“Ask the Doctors” is a nationally syndicated column written by Eve Glazier, MD, president of the UCLA Health Faculty Practice Group, and Elizabeth Ko, MD, medical director of the UCLA Health Integrative Medicine Collaborative.
DEAR DOCTORS: How do I tell my doctor that I have a problem with alcohol? I’m prescribed pain medicine, which I don’t abuse. However, my alcohol consumption has increased, especially since my mom died last fall. I want to bring it up, but I am not sure how, or even if I should.
DEAR READER: We want to begin by saying that it takes courage to recognize when you have a problem. Alcohol is a widely accepted part of adult life, which makes it easy to label potentially damaging behavior as merely social drinking. By acknowledging your concern about the changing role of alcohol in your own life, you’ve taken an important first step to regaining control and balance. You’ve also opened the door to examining why this has occurred, which can be painful.
It’s understandably difficult to share this kind of very personal information. But in addition to the impact that substance abuse can have on one’s physical and mental health, the fact that you are taking pain medications makes this important information for your doctor to have. Alcohol can reinforce the sedative properties of a range of prescription pain medications. This can lead to unexpected, and even dangerous, results. It’s important to become aware of any potential side effects that can arise from mixing alcohol with the medications you have been prescribed.
In our experience, excessive alcohol use begins as a behavior, a numbing process used to medicate underlying pain or emotion. When someone understands what’s behind this behavior, whether it’s boredom, anger, disappointment, fear, anxiety or, as in your case, grief, they can begin to focus on healthier, more useful and more healing coping mechanisms. We think you will be best served by approaching your doctor with honesty and clarity. It will also be helpful if you have a goal in mind. It may be as simple as wanting your doctor to have this information as part of your medical history. Or perhaps you would like to engage further and get support, information or a referral. By beginning with “I just wanted you to know” or “I wonder if you can help me with,” you’re setting the stage for the conversation you’re comfortable having at that point in time.
When someone’s alcohol consumption edges into heavy-drinking territory, which is presently defined as 15 or more drinks per week for men and eight or more drinks per week for women, we use what is known as the CAGE questionnaire. We ask if the person feels they should cut back on drinking, if they get annoyed when someone questions their alcohol use, if drinking makes them feel guilty, and if they have recently started the day with a drink. A single “yes” answer to any of the questions indicates the need for further evaluation. Two or more affirmative answers indicate an increased risk of alcohol dependence. While letting your doctor know about your struggle with alcohol can feel intimidating, it’s actually important information for him or her to have to help you maintain your good health and well-being. In sharing this information now, you may be preventing future pain and harm.
