who are struggling with terrible heartburn and they don't realize that those two glasses of wine are probably having a direct impact on that. Other things, we know that alcohol can make you dehydrated, so you may notice that your skin changes, it impacts how you sleep, so 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. So lots of little day-to-day ways that alcohol may be impacting your health and your experience.

Mel Robbins (00:20:48):

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

Dr. Sarah Wakeman (00:21:01):

Yeah, you'll see a lot of really quick things. So when you'll sleep better and feel more restored, you may lose weight. There's a lot of calories in alcohol, so if your goal is to lose weight, you're drinking a ton of liquid calories, so you may find that that's better. You may find that your exercise capacity goes up resting more and 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. So 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 (00:21:41):

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

Dr. Sarah Wakeman (00:21:51):

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

Mel Robbins (00:22:09):

Really?

Dr. Sarah Wakeman (00:22:10):

Yes, because alcohol dilates your blood vessels. So you may have experienced, if you drink a couple glass of wine, you actually feel flushed and

Mel Robbins (00:22:16):

Feel

Dr. Sarah Wakeman (00:22:16):

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 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. You may be drinking because your mood's 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 (00:22:40):

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

Dr. Sarah Wakeman (00:22:47):

And people may be surprised to hear that it makes you fall asleep quicker. So often people are like, oh, alcohol helps me sleep. I fall asleep so quickly. But when we think about sleep architecture, there's different cycles to sleep. People are probably familiar with REM sleep is that deep rapid eye movement sleep, but there's different cycles that your brain naturally cycles through in the night. And the balance of those cycles is really important to get restorative sleep, which is when your body rests and heals. And 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, and so 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 (00:23:41):

I have another question, Dr. Wigman. Can you walk us through what's happening in your body 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 (00:24:00):

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 often is a constellation of symptoms that include headache, feeling anxious, often actually having diminished exercise tolerance. So you can't have the same aerobic capacity that you did before feeling irritable. Those are all sort of symptoms of hangover that people have probably experienced. There's an older school of thought that actually it was mild alcohol withdrawal. So withdrawal is when you are drinking so much that when you stop drinking, you actually get symptoms. Seems like that is likely not the case. The constellation of symptoms is quite different. And so the thinking is that it's a combination of really two things. One is dehydration. So we already talked about how alcohol make you pee more and so you get dehydrated. And then the other is actually byproducts from the drink that you're drinking itself. Either the sort of breakdown products of alcohol or there are certain types of liquors and drinks that have other types of molecules that can build up and make you feel even crummier. So 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 it's really sort of toxic byproducts and dehydration. If I were to sum it up, of what's causing a hangover,

Mel Robbins (00:25:19):

Why is anxiety one of the biggest kind of symptoms of a hangover? An alcohol withdrawal?

Dr. Sarah Wakeman (00:25:26):

Yeah, it's probably the effect of these byproducts that then are still impacting the way your body functions your brain, and it takes a long time for your body to excrete them. And so we can see just feeling that really anxious, restless kind of gross feeling afterwards.

Mel Robbins (00:25:40):

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

Dr. Sarah Wakeman (00:25:49):

Yeah, it does, especially over time. And so what we see when people have drinking have been drinking over a long time is actually your body starts to adjust because our bodies are very adaptable. So if your body's used to having three or four drinks every night, your body's going to start to accommodate to that. And so what we see is actually changes in the brain. So you see changes in the amount of receptors you have, the amount of hormones you have, your dopamine levels, your stress hormone levels. So 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. So 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's 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 your body's gotten so adapted to always having alcohol on board that it takes time actually for those changes to reset.

Mel Robbins (00:26:49):

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 (00:27:18):

Yeah, there's a couple really important things to know. First, alcohol itself can cause depression, anxiety. So if you are, 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 running, working again at cross purposes with your efforts to try 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 sort of a slowing down effect. So some people take medicines in a class called benzodiazepine, so things like Xanax or Klonopin or Ativan, those when mixed with alcohol have sort of a combination effect that can actually slow down your breathing, could cause an overdose, could make you very sick, could make you more sort of impaired sooner. So really important to not mix those medications with alcohol.

Mel Robbins (00:28:18):

Wow. How does alcohol compromise your memory?

Dr. Sarah Wakeman (00:28:23):

So alcohol affects all parts of the brain, including the amygdala, which is an area that lays down memory and it has complicated actions in the brain, so 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 so they can only remember things from the past, but they're unable to make any new memories. And that's a very extreme example, but we see it in the hospital and it's really scary when it happens.

Mel Robbins (00:29:20):

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

Dr. Sarah Wakeman (00:29:28):

We actually see brain damage on people who've had chronic heavy alcohol use over many years. So if you take a picture of the brain, like with a CAT scan or with an MRI, what we describe it as is volume loss. So normally you want to see a big, healthy, robust brain, and as you age and with types of dementia, one thing that we see is the brain starts to shrink. So the actual functional parts of the brain are smaller. We see that process accelerated with heavy alcohol use. So often take someone who's in their fifties 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 (00:30:16):

That's scary.

Dr. Sarah Wakeman (00:30:17):

It is really scary.

Mel Robbins (00:30:18):

So the next question is from a listener who, how did your parents talk about alcohol use with you? Did they allow it? Did they ground you? How did they handle it? You can speak freely. Ok.

Oakley Robbins (00:30:34):

Well, I think from a young age you were more practicing safe ways of using it, healthy ways of using it like a glass of wine at dinner or a little bit of a drink at a party or something. Before any parties or anything really happened, you would talk to the three of us kids and always tell us that if we do go out and do something because teenagers and stuff happens and kids do stuff, and if you're a parent listening to this and you're like, oh, that's bad. Well, you did it too, so that's okay. You always said that if we're ever going to do anything before we do it at a party or somewhere else, you want us to do it with you so that

Oakley Robbins (00:31:12):

It's like we're in a safe environment, we're with people we care about, you can take care of us, and it's all safe. No drinking and driving, that's your number one rule.

Mel Robbins (00:31:21):

That's my number one rule. And what's the rule too, about if you're going to be at a party where you are drinking, what do you have to do?

Oakley Robbins (00:31:29):

Either have a driver who my mom trusts or stay at the party or final option, call mom or dad and ask for a ride.

Mel Robbins (00:31:40):

And what do we do if you tell us where you are and drinking's involved and the police show up or something happens like, do we ground you?

