Category: Health & Well Being

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Dealing with an alcoholic – How to cope @ClevelandClinic

August 1, 2022 / Mental Health

Dealing With Someone Addicted to Alcohol: 9 Tips To Cope

Be honest, be safe and don’t blame yourself

It starts with a beer, a glass of wine or a cocktail. Then there’s another … and another … and another. You watch as your family member or friend slowly changes with each tip of the bottle.

It’s a routine you’ve witnessed repeatedly — and it never gets less painful to watch. So, what can you do? Addiction psychiatrist Akhil Anand, MD, offers these tips to help you persevere.

1. Don’t blame yourself

Caring about someone with an alcohol addiction can lead to worry and sleepless nights. You might spend a lot of time thinking about your actions as it relates to their addiction, says Dr. Anand.

If that describes you, take a step back. “You are not responsible for what someone else does,” reassures Dr. Anand. “It’s their decision to use alcohol. Don’t carry that weight.”

2. Protect yourself

“Angry drunk” isn’t just a phrase. It’s often a reality that grows more concerning with every downed glass. Studies show that the risk of a situation turning violent is five times higher when alcohol enters the mix.

If you’re going to engage someone who’s been drinking and shown flashes of violence, don’t do it alone. Bring someone you can trust with you, advises Dr. Anand.

And if you feel threatened, call the police. “Don’t put yourself in danger,” stresses Dr. Anand.

3. Talk to someone

Being close to someone addicted to alcohol can bring an immense amount of stress into your life. A lot of emotions — frustration, sadness, bitterness and more — may whirl through your mind.

Talking to an addiction counselor can help you better understand the situation and work through your feelings. Programs like Al-anon, Alateen and Families Anonymous offer opportunities for emotional support.

“Don’t forget to take care of yourself,” says Dr. Anand. “It’s not easy when your life intersects with someone dealing with an addiction. It’s important to find an outlet where you can talk about it.”

4. Learn to say ‘no’

When someone gets too drunk or hungover to fulfill their basic responsibilities in life, they often rely on those around them to get the job done. And all too often, their friends and family pick up the slack.

But that attempt to be helpful can send the wrong message: “If you take care of problems for them over and over again, they never see or feel the consequences of their drinking,” explains Dr. Anand.

So, take a step back and let them deal with the after-effects of their addictive behavior.

5. Don’t cover up bad behavior

Did a night of excessive drinking leave cans or bottles littering your living room floor? Or splatters of vomit in the bathroom? Don’t rush to clean it up. Let the person who made that mess see it.

“It’s not your duty to hide the results of their drinking so they avoid feeling any sort of embarrassment,” says Dr. Anand.

6. Avoid negotiations

It’s natural to want someone you care about to stop drinking so heavily. Odds are, your desire is no secret, either — which is why you should be wary if that person tries to “trade” a change in addictive behavior for something.

“You cannot negotiate someone into sobriety,” says Dr. Anand. “They need to take the action — and it should not be dependent on you somehow making it worthwhile for them.”

7. Be honest

Don’t make excuses for someone’s addiction or downplay it. “Be open and honest,” encourages Dr. Anand. “Communicate in a way that is calm and constructive but not emotional.”

8. Limit expectations

Celebrate if a friend or loved one with an addiction takes a step toward rehabilitation … but don’t be surprised by a stumble. Relapse rates are common among those who seek treatment for an addiction.

An addiction is a brain disorder, after all, and not something that’s easily resolved. It can take 10 or more attempts at treatment before someone makes progress on overcoming an addiction.

“It’s best to know that going in,” says Dr. Anand, “because it’s very hard to watch it happen.”

9. Stay positive

Coping with someone addicted to alcohol isn’t easy. It can test your patience and shatter your feelings. But try to separate the person from the addiction. Do your best to understand that they’re dealing with an illness.

“Let them know that you care,” says Dr. Anand. “Offer unconditional love and give them positive affirmations. Be there for them as much as you can — but make sure you take care of yourself, too.”

To hear more from Dr. Anand on this topic, listen to the Health Essentials Podcast episode “How To Help Someone With an Alcohol Addiction.” New episodes of the Health Essentials Podcast are available every Wednesday.

