Prompt: We know the risks. From our first encounters with alcohol advertising, and if you’re anything like me, that’s at a very young age, we’ve been told to please drink responsibly. We’re told that continued overindulgence of alcohol will shorten our lives, impair the structure and memory of our brains, and increase the risk of strokes and even heart attacks. In contrast, the National Institute on Alcohol Abuse and Alcoholism reports that people who drink a moderate amount have a lower risk of developing coronary heart disease than their non-drinking counterparts, that alcohol can inhibit and reduce the accumulation of fat in the arteries. And yet, in 2016, our booze intake was 2.35 gallons per year, up 9% from the year before. The healthy standard is 2.1 gallons per year, set by the Healthy People 2020 government initiative by the previously mentioned NIAAA.
Millenials are dying from alcoholism-related diseases at an alarming rate. In a quote from a University of Michigan study, “compared to 1999, the researchers found, the annual rate of cirrhosis deaths jumped 63 percent by 2016, while liver cancer deaths doubled. The rise was even starker when compared to other causes of deaths… the largest relative rise in mortality was remarkably seen among the young. The annual death rate jumped an average 10 percent each year from 2009 to 2016 for people between the ages of 25 to 34.” (https://uproxx.com/life/millennials-dying-alcoholism-diseases-cirrhosis-liver-cancer/)
So if the key, then, is moderation, then why is this discussion so difficult and why do so many of us struggle to find that sweet spot? That’s the discussion we’re going to have today. [Notes on format, including time for questions.]
Jada: Jada N. Hector is an accomplished mental health clinician (Licensed Professional Counselor) and author with an array of experience from treating severe mental illness, trauma, substance use and abuse, sexual health, to everyday mental health struggles. These days, Ms. Hector lends those experiences to help remedy gaps in mental health surveillance, treatment, and recovery options, create better policy, and heal communities. To do so, Ms. Hector specializes in forging systemic change for lasting success of mental health and substance abuse programming through education and consultation. Additionally, her former work in the service industry has helped to bring her expertise in addressing/reducing stigma and introducing the concepts of harm reduction to service industry professionals. Lastly, Ms. Hector is an Adjunct Instructor at UL Lafayette teaching Crime and Mental Health as well as Drug Policy. Brenna: Brenna McHugh is a Marriage and Family Therapy Trainee who works as a counselor in residential and intensive outpatient treatment for substance use disorders in Berkeley, CA. After over a decade working behind the bar and as a brand representative, Brenna saw a need for mental health support specifically tailored to the needs of the hospitality industry and is currently completing a Master's in Counseling Psychology in order to focus on longevity in hospitality careers through building balanced lifestyles. She is partnered with Jigger & Dash Wellness in San Francisco and Camp Runamok in Kentucky as a Mental Health Consultant, has taught for the USBG, the Rochester Cocktail Revival, and Portland Cocktail Week, and represents the Scotch Malt Whisky Society in Northern California. Jesse: Jesse Roessler is a Licensed Professional Counselor in the state of Louisiana. A semi-native New Orleanian (his grandfather was a brewmaster at Jackson Brewing Company), Jesse has worked as a substance abuse counselor in both inpatient and outpatient settings. Mr. Roessler's main interest as a clinician is identifying existing gaps in mental health services and how to bridge those gaps. Lauren: Lauren Myerscough is the cofounder and CEO of Cocktail & Sons, a line of all natural, handcrafted syrups for the home and commercial bar. As a bartender and consultant for the past 15 years, Lauren has worked dive bars to Michelin stars, making drink menus for brand events to the New Orleans Superdome, and most recently served as the Garden & Gun Artist in Residence at Palmetto Bluff. In a past life, she was an attorney specializing in business formation and compliance and edited a volume on property law and morality.
Prompt: Before we jump into a discussion on moderation, it’s important that we’re all on the same page with what these words mean.
Prompt: What are we talking about when we say sobriety or moderation or abuse? We have these definitions provided by the medical community, but they’re vague.
Reply [Brenna]: The spectrum of use-problem-abuse-addiction and that not everyone that “abuses” substances (alcohol, etc) is addicted. While percentages may be higher in some industries, such as ours, in the general population in the US only 5.47% have a Substance Use Disorder (https://ourworldindata.org/substance-use). The tools to overcome abuse are slightly different from addiction, and moderation is in reach for this population.
Sobriety v moderation caveat (Sobriety doesn’t mean abstinence, but it does not include drinking.)
Prompt: What are some other types of behaviors that require definition? We talk about substance abuse, and alcohol is pretty clear cut. But what happens if, while drinking in moderation, we’re also taking pills, prescribed or not, or what if drinking is a byproduct of another type of addiction?
