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Not all of us can handle the same amount of alcohol. Our tolerance is affected by our varying body types, genders, genes, minds, and experiences. Here, five students talk about what influences their own tolerance, and three experts suggest customized strategies for drinking more safely. Here’s what our featured students are dealing with:
- A family history of alcoholism
- Fatigue and stress
- Being female and/or small-bodied
- Medication interaction
And here are our experts:
* All students’ names have been changed for privacy. All students featured are age 19+.
Drinking while female and/or small-bodied: Carly’s story
“I’m 152 cm (5’0”) and I weigh 48 kg (105 pounds). Alcohol affects me a lot faster than other people. Whenever I go out with my friends, I feel like I’m trying to keep up with them, whether that be the amount of alcohol I consume or how fast I drink it.”
Carly*, female, fourth-year student, Ontario
- Being female is more relevant than being small-bodied to how our bodies process alcohol. Women get drunk faster than men on the same amount of alcohol, even if they have the same body weight.
- People with lower body weights have a slightly higher Blood Alcohol Content [BAC] after drinking the same amount as heavier people.
- Most women have a lower ratio of muscle to fat than most men, meaning they have less blood and water to dilute the alcohol.
- Women typically have less alcohol dehydrogenase (an enzyme that breaks down alcohol).
- The sex hormones interact with alcohol: Alcohol is often more intoxicating just before menstruation.
How Carly handles it socially
“After every alcoholic beverage, I drink a glass of water, and beforehand, I make sure I eat a good, hearty meal. My real friends know that I need to slow down on my drinking, so I don’t feel pressured to drink more. They encourage me to have just a couple and take it seriously. They have seen firsthand how alcohol affects me. All of my friends are a lot taller or bigger than I am. I don’t try to keep up with bigger drinkers; it doesn’t turn out well.”
Red flags for women and small-bodied drinkers
- Avoid hanging out with people you don’t know very well, who may not understand why you are choosing to drink less.
- Avoid hanging out with anyone who drinks excessively.
Strategies that work
- Alternate your drinks: “Alternate between drinking something that has alcohol in it and something that doesn’t. This way, you’re not only drinking alcoholic beverages, and you have rest periods between drinks.” —AG. See Alternate and/or dilute your drinks (below).
- Make a drinking plan in advance: “Sticking to a plan is the best strategy.” —SL. See Shake up your habits (below).
- Tag team with friends: “Having a buddy system in place is a way that friends can keep an eye out for each other. This should be discussed ahead of time. Talk about how you’ll help each other out, so that the expectations are clear before the night begins.” —AG. See Practice saying “no” to a drink (below).
Drinking while medicated: Julian’s story
“I took Cipralex for depression and anxiety for about a year. I was told that I could drink in moderation, but whenever I drank too much, it made the medication less effective. I would revert back to how