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Starting a Workout Routine – Tips to start moving and grooving @ClevelandClinic


Exercise is a vital part of a healthy lifestyle. But if you’ve gotten out of the habit of being active — or have never found an exercise routine that works — it might feel like an impossible task to get started.
Luckily, it’s never too late to figure out a workout routine. Here’s how to start exercising — and tips to stay motivated when all you want to do is hang out on the couch instead.
What should I include in my exercise program?
Every exercise session should include a warm-up, a conditioning phase and a cool-down phase.
The warm-up
In a nutshell, a warm-up helps your body adjust slowly from rest to exercise. Making this part of your routine reduces the stress on your heart and muscles, and slowly increases your breathing, circulation (heart rate) and body temperature. A warm-up can also help improve your flexibility and reduce muscle soreness.
The best warm-up includes stretching, range of motion activities and beginning the activity at a low-intensity level.
Conditioning phase
The conditioning phase follows the warm-up and is the time when you’re burning calories and moving and grooving.
During the conditioning phase, you should monitor the intensity of your activity. The intensity is how hard you’re exercising, which can be measured by checking your heart rate.
Over time, you can work on increasing the duration of the activity. The duration is how long you exercise during one session.
Cool-down phase
The cool-down phase is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near-resting values.
However, a cool down does not mean to sit down. In fact, for safety reasons, don’t sit, stand still or lie down right after exercise. This might cause you to feel dizzy, lightheaded or have heart palpitations (fluttering in your chest).
The best cool down is to slowly decrease the intensity of your activity. You might also do some of the same stretching activities you did in the warm up.
General exercise guidelines
In general, experts recommend doing a five-minute warm up, including stretching exercises, before any aerobic activity, and include a five- to 10-minute cool down after the activity. Stretching can be done while standing or sitting.
Here are some other things to keep in mind when starting a workout routine:
Determine the best exercise routine for your lifestyle
Not everybody likes to hop out of bed in the morning and go for a run. Figuring out a routine that fits your lifestyle can help you be more successful.
Here are some questions you can think about before choosing a routine:
What physical activities do I enjoy?
Do I prefer group or individual activities?
What programs best fit my schedule?
Do I have physical conditions that limit my choice of exercise?
What goals do I have in mind?
(These might include losing weight, strengthening muscles or improving flexibility, for example.)
Don’t try and exercise too much too fast
Gradually increase your activity level, especially if you haven’t been exercising regularly. Guidelines around how often to exercise also differ depending on your age, any health conditions you have and your fitness history.
Set big and small goals — and be specific
If you’re looking to reach a particular goal, exercise specialist Ben Kuharik suggests setting mini goals to achieve along the way. This ensures your motivation stays strong over the long haul.
Setting a specific goal is also important. “For example, if you want to lose some weight, it’s hard to be motivated or stick to a plan,” he says. “That’s because you don’t have the excitement in knowing you are getting closer to achieving it.”
Having smaller goals or milestones to reach in between the big ones keeps you on track. “If you want to lose 8 pounds in two months — and you set a mini goal of losing 1 pound a week in the process — you get the sense of accomplishment that reaffirms your efforts,” Kuharik says. “And this can snowball into achieving even greater goals.”
This also applies if you fall short of your goal. “If you only lose 7 pounds in two months, you’re still 7 pounds down than when you started,” Kuharik affirms. “You’ll feel great about the progress you’ve already made.”
Schedule exercise into your daily routine
Plan to exercise at the same time every day, such as in the mornings when you have more energy or right after work. Add a variety of exercises so you don’t get bored.
Where exercise is concerned, something is also always better than nothing. “Not every day will go as planned,” Kuharik notes. “If you unexpectedly have a tight schedule or are even just having an off day, doing half of your planned workout that day is much more rewarding and beneficial than skipping it altogether.”
Exercise at a steady pace
Keep a pace that allows you to still talk during the activity. Be sure not to overdo it! You can measure the intensity of your exercise using the Rated Perceived Exertion (RPE) scale. The RPE scale runs from 0 to 10 and rates how easy or difficult you find an activity.
For example, 0 (nothing at all) would be how you feel when sitting in a chair; 10 (very, very heavy) is how you feel at the end of an exercise stress test or after a very difficult activity. In most cases, you should exercise at a level that feels 3 (moderate) to 4 (somewhat heavy).
Keep an exercise record
Keep a record of how much and when you exercise. This can help you look at goal-setting, as well as get a sense of how much activity you’re doing in a given week.
Time your eating and drinking properly
Wait at least one and a half hours after eating a meal before exercising. When drinking liquids during exercise, remember to follow any fluid restriction guidelines you might have.
Only buy what you need
Exercise doesn’t have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you’re sure you’ll use them regularly. But you’ll want to dress for the weather (if working out outside) and wear protective footwear. Sneakers are the one thing you should prioritize, as you want to make sure your feet are protected.
Stick with it
If you exercise regularly, it’ll soon become part of your lifestyle. Make exercise a lifetime commitment. Finding an exercise “buddy” can also help you stay motivated.
Don’t forget to have fun
Exercising should be fun and not feel like a chore. “Consistency is key — but to do something consistently, it’s important to find a way to enjoy it,” Kuharik says.
So, above all, choose an activity you enjoy! You’ll be more likely to stick with an exercise program if you don’t dread working out.
“Try to look at exercise as an opportunity to get away from stress, clear your mind and leave nagging thoughts at the door,” Kuharik encourages. “With this in mind, over time, you will look forward to giving your mind a break and feeling good after a great workout session!”
Exercise: Where To Start
You should always talk to your doctor before starting an exercise routine. Together, you can figure out a plan to ease into regular physical activity.
And walking and climbing stairs are two easy ways to start an exercise program.
Walking guidelines
Start with a short walk. See how far you can go before you become breathless. Stop and rest whenever you’re short of breath.
Count the number of steps you take while you inhale. Then exhale for twice as many steps. For example, if you inhale while taking two steps, exhale through pursed lips while taking the next four steps. Learn to walk so breathing in and exhaling out become a habit once you find a comfortable breathing rate.
Try to increase your walking distance. When setting specific goals, you might find you can go farther every day. Many people find that an increase of 10 feet a day is a good goal.
Set reasonable goals. Don’t walk so far that you can’t get back to your starting point without difficulty breathing. Remember, if you’re short of breath after limited walking, stop and rest.
Never overdo it. Always stop and rest for two or three minutes when you start to become short of breath.
Stair climbing
Hold the handrail lightly to keep your balance and help yourself climb.
Take your time.
Step up while exhaling or breathing out with pursed lips. Place your whole foot flat on each step. Go up two steps with each exhalation.
Inhale or breathe in while taking a rest before the next step.
Going downstairs is much easier. Hold the handrail and place each foot flat on the step. Count the number of steps you take while inhaling, and take twice as many steps while exhaling.
Whichever activity you choose, remember, even a little exercise is better than none!