Oakley Robbins (00:31:49):

No, why? You ask me to call you and Well, you don't ground me. Because again, it's a natural part of life. It's experimentation, everybody experiments. And also, wait, why don't, because we're getting punished enough by the cops. I feel like that's,

Mel Robbins (00:32:05):

That's a great question, Oak. I'll tell you why. Because here's how I've chosen to handle this issue with your dad because this is a deeply personal issue in terms of how you decide you're going to talk about it with your kids. And so for us, we took the time to figure out what do we value here? Because number one, every kid is going to experiment, just every kid, just assume they're going to experiment. And number two, if you assume that they're going to experiment and you can't stop that from happening, what is it that you value most? For me, what I valued most was open communication, trust and safety. I took the focus off trying to control something I couldn't control, which was whether or not you drink. And I put all of my attention on how do I navigate this as a parent through my highest value, which is creating trust with you, creating open communication with you and keeping you safe.

(00:33:13):

And safe means not only no, driving safe also means your use of it not being one of these kids who is they binge drink like crazy because they have to sneak it. And so they just chug the, because we saw this over and over and over with kids whose parents punish them when they drank Orban the alcohol or pretended it didn't happen. It created a lack of trust. It created sneakiness, it created lying, all of which led to very dangerous behavior. And so for me, I don't know whether it's the right call or the wrong call, it has been a very smart and successful call for us because it's aligned with our values.

Mel Robbins (00:33:52):

And so that's why now if you lied to us, I'd punish you.

Oakley Robbins (00:33:57):

Yeah, I would get punished

Mel Robbins (00:33:58):

If I lied. Yes. If I ever found out that you got in a car with somebody who was drinking or you yourself got behind the wheel, you would lose the right to drive for a year.

Oakley Robbins (00:34:06):

Yeah, that is so true.

Mel Robbins (00:34:07):

And that's no joke because we live in a rural area and I had a friend die in high school because of drinking and driving. And so that's why my values are that. And so I just feel like that's the formula for anything that you're navigating, whether it is sex or it is alcohol or it's drugs or it's anything. Figure out what you value most and be honest with yourself about what you can control and what you can't control. Because if you don't understand that, if literally if I were to ban you and say you're not allowed to drink, can't drink until you're 21, it just makes you want it more and it also makes you go, I'm not telling you what I'm doing. And so that's how we handled it

Mel Robbins (00:34:52):

And that's why I don't punish you when you do what you say you're going to do and when you stay where you're supposed to stay and when you don't drive

Oakley Robbins (00:35:00):

Valid. It's true.

Mel Robbins (00:35:02):

I'm really excited to talk to you because I have been thinking a lot about my relationship. It sounds weird to even say my relationship with alcohol. I've been thinking a lot about drinking and I have this very conflicted relationship with drinking. My husband doesn't really drink, and so that means that I have a partner that is never pouring himself a drink at the end of the day. And that has made me think a lot more about why am I drinking? And I've noticed I we're just going to jump in with a confessional. Is that okay? I mean, is this the way that we should start? This thing means? Okay, great. I've just noticed that I have a lot of adjective about it. Should I drink? Should I not drink? Is it bad if I'm drinking? I wanted to talk to you because I love your website and I love your approach to having people, as you say, have a normal relationship with alcohol and with their urges.

(00:36:10):

And I don't even know where to begin. I just am really excited to talk to you about this because I don't know why I'm so conflicted about it. I wish I weren't. And I guess the other thing that's been happening for me is that the more that I learn about neuroscience and the body and the fact that alcohol is poison, the more I'm thinking to myself, why the fuck am I drinking if it's this bad for me? Oh yeah, I know. Because I like the taste of it. And every once in a while it's fun to celebrate with friends. So that's me. That's me. The hot mess. Mel Robbins with alcohol

Rachel Hart (00:36:51):

Or maybe not a hot

Mel Robbins (00:36:52):

Mess a little bit,

Rachel Hart (00:36:53):

Maybe normal to be conflicted.

Mel Robbins (00:36:55):

Is it normal to be conflicted about alcohol?

Rachel Hart (00:36:56):

Yes. Yes, of course it is, of course, because think about it, on the one hand you're like, okay, I'm learning about this and it's a poison and it's bad for my body. And on the other hand, it's like a billion dollar industry and we are exposed to so many messages about alcohol, and I just think we are getting all these conflicted messages all the time that it's the thing that makes things fun and fancy and adult and how you do something special and then at the same time it's like, oh, by the way, you're poisoning yourself. So I think that that's very normal. And I just want to tell you that I think the vast majority of people that I work with start out in this place of I'm not really sure what I want to do. I'm not really sure what is right. I just know that I have this kind of, I don't know if it's an intuition or this little kind of quiet whisper that I don't know, something doesn't feel right or something about my relationship feels a little off and maybe I want to do something about it.

(00:38:06):

It's just that this is also such a highly charged issue. And so I think a lot of times people have that intuition, they have that kind of inner knowing of, I don't know, maybe I want to look more closely at this. But then like, oh God, what does that mean? Do I have to stop drinking for the rest of my life? Do I have to put a label on? So what you are experiencing, I just want to say is very normal. The conflict that you have. For a long time, I was like, do I have a split personality? What is going on? Because part of me had so much desire and loved to drink, and part of me was also like, I don't know that this is creating the best outcomes for you. And I thought that that conflict was a sign that something was wrong with me rather than, yeah, no, you've got two different parts of your brain that care about different things. And so yeah, you're going to be conflicted sometimes about your desires. That's normal.

Mel Robbins (00:39:02):

Is it appropriate for me to tell you this soon in our relationship that I love you? Well, because starting to think about how you're right, I've started to think about this. There's something wrong with me and I have a problem. And when I look at everybody's relationship with alcohol, it is kind of fucked up because we have all of this messaging at us. Most of us have had periods of our lives where we drank. And I even look at our 20 somethings who are just through the college year or just got out of college and their relationship with alcohol's crazy. They just go on these benders and then it's like, oh, I'm not going to drink all week. I got to get back healthy again. And that's what I used to be like. And I think about how much effort goes into the, am I going to have a gin and tonic tonight or am I not going to have anything at all? And then if I do have a drink, I should probably take some Advil before I go to bed. And the whole cycle that happens in the morning when you feel kind of hung over and I wake up and I'm like, why did I do that?

