Navigating Alcohol & Substance Use Disorders During the Holidays

Alcohol use disorders (AUDs) are the most prevalent of substance use disorders worldwide (Pubmed). These disorders are characterized by difficulty controlling or stopping alcohol use, by individuals whom alcohol has caused adverse social, occupational and/or health consequences.

Although individuals may choose to drink, Alcohol Use Disorders are considered a disease, as genetics and family history play a significant role in these disorders. For example, heritability seems to account for over half of alcohol use disorders. As a clinician, I’ve found that people’s brains are wired differently when it comes to substances. I’ve met patients who tried alcohol a couple times, decided they didn’t like it, and will rarely (if ever) have a drink. I’ve also met patients who quickly developed severe alcoholism, shortly after becoming exposed to alcohol. The same goes for marijuana and basically any illicit substance; some individuals seem to be wired to have severe cravings and difficulty controlling certain substances – and this is where genetics come into play. This is one of the reasons why I get concerned about kids “experimenting” with different substances. The more someone tries, the more likely they’ll find something that they like too much.

As a psychiatrist who trained in treating addiction at Johns Hopkins Hospital and currently treats a large number of patients for substance use disorders at Rittenhouse Psychiatric Associates, one of my first recommendations to all patients is to “change people, places and things.” This adage is commonly used at Alcohol Anonymous meetings, and it refers to the fact that recovery tends to be a lot more successful, if individuals can decrease triggers, that may lead them to make the decision to drink or use substances.

Let’s talk about the holidays. The holidays can be a very enjoyable time, for families, friends, and even colleagues to gather and celebrate – and Alcohol seems to be standard at almost any holiday event. Watching football? Let’s have a few beers. Coming over for dinner? I’ll bring red and you bring the white. Time for dessert? Let’s make a giant bowl of spiked eggnog and hope that no one pulls a Clark Griswold. Not only does alcohol use and even binge drinking increase between Thanksgiving and New Year’s day, but DUIs, car accidents and alcohol related fatalities also spike during this period every year.
While I recommend that patients who struggle with an alcohol use disorder avoid triggers (especially early in their recovery), I also make it a point to discuss that isolation can be extremely problematic and time with family and friends can be therapeutic. This can be a bit of a conundrum, if not properly navigated.

So, a few tips for the holidays, for those in recovery or struggling with an alcohol use disorder:

1. Be thoughtful about which gatherings you attend; if your boss throws a holiday party for you and your colleagues each year, where binge drinking is the norm, or where you have in years past been unsuccessful at controlling your intake, this year’s work gala may be one to miss.
2. Lean on your family and supports. If you are able to be open with a few close family members or supports about your difficulty with alcohol, it may make it easier to navigate an event. This also sets up additional accountability; if you tell a couple individuals that you care about that you are not going to drink, and they are there, you will likely not want to disappoint them. They may also go out of their way to make it easier for you to drink less as well (by not offering drinks, or changing the subject if someone mentions you not drinking for example).
3. If you have a therapist, a close friend who knows about your struggles, or a sponsor (in AA or NA for example), consider planning a check-in call or two, during events. This will add additional accountability, and also may help you to feel proud about how you are handling yourself, in real time. This confidence may be just what you need, to make it easier to turn down a drink, or keep you from feeling alone in your struggles.
4. Check in with yourself as well! Set an alarm on your phone, to reflect on how the night is going, every 30 minutes or hour. If you notice that your anxiety, cravings or distress are increasing, it may be time to excuse yourself. This doesn’t necessarily mean leaving, but it could mean “taking a phone call” – and going outside for a walk, calling a friend, or even doing a meditation in your car or a guest room.
5. Plan an escape. If you’re struggling, it will be a lot less overwhelming to leave, if you already know ways that you could do it. I’ve had patients schedule a second gathering, with sober friends, a couple hours into a party, I’ve had patients blame an early night on their dog needing to go out, I’ve also had patients let one or two people know they’re not feeling great (not necessarily a lie) and excuse themself for an early night.
6. Plan holiday activities that you know you will enjoy, where you’re unlikely to be triggered to drink. Be creative with this. Examples could be a daytime cookie bake, helping family members pick out decorations or a tree, a white elephant gift exchange, a board game with nieces and nephews, story telling, volunteering w/ family and friends, or a religious gathering. Create a new tradition, that fits your values and needs, and still can include family and friends.
7. Be honest and have self-compassion. If you are unsure if you can safely attend certain events or be around certain individuals during the holidays, allow yourself to refrain from those events. This is especially important if someone is early in recovery, or just starting to control their drinking.
8. If there’s any uncertainty about your specific situation, it’s incredibly important to discuss with your mental health professional or call for an evaluation with someone who focuses on addiction.