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Alcohol has risks. We must all aim to minimise those risks. @Dr.Paddy_Barrett preventative cardiologist @HealthBlackrock

Let’s start with some simple facts.
Alcohol is a toxin.
Alcohol is a factor in1:
30% of suicides
40% of fatal burn injuries
50% of fatal drownings
50% of homicides
65% of fatal falls
29% of fatal road traffic accidents
Globally, alcohol is responsible for 3 million deaths per year; in the United States, it is the third leading cause of preventable death2 3.
It is hard to see the upside when you see these figures.
So let’s go a little deeper.
First off, I drink alcohol. Not a lot. But I do drink.
So any comments made here are not some puritanical position on alcohol but reflections on the data that exist in the literature.
Multiple studies have demonstrated that excess alcohol consumption, usually defined as consuming greater than 2 to 4 drinks per day, is associated with worse outcomes and a greater likelihood of dying when compared to someone who drinks less than 2 to 4 drinks per day4.

Alcohol Dosing and Total Mortality in Men and Women: An Updated Meta-analysis of 34 Prospective Studies. Arch Intern Med.2006

In the study shown above, females start to accrue an increased risk at greater than two drinks per day on average and males at greater than four drinks per day.

These findings shouldn’t come as a surprise to anyone.

Surprisingly, on average, individuals who consume less than two drinks per day appear to have better outcomes than those who do not drink at all. This is where things start to get a little counterintuitive, and the story of alcohol being beneficial for you starts to appear.

This relationship is known as a ‘U’ shaped curve where those in the middle have the best outcomes, and those on the edges have worse outcomes. A kind of ‘Goldilocks’ relationship; “Not too hot. Not too cold. Just right.”

How might we explain this?

