Sober Healthcare

Thoughts on alcohol, coping, and being a healthcare professional.

Alcohol wasn’t really a part of my life until I became a dentist.

I had a handful of experimentations in high school and college. Didn’t care for it. To be fair, I wasn’t drinking any of the good stuff. Natty Light and a budget tequila that comes in a plastic jug… not quite the nectar of the gods. When I turned 21, I would order a generic lager or ale, or maybe a Seven and Seven if I was feeling fancy. Only 2-3 drinks in an evening at the local pub, and only on weekends. I had a healthy relationship with alcohol, especially for someone my age.

Things started to change when I went to dental school. I still only drank on the weekends, but I started passing the 3-drink mark more regularly. That kind of thing sneaks up on you. It wasn’t a conscious decision other than I remember the feeling that I needed to blow off steam by the end of the week. It wasn’t just the standard academic pressure; I was seriously doubting if I was cut out for dentistry. In my third year of dental school, I experienced my first real episode of depression. That’s a story for another time.

I finished dental school and my residency with my drinking boundaries still fairly firmly planted in the ground. I usually only drank on the weekends. If I was at a restaurant on a Thursday to celebrate a special occasion, then I’d have a glass of wine. I never drank alone.

In 2006 I officially entered the working world as a dentist and I began to misuse alcohol.

Prevalence in healthcare

Substance Use Disorder (SUD) is defined as “uncontrolled use of a substance despite harmful consequences” (source). It’s estimated that the prevalence of SUD amongst healthcare providers is the same as the general population (about 10%), though we are more likely to abuse alcohol and prescription medication (source).

Data is sparse but there are reports of certain professions abusing certain substances at higher rates due to access (e.g. pharmacists and prescription medication, dentists and nitrous oxide).

Alcohol Use Disorder (AUD) is essentially the same as SUD but with alcohol (source). Of note is the definition of alcohol misuse, which is “drinking in a manner, situation, amount, or frequency that could cause harm to the person who drinks or to those around them.” Habitual misuse increases the chances of an AUD.

My story

Did I have a Substance Use Disorder with alcohol? I certainly didn’t feel that way at the time. The definition of an SUD talks about “uncontrolled use” and “harmful consequences.”

My story wasn’t one of dependence or addiction. I knew of people who had battled big scary demons. They wanted to resist their temptations but their willpower would bend and break. I had never felt such a powerful urge to drink, so I thought I was very much in control.

And my story wasn’t one of terrible consequences. I was in good health. My decision to have a few cocktails with friends at a study club on a Tuesday night didn’t lead to missing work on Wednesday or showing up with a pounding headache while trying to care for patients. Aside from the occasional weekend hangover, there weren’t any harmful consequences.

As my professional career progressed, my once firm boundaries with alcohol began to blur and fade. I would have a couple glasses of wine at the end of a long day of patient care. I would have a cocktail before a networking event to start getting into a social mood early. It was a hundred small concessions— rewards and justifications— that slowly but surely eroded my sense of autonomy. Having a couple drinks on any given night was just a forgone conclusion. I didn’t have to drink… I was just choosing to drink with increasing frequency.

Here is a not uncommon scenario from the seven year period I was part-time in my practice and part-time editor of an industry publication:

• Monday: Long day of patient care from 10AM - 8PM. Get home exhausted and open some wine for dinner. Have a couple of glasses.

• Tuesday: Work from home on the magazine. No booze.

• Wednesday: See patients from 7AM - 3PM. Rush out of the office to LaGuardia or JFK. Sit in the Delta Lounge and have a free glass of wine. Get on a plane to fly to wherever and have another free glass of wine (or 2 if it’s a longer flight). Land and grab dinner near the hotel and I might as well have another glass of wine.

• Thursday: Visit with clients for the magazine and take one of them out to dinner. Have a cocktail and glass of wine with dinner.

• Friday: Fly back home. The weekend starts! See friends for dinner. 3-4 drinks would not be unusual.

• Saturday: 3-4 drinks with friends over the course of the day.

• Sunday: See Saturday

• … and repeat.

I always felt in control and I was not facing any negative consequences, so I did not meet the strict definition of an SUD.

Why and how I changed my routine

Life continued on. In 2021 I transitioned out of my clinical career (see How I Stopped Being a Dentist) and I found that my drinking decreased significantly, especially during the week. My wife and I were looking to take better care of ourselves post-COVID and so we become more thoughtful about our diet, exercised more, and dialed down those casual glasses of wine.

Over the past two years I started to get occasional headaches the morning after drinking. I had my share of hangovers in my life but this was different— I could get a nasty headache even just after having two drinks. It was totally unpredictable. Yes, I tried all of the post-drinking rituals in the book, from drinking lots of water and electrolytes to taking prophylactic ibuprofen. Sometimes it worked just fine and other times I would suffer the consequences the next day. It occurred to me that I was in my mid-forties, and maybe my body just couldn’t process the stuff as well as it had previously.

So now I was facing harmful consequences. The allure of a well-crafted cocktail or a perfect wine pairing wasn’t so enjoyable as to offset the discomfort that could follow. I decided to dial down my drinking even further. I had heard anecdotally from friends and colleagues that going sober came with a host a benefits, including sleeping better, increased energy, and thinking more clearly. I wanted to do a solid month without any alcohol and see where that took me. That should be easy since I was in control, right?

I kept finding excuses to push off my dry month. We have a vacation coming up. It’s the holidays. And what about that friend’s big birthday party? For the first time, it dawned on me that I might not be as in control as I had thought. Uh oh… I wasn’t really in control and I was facing harmful consequences. This was my wake up call.

My wife and I did a dry January this year. It extended into February, then March. I’ll be honest with you, I felt great but I don’t know that I felt all of the health benefits like improved sleep. I just felt better on average, and I certainly didn’t miss the occasional morning headache.

We decided to break the streak on my wife’s birthday in early April with a glass of wine at dinner. A single glass of wine. In the past, that would have easily been a cocktail at the bar followed by sharing a bottle at the table. And that’s what’s changed the most for me: I don’t desire alcohol anymore. Under the right circumstances I will still have a drink, but when the waiter comes by the table and asks if I want a refill, I can say “no thanks” and actually mean it. Those three months were like a reboot for my brain.

Taking care of each other

I didn’t think I met the definition of a Substance Use Disorder. Maybe I was right, but I certainly was misusing alcohol. Whatever my diagnosis was, I’m fortunate that I was able to overcome it easily. But not all of us are so lucky.

Let’s look out for one another, especially your colleagues. The data I shared earlier suggests that healthcare providers have the same prevalence of SUDs as the general population, but I would not be surprised if we had higher rates of alcohol misuse. And the line between misuse and an AUD/SUD get get quite thin. People can fall into an SUD because they’re trying to cope with depression (see Let’s Talk About Depression in Healthcare) or other mental health issues. But they also might just be slowly slipping into an unhealthy lifestyle after years of stress or an imbalance between work and life.

If you or someone you know is potentially suffering from a substance use disorder, you can get free, confidential help by calling this hotline.