SUMMARY KEYWORDS

drinking, help, doctor, struggling, alcohol, healthcare provider, primary care provider, support, recovery, stop drinking, anorexia, bulimia, eating disorders, alcohol use disorder, body image, anxiety, struggles, struggle, sobriety, community, accountable community, sober curious, maladaptive coping strategy or coping mechanism

SPEAKERS: Casey McGuire Davidson + Megan Popp

00:02

Welcome to the Hello Someday Podcast, the podcast for busy women who are ready to drink less and live more. I’m Casey McGuire Davidson, ex-red wine girl turned life coach helping women create lives they love without alcohol. But it wasn’t that long ago that I was anxious, overwhelmed, and drinking a bottle of wine and night to unwind. I thought that wine was the glue, holding my life together, helping me cope with my kids, my stressful job and my busy life. I didn’t realize that my love affair with drinking was making me more anxious and less able to manage my responsibilities.

In this podcast, my goal is to teach you the tried and true secrets of creating and living a life you don’t want to escape from.

Each week, I’ll bring you tools, lessons and conversations to help you drink less and live more. I’ll teach you how to navigate our drinking obsessed culture without a bus, how to sit with your emotions, when you’re lonely or angry, frustrated or overwhelmed, how to self soothe without a drink, and how to turn the decision to stop drinking from your worst case scenario to the best decision of your life.

I am so glad you’re here. Now let’s get started.

 

Hi there.

Today we are talking about

how to get help from your primary care provider if you’re struggling with alcohol.

I know this is a question that I had and that a lot of women have. In terms of wanting to talk to their doctor, but also not being sure how that will be interpreted and how that will show up in their file or even what their doctor can provide and can’t provide.

 

[00:01:47]

So, today we are talking with someone who can help take us through all of those questions.

My guest is Megan Popp. She’s a family nurse practitioner with almost six years of recovery. from alcohol and 15 years of recovery from an eating disorder. She opened up her own medical practice that specializes in family centered care, internal medicine and geriatrics.

 

[00:02:13]

Megan has a great passion for mental health and sees most of those patients herself. She’s a mom of three, one set of twins, and an avid distance runner.

So, welcome. I’m so glad you’re here, Megan.

Hi, thank you so much for having me.

[00:02:29]

I’m so happy to be here and excited to have this conversation.

This conversation is really important because often we tell women who are struggling like, talk to your doctor. I know that withdrawing from alcohol, depending on your body, depending on whether you’re physically dependent or how much you drink can range from Just a bad hangover and a bunch of symptoms afterwards to something that is really, truly dangerous that that is deadly if you don’t take care of it.

 

[00:03:01]

So, there’s also questions about when I go to my primary care provider, will they put it in my file? Can they even help me? What can they do if they write it down? What does that mean?

 

So, I’m glad you’re here. So, we can answer all of those questions.

Yeah, no, absolutely. Those are all phenomenal questions.

[00:03:22]

And, you know, I think it’s so interesting with alcohol because there’s such a spectrum and such a gray area and every patient is coming to you with an individualistic need and treatment.

So, yeah, I’m, I’m excited to have this conversation.

Yeah, and there’s also questions about, like, what it means for future treatment, what it means for anything else or any stigma that might be associated with it.

[00:03:44]

So, why don’t you start us off with just what can primary care doctors actually do to help you?

 

Yeah, no, that’s great. So first, I mean, I’ll jump right into it.

You know, I think with alcohol, alcohol isn’t necessary the problem. It’s the ineffective solution, right? It’s a maladaptive coping strategy or coping mechanism.

 

[00:04:07]

And so, I think a lot of people, you know, they come to their primary care provider and that primary care provider may not be, you know, that educated in alcohol use disorder, alcoholism, or even addiction at all, or they may have their own like internal bias or prejudice when it comes to their own alcohol use.

 

[00:04:24]

So, they may not be great in terms of, you know, the addiction side of things, but they might be able to help you figure out the why’s. Why is the patient drinking? Why is the patient trying to escape their life? Do patients have a co-occurring, you know, mental health? Disorder, anxiety, depression, borderline personality, you know, bipolar do they have something other trauma, some PTSD, something going on at home, their marriage, their social status.

[00:04:48]

I mean, all of those things a PCP can help screen for. They can also obviously do blood work, see if you have some type of medical condition, and then they can do appropriate referrals to get you into the right type of care, whether that be an addiction treatment center, you know, a psychotherapist, a psychiatrist, support group, grief counselor, PTSD therapist.

[00:05:08]

I mean, they’re going to be the hub for you and, and getting that you know, treatment appropriate to what you need. Yeah, and I don’t know about you, but it’s pretty varied in terms of how much time you actually even get with a primary care provider. I know when I’ve gone for my annual checkups, or I went because I was having really bad anxiety you know, the nurse comes in typing all the stuff.

 

[00:05:33]

If they ask why you’re here, they weigh you, they do whatever, take your blood pressure, and then. The primary care provider comes in and reads the form and checks you out for X amount of time, which is not usually that well. And I know for me, sometimes it’s hard to get in with my main primary care provider.

[00:05:54]

So I, you know, just get sent to whoever is around and it’s hard to establish a relationship there. So like, what do you think about? that? Yeah, no, that’s a good question. You know, for me, I have 15 minute appointments for patients that I’ve already seen before or a 30 minute appointment with a new patient.

[00:06:11]

And that’s typically across the board, what primary care providers will allot for themselves, unless it’s like a comprehensive type of holistic doctor, they might do a little bit more time with their patients. But, you know, patients and providers like a provider should really focus on their patient and never make them feel rushed.

