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What Doctors Need to Know About Today’s ‘Healthy Abstainer’
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In Short: Doctors are rethinking their approach to patients who abstain from alcohol for health reasons, not illness.
Doctors are rethinking their approach to patients who abstain from alcohol for health reasons, not illness, according to a recent report in Medscape.
"As doctors, we’re always looking at pathology, and you start to have this almost biased thinking... but it can be refreshing to tilt our frame of thinking," said one expert.
"We’re at an inflection point," said Daniel Siconolfi, PhD, a behavioral scientist at RAND in Pittsburgh.
"It’s weird — I’m a doctor, and I can look at labs and look at the PHQ-9, but I’m always following what patients are doing in their community. For a lot of folks who do drink, alcohol is really part of their community," said Akhil Anand, MD, an addictions psychiatrist at Cleveland Clinic.
"I think a lot about, ‘What is a good outcome for someone?’" said Anne Fernandez, PhD, clinical psychologist and associate director of health services and policy at Rutgers University’s Addiction Research Center.
"Some patients may also benefit from formal support, and physicians can facilitate those referrals," noted the report. The trouble with past alcohol research is that it grouped healthy abstainers with “sick quitters” (former drinkers who’d stopped due to health problems), creating a bias that made moderate drinkers look healthy by comparison.
"Maybe they’re ‘sober curious,’ joining the wellness movement, or finally getting the memo that past research on the benefits of moderate drinking was wrong," said Siconolfi.
"If someone is telling you that they cut back, the number one thing to do is to cheerlead, support, and congratulate them," advised Fernandez.
"I had a patient the other day, and he’s not doing anything textbook — no evidence-based therapy, he’s not taking any medications for cravings, he’s not going to AA meetings, and he didn’t go to residential treatment," said Anand.
"Evidence about the health risks of alcohol use is becoming clearer, along with a growing visibility of sober curiosity and abstinence challenges like Dry January and the proliferation of nonalcoholic options in nightlife and retail settings. Health and wellness goals are primary drivers for many people," noted the report.
"Today’s youth are experiencing what some consider delayed adulthood," said Siconolfi.
"Drinking patterns today are different from past generations," said Anand.
What's still developing
- Some who say they’ve cut back may still participate in high-intensity drinking — 10 or more drinks on a single occasion — and “that’s happening more and more,” he said.
- People of all ages can succumb to the “abstinence violation effect, where a setback becomes all-or-nothing thinking that leads to abandoning the goal entirely,” Siconolfi said.
Sources
- Medscapelink