Prompt: When we began this conversation, the term harm reduction kept coming up when we talked about goals and treatment. [Read slide]. Can you give some examples of harm reduction employed today, and why do you think this is the best tact to take when we talk about substance use and abuse?
Reply [Jada]: Syringe exchanges, Narcan. Translation to bar community (ex. doing fewer shots, cutting back).
Prompt: For clarification, let’s go to the next slide.
Prompt: [From last slide]
Reply [Brenna]: We need to address the difference between “moderate risk” (shown here) and “moderation” how we mean it.
Prompt: So now that we have a rough definition of moderation and we know where it sits in the spectrum, why do we still have such a problem implementing moderation in our daily lives? In this next section, we’ll break down the problems, educational, societal, and environmental, that impact the way we look at drinking.
Prompt: The biggest problem with moderation is in the definition itself. There is no single definition for moderate drinking, and it varies by demographic. So it can be difficult to determine whether your drinking falls under that classification. According to the CDC, the Dietary Guidelines for Americans defines a moderate drinking level as one or fewer drinks per day for women and two or fewer drinks per day for men. According to the Linus Pauling Institute at Oregon State University, the U.S. Department of Agriculture adds that moderate drinking in individuals over 65 years old is also defined as one or fewer drinks a day. Heavy drinking can mean anything over these limits, but there is some gray area. The U.S. Department of Agriculture defines heavy drinking in men as five or more drinks at one time or 15 or more drinks over the course of one week. For women and adults over 65, this limit is defined as four or more drinks on one occasion or eight or more drinks over the course of one week. In general, the typical moderate drinker keeps consumption to the low levels that have been associated with health benefits. A single drink is defined as 14 grams of alcohol, the amount found in about five ounces of wine, 12 ounces of beer, or 1.5 ounces of liquor.
But it can also mean different things depending on whether or not we like what we’re trying to moderate. In a study published in Appetite magazine, the authors presented volunteers with a plate of 24 chocolate-chip cookies and asked the panel to define three things: how many cookies they thought a person should eat at a time (on average, 2.25 cookies), how many could be considered a “moderate” amount (slightly more than three cookies), and how many would be considered an “indulgent” amount (just under six cookies). In the second part, a separate group of volunteers viewed photos of gummy candies and then answered a similar set of questions: how many candies a person should eat at a time (around eight), and what would constitute moderate (around 11) and reasonable (just over 14) amounts to eat.
In other words, we tend to define moderation as whatever we’re already doing — or, in some cases, we push the threshold to just above our normal habits, so that moderation comes to mean a bit more than we have been.
Reply: The definition of moderation is purposely vague. Moderation is a relative term, not absolute: moderate in relation to what? We tend to want to view ourselves in the best light, so it makes sense that moderation is where we are already.
Humans tend to think of the relationship between quantity and quality as a graph with a diagonal line going straight up. The reason we think this way is because it’s simple. I’m convinced that our brains are built to find simple patterns in what they observe, and that we need to train them to understand and detect anything more complex. In fact, even this quantitative model is a bit more than our brains like. Ideally it would be simply lots=good, little=bad. This model provides us with simple general rules to judge things. It can be easily inversed when appropriate: in the case of trans-fats or fuel consumption, lots=bad, little=good. There is also cultural variation in how we see things. Americans tend to view large things and large quantities as good much more than in some other places, notably Japan. Just look at portion sizes, for example… Still, everywhere in the world there is a clear tendency to use simple rules to judge things. In reality, it’s more like a bell curve.
Prompt: Let’s talk about the social aspects of drinking. It’s easy enough to exist in a bubble, but what’s happening when we have a night out? So often, the routines that we find so sustainable when we’re by ourselves go out the window when we find ourselves outside of the confines of our homes. We broken down the social aspects of drinking into three main categories that influence the way we drink.
Reply: Environmental Isolation - surface level interactions. Core support from family, friends, and others. Greater attachments. Emotional need for a greater connection. American culture and values. Need for a “third place” (Bars, cafes, sporting events, weddings, parties)
Trauma (self-medicating) Anxiety - short and long term impact of alcohol on anxiety, adrenaline, and cortisol Social anxiety disorder is a mental health condition in which individuals experience heightened stress in social situations. They may fear doing or saying something embarrassing in front of strangers, friends or a group of people. In response, they turn to alcohol. The tension reduction theory, which states that individuals with social anxiety consume alcohol at social functions to reduce stress, may explain why. Many are motivated by the idea that alcohol reduces anxiety. If alcohol alleviates anxiety once, the likelihood of continued social drinking increases. Peer pressure - learning how to say no, challenge coins, icing, shots at bars Social bonding, ritual roles
Prompt: Speaking of peer pressure...
Prompt: For example [read slide]. How does that relate to being out with your friends?