[00:06:29]

You can get a lot done in 15 minutes if you’re efficient with your time and you’re actively listening to your patient. So, yeah. I mean, I think in terms of time, like for a patient my advice would be, to come with a list of questions because I think you get in the room. I’ve even done this as a patient myself and you get your anxieties out of control. You were distracted by the medical assistant that came in, all these people are coming in. There’s like an interrogation light on your face and you can kind of loosen site of why you came in the first place and then you leave the appointment, you’re like, Oh my gosh, I forgot to ask that question I wanted to.

[00:07:00]

Yeah. So, I love when patients come with a detailed list, questions they want to ask me. It just makes everything more organized.

Yeah. And so, when I first went to like 95 percent of the time, I went to see my primary care provider. And I was not ready to stop drinking even if I was worried about it. They would ask you or you would write down and say, okay How much do you drink and I would be like a to couple drinks couple times a week, right?

[00:07:30]

And even when this is funny, when I finally stopped drinking, I was probably a couple months sober, was the first time I saw my doctor actually wrote down how much I used to drink. But I was like, oh, I never drink anything now. And I was so proud of myself. But then, something got written in my chart and I was like, dude, I don’t drink anymore.

[00:07:55]

Like, why are you writing that down? You know? So, first, I want to ask, like, When someone, well, what are the usual symptoms of someone who is drinking that people should be aware of? Like, if you are feeling X, it might be related to your alcohol consumption. Like, let’s start there and then kind of decide whether you need to.

[00:08:20]

Yeah, absolutely. So, mild symptoms of an alcohol use disorder are, you know, the next morning having some nausea, maybe even vomiting. You know, some like agitation or anxiety, feeling a little restless in your skin. Those are kind of some of the physical symptoms, you know, more severe or moderate to severe symptoms would be like tremors.

 

[00:08:41]

Trouble swallowing, you can get that esophageal stricture in your throat and or like coughing up blood. If you have esophageal varices if you’re having hallucinations, that’s a really severe symptom. Obviously seizures, extreme symptom, you know, in terms of your life, you know, are you not finding joy in the things that you use to find joy in?

[00:08:59]

That’s a big one. Are you starting to have consequences because of your drinking? Are people starting to notice you’re drinking? your Bad, you know, outcomes when you do drink, you know, are you starting to miss work? You know, that happens a lot having to call out. Maybe you need a medical excuse because you’ve missed so much work from your drinking.

[00:09:15]

Are you having to drink more? That’s a big one. So, you know, used to just drink one glass of wine a night. Now you’re drinking a whole bottle. That’s a big one that I see a lot.

Yeah, that’s one that I definitely, yeah, for sure. When you are talking to people, you know, I know that I went for a long time to my therapist or to my doctor and talked about a couple of things.

[00:09:41]

I talked about insomnia. So hey, I’m so stressed out. I wake up at 3 a. m. XYZ. I talked about anxiety. I talked about some depression. I did not talk. About my drinking and I was kind of surprised they took my answer. I would say I was relieved. They took my answer in terms of how much I was drinking at face value.

[00:10:05]

But what happened there is they prescribed me like I got sleep medication. On top of drinking a bottle of wine a night, I would take an Ambien, and I know that’s extraordinarily dangerous. I’m not sure I knew that then. I don’t think I knew that then. Can you talk about sort of the issue? I was also taking anti-anxiety meds.

[00:10:27]

I mean, you know, it’s hysterical. I mean, not really, but I was taking all these medications to counteract the effects of the alcohol I was drinking. So common. I mean, I see this all the time and I because of my own experience through, you know, my own alcohol use disorder and learning so much about addiction.

[00:10:44]

I’m really good at screening for these types of things now. So basically, you know, higher, higher blood pressure, reflux, insomnia, those 3 a.m. wake ups. So basically what happens is, you know, when you’re drinking alcohol, it’s a depressant and it’s Like kind of numbing that sympathetic nervous system in your body, in your body, you have a sympathetic nervous system and a parasympathetic sympathetic is fight or flight.

[00:11:07]

Parasympathetic is rest and digest. And we’re constantly trying to remain in homeostasis and that balance. So, when you drink alcohol, you’re suppressing that fight or flight. So the reason you wake up at 3 a.m. is because that’s been suppressed and now it’s ready to come out in full force. So, when you wake up at 3 a.m., as the alcohol’s wearing off, your body is thinking a saber toothed tiger is chasing them. And if you’ve ever woken up at 3 a. m. after a night of drinking, you know exactly what I’m talking about. Your heart is racing. It’s beating out of your chest. You might be sweating. You know, you feel impending doom.

[00:11:37]

You feel anxious. You feel like you know, pending doom. Like I, I didn’t know that that feeling of doom was common other than me, but I definitely felt it.

Yeah, I had my own experience with this. I went to a doctor, you know, probably six months before I decided to stop drinking and I had all of those symptoms.

[00:11:57]

I had hypertension. I had horrible reflux. I was throwing up blood. I was so anxious. I mean I was having full blown panic attacks. These are all the red flags for someone to at least ask me a question about my relationship with alcohol. And that was not asked at all. There was no questions about how much I was drinking, my relationship with alcohol, when that’s really why I’m so passionate about what I do now.

[00:12:19]

Because if you can catch those patients, you can get them to go from pre contemplation to contemplation about their relationship with alcohol, and it can literally change their life. So you went into your doctor and said, I’m throwing up blood. I have reflux. I have insomnia. I have anxiety. And did they just try to treat the symptoms?

[00:12:41]

I mean, what did they say to you? What did they think was the reason for that? Yeah. So in the provider’s defense, and she was a great provider, but she, you know, I wasn’t completely honest with her about my alcohol use, but she gave me a prescription for Pepcid and Lexapro. Neither of which I took, neither of which I took.