Mel Robbins (00:41:22):

Do you drink? I have so many questions.

Rachel Hart (00:41:24):

Yeah. Okay. Well, so I mean, I will say that I started drinking in college. I was 17. Oh, that's late. I'm a

Mel Robbins (00:41:31):

Way better drinker than you are.

Rachel Hart (00:41:33):

I started at

Mel Robbins (00:41:34):

14, man.

Rachel Hart (00:41:36):

I was very quickly like, oh, this is the solution to all my problems. We don't have to feel awkward, we don't have to feel anxious. I don't have to listen to any of my internal critic or any of my hangups. This is amazing. Where has this been? Right? So I mean, I think that was my experience, what you're describing, the kind of 20 something that I would work very hard during the week, by the way, also during the week, a constant kind of Ps, don't ever make any mistakes. Don't do anything wrong. You must do everything perfectly. And then the weekend for me was my outlet to be like, okay, finally, not only do I get to stop feeling anxious and awkward and have these hangups, but also I can be a little wild and mess up. And this is the way to feel sexy and confident and have fun.

(00:42:27):

And so that was something that my brain was learning. Again, I think it's really important to reiterate that we are learning something when we drink. The brain is always learning. We're not just learning to acquire the taste. We're learning about, Hey, this is what we do at sporting when we watch the game or at sporting events or at celebrations or on vacation. So we're learning both when we do it and we're also learning, this is how I relax, this is how I connect, this is how I open up. And so all of that is unconsciously happening below the surface. And I think we get to this point where we start to want to examine our drinking and maybe I want to drink less, or maybe I'm unsure about this. And we are trying to do it from this place of, okay, well I know it's not good for me. I know I shouldn't do this. Or I should be more responsible, as opposed to, Hey, what has my brain learned? Can I start to understand that? Can I start to teach my brain something different about what alcohol is a symbol for? I mean, it becomes a symbol for so many things. And I think we just look at it from the superficial of like, oh, I just like the taste, right? Or I was like, I'm just into craft cocktails. That's just my thing.

Mel Robbins (00:43:50):

I like the ceremony and the smoke and the sprig of rosemary that comes out of that thimble that they serve it in for $20.

Rachel Hart (00:44:02):

But right there is so much when you think about it, you go to a fancy restaurant and you're getting the wine pairing and the sommelier coming over and you're getting all this information about where it was grown and the type of grape. And yeah, I mean, we are building up all of this kind of excitement and drama around it. And by the way, I'm not saying any of that is bad, but I think we just have to understand that there's a reason that we attach all this kind of symbolism and desire and what it starts to represent. So that's all going on. And then we have the other side of, okay, well if I had too much to drink, I was obviously stupid and I should know better. And why am I still making these same mistakes? I should have grown out of this by now. So there's this idea that all of our desire and urges should just be conquered by our intellect, and that doesn't make any sense.

Mel Robbins (00:45:04):

I just love everything that you're saying because I'm starting to realize that one of the reasons why I've never been drawn toward just being a person that doesn't have alcohol in their life period, is that it also felt, for me at least, I know for some people it's incredibly important and empowering, and it is the choice that is the right choice and the choice you need to make. But for me, there was something about it that felt like a part of the thing I'm already doing, which is making myself wrong

(00:45:43):

About the urges. And I have always said to myself that I just wish I could be the kind of person that had no drama around it, that if I wanted a glass of wine, I had a glass of wine in the moment, and if I didn't feel the need to finish the whole bottle of wine I that I wouldn't have this whole shame cycle and conflict of whether or not I'm going to drink or not drink. And when you said the thing about how it's part of how we watch sports, it made me realize there are so many stories that your brain has learned about when and where and why you drink alcohol. And I think the single two biggest stories for me are, number one, that alcohol for me is about belonging, not belonging to the alcohol. But my brain has hardwired the moment that I first had a drink when I was 14 years old, and I was dating somebody who was two grades ahead of me. And at that point in time, I think it was still grandfathered in that if you were 18, you could buy alcohol in Michigan.

(00:47:05):

And so my boyfriend could buy alcohol or no, his friends could buy alcohol. He was 17. And we went out, we would go out to Lake Michigan, and I remember when we were first dating, we pull into the state park and there were all the seniors out there. And my boyfriend was a junior and I was a freshman, and I was so scared because I was the only freshman or sophomore that was out at that beach, the sun setting. We get out of the car, he grabs my hand, we walk towards all his friends, and one of the gals turns me and says, Hey, Mel, would you like a rum and coke? And when she handed me that rum and coke in a red solo cup, I immediately exhaled and was like, okay, I'm part of the group. And so the trigger for me is anytime the waiter comes around or I am going over to a friend's house, this just happened last night. I was not planning on having anything to drink last night. And then I went over to my friend's house, she had two glasses out and a bottle of cair, and she poured two glasses and said, let's go walk around the garden. And I'm like, okay, okay. I'm going to join in with you and it feels good to join in. And the sair tasted great, and I had a glass of wine that was that. And then I came home. But of course as I'm driving home, Rachel, I'm like, why'd you do that?

Rachel Hart (00:48:28):

Yeah, right? Because making it mean that you did something wrong as opposed to like, can we just love your brain for a second that it's like, Hey, I want to belong. How normal of me, how human of me that I want to feel connected. And at some point you're 14 and the brain's like, oh, this is how we belong. You have the red solo cup, I have the red solo cup look belonging. And so that's what I'm talking about when I'm saying, what was your brain learning right now? You not, may not have made consciously that connection in that moment, but at some point your brain did make that connection. It did make that association. And so then it's like, wait, if this is a symbol of belonging and I want to belong because who doesn't, then what's going to happen? All of a sudden it's like, okay, so I go see my friend and she pours two drinks and I'm like, no, thank you. Are we disconnected now? Do I not belong? And

Mel Robbins (00:49:29):

I know intellectually, Rachel, that she wouldn't give a shit. She'd just take my glass that she poured and poured in hers and then give me a seltzer. She can roll with it. It's not that big of a deal. But this goes deeper what even is an evening routine. Before we jump into why this topic about evening routines is so important, I want to just take a minute and zoom out a bit and have you just think about your day. Okay. How many times have you gotten to the end of the day and you think, oh my God, where did the day go? I mean, I don't have any time. I didn't get to the most important things on my list and now it's evening and I'm tired and I still have to cook dinner and I still have to walk the dog. I've got that series that I want to watch and I've got the things that I want to do, and now all of a sudden I don't even have any time.

