How Much Is Too Much?

There is joke among doctors, "What is an alcoholic?" "Someone who drinks more than his doctor."

Recently, a friend was injured when he fell following an evening of drinking. While his injury was fairly significant, thankfully there shouldn't be any long-term physical sequelae. This isn't about him.

What has been fascinating [is that the right word? Interesting? Challenging?] has been the ripples of responses within our circle of friends. There are all varieties of drinkers amongst my friends. Some barely drink at all. Some drink fairly impressive amounts on a regular basis. A few have discriminating tastes, and they take pride in their knowledge of variety of wines, crafted cocktails, and high end beers. Others have palates which are not so picky. Equally diverse has been the reactions following our friend's injury. Some barely acknowledge that anything happened. Some have considerably curtailed their own drinking, whether consciously or not. It seems like a few have even doubled down and picked up the pace.

Which leads me to the question I posed in this post, "How much is too much?"

As a physician, I've often struggled with this question. In rehabilitation, we often care for people who have had serious injuries caused by alcohol, as consequences of their own drinking or someone else's. I've care for people with head injuries, spinal cord injuries, severe fractures, liver failure, and burns. With each patient, I am stunned how quickly a life can change in a moment of bad judgment. After such an injury, however, my role is fairly clear cut.

What to say to people who haven't (yet) been affected? In my outpatient practice, it is fairly routine to ask people about smoking and drinking habits during an evaluation. These are people who may be coming to me for neck pain, tendon problems, sports injuries, or arthritis. What should be my flag to act on the information I collect and express concern about alcohol?

One might think that there is consensus among the healthcare professions about guidelines for alcohol consumption. I'll be the first to acknowledge that I am not an expert. There are guidelines which indicate amounts that may be beneficial for one organ systems, but often they conflict with guidelines for amounts that could harm a different organ. There is disagreement about how guidelines should be adjusted for gender or body weight. Genetics can influence how well people process alcohol, and they seem to influence who is at risk for addiction. Honestly, even if I knew how to weigh all of these different factors, I don't think I could effectively do that during a clinical encounter when I'm supposed to be treating knee pain.

I have equal confusion in a social context. There often is not a good correlation between the people who drink a lot and the people who suffer consequences from drinking. That makes it hard to rally support to intervene, when the people needed to help with an intervention may actually drink more than the person who really has a problem. Then, there is not even great agreement about what constitutes the best help: programs that advocate abstinence or ones that focus on harm reduction? Programs that are professionally based or community-volunteer led?

I really struggle with this both professionally and personally. I want to be a good physician and a good friend. I want to be an effective resource and advocate. How do I distinguish who needs help from those who are simply enjoying a vice responsibly? Then, how do I help? I know there are no easy answers to any of this. I have been struggling with the questions of how alcohol (and other substances) fit within a social milieu since college. It just feels more acute, more emotional, right now having had a friend get hurt.

The Dark Lord Tastes Like...

It is always tough for reality to live up to expectation. Earlier this year, I had a delightful experience where my expectations were met. Opus One is one of those wines that gets a lot of hype. I had a glass in 1996 and wasn't super impressed. It might have been the state of clarets back then. It was more likely an indictment of how green my palate was. Jumping forward 15 years, we ordered a bottle on a recent cruise. I was truly impressed. It certainly deserves its reputation.

Not so the Dark Lord. This beer has legendary status amongst craft beers. I have heard about it for years. It is available once a year at a festival in Indiana; tickets sell out in five minutes. A colleague of mine offered to pick me up a bottle this year. I was so excited!

Last night we cracked open the Dark Lord. Many words could be used to describe this beer: sweet, syrup, coffee, chocolate, intense, experiential. However, would I describe it as good? Not really. At first I thought it wasn't a style I'm wild about...my phase of liking heavy dark beers ended about five years ago. However, my partner loves dark beers and he disliked Dark Lord even more than I did. It really tastes like they are trying too hard, and their cult-like following does not want to admit that their holy grail of beers, The Dark Lord, tastes like alcoholic YooHoo.

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My New Year Celebration

What a great start to the new year.  Rob and I headed out to San Francisco last Thursday to hook up with some friends.  One of them had scored some free VIP tickets to Cavalia....sort of a horse based Cirque du Soleil.  The shows was a solid "good"....with parts being great.  Regardless, it made for a great start to the weekend.

On Friday we headed up to the wine country.  We first made a stop at Gundlach-Bundschu, a Rhine-style winery in Sonoma.  We discovered this a few years ago. We had rented a limo for a tour of wineries, and the driver had suggested this winery.  We all fell in love with it.  The trip this weekend was mostly so that John could exchange a few bottles that had been sent in error.  However, after a fabulous tasting, Rob and I couldn't resist signing up for their wine club!

We then headed over to Guerneville on the Russian River.  We had rented a home through VRBO.  The place was situated high above the river, pretty much hanging on the side of the hill.  The house was great; the view was spectacular. After a major grocery run, we settled in for the weekend.

I was head chef for the weekend.  We ate, drank, and hot-tubbed our way through the new year celebration.  Entertainment included Scrabble, Killer Bunnies, and "Priscilla, Queen of the Desert."

I have a superstition that how you spend the New Year is how you will spend the year.  I try to avoid bars, clubs, and the TV.  I want my year to be full of love, loved ones, good food and great wine.

If my superstition holds true, 2011 will be just awesome!

Lightweight

I'm out in eastern Washington state visiting Rob's family. Today we are out wine tasting. The wineries out here are lovely. I'm surprised how much I enjoy the merlots. It seems that every time I go on wine tours I get tipsy much faster than everyone else. I am such a lightweight. Unfortunately, I am a sleepy drunk, so I need to stop before I drink too much.

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