[00:13:00]

But you know, if she had maybe questioned me about my relationship with alcohol, I think I would have been more open to talking about it, but since she didn’t bring it up, I was like, well, it must not be, you know, an issue at all. And I think some providers, if they come with their own prejudice or beliefs about alcohol will either just Be like, well, you’re not an alcoholic, so just cut back a little bit when and I’ve heard that right when, in fact, you really need to kind of analyze your relationship with it.

[00:13:25]

And it’s adorable because you’re like, oh, just cut back. I hadn’t thought of that. You know, while you’re studying, like every ounce of energy, beating yourself up or making rules or trying to stop and failing.

So, yeah, I’ve heard people doctors who’ve said, you’re not an alcoholic. You don’t really have a problem, which is so dismissive.

[00:13:46]

If someone is brave enough to even ask about their alcohol use, like it’s. Like they’ve been thinking about this for a while. It’s not casual. Like, Hey, I think I’m drinking too much. And then the other thing I’ve heard is like, okay, go to AA. Like, that’s the only thing they know. And if that’s not where you are, you aren’t ready for that.

[00:14:09]

You can also feel really dismissed. Cause you’re like, well, I’m not an alcoholic. I don’t believe or whatever that is. Or you have beliefs around yeah. The program or whatever you like, those are two very, very different answers that really don’t have much bearing on what’s going on specifically with you.

[00:14:33]

Like, it’s not a medical decision. It’s a right, you know.

No, absolutely. And I love like how we’ve kind of started to use as providers, the term alcohol use disorder rather than alcoholic, because alcohol use disorder implies that we’re on a spectrum. It’s not like a present tense type of thing. And there’s such a gray area and patients are going to kind of fall all along that spectrum.

 

[00:14:53]

Like, you might have a patient that does need to go to AA because of the accessibility of it or the severity of it or whatever, but then you have a patient who’s maybe just having occasionally bad episodes from drinking, but. Probably it’s heading on the wrong path that would do much better on like an online recovery platform or, celebrate recovery something, different in terms of using that label alcoholic.

[00:15:13]

So, yeah, it would be great if providers were more educated on the different types of avenues of recovery. I mean, there’s so much more AA is great. However, it’s been around a long time and we have so many more players on the field now when it comes to recovery. Yeah, yeah.

 

[00:15:29]

And one thing you said when we were talking about this before we jumped on, I wrote it down because I thought it was such a great way to ask the question without, saying too much and, I don’t know, we probably shouldn’t be concerned about what we say to our doctors, but I’m just trying to be. Thank you.

[00:15:50]

Thinking about the way that I felt when I was first coming into this you said you could approach them by saying I’m really interested in my relationship with alcohol based on how much I’ve been reading about how bad alcohol is for you and I want to take a look at the effects it’s having or it’s had on my body and you can they can do lab tests. You. And they can also give you referrals for experts in the area without you stating, like, I’m super worried about my drinking.

 

[00:16:24]

I’m drinking too much. I’m doing X, Y, Z.

Yeah, absolutely. The way that we worded that, you know, if you don’t want to just come right out to your doctor and say, I’m worried I’m an alcoholic or, or however you want to word that, but instead saying, like you said, I’m curious about my relationship. I’m curious if any of the amount of alcohol that I have consumed has done any damage to any of my organs.

[00:16:43]

I would like. blood work, I’d like to discuss these types of things. And so ,what is done with the blood work?

Yeah, that’s a great question. I mean, if you come in, you know, we’ll kind of start from the beginning. If a patient comes in, every provider is going to screen for how much alcohol a patient is drinking simply because we need the medical history, but also because the alcohol can interfere with lots of medicines that we might prescribe you.

[00:17:05]

You know, there’s Antibiotics that you can absolutely not take with alcohol. I mean, there’s you know blood thinners You can’t be on with alcohol. So, it’s really important that we screen for that it that does go in your chart.

You know, we joke in medical school in graduate school that however much the patient tells you they drink you have to multiply that by three And that’s actually how much they’re drinking so yeah, but be honest with your provider, you know, if you can I think You know, being honest about your relationship with alcohol.

[00:17:32]

The good that comes from that outweighs any bad of anything being in your chart. So, just remember that.

Yeah. But, um, but yeah, no, anyway, once we go through that, then, you know, it depends on if you’re there for a physical or, you know, just establishing care. But typically we like to get blood work every six to 12 months and we’ll do a full panel.

[00:17:51]

We check your kidney, your liver, your thyroid, you know. Sometimes people who are drinking a lot over time can develop pre diabetes or diabetes, so we’ll screen for that. A lot of times you’ll see people with alcohol use disorder have vitamin deficiencies, specifically like vitamin D, B1, thiamine, B12, and so, you know, we can kind of start them on vitamins or different medicines if we need to regarding their blood work.

[00:18:14]

That’s super interesting, because I never even knew exactly what they tested for, although I’ve heard like, oh, there are issues with the liver, I have fatty liver, whatever that was.

Yeah, and fatty liver can definitely be exacerbated or even caused by alcohol use, or just being overweight, so sometimes it’s just an issue with lifestyle management.

[00:18:34]

Yeah, yeah, and I never even knew what that was. I just sort of heard about it and was like, oh, that’s something. Yeah, it’s like fatty deposits in the liver and that actually can be reversed, but cirrhosis is a much different situation.

Yeah, yeah. Will you tell us a little bit about your story? Because when you said that, you know, your doctor didn’t bring it up with all your symptoms, so you didn’t think it was an [00:19:00] issue related to your drinking.

[00:19:02]

I mean, you’re a primary care provider, right? And in the medical field. So, What was your drinking like, and how did you realize maybe it was an issue? Yeah, I mean, at that time, you know, I was a labor and delivery nurse. I was not a primary care provider. I actually went to graduate school one month sober. I had a fire in me to kind of be an advocate for people like me.