Mel Robbins (00:50:16):

And it happens all the time, doesn't it, that you get to the end of the day and you're just too tired to do anything except for slouched down on the couch. What is it about the evening? It's like when the evening starts, all of a sudden the time it just goes by so fast, nine to five drags, but five to nine, it's like the time doesn't even exist and you're probably giving it all during your nine to five. But what about the five to nine or your nine to 11? What if there was a simple way to really take advantage of the end of the day, even though at the end of the day you're really tired? Just imagine if every evening you just had this rhythm, this simple routine that you would just do that was as easy as turning on the TV this evening routine would really set you up not only to make the most of this big chunk of time that you have at night, but also in a really easy way to set you up for tomorrow morning.

(00:51:27):

It sounds great, doesn't it? I know. So I dug into the research and the fact is there are very simple steps that you can take. And I've been trying them out. I've been road testing them for both you and me because just like you, I want to make the most of this time. And I don't want it to be hard because during the day is hard enough. And so I've done the work and I've boiled it down to the four simple steps that you can take that will help you have a better night every night, a more relaxing evening, every evening. And even better than all of that by doing the four simple steps you're going to set yourself up to also absolutely rock your day tomorrow. And I'm really excited to share this with you because I've been like the Guinea pig test in this, and I can't wait to hear what happens in your life when you try this because it actually works.

(00:52:20):

And here's the other thing that's interesting about the topic of evening routines, whether you've ever thought about it or not, you do have an evening routine. I mean, stop and think about what do you do between five and nine? What do you do between nine and 11 if you're up that late? Are you doing a whole lot of nothing? Are you pouring a glass of wine and then that turns into a half a bottle and then that turns into the bottle. I mean, that's a routine. Are you scrolling through social media for four hours and then all of a sudden you're like, oh my gosh, what just happened? I should have gone to bed hours ago. That's a routine. Eating at nine o'clock, that's a routine. Leaving all the dishes in the sink and hoping that somehow when you wake up tomorrow morning, they're not going to be there.

(00:53:05):

They're going to be magically washed and put away. That's a routine, and I know I'm being kind of snarky about it, but I am doing it for a reason.

Mel Robbins (00:53:15):

I want you to stop and think about what you're doing every evening. Is it serving you? Is it you up for success? Does it help you sleep better at night? Does what you do at night make you feel like the person that you want to be? Now, for a long time, I did not take this conversation seriously. My evening routine looked a whole lot like this. It was a combination of disaster, a lot of drinking, tablespoon of regret, dash of delaying all the things that I didn't feel like doing, pushing them off until the morning if I cooked dinner, did I clean it up? No. Why would I clean it up? Why would I clean up the dishes at night when I could just stack them in the sink and squirt a bunch of suds all over 'em and then put all the hot water on it?

(00:54:05):

And it's almost like I thought that maybe those bubbles that would come up were going to be like the magic scrubbing bubbles on TV and they would just take care of the mess. I don't know why I thought that's what was happening in the sink, but that's what I thought was happening. And you're probably laughing because either you do this, right, you just stack the dishes and the thing with all the dish soap, you put all the water in there, and if you're not the one doing that, somebody in your family probably does that. And I'm not even through the rest of my evening yet in terms of what my old evenings used to look like. And this is probably around seven o'clock at night. So my evening routine begins by just stacking dishes, not doing them, creating this giant stack of goopy messy bubbles in grease.

(00:54:47):

And then you know what I would do? I'd start checking my email after work because nothing relaxes. You like cracking open your laptop at night and plopping on the couch while you're trying to watch a series answering emails. I'd pour myself a drink, I'd continue drinking. The other thing that I would do, I would endlessly scroll through my phone. Would I pack the kids' lunches? Of course not. Why would I do that? Would I put my gym bag out? I can do it in the morning and then I would spend about an hour. Do you ever do this? Just clicking through the television? Have you ever wondered how can there be thousands and thousands and thousands of things that are on the TV but absolutely nothing to watch? I'd have about a thousand thoughts hit me where I'd think I should really go to bed.

(00:55:25):

Would I go to bed? No. Would I read a book? No. I would just sit there and do nothing literally. And all of a sudden you're like, oh my God, it's midnight. What the, I should have gone to bed earlier. And then what happens? Well, now you're all stressed out because you realize that you just wasted yet another evening. And then what happens? You're freaking wide awake. So you climb into bed, you're wide awake, you're staring at the ceiling. You realize that there are all these things that you wanted to do tonight that you didn't do. And now I'm laying in my bed and my phone is right there. And then I see that I've got my journal by the table because I'm supposed to be doing a gratitude journal. So I crack that sucker open at 1215 at night. And what am I doing?

(00:56:06):

Instead of doing gratitude, I'm now making a to-do list of everything that I didn't do today. Oh, I better do this. I better do that. I forgot to do this. That was my evening routine. And this really isn't a joke. I'm being a little dramatic and funny about how I tell you, but if you really think about how easy it is to fall into an evening where the rhythm isn't setting you up for success, the rhythm is creating a giant mess for you to wake up to tomorrow morning. And don't tell me this isn't you or somebody that you love. And here's the other dirty little secret about your evening routine. Not only does what you do at night impact how your evening goes, but what you do at night single handedly determines what's going to happen tomorrow morning. Because let me tell you what used to happen to me after the kind of night that I just described.

(00:57:03):

So I would eventually drift off to sleep and then all of a sudden the alarm goes off and I say all of a sudden, because it's as if morning came in the blink of an eye and it's like, did I even sleep? I mean, it's already morning. Oh my God. And you wake up and you have a giant anxiety attack from the moment that your eyes are open. Why? Because you're behind the ball. You're completely disorganized. You didn't get the greatest night's sleep. You walk out into the kitchen and then all of a sudden, what's in the sink? Oh, the stack of dishes from last night. And what are those dishes like? They're not clean, they're cold, and there's dirty, disgusting water that was even more disgusting than the taco meat that was stuck on the pan that you were trying to soak off. And now what do you have to do?