Enter the darling of the 1990s, Resveratrol. This compound in red wine spawned the mantra that red wine was ‘good for your heart’. This was based on research that suggested that it might reduce cholesterol levels, among other things.

But to consume the levels of Resveratrol tested in some of the animal studies that demonstrated benefit, you would have to drink 40 litres of wine…… Per day.

Not exactly a feasible strategy. Even with the best will in the world.

Let’s look at a more plausible explanation.

Data on alcohol consumption and outcomes are almost always based on observational data, not randomised controlled trials. This means that other factors or ‘confounders’ may explain the difference between the groups, not the alcohol consumption alone.

When you look at the trials that suggest a benefit of modest alcohol consumption, you will often find that this group tend to exercise more, smoke less, be in a higher socioeconomic bracket etc. This is referred to as a ‘healthy user bias’ and is likely to explain the difference between the groups.

Most trials try to correct or adjust for these confounders, but in truth, it is very hard to do. A recent publication looked at this problem and attempted to (as much as possible) correct for these ‘healthy user’ bias factors and then compare outcomes between alcohol consumption groups. The results were a little more in line with what we might expect.

Those in the lowest alcohol consumption category had the best lifestyle factors overall. When these healthy factors were corrected for, any benefit seen with modest alcohol consumption disappeared. What remained was a linear relationship between alcohol consumption and coronary artery disease5. Much more what you might expect.

Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Netw Open. 2022

Research like this and other studies is where the more recent media reports of ‘any’ alcohol being bad for you have come.

So, alcohol is a toxin. But, as Paracelsus notes:

“The dose makes the poison.”

Even water consumed to excess can be lethal.

We know that excess alcohol consumption is harmful. But I don’t think there was any great uncertainty around that point.

The key takeaway is that modest alcohol consumption is unlikely to be ‘beneficial’ to you. As much as you loved the idea that red wine was good for your heart, we can say with reasonable confidence that this is not the case.

The real question we need to answer is whether consuming modest amounts of alcohol is considerably worse for you when it comes to heart disease and death from any cause.

Based on the literature to date, it seems that the incremental risk for modest amounts of weekly alcohol consumption is likely to be small. But that doesn’t mean there are no downsides.

Sleep

One of the main reasons I significantly reduced my alcohol consumption was its effect on my sleep. If I drink more than one drink, I find that the quality of my sleep gets worse. I am much more likely to wake in the middle of the night and feel the effects the following day. But that’s just my personal experience.

Although alcohol is likely to make you fall asleep faster, it impacts your sleep quality6. Additionally, alcohol also reduces the percentage of REM sleep a person gets overnight7.

A workaround for me is to consume any alcohol during the daytime, so my sleep is unlikely to be affected, and if I am going to have a drink, I make sure it is worthwhile. I.e. I am with friends, or it is a high-quality drink. No more drinks on airplanes for me. Mainly because you lose about 30% of your sense of smell and taste in a pressurised cabin and therefore you are less likely to enjoy your drink8. Why do you think they serve you tomato juice and the fact that you think it’s tolerable?!

Humans have been consuming alcohol as far back as the ancient Egyptians, and some evidence suggests the Chinese were consuming alcohol as far back as 7000 B.C. So I don’t see alcohol disappearing any time soon.

The question we all need to ask is:

How much are we realistically drinking on a daily or weekly basis &

Is it likely to be doing us harm?

Only you can answer that question.

The only way to be certain you are doing no harm is to eliminate alcohol entirely. But life is full of risks, some of which we can control, some we cannot.

And some risks are worth taking.

Want to eliminate all road traffic accidents worldwide?

Simple.

Ban cars.

But at what cost?

The risks of driving are a risk most of us are willing to take.

Alcohol has risks.

We must all aim to minimise those risks.

Whatever that means for you, only you can decide.

1

https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/Whats-the-harm/What-Are-The-Consequences.aspx

2

Mokdad, A.H.; Marks, J.S.; Stroup, D.F.; and Gerberding, J.L. Actual causes of death in the United States, 2000. JAMA 291(10):1238–1245, 2004. Erratum in JAMA 293(3):298, 2005.

3

Centers for Disease Control and Prevention (CDC). Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Annual Average for United States 2011–2015 Alcohol-Attributable Deaths Due to Excessive Alcohol Use, All Ages.