[00:19:25]

So, that’s why I went to school. But, you know, my issues with drinking, I started drinking really young. 13 and I struggled with perfectionism and eating disorder. And you see a lot of, you know, eating disorders correlate with alcohol use disorders and women. Those two go, they’re parallels or there’s a lot of them, but yeah, I mean, I was a college athlete, had a lot of pressure on myself.

[00:19:44]

So, I was more of like good girl during the week and then. bender on the weekend and then had, you know, three children. I had really bad postpartum anxiety, not postpartum depression. I had severe postpartum anxiety, which they’re very different. It’s coming out now some more research about how PPA is different in terms of just being more wound up than I was sad.

[00:20:04]

And, you know, I used alcohol cause wine really helps you calm down until you’re in a deep hole and can’t get out of it. Right.

So yeah. I mean, fast forwarding to that doctor’s appointment. I mean, I was starting to have. real consequences, physical and, you know, in my everyday life from my drinking.

[00:20:19]

And that was 6 months before. And so, I left that appointment, didn’t take any of those meds. And that last 6 months, my drinking was really bad. It just got worse and worse and worse. And my last day was April 21st, 2019. I kind of had what you would call a spiritual awakening moment. Spontaneous sobriety moment.

 

Casey McGuire Davidson 

Hi there. If you’re listening to this episode, and have been trying to take a break from drinking, but keep starting and stopping and starting again, I want to invite you to take a look at my on demand coaching course, The Sobriety Starter Kit®.

 

The Sobriety Starter Kit® is an online self study sober coaching course that will help you quit drinking and build a life you love without alcohol without white knuckling it or hating the process. The course includes the exact step by step coaching framework I work through with my private coaching clients, but at a much more affordable price than one on one coaching. And the sobriety starter kit is ready, waiting and available to support you anytime you need it. And when it fits into your schedule. You don’t need to work your life around group meetings or classes at a specific day or time.

This course is not a 30 day challenge, or a one day at a time approach. Instead, it’s a step by step formula for changing your relationship with alcohol. The course will help you turn the decision to stop drinking, from your worst case scenario to the best decision of your life.

You will sleep better and have more energy, you’ll look better and feel better. You’ll have more patience and less anxiety. And with my approach, you won’t feel deprived or isolated in the process. So if you’re interested in learning more about all the details, please go to www.sobrietystarterkit.com. You can start at any time and I would love to see you in the course. 

 

[00:20:35]

I woke up after a three day bender, just feeling absolutely horrible about myself. I had extreme, intrusive, suicidal thoughts, which I had never had before. And I had this voice that was like, Just end it. Like, your life is better off with Like your kid’s life is better off without you. These were really scary thoughts.

[00:20:55]

And then, I had another voice telling me just to stand up. And when I stood up, I like fell to my knees and I begged God to save me. I, I surrendered. I surrendered my ego that day. I surrendered spiritually, physically. mentally. And I stood up and never drank again. So I think I had the act of God on my side.

[00:21:12]

Did you get support from that after that? Like where did you go and what did you do? Yes. I think I had what you would call like a boiling point that day. My life had come to a culmination and, you know, spiritually, metaphysically, however you want to word it, something had changed within, within me. So from there, I stood up and I called a therapist.

[00:21:32]

I just said, I think I need help. I asked for help. I think that’s what it was. I think I was hiding my problem for so long. And finally I told someone and I think telling someone and when patients come in and talk to me about their issues and they’re crying and they’re looking at me and they seem embarrassed.

[00:21:47]

I look at them directly in their eye and I say, I am so proud of you. This part right here. Coming to me and telling me you have a problem is an act of courage, and it is the hardest step in this journey, and you just got through it.

So yeah, I called a therapist. I told my friends, like my best friends didn’t even know.

[00:22:04]

They had no idea that I was struggling as bad as I was. And then you know, I Took a recovery in like full send mode. I went to AA in the next town over. I joined like every online recovery group and I read every Quit Lit book and I just threw myself into recovery. So, it really worked for me. Good for you.

[00:22:22]

I think the hard thing is learning to deal with your emotions that first year sober. That was the hardest part for me. Tell me about that.

Yeah. Well, I think, you know, I couldn’t numb out from them anymore. I had to feel them, you know, what you feel, you heal, what you resist, persist. So, I was constantly just resisting my emotions by numbing them.

[00:22:41]

And so, yeah, I learned to feel my feelings at 34 and yeah, I mean, I, I still struggle with, you know, some big emotions. I do not struggle with any cravings or anything, you know, now that I’m 6 years into recovery, but yeah, I mean, I think I’ve learned healthy coping skills, which is fun to learn in middle age, but I think also too, I’ve become my authentic self, I think when you’re drinking, you’re not being authentic to who you are. You’re an altered version of you. And so, it’s taken me a long time to figure out who I am, but I’m really proud of who I am and I stick to my core values now.

Yeah. I mean, I think that’s wonderful. And I have to say that I don’t think most of us got taught healthy coping mechanisms when we were growing up.

[00:23:25]

I mean, I went to therapy after I stopped drinking like four months in, I had also gone to therapy when I was drinking, but like you said, if you’re not honest with people and you’re not ready to ask for help. There is only so much that therapists can do, right? We were, we were addressing sort of the the peripheral issues and trying to solve for them and hoping that that would somehow allow me to quote unquote, drink like a normal person.

[00:23:55]

And lo and behold, that didn’t work. But I think that, I mean, I wish everyone could have. A primary care provider like you to get that response when someone comes in and actually admits that they’re worried about their drinking or that they need help. When I went to my doctor and I was having severe anxiety.

[00:24:18]

After I stopped drinking, which I mean felt great for a while. And then I had like a severe anxiety attack and amazingly, you know, a year later, after figuring out a million different things, it turned out I had a mood disorder, which had been recurring. Pretty much my whole life and I couldn’t know that because I was drinking so much.