(00:57:45):

You have to stick your hands in this cold, greasy. That's how you start your day and then you can't find your keys and you can't find your backpack, and now you're late. And this is how you're starting your day. That was my life for a very long time. And if you stop and consider this, if you just keep waking up every day and you're not getting a great night's sleep and you're not set up for success and you never have time for yourself, no wonder you feel like you're caught on this loop of never being able to break out of it. And I don't want you to make the same mistake that I was making. I literally was making this mistake. Okay, tomorrow morning. Tomorrow morning, it's the new me. Tomorrow morning I get a fresh start. Tomorrow morning, I am going to wake up and seize the day.

(00:58:26):

Well, that's only true if you did last night's dishes. If you didn't set yourself up last night, the new you is waking up and cleaning up the old messes. And I don't want you to do that. Let's pivot to this accelerating mental health crisis that we are reading about. We are experiencing every single one of us, Lisa. I don't have a single friend who doesn't have a family member who is spiraling and all through the lockdown. And coming out of the last three years, it doesn't feel like a new normal. It feels like there is something that's been bubbling underneath the surface. And if it hasn't already erupted with the young people in your life, it feels like everybody is very tender and that there is something going on beneath the surface. And so I would love for you to talk about what you've seen and what your concerns are about what and how this age group 11 to 25 roughly experienced the last three years, social isolation and lockdown.

Dr. Lisa Damour (00:59:47):

Well, let's look at it this way. Teenagers have two jobs. Their jobs are to become increasingly independent and to spend as much time with their friends as possible. And those jobs were made impossible by what they went through. And I'll tell you, Mel, I saw a wide range of responses, a few kids, but this isn't a sign that this was a good thing. Were glad to be home. Were anxious about school. Very, very small minority of kids felt some relief under lockdown, but we now have the reality that they do need to return to the world at large. And that's harder than it was before. Most kids just suffered through it, found their way one way or another, while feeling miserable. I mean, they were miserable and miserable in all of its variety, some incredibly anxious about what was happening with their social lives. Some unable to do school in 2D.

(01:00:56):

That is its own fascinating universe of kids who were otherwise very strong students. And I saw several of these really as long as they were in a bricks and mortar school could do school, and as soon as it was collapsed into a 2D space, were actually incapable. And it got me thinking, you can hear I get excited about the phenomenology of this. It got me thinking about, oh, we never knew that so much of what kids kept some kids organized at school was moving physically from room to room. So, oh, I must be in this class now because I'm sitting next to the kid. I said next to in this class I'm going to focus on this class. Or that they knew that it was time to get out their notebook because everyone around them was getting out their notebook or they knew that it was time to start writing down notes, noticing people doing it.

(01:01:43):

I just became completely fascinated by all of these ancillary supports that we had never thought about because we had never been put in a position to think about. And I watch kids who really were incredibly strong academically crater. I mean absolutely be completely unable to do school. There were also kids who could do school. They just hated it and they did it and they hated it. So we saw all of that. And then at the other far limit, and unfortunately we saw way too many kids in this area, I saw kids derailed who developed horrifying eating disorders who were smoking so much weed that it really probably changed their developmental trajectory at least for a while, who ended up in just rip roaring social conflicts that I think were partly to deal with boredom and partly out of desperation and partly out of who knows what. I will tell you, Mel, and from having read my work, I am generally on the kids are resilient. It's all good. We'll find our way through this. And I still believe that. But I can tell you having been a practicing clinician for a long time before 2020 march and then post the stories I hear now of kids derailing are just much, much more extreme than what I used to hear. And that part is alarming to me, and I don't get alarmed very easily.

Mel Robbins (01:03:15):

Wow, what do we need to know? Because what we saw, which was very interesting, is we saw a lot of grief because our daughters were in the middle of their college experience. And so there was daily ricocheting emotion about policies changing. Are we going back? Are we not going back? Who's going back? Am I going to live off all of that stuff? And then all of those sort of milestones of graduation or prom or all of these things that people look forward to or just expected being ripped away. And so I saw a lot of that. And I also have lots of friends whose kids just opted out of school, who started smoking pot, who became incredibly rebellious, who became super depressed eating disorders. And so I think we've all, if it's not happened in our family, we have somebody close to us who is going through it. And what do you want us, first of all, to know about how not being able to do the two things you're supposed to do, which is become more independent and spend more time with your friends, how does that impact a child developmentally?

Dr. Lisa Damour (01:04:44):

I think the best language for this is to think in terms of delay, not loss, though there's a lot of loss and what your daughters, they lost elements of college that they're never getting back. And I think that needs to be acknowledged as exactly what it is. But in terms of developing a sense of independence, finding one's path and one's interests, developing one's peer relationships and increasing reliance on peer relationships and moving out into the peer world, we just have to accept that there's a delay in that and there's no getting around the fact that there's a delay. I really do think that development isn't the most powerful force in the world and kids will find their way back onto a trajectory that works for them. I really do know that humans as a group bend towards health, but sometimes I think it's hard for us to accept that there are delays.

(01:05:39):

And I have sometimes found myself in conversations where people are hand wringing about how kids look academically, which we are still seeing the aftermath academically. And I say to them, okay, but wouldn't it be so weird if kids didn't go to school for a year and a half and they came back and we saw no impact from that? That's true. We would've been thinking, what have we been doing all this time requiring them to show up for school? So we just have to say they're going to be delayed because they missed out. And that language I think is better than a lost language. I also think we got to look for the big stuff. So we had talked about suicidality. Let's just hit it head on. It's the scariest thing. So it is true, Mel, that thoughts of suicide are actually not rare that I don't have the statistics at my fingertips, but I know that when we've looked before 2000, we would take surveys of adolescents and the frequency with which the thought had crossed their mind and it's not fair.

(01:06:39):

And I remember being a teenager, and one time my mom and I were in a fight and I was like, oh, wouldn't she? If I hurt myself right now, she'd feel so bad. So did I think about it? Yes. Was I myself close to doing it? No. Right. So I do want people to know that if you have a worry about a teenager or anybody in your life around questions of whether they are suicidal, what we recommend as psychologist is you just have to ask. You have to ask. And here's how I would have you do it. I would say to the person, listen, I need to ask you a question. And this may feel out of the blue, something like that. But because, and then you tell them why, right? You don't just ask randomly. You say, because you've been in your room for a day and a half, or you have not seemed like yourself or you were so upset about that thing.