Prompt: Now that we’ve identified some of the factors that influence our perceptions of drinking, what are some steps we can take to get on the right track to moderation?
Prompt: [Read slide]
Reply: Personal stories from panelists.
Prompt: In what ways is your use aligned or misaligned with your core values? How do you explore what those values are and find ways to live in alignment with those?
Reply: The Personal Iceberg is a Satir technique used as a transformational tool to explore the self. The tool utilizes the metaphor of an iceberg to represent human experiencing; the small tip represents visible behaviors, which is often what we focus on as we move through life because it is so easily accessible to us. But as the Iceberg metaphor illustrates, the observable is only the tip of human experiencing. Each layer under the water represents a part of personal experiencing that is unique to each individual, and if explored, gets us closer to who we each are in the world.
Reply [Brenna]: Exploring what underlying mental health concerns may be impacting your use, bolstering support around those, medication and/or therapy
[Jada] Ebbs and flows, realizing how to pull yourself out of the cycles.
Prompt: “Have a drinking plan for your week,” Glaser tells me. This should include capping the overall number of drinks you consume, never drinking before a certain time of day, and designating multiple days where you don’t drink at all. “Give your liver a break, give your brain a break, give your evenings a break where you are able to fully focus and remember every single word of the book you are reading,” she says. “Be more present.”
Certainly setting boundaries for yourself is important, but what else can we do to enforce our boundaries and support friends in their own processes?
Reply [Jada]: List of examples for setting boundaries (harm reduction). Stigma and access to care and treatment.
Prompt: We’ve laid a bunch of heavy stuff on you today. So before sending you out back out into the chaos of Tales, we’ve asked Effie Panagopoulos, founder and CEO of Kleos Mastiha Spirit to lead us in a five minute meditation. Think of it as a little palate cleanser.
Please drink responsibly: The science of moderation
The Science of Moderation
Substance Abuse Counselor
CDC definition of moderate drinking:
Up to one drink per day for women
Two drinks per day for men
Moderation v Addiction
Alcohol Use Disorder
(formerly Alcohol Addiction)
DSM V definition:
A chronic relapsing brain disease
characterized by compulsive alcohol
use, loss of control over alcohol intake,
and a negative emotional state when
Signs of addiction: Continued use
despite ongoing negative consequences,
Not abstinence from a substance, but
rather not being impaired
The consumption of more than one
drug at once. Although
polysubstance abuse often refers to
abuse of multiple illicit drugs, it’s
also inclusive of prescription
medications used in nonmedical
Life in moderationb.
A form of addiction that involves a
compulsion to engage in a
behavior – sometimes called a
natural reward – despite any
negative consequences to the
person's physical, mental, social or
What is harm
“Harm reduction can be described as a strategy directed toward individuals or groups that
aims to reduce the harms associated with certain behaviours. When applied to substance
abuse, harm reduction accepts that a continuing level of drug use (both licit and illicit) in
society is inevitable and defines objectives as reducing adverse consequences. It
emphasizes the measurement of health, social and economic outcomes, as opposed to
the measurement of drug consumption.
Harm reduction has evolved over time, from its initial identification in the 1980s, as an
alternative to abstinence-only focused interventions for adults with substance abuse
disorders. At the time, it was recognized that abstinence was not a realistic goal for those
with addictions. In addition, those individuals who were interested in reducing, but not
eliminating, their use were excluded from programs that required abstinence.”
Social aspects of
Environmental Peer Pressure
Isolation, Culture and values,
Need for a neutralizing place
Challenge coins, Icing, Shots
Tension reduction theory
When a person does something for another person - a pro-social act, as
it's called - they are rewarded not only by group approval but also by an
increase of dopamine and other pleasurable hormones in their blood.
Group cooperation triggers higher levels of oxytocin, for example, which
promotes everything from breastfeeding and women to higher levels of
trust in group bonding in men. Oxytocin creates a feedback loop of good
feeling and group loyalty that ultimately leads members to ‘self-sacrifice
to promote group welfare.’
“The self-determination theory holds that human beings need three
basic things in order to be content: they need to feel competent and
what they do; they need to feel authentic in their lives; and they need
to feel connected to others. Those values are considered “intrinsic” to
human happiness and far outweigh “extrinsic” values such as beauty,
money, and status. Bluntly put, modern society seems to emphasize
extrinsic values over intrinsic ones, and as a result, mental health
issues refused to decline with growing wealth. The more assimilated a
person is into American society, the more likely they are to develop
depression during the course of their lifetime, regardless of what
ethnicity they are.”
“Developing a healthy relationship with alcohol starts by
being honest about its pleasures and drawbacks, and
sharing strategies that help achieve balance. For many
people, that’s sobriety. For some of us, it’s making sure
drinking doesn’t become a lifestyle, and remains a
Social Media Supporting New
Access to Care