[00:24:41]

I just blame myself and the symptoms were so mixed up. But I went to my doctor at that point and said, basically like I’ve quit drinking, but here’s how I feel like total anxiety feel like I can’t cope want to jump out of my skin. And I was like, I can’t go back to drinking. So, you need to help me. Like I was at that point.

[00:25:03]

Yeah. And she did. I mean, she sent me, you know, referred me to a great therapist and prescribed some anti-anxiety medications. And I went back to her a couple different times. And then, my therapist took me up with a psychiatrist who was able to better prescribe medication for what I needed. And at the same time, I was working with a coach and in the online groups and not drinking and working out and trying all these other things to make me feel better as well.

[00:25:34]

Yeah, I mean, I think what you’re talking about is like, even if the provider doesn’t have their own experience with alcohol or addiction, you know, if they approach you with empathy and understanding, shame can exist, shame will die, you know, and so that can help a patient so much. And then, the other thing that’s so interesting about your story is that your provider did a really good job figuring out your why.

[00:25:55]

Your why of drinking was because you had an underlying, you know, co-occurring mood disorder, and that helped you stay sober. So, that was actually a really good provider. And that was after I was in therapy for like a year and I think I was on Lexapro and which is anti-anxiety, anti-depression, something to that effect.

[00:26:15]

Both. Yeah. SSRI.

Yeah. Yeah. And I had been on it for like a year. And I’ve been seeing her weekly and she sort of was like, I think that this might be something else because this seems to sort of descend on you with no major trigger and be really bad. And then sort of lift with no major solution. And if you are on Lexapro or whatever, this shouldn’t be happening in the same way.

[00:26:46]

And so, that was really helpful in finally figuring that out, but I wouldn’t have known that if I hadn’t, you know, been journaling or writing my coach like I could look back and literally see exactly. When it started, how I felt, when it lifted, I mean, it was kind of incredible.

Yeah, and I think a good therapist or a good provider can see those blind spots for you.

[00:27:08]

And that’s why finding a good one is so essential, you know?

Yeah. Yeah. Well, so we talked about some of the things that your primary care provider can do and can help you with and one of the things I asked you is what can primary care providers prescribe? What can’t they prescribe sort of, you know, what areas are they able to help in?

[00:27:37]

What areas do you need to go elsewhere?

Yeah, that’s also a really good question. So, in terms of medicine, they can definitely prescribe the treatment for anxiety and depression. You know, if you’re dealing with kind of a Bipolar or schizophrenia that has to be treated by a psychiatrist, but they can refer you out for that.

[00:27:55]

So, when you are looking at anxiety and depression, you know, those are SSRIs, SNRIs, serotonin reuptake inhibitors and norepinephrine. So those meds can be given by a PCP. If you’re looking for medicines like naltrexone or Antabuse, those medicines have to be prescribed. You typically buy like a pain clinic or an addiction treatment center.

[00:28:14]

Again, we can refer you out for those. And will you tell us what Antabuse and naltrexone are and how they work?

Yeah, absolutely. So, naltrexone is a medicine that kind of blocks like the opioid receptor so that when you take the medicine and you drink you feel less pleasurable effects from the drink itself or the drug. Whatever drug it is that you’re using so you’ll see someone Actually kind of try to moderate their drinking with naltrexone and you know, the good is that yes, they’re got to learn over time that you know, even if I have four beers, I don’t get any dopamine hits from this. So over, you know, 3 to 6 months, I’m got to stop drinking because I’m not getting the dopamine hit However, the bad is you know, not every patient is got to take that medicine They’re got to take it on days that they want and then, the days that they want to binge drink, they’re not going to take it.

[00:29:03]

So, and I also wonder that, I mean, four drinks is pretty harmful to your body and to your sleep and to your anxiety. So, you’re not getting the dopamine hit, but you’re still doing the harm to your body. I wonder if people would just drink more to try to get that dopamine hit or they keep drinking so that they don’t have to deal with the social emotional.

[00:29:28]

Yeah. Pressure slash, you know, fitting in slash questions slash whatever. And yet they’re still consuming the substance that is causing all these other symptoms.

Yeah, I think for, you know, in my own experience, just having, you know, these patients come back to me after they’ve been started on it, I’ve seen a few patients that they were really successful on it.

[00:29:48]

So, I don’t want to completely knock it. It’s not my favorite.

Yeah, it’s not my favorite drug of choice because there’s so many other layers when it comes to alcohol use disorder. And, you know, over time, I think they’re learning not to get that dopamine hit and it’s conditioning them. But that’s kind of a certain specific patient that would work for.

[00:30:04]

And then, Antabuse is different. This has to be someone that has an abstinence from alcohol because if you take an abuse and you drink you’re going to get violently ill. GI, you know, vomiting, that type of thing. So, that one should be for someone who’s planning on abstinence. Where naltrexone could be someone that’s trying to moderate.

[00:30:21]

Yeah, and how does, I mean, it sounds like anti abuse, you would take it with a preventative, you know, like it, I literally cannot drink or I will be very sick.

Yeah. Yeah. And I think if you use these meds as a tool in your toolkit instead of an end all be all, then they’re more successful.

Yeah, I’ve had, you know, coaching clients that I’ve worked with who have done really well with an abuse as a, it takes the decision off the table versus debating or being like, I’ll only have one or whatever it is.

[00:30:56]

Right. And a couple of taking now Trexone too, but as a coach, I really advocate not drinking at all. For at least 100 days. I mean, I advocate, you know, getting away from alcohol completely and not moderating. But now, Trexone, I think help them be like, even if I were to drink, I wouldn’t get the payoff. I want, I think for majority of majority of people.