(01:07:30):

I need to ask, have you had any thoughts of harming yourself or ending your life? And the reason we're reluctant to do this is we're afraid we're going to give the person the idea That's a concern. We know that's not a concern. What we do know when we have researched adolescence is if a teenager is thinking about suicide, they're glad you asked. So I think we start with the scariest thing and how to address the scariest thing, and then we can go think down the line of more manageable concerns. But that is the one we just have to address very directly.

Mel Robbins (01:08:04):

Thank you. And it was very reassuring to hear the research that teenagers are just glad you asked.

Dr. Lisa Damour (01:08:10):

They're glad you asked.

Mel Robbins (01:08:11):

Yeah. We did a episode with our 18-year-old son now where he disclosed to me on the episode, I did not know that this was the case, that he had had big scary thoughts like that freshman year, and I had no idea. And so one of the things that was interesting about it is he was pretty surprised to learn that it is frequent and normal to have a thought like that. And there's a big difference between having a thought and actually wanting it to happen and that they do come and go and they do go away. And it doesn't mean you're at the end of the end, but even just talking about it made feel better. And so I love that you just gave us permission based on the research to just ask and they will feel better even if the thought didn't even cross over mind. Thank you for checking in. I would love for you to help us understand some of the issues that you've seen coming out of this and how to really parse, especially in the wake of the rising crisis that you're seeing, even if it's just starting to come to the surface, it's sort of even delayed that now we're kind of through it and quote back to school and back to this, that there's still this delay and there's still this hangover, so to speak,

(01:09:33):

Of the emotional experience. And I'm convinced everybody's nervous system is in fight or flight still.

Dr. Lisa Damour (01:09:40):

I'm with you on the nervous system stuff. I mean, that really rocked up our world. And when we think about really hugely unsettling events, they do sort of rewire our nervous system. And I think that we're having to find our way through that. Two things we are seeing aftermath, and we can be very specific about that. I really worry about eating disorders. I really worry about kids who are abusing substances. We don't know yet what the snapshot of mental health is right this minute for teenagers. And part of what's confusing is that in February of this year, the CDC released a report that was very devastating about adolescent mental health. But what's important about those numbers is that they were collected in the fall of 2021, asking about mood over the previous year.

Mel Robbins (01:10:28):

Dr. Lisa Damour (01:10:29):

Yeah. That kind of got lost in a lot of the reporting. And I think that's actually a really critically important point because when I think about the fall of 2021, what we were looking at were kids who were either entering their third school year that was disrupted.

(01:10:42):

They were all entering their third school year. Either they were going back in masks and terrified or not going back in masks and terrified or still hybrid and unhappy. So it was a very particular time. So just to say we kind of don't know and we won't know for about another 18 months where we stand. Now, anecdotally, and this is important to say for kids who are back to their regular routines, they look to me like kids did before 2020 that I'm seeing a lot of just typical adolescence, which is also rich and spicy on a good day. But it's typical, right? But the things I worry about, I worry about increased isolation. People spend more time away from one another. I worry about eating disorders in kids of all genders. We have traditionally attached these to girls. That's not actually how it works. And I worry about, we haven't talked about social media.

(01:11:38):

It's a big topic and I feel like it's way more complicated than just all good or all bad. I worry about the norms in digital environments where kids hang out. And what I mean by that is that one thing I feel that we definitely saw between March, 2020 and then the subsequent years was the kids who were stuck at home, who felt like they were going to use that time to get in shape and improve themselves. So they start searching online for fitness, diet, exercise, anything like that. The algorithms that drive social media pick this up and start to flood their feed with image after image after image of ultra thin or ultrafit, and then how to lose weight. And here's an advertisement for it.

(01:12:28):

Teenagers are vulnerable to norms. They're more vulnerable to norms than kids are. They are more vulnerable to norms than adults are. And it's hard, we can't prove this with the data, but I will just go out on a limb and say, I am convinced if you are looking at 4,000 images a day of ultrafit, ultra thin people, that impacts real world behavior and that changes how you eat and that changes how you exercise. And we did see an explosion of eating disorders. So what I would say is we got to watch where kids are online now and forever because the norms are powerful.

Mel Robbins (01:13:08):

I can't agree more. In fact, it happened to our daughter, and I remember when she got into treatment for disordered eating, she ended up deleting her visco and her Instagram. And I don't even think TikTok was really a thing. This was back in high school, so it hadn't quite exploded yet. And she said, my entire feed is basically models and waste trainers and puppies, and it makes me feel terrible. And I keep looking at these images and it makes me feel like I need to get like that. And I know that these are fake. I know there are filters, but I still can't help it. I want to be like that. And so it drove all of this obsessive behavior. Is there also a connection with the spike in eating disorders because it is typically something driven by this need to control?

Dr. Lisa Damour (01:14:09):

It's interesting. I wrote a piece for the Times, I think it came out in April, 2021 about the spike in eating disorders. And there's a variety of reasons that can come into it. So some is everything feels out of control. Here's one thing I can't control that can be really powerful. Another that one of the experts I interviewed referenced that I thought was really important is that we had a lot of very hard driving teenagers with a whole lot of energy who suddenly couldn't do the things they usually did, who would've poured their growth, self-improvement juice into band and sports and all these other things, and who had just a whole bunch of that lying around. And so then they turned it against themselves into I'm just going to get really fit. I might as well do something to make myself better finger better in this time. But I do also just think if all you're looking at are ultra thin ultrafit bodies and you are not going to school and looking at normal bodies in 3D, your sense of what bodies looks like changes and your view of your own body changes,

Mel Robbins (01:15:18):

I want to ask you a very specific question on this topic because I think there's also this kind of cultural obsession with being in shape and being healthy and being good looking. And if you've got a kid that suddenly goes on a health kick and now they're exercising and they get positive reinforcement because they're looking great and they're not going to run the 5K and now they're going to get in triathlons or now everyone's like, oh, you look great in that bathing suit. Where is the line where it's a healthy thing versus this is now something that's scary? And I think we all know when somebody has stopped eating when they're deteriorating in terms of their weight, but I miss the signs and kids are also remarkable at just kind, oh, it's fine. I'm just ah, and then because it's in this lane of, but they look better, but they're exercising, but they say they're going for a run. How do I insert myself here? How do you do that?