4

Alcohol Dosing and Total Mortality in Men and Women: An Updated Meta-analysis of 34 Prospective Studies. Arch Intern Med.2006;166(22):2437–2445. doi:10.1001/archinte.166.22.2437

5

Biddinger KJ, Emdin CA, Haas ME, et al. Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Netw Open. 2022;5(3):e223849. doi:10.1001/jamanetworkopen.2022.3849

6

Britton, A., Fat, L.N. & Neligan, A. The association between alcohol consumption and sleep disorders among older people in the general population. Sci Rep 10, 5275 (2020). https://doi.org/10.1038/s41598-020-62227-0

7

Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013 Apr;37(4):539-49. doi: 10.1111/acer.12006.

8

Burdack-Freitag, Andrea & Bullinger, Dino & Mayer, Florian & Breuer, Klaus. (2010). Odor and taste perception at normal and low atmospheric pressure in a simulated aircraft cabin. Journal für Verbraucherschutz und Lebensmittelsicherheit. 6. 95-109. 10.1007/s00003-010-0630-y.

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This fresh English Pea Pasta recipe is loaded with healthful pea protein and flavored with garlic, mint and grated Parmigiano Reggiano.@ClevelandClinic

There is something special about using fresh peas straight out of the pod. This recipe was inspired by our root-to-stem philosophy of cooking: It always seems like such a waste to throw away the pea pods, but they are relatively inedible. To make use of the pods, we’ve pureed them into a spring-fresh pasta sauce. Remember: Pasta for breakfast is a great choice, especially when it’s loaded with healthful pea protein.

Ingredients

Kosher salt
1 pound fresh English peas in pods (yields about 1 cup shelled peas and about 3 ½ cups pods)
½ cup water
¼ cup extra-virgin olive oil
2 small spring onions or 2 large shallots, chopped
2 small spring garlic (whites) or 3 garlic cloves, minced
2 tablespoons Greek yogurt (optional)
12 ounces whole grain pasta, such as linguine, rigatoni or small shells
Freshly ground black pepper
¼ cup fresh mint (peppermint preferred), thinly sliced
Espelette pepper to taste (optional)
Grated Parmigiano Reggiano cheese (optional)

Directions

  1. Bring a large pot of water to boil and add enough salt to make it salty like the sea.
  2. Meanwhile, wash the peas. Pull off the stem ends: remove the peas and place in a small bowl. Reserve the pods.
  3. Fill a bowl with cold water. Set aside. Add the empty pea pods to the pot of boiling water and cook for 5 minutes. Using a slotted spoon or spider, remove the pods from the boiling water and transfer to the bowl of cold water to cool quickly. Drain the pea pods and add to a Vitamix or high-speed blender. Add ½ cup water. Puree for 2 to 3 minutes.
  4. Place a fine strainer over a bowl and add the pea pod puree to the strainer, pressing on the solids to release as much puree as possible into the bowl. Discard the solids in the strainer. Reserve the puree in the bowl; season to taste with salt and pepper.
  5. Cook the pasta in the pot of boiling water until al dente, stirring occasionally.
  6. Meanwhile, in a large skillet, heat the olive oil over medium heat. Add the onions and garlic and sauté until softened, 3 to 4 minutes. Add the peas and cook 2 minutes. Stir in the reserved pea pod puree and Greek yogurt, if using, and cook just until heated through. (Don’t overcook the peas or puree as the sauce will turn brown).
  7. Using tongs or a spider, transfer the pasta to the sauce in the skillet. Toss until combined. Season to taste with salt and pepper. Transfer the pasta to the serving bowl. Add the basil and mint. Serve with Espelette pepper and grated Parmigiano Reggiano cheese, if using.

Nutritional info (per serving)

Makes 4 servings.

Calories: 554 kcal
Total fiber: 12 g
Soluble fiber: 0.1 g
Protein: 15.5 g
Total fat: 16.7 g
Saturated fat: 2.0 g
Healthy fats: 12.1 g
Carbohydrates: 84 g
Sugars: 7.7 g
Added sugars: 0 g
Sodium: 178 mg
Potassium: 433 mg
Magnesium: 14 mg
Calcium: 134 mg

Source: The What to Eat When Cookbook by Michael F. Roizen, MD, Michael Crupain, MD, MPH and Jim Perko, Sr, CEC, AAC.