[00:31:21]

Moderating your drinking is extremely mentally exhausting and almost impossible. I don’t know that I’ve ever met anyone that’s been successful at just cutting back, you know, so yeah, yeah. Or at least not for a long. I know it’s a lot of like white knuckling being irritated when you’re not drinking and then basically breaking it 5 days or 7 days or whatever.

[00:31:43]

Or you just, I mean, I decided a million times I was only going to have two drinks a night or only one or only when I’m out. I mean, that literally never happened. Like, yeah, if it, if I did it, it was once and, and it was really hard.

Yeah. The other thing about the Naltrexone and the anti-abuse is while those do work occasionally, we’re not also diving into the why, why it’s, is the person drinking because that’s what’s going to keep someone sober.

[00:32:09]

Yeah, yeah, absolutely. And that’s something that a therapist can help with. Can your primary care provider do that in the time that you’re with them, or how, how would someone approach that? Yeah, I think that they, you know, if they’re, you know, a good provider, they’re listening, you know, the way to be a good provider is to be a good communicator and a good listener.

[00:32:29]

So, if they’re doing those two things, I think they can help screen for that, you know, and ask the right questions.

Yeah and so, you had mentioned that there were certain antibiotics, certain drugs that you absolutely should not take if you were drinking. I mentioned that I actually didn’t figure out how dangerous it was for me to take a sleeping med after drinking a bottle of wine.

[00:32:53]

And honestly, when I would get all these medications and they would say, yeah, you can’t drink on these, I thought that, you know, it was sort of like CYA. Like, the doctors had to say that, but they didn’t really mean it. Will you tell us what the specific ones are that would be dangerous combined with alcohol and what the effects could possibly be?

[00:33:16]

Yeah, absolutely. So, the biggest one, like antibiotic wise, it’s Flagel, like you 100 percent cannot drink on that antibiotic. Flagel is typically used. On which one? Flagel? Yeah. Flagel. Yeah, it’s an antibiotic that we use. And that you know, you see people use Flagel for like bacterial vaginosis or diverticulitis.

[00:33:32]

It’s not a super common one, but if you do have a patient population of, you know, younger women, you’re going to see a lot more of that bacterial vaginosis. And I always have to educate them, like do not drink on this. Cause you can get severely ill at GI vomiting, that type of thing. Dehydration. And then, you know, in terms of psych meds, you know, benzodiazepines like Xanax or Azepam, they have such a depressant effect on you and alcohol is a depressant so you get like a synergistic effect of that depressing of the central nervous system and you can possibly not even wake up if you’re drinking on those medicines.

[00:34:03]

And then, the Wellbutrin, that one’s norepinephrine, it can lower your seizure threshold, so that if you drink, you can actually, you’re at higher risk to have a seizure. And then, SSRIs, again, depress the central nervous system, so you have to be very careful with your alcohol use. There’s some you can drink a little bit with, but if you’re a binge drinker, you have to be very careful with SSRIs.

[00:34:22]

Yeah. And what about detox? What are the symptoms that someone would need assistance to stop drinking? Does tapering work? Or at what point do you go to an emergency room? You know what I mean? Like, what if you stop drinking and then you start having symptoms? I’ve never been quite clear on where that line is.

[00:34:43]

Yeah, absolutely. So, there’s a score that we do, like a screening tool called the CEWA score. And it’s like kind of a range, so 0 to 8 would be symptoms, like how we score it. Like headache, brain fog maybe like itchy. feeling warm, not being able to like kind of cool] down. That one, you can probably, you know, just stop drinking on your own.

[00:35:03]

You’re fine. 8 to 15. This is where you’re having some tremors you know, extreme agitation, extreme anxiety. That one can usually be, what are tremors? Is that just when your handshakes?

Yeah, usually bilateral. So not, you know, one sided. So, you’ll see patients hands shake a little bit. That one, you know, typically you can probably taper at your PCP, and they do what’s called a benzodiazepine taper, like a two week Ativan or Alprazolam clonazepam taper.

[00:35:32]

You take that home?

Yeah, they’ll give you a 2 week prescription.

So, your primary care provider can help you with that?

Yeah, absolutely. They can taper you as long as you’re falling. Following in that 8 to 15 on the CEWA score. And then, if you’re scoring over 15 on that score, that means you’re having, you know, hallucinations, visual, auditory hallucinations, extreme tremors maybe you even had a seizure that you typically those patients are coming in through the emergency room that has to be a medical detox facility.

[00:36:00]

Okay. And so, do you recommend that people go and try to taper or talk to their doctor at a certain level of alcohol consumption or if they try to stop and then the symptoms come? What’s your take on that?

Yeah, I would always try to discuss with your doctor about how to taper because it is one of those drugs that you can die from if you don’t withdraw appropriately.

[00:36:28]

I mean, it’s very serious how you withdraw from alcohol, so because of the risk of seizures and what’s called delirium tremens, which is a condition where we get abnormal heart rhythms, higher C, higher risk for seizures and the hyperthermia. So, yeah, definitely talk to your doctor about it. But yeah, I mean, I think if you can. Safely.

[00:36:46]

You know, detox with a benzo taper. That’s going to be great. And as long as you’re doing that in conjunction with therapy, they’re coming in, checking on you daily, you know, you’re going back to your PCP in and out. And then, also doing, you know, the figure out the why’s of the drinking, not just doing the taper.

[00:37:03]

Yeah. Okay. That’s great. So, what would be the red flags or the green flags if you are talking to a doctor and you’re, you know, like, okay, this is someone who can help me, or this is someone who might not be a great fit as a doctor and I should try to approach someone else?

Yeah, I love this question. So, you know, in general, my favorite thing to say is, you know, a provider should avoid three things.