Dr. Lisa Damour (01:16:36):

It's tricky and it is easy to miss some framing stuff. One is teenagers shouldn't be losing weight, and usually they're gaining weight in the course of typical development and later puberty that they're gaining weight and they're gaining strength. So if you notice that your teenager has lost weight, you should be attentive to that. It's just an unusual thing for teenagers to do. And it's not bad. I mean, you can talk with your pediatrician and there are some teenagers who the pediatrician may say this weight is not in a healthy place. Losing some weight would be a healthier thing to do. Then you can do that with the nutritionist and the pediatrician and do it in a controlled and careful way. But one thing I've learned from my colleagues in the eating disorder world is by the time a teenager's losing weight, something's usually up. Wow. I think that's just a valuable marker to have. The other thing that we want to watch out for is dropping entire food categories. So I'll put it this way. Not everybody who becomes a vegetarian goes on to develop an eating disorder. Everybody who goes on to developing an eating disorder drops a food category.

Mel Robbins (01:17:55):

Oh my God. I literally just had this conversation with somebody about how it's become, and you say why? You said teenagers are so 11 to 25, very impacted by norms. And our daughter, the one who did have disordered eating, did a research paper in college about, I don't even remember the name of it, but that there's a lot of people in her age group that are gluten-free or vegan or dairy-free or this, and it is a socially acceptable and praised way to have disordered eating. It's not actually an allergy. It's literally it's crossed a line. Is that what you're talking about?

Dr. Lisa Damour (01:18:47):

It is a flag. It's a flag. And one of the ways I sometimes assess that flag is I'll sometimes care for teenagers who are like, I don't eat sugar. And I'll be like, Hmm, am I, my eyebrows will go up. But if I also know that they don't eat sugar, unless somebody brings in some really good cupcakes, I don't worry about it too much. So there's what people say and what people do and what we want fundamentally is to see that food is a pleasure, that it is a wonderful source of energy, that there's variety in a young person's diet and any of our diets. So those are the flag. Those are some flags to keep an eye out for. And then I would say if concerns really start to rise, we can actually go back to where we started around people having two sides,

(01:19:35):

And it's the job of all of us and teenagers are developing in their capacity to take good care of ourselves. That's our job. And so if a teenager is suddenly eating nothing but celery and running a lot, that kid is not taking good care of themselves. And so before it gets to that extreme, I would want the loving person in their life to say, Hey, I see that you're getting pretty fit, but I'm not so sure you're taking good care of yourself. Are you taking good care of yourself? Are you eating the kind of variety of nutrition? Are you being gentle enough on your body like exercise? Yeah, but not to the point of injury to use that as a guardrail that fundamentally that's the goal is for the teenager to be doing a really, really excellent job of caring for themselves. Beautiful.

Mel Robbins (01:20:24):

If you can't afford to go to somebody in functional medicine to get this all tested, how do you figure out what's going on? You have in your new book, young forever, you have all of these self assessments that you can do, but do you have to testing at some point or is there a way for you to

Dr. Mark Hyman (01:20:45):

Get testing,

Mel Robbins (01:20:46):

Have an accessible way? Because one of the things, I agree with you, I agree with you that our medical approach and the medical system is about treating illness versus keeping you healthy and whole. I agree that we treat symptoms, but we have a hard time getting to the root cause.

Dr. Mark Hyman (01:21:07):

I agree. I agree.

Mel Robbins (01:21:09):

I just, I know that what's going to happen with this conversation, Dr. Hyman, is that we are going to activate anyone listening to absolutely take the next 10 days of your life and see what happens when you reset your diet and you remove a few things. Absolutely. Add in those simple supplements that cost you less than a dollar a day, and you are worth that investment in yourself and see what happens. Absolutely. Take the steps to lower your stress and tap into your body's ability to reset. Even just the five deep breaths a day that activate and tone the vagus nerve. But if somebody's going, I want to learn more, what is the next right step?

Dr. Mark Hyman (01:21:55):

That's a great question, and one of the challenges I've always had with medicine is it's kind of a secret guild and doctors hold the brains. They can order the tests or they can't. They'll give you the results or they won't. They'll help you interpret them or they won't. And so you're at the sort of women mercy of whoever you're seeing, and most doctors do a good job and want to help people, but it kind of kept in the guild. So in the book Young Forever, I do have really extensive questionnaires that allow you to figure out almost 80% of what's going on, and then depending on what you find in those, you can kind of follow up with different kinds of testing. But because of this problem exactly that you're talking about, I decided to co-found a company with a good friend called Function Health, which allows you, without a doctor's order to go to any Quest lab in the country, and there's thousands of 'em, get a blood draw of over a hundred biomarkers that normally cost $15,000 for 500 bucks. And it comes with a whole interpretive map and framework and dashboard that's filtered through the lens of functional medicine that I wrote that allows people to not have to go see the doctor and still do 80% of, or

Mel Robbins (01:23:02):

Why the hell did I go to your clinic then? If I could have just done this. Dr. Hyman bearing the lead. No, I'm just kidding. I am just kidding everybody. I do want to say something that I was able to go to the medical center right here in this tiny town of Manchester, Vermont and have blood drawn for those

Dr. Mark Hyman (01:23:22):

Tests.

Mel Robbins (01:23:23):

And so you don't have to go to your primary care, you don't have to go. All of the MinuteClinics that are popping up are places where you can go if you're going to do those things to order the blood draws.

Dr. Mark Hyman (01:23:34):

Well, the thing is, you have to usually get a doctor's order. So the beautiful thing about function health, this company that we created was that you don't need a doctor's order. So you can go to the website, sign up, and they'll network with over 50 different states and doctors and every one, I love this. Or you can just go and get kind of the

Mel Robbins (01:23:51):

Testing done,

Dr. Mark Hyman (01:23:52):

Get the testing done, get your results, and track it over time, and you can see your hormones, your thyroid, your insulin, your age related markers, your brain chemistry so much about what's going on with your

Mel Robbins (01:24:02):

Body. What's so cool about this, if you can afford to do it, and we'll put the link in the show notes, is it's like getting an x-ray of your insides,

Dr. Mark Hyman (01:24:12):

And

Mel Robbins (01:24:13):

You've proven to us that you heal from the inside out.

