In the latest installment of our occasional conversations with Fort Worth leaders, Dr. Adnan Iqbal, the medical director of psychiatry at both Texas Health Recovery and Wellness Center and Texas Health Arlington Memorial Hospital, discusses the dangers Dry January can pose for heavy drinkers, as well as how the month can be used as a launchpad for a healthier lifestyle.
This conversation has been edited for length and clarity.
Alexis Allison: What is Dry January?
Dr. Adnan Iqbal: Dry January actually started in England. It was a public health initiative started by a charity named Alcohol Change UK. I believe their intention was to have some sort of reduction in alcohol (misuse) and bring awareness to its excessive use, primarily during holidays. It started from there and it’s broadly caught on.
Allison: How does it work? Basically, people give up alcohol for one month — is that accurate?
Iqbal: That’s correct. It’s a new year promise you make to yourself that you will quit alcohol for one month. It’s a very enviable commitment, but I think there are a lot more aspects to it rather than simply cutting down or stopping alcohol just for one month. There are multiple factors which can also affect how effective Dry January is.
Allison: Can you tell us about some of those factors?
Iqbal: The important thing to understand is alcohol use becomes problematic and risky when you cross certain recommended (guidelines). It could be either binge drinking or excessive and chronic alcohol use — which has very significant negative consequences for health. It increases the risk of cancers, liver disease, heart disease, weight gain, (high) cholesterol. Many aspects of our body or many organ systems are affected by alcohol. If we are trying to get some benefits out of Dry January, it has to be more of a consistent and concerted effort. If someone has problematic drinking before Dry January, they need to use Dry January as a launching pad toward their recovery or decreasing the amount of alcohol they’re using. So that’s very important.
Binge drinking occurs when a person brings his blood alcohol concentration to 0.08 or above. For men, this typically happens if they drink at least five drinks in about two hours; for women, it’s at least four drinks.
Allison: To step back for a minute, what is chronic alcohol use? How could someone know if they are drinking too much?
Iqbal: It’s called ‘alcohol use disorder’ in psychiatric Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and there are different intensities: mild, moderate, severe. If, over time, your alcohol use has increased in amount and you need more alcohol to get the same level of relaxation — that means you’re developing tolerance. Then you are increasingly using alcohol and getting into hazardous situations — could be driving while drunk or other social dysfunction. It’s called psychosocial dysfunction, in which your job is being affected, your day-to-day living is being negatively affected.
Once you suddenly stop, you develop withdrawal symptoms. And they range from simple anxiety, tremors, nausea, to very serious withdrawal symptoms: hallucinations, seizures. On top of it, people who are chronically excessively using alcohol can develop liver inflammation. If the inflammation is not corrected, then they can develop cirrhosis of the liver, which is a fibrosis of the liver. Gastric ulcers, cholesterol will go up, (increased risk of developing) diabetes, there is a long list of medical conditions which are associated with excessive and chronic heavy alcohol use. There is a long list of cancers which are clearly associated with chronic excessive alcohol use.
Allison: So if people do drink alcohol chronically, and they wanted to use Dry January as a launchpad to a healthier lifestyle, how would you recommend they go about doing that? What are some best practices for them?
Iqbal: I would advise them to contact their physician first. Seek their guidance. Especially if they have some underlying conditions such as hypertension, heart disease, history of seizures, I would not advise them to suddenly join Dry January on their own because they are at a higher risk of developing fairly complicated withdrawal symptoms.
There are quite a few medications which can be prescribed prior to Dry January or even at the start of Dry January, and those are called “taper down dosages,” meaning you start at a certain dose and you gradually decrease that medication until you no longer have any withdrawal symptoms. The benefit of those treatments are avoiding serious withdrawal symptoms such as delirium tremens. If the DTs are untreated, they can lead to death as well.
And I believe evaluation is important if the family or the patient feels that their alcohol use or habits are causing multiple complications in their life. It’s always a good idea to seek guidance and evaluation by a substance abuse counselor, substance abuse program, psychiatric practice. These can be done in various places. Even a primary care clinic can do assessments. There are standardized scales they can utilize to see the extent of their alcohol use, and they can guide them toward the recovery process.
Allison: I know we’ve talked a bit about people who use alcohol chronically but what about people who maybe have a drink every now and then but they still want to do Dry January? What would you tell them?
Iqbal: That’s good. I believe there is no harm in joining Dry January. Thirty days is a significant amount of time in which they can basically see if they can live without alcohol. There are health benefits of not drinking alcohol excessively.
Dry January could be, like I said, a great launching pad to a new lifestyle in which alcohol does not play a significant role. They can sustain themselves emotionally, physically, without alcohol.
And then there are guidelines of what is considered moderate alcohol use or recommended use. So usually recommended use is one to two drinks per day for men and one alcoholic drink per day for women. That’s considered mild to moderate recommended alcohol use. If you go above that, then you are getting into higher risk of developing medical complications, emotional complications, a lot of mood disorders which occur with the alcohol use disorder. Depression, anxiety. Insomnia is another major concern. So I think the key point is moderate use of alcohol.
If someone quits for a few days, and on the weekend they binge drink, that loses the benefits of a moderate alcohol use or recommended use. Binge drinking suddenly exposes your body to excessive alcohol amounts and that has the same level of negative health effects as chronic alcohol use. So I believe the consistency of moderate use is important if one wants to continue drinking.
Allison: Is there anything else that you think we should know?
Iqbal: The drinking patterns are important. That’s the key takeaway point: One to two drinks (per day) for men, one drink for a woman. It does have health benefits, primarily cardiovascular. It has shown to prevent, to some extent, the clogging of arteries, reduce the risk of diabetes. Mild to moderate (use), one to two drinks, increases the HDL level, which is a good cholesterol.
If you’re dry or if you haven’t used throughout the week, but you binge drink on the weekend, then you lose the benefit of that consistently low level of alcohol consumption. So moderation is important. If you’re drinking more than (what’s recommended), then you need to consult your physician to seek some guidance whether you have a risk of withdrawal symptoms.
If you have a history of withdrawal symptoms, you should not be committing to Dry January without the guidance of a medical professional. And then use Dry January as a launching pad for a new lifestyle in which either you’re completely dry or you are using within the recommended alcohol consumption guidelines.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.