[00:37:31]

One is sameness, treating every patient the same. And this happened to me not too long ago, I went to see a provider and they were talking to me like they were reading from a prompter. And I knew that they had said this exact same thing to me. The 12 other patients that day. That that’s, that’s a red flag to me.

[00:37:47]

You know, the other one is complacency. So, avoid sameness, avoid complacency. Complacency means that a provider is not using evidence based practice. So are they going to medical conferences? Are they learning new information coming down the line?

You know, one of my favorite things to say is if you have a doctor that’s telling you that alcohol is good for you, even, you know, a glass a day thins the or it’s good for your cholesterol.

[00:38:08]

The Surgeon General has now come out and said it, there’s actually no amount of alcohol that is good for you. So, if you have an old school doc still trying to tell you that, that’s a red flag. And then, the last one is pity. You know, if you have a doctor looking at you with pity, I think that’s a red flag as well.

[00:38:22]

I think that, you know.

Empathy is something, you know, is it nature? Is it nurture? I’m not sure where we learn it. They definitely don’t teach you empathy in school. But I mean, empathy is learning to sit in the dark with a patient and then grabbing their hand and pulling them to the light. So, if a patient or a provider is looking at you with, you know, judgment and self-righteousness instead of injecting curiosity into what’s going on with you, that’s a red flag.

[00:38:46]

So, red flags would also be If you ever go to a doctor, this is my, like, least favorite thing, and they are looking at the screen the whole time, and they never look at you. That nonverbal communication is a big red flag for me as well. Like, look at [00:39:00] me. I had a really good instructor in graduate school that was like, Don’t treat the computer, treat the patient.

[00:39:06]

So, I think that’s another red flag. And then, also, like leaving the appointment, feeling rushed, unheard, unvalidated, disrespected, you know, there’s a new term out called medical gaslighting, and I think that’s a big one where, you know, a provider might make you feel like it’s all in your head. or your pain isn’t real.

[00:39:23]

Those are big red flags. And then in terms of green flags, like, you know, green flags are someone that is actively communicating, actively listening. They make you feel validated. You know, I, a provider may have 20 patients that day, but they can really, if they are actively engaging with you, then you’re going to feel like you were heard and you were validated, you know, Yeah, ordering appropriate tests.

[00:39:43]

So, another red flag would be someone that’s ordering unnecessary tests and making the appointment really expensive. So, someone that’s doing the appropriate type of follow up blood work or treatment, you know, I think also a provider that’s available. That’s a big one for me. Like, can I get in contact with them?

[00:40:00]

You know, do they have a portal? Do they answer my messages? That’s a green flag as well.

Yeah. Yeah, those are great. I was thinking of a couple examples when you were saying that I had actually gone to a new primary care provider and I wanted to ask about hormone replacement therapy because I just listened to a podcast all about it.

[00:40:24]

And I was like, and then, and then I had a friend who had done it and said it was great and yada yada. And the doctor said to me, well, that’s a last resort because hormone replacement therapy causes breast cancer. And I was like, okay. But I didn’t want to be like the podcast. I just listened to told me that was completely untrue because I didn’t want to be that girl, but I did.

[00:40:48]

I was like, okay, she’s not the doctor that I can talk to about this, right?

Yeah, yeah, I mean, and you are correct, hormone replacement therapy does not cause breast cancer, all of those studies have been debunked, I just went to a medical conference about this, big fan of HRT for the right type of patient, but yeah, I mean, in that case, you could, you could put her in her place and let her know, you know, the new, maybe go check the evidence based research, but the other option is, you know, just keep her there.

[00:41:13]

Advocating for your own care and find a different provider. I think when you are looking at providers, it’s almost like dating. Like, you had a date around a little bit, so yeah, and I was talking to Amanda E. White. We did an episode called therapy for women. I’ll, I’ll link to it on the show notes and she was talking about how, you know, you should talk to two or three therapists in the beginning.

[00:41:36]

You can tell your therapist. Hey, I’m. I’m really, you know, it’s important to me to find the right fit. So ,I’m talking to a couple of different therapists. I want to find someone I connect with and, you know, I think we go in and we take the first available. And then, if we, we feel guilty, if we want to change it, like you’re cheating on your hairdresser and you don’t want, you don’t want the therapist to like, be mad at you or you’re like, it must be something on me if I’m not connecting.

[00:42:03]

And so, in that episode, she really talks about. Okay. You know, red flags as well and green flags for looking for through a for a therapist and sort of giving you permission to talk to a number of different ones to find the one that’s a right fit for you. And I think that can apply to doctors as well.

[00:42:19]

Right? Absolutely.

Absolutely. I mean, not to get too metaphysical. physical on you, but I think we’re all connected energetically to consciousness. And sometimes we’re just not on the same frequency as other people. You know, you, it’s almost like you can feel it in the room if, if the vibes are good, you’re feeling safe, ultimately, you know, when you’re with your provider, you should feel like it’s a safe space and that you don’t feel rushed or that they’re not listening to you.

[00:42:43]

Yeah. Yeah. Well, so. As we wrap up, what else should someone listening to this, maybe someone who’s worried about the alcohol that they’re consuming, they might be worried about what it’s done to their body or they’re having anxiety, they’re having panic, they’re having that doom feeling, which I know I did waking up at 3am, like what should be their next step or what do you want them to know as we’re sort of wrapping this up?

[00:43:11]

Yeah, I think if you’re afraid, you know, to talk to your primary care provider or your therapist, maybe go into the appointment just being like, I’m curious about my relationship with alcohol. What can we do to discuss that? And kind of open it in that way, rather than being like, I think I have a problem, which a lot of people would struggle saying that.

[00:43:28]

I think that could really open up some good dialogue between you and the provider.