Dr. Mark Hyman (01:24:16):

Yeah, yeah. It's absolutely true. And I'm so excited about this approach because it empowers people to be the CEO of their own health. The reality is that even if you go to the doctor with all these complaints, they're going to be able to manage your symptoms. I don't want to manage people's symptoms. I want people to get better. I want people to reverse these problems and not need a doctor. And the truth is, most of the things that work are not things you're going to get at a doctor's office, which is drugs and surgery. So sometimes you need them, and I use them. That's not a bad thing, but most of the problems we have don't respond very well to that. And all these things that we talk about, whether it's depression, I mean, antidepressants just suck. They don't work that well. They have all these side effects and anxiety. Medications are highly addictive. I mean, they just cover over the symptoms. What if you could actually figure out why you're having the problem and fix it?

Mel Robbins (01:25:03):

Well, I think you told us why. It's inflammation. It's a gut that's out of whack. It is the stressors in your life. It is the toxins in your environment and not understanding that your body has this elegant design that is super intelligent and responsive and can heal itself if you are conscious and intentional about the right input.

Dr. Mark Hyman (01:25:28):

And that's exciting. That's happening now in science is we're actually getting there. The old paradigms dying and the longevity space I've been working in, and when I wrote about it young forever, where these scientists are now talking about what's underlying all these diseases, these 155,000 diseases, that's not what we need to be thinking about. It's these 10 underlying problems that tend to go wrong as we get older that can explain all disease. And if we treat those, we may not be able to just extend our life by five years by getting rid of cancer or heart disease. But by 30 or 40 years, that means living to be 120 and being in good shape. I don't want let to be 120 in a nursing home in a wheelchair. I'm able to ride my bike, go for a horseback ride, make love. That's what I want to do when I'm a hundred or 120.

Mel Robbins (01:26:11):

Wow. I am glad that you said that because oftentimes I hear the word longevity and I had that reaction. I don't want to be rotting away in a nursing home. Exactly. 125, that sounds terrible. It's

Dr. Mark Hyman (01:26:22):

Terrible because most of what we see, Mel in the world is abnormal aging, and we think that's normal. Oh, it's normal to become frail and decrepit and not be able to do what you want and lose function. And the truth is that most of us, our health span doesn't equal our lifespan the last 20 years of our life.

Mel Robbins (01:26:37):

What's the difference between a health span and lifespan?

Dr. Mark Hyman (01:26:38):

Well, health span is how many years. You're healthy, you can do what you want. Lifespan is how many years you're alive. So if you're fine until you're 60, then you get dementia in your nursing room for 20 years. That's not good. So that's what you want to do is make your healthspan equal your lifespan. So on my last day, I want to go for a hike with my beloved. I want to come home, make a delicious dinner. I want to have a bottle of wine, probably a pint of Ben and Jerry's ice cream and

Mel Robbins (01:27:03):

Wait a minute, make love that wasn't on the diet.

Dr. Mark Hyman (01:27:05):

Who cares? I'm 120 and then I make love and I close my eyes and drift off and maybe take a jump in the pond.

Mel Robbins (01:27:14):

That sounds incredible. My mother-in-law is 85 years old. She jumps out of airplanes. She walks five miles a day.

Dr. Mark Hyman (01:27:21):

There you go.

Mel Robbins (01:27:21):

She's having the time of her life. When Chris and I went alcohol free for a bit, she's like, I'm not doing that. I have my one glass of red wine a day. That's what I need. She plays cards. She prioritize friends.

Dr. Mark Hyman (01:27:32):

Yeah, exactly.

Mel Robbins (01:27:33):

She is the definition of vitality at that age, and she's like the Energizer bunny. I can't imagine her running out of steam. And that's what I think you're talking about when it comes to vitality. Hey, it's Mel. Thank you so much for being here. If you enjoyed that video, bye. God, please subscribe because I don't want you to miss a thing. Thank you so much for being here. We've got so much amazing stuff coming. Thank you so much for sending this stuff to your friends and your family. I love you. We create these videos for you, so make sure you subscribe.

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Guests Appearing in this Episode

Dr. Sarah Wakeman, MD

Dr. Sarah Wakeman is a physician and addiction medicine expert, dedicated to advancing compassionate care and treatment for substance use disorders.

Why medication to treat alcoholism is ‘vastly underutilized’
Nearly 30 million Americans struggle with alcohol addiction. Medication used to treat alcohol-use disorder have been on the market for decades, but is rarely prescribed. Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Mass General Brigham, joins Ali Rogin to discuss medication’s potential for treating this disease and why it’s underused.

Resources

- PBS: Why medication to treat alcoholism is vastly underutilized
- Mass General Brigham: Substance use disorder: addictions & treatments
- Columbia University: How much is too much to drink?
- Journal of Clinical Medicine: Alcohol and the intersection of your gut, liver, and brain
- American Addiction Centers: Alcohol and Memory Loss
- Alcoholics Anonymous: Find an A.A. Near You
- Addiction The Next Step: Crisis Toolkit
- Insider Science: What happens to your body during a hangover
- Northwestern Medicine: What alcohol does to your liver
- National Institute on Alcohol Abuse & Alcoholism: Effects on health
- The New York Times: 48 million Americans live with addiction. How to get help
- University of California: SMART Goals, a how-to guide for setting them
- Henry Ford Health: Hangxiety - the link between alcohol & anxiety
- Pharmacology Biochemistry & Behavior: Tolerance to alcohol
- New England Journal of Medicine: Alcohol and the risk of breast cancer
- The New York Times: Why does alcohol mess with my sleep?
- Mass General Brigham: Inserting Substance Use Disorder care into the medical system
- WBZ News: MGH to quiz patients about use of alcohol and illegal drugs
- Rutgers: Women increase drinking during pandemic
- The New York Times: Could all those ‘quarantinis’ lead to drinking problems?
- Tasty: 47 easy and delicious mocktail recipes
- The New York Times: The best non-alcoholic drinks
- National Public Radio: 6 strategies to help you take a break from alcohol
- University of Kansas: Why you need a ‘why’ & how to find it
- National Institutes of Health: Alcohol’s effect on the brain (video)
- Nature: Alcohol consumption and gray & white brain matter
- National Institute on Alcohol Abuse & Alcoholism: Join a study
- Alcohol Clinical & Experimental Research: Effects on cortical thickness
- New England Journal of Medicine: Alcohol and the risk of breast cancer
- Sleep Foundation: Alcohol and sleep
- Mental Health America: What is codependency?
- American Addiction Centers: How to help an alcoholic‍
- America’s Rehab: How to talk to an alcoholic in denial

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2 Million Readers. 1 Life-Changing Newsletter

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2 Million Readers.
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