I also think, you know, In terms of my own experience, asking for help literally changed my life for the better. I resisted that. I was like, I suffered from hyper independence and perfectionism, so I was not going to be the one that said, I had a problem until my life was almost over, you know?

[00:43:50]

And so, I will scream from the rooftops that, it is okay to ask for help, and I think it’s a sign of strength when you do. It’s not a sign of you being weak at all. It’s the opposite of that.

 

 

Yeah, and I, I mean, I did the same thing. I was, you know, worried about my drinking for a very long time, but it was sort of the death of a thousand cuts.

 

[00:44:09]

And I kind of had 4 or 5 of those cuts in the week before I ended up quitting. And it was, you know, hangover, not remembering the shows I watch. Or waking up at 3 a.m. or being brutally hung over and not liking the way I looked in the mirror. Like, those were all the cuts. And one night at 3 a. m. I woke up and I was on one of these, you know, secret private Facebook groups and someone else was way braver than me in saying sort of, day one again, because I wasn’t posting that.

[00:44:37]

And in the comments, someone recommended a sober coach and I, I went into work at. I went in earlier, but at 10 a.m. I signed up with this coach and, you know, all I thought was like, I can’t do this to myself anymore. I can’t feel this way anymore.

Yeah, I think you bring up a really good point that one of the greatest indicators that you can keep a patient sober is community. You’ve got to get a patient in an accountable community. There are so many online that you can join. I mean, thank goodness we have that now in 2025. And then, the other thing I’ll add is like really, you know, getting some self-agency over your life.

 

[00:45:14]

I think that’s so important. So, kind of building up that patient’s, you know, self-concept and that they have control over, you know, certain areas of their life, that is a game changer when it comes to sobriety as well.

 

That’s great. This is super helpful.

It’s a conversation I’ve wanted to have for a long time because I think that a lot of people don’t know what their doctors could say, don’t know exactly how they could help them. Don’t think they’re that bad, but also if you can get referrals or get your blood work done. If you have an insurance system where you need to move through a primary care provider to either get a referral to a therapist or psychiatrist, or to get, you know, you can get prescribed anti-anxiety, anti-depression meds from your you know, I know that most.

 

[00:46:08]

People that I’ve talked to often have an underlying mental health issue or poor boundaries or difficult relationships, or they’re overwhelmed. I mean, there’s always something.

Yeah, no, absolutely.

Yeah. I mean, and like I said before, your PCP can be your hub for you. They can be your home base. So, finding a good one is essential.

[00:46:27]

I mean, and this is also a provider that can, you know, go with you through the years, you know, your family care provider internist. They can be your doctor, you know, all the way up until you’re in a geriatric age range. So., yeah. That’s a long relationship.

 

Yeah. Well, so how can people find you and follow up?

[00:46:45]

Yeah, absolutely.

Well, if you’re in Northeast Georgia, I have a practice called Northside Forsyth Family Medicine & Geriatrics. On my Instagram, MeganEileen3. I’m doing a lot of cool stuff about nutrition and recovery, you know, running if you’re into that. And then, I’m hoping to start my own podcast in the next few months.

[00:47:03]

Oh, that’s awesome. Oh, one last question I had.

You mentioned that there is a connection between eating disorders and alcohol use disorder and, and they’re sort of often connected or co-occurring or someone who struggles with one might struggle with the other. Can you talk about that a little bit?

 

[00:47:23]

Yeah, I think ultimately the correlation there is the control, right? So I know when I was younger, I developed an eating disorder because everything in my life was out of control, but I could control the food. And kind of similar with alcohol, you know, almost in a different way. Like I think for me that it translated into, you know, I am So good.

[00:47:42]

I’m doing everything right. I’m making good grades now. I want to go and be reckless. I want to lose control, I want to, I want to keep the control and now I want to lose it.

So yeah. I think also too, it’s just hard for women in general. I mean, honestly, about 1 in 4 women struggle with an eating disorder, you know, growing up in the 90s and 2000s. And the models that we had to look up to, I think, probably played a lot into that.

 

I think now, you know, like my children, I think they have a better body image than what we were looking at when we were younger. But, but yeah. I mean, a lot of that I think also correlates with anxiety. And I think that was a big part of mine is I needed to learn to treat my anxiety around my body image and around alcohol.

 

[00:48:21]

Yeah, absolutely. I went to boarding school and there was almost like competitive bulimia, like I was taught how to be bulimic. I apparently was not very good at it because I was like, okay, this is a lot. I don’t think I could do this. But I mean, you know, people were logging their food. Like, I ate four carrots for a lunch, you know, and so it is when we were growing up.

 

[00:48:45]

It was. People didn’t realize how bad it was and we were almost teaching each other how to do it.

Bulimia is really interesting. I struggled with anorexia and bulimia.

And anorexia is about control. But bulimia, to at least in my experience, was like a purging of emotions. Like, I felt rage and I needed to get it out and like, physically get it out. So, sometimes bulimia is more of an expressive type of emotion.

 

Yeah.

[00:49:13]

Okay. Well, that was really helpful. Obviously, I am definitely not an eating disorder expert at all. If someone’s interested in learning more about that, what do you recommend?

Yeah, I mean, again, your PCP can help get you into the right centers for that. Eating disorders are very hard to treat and they can be lifelong.

[00:49:30]

So, you know, and again, there’s a lot of co-occurring mental health disorders with eating disorders. So, telling someone, kind of the same thing, you know, with alcohol use disorder, making sure someone is aware that you’re struggling with it. And then, there’s a lot of really good support groups for, for people who are struggling with that.

 

[00:49:46]

That’s awesome. That’s super helpful. And that’s another reason to go to your PCP.

Well, thank you so much. I really appreciate it.

Absolutely. This was so much fun. Thank you so much for having me on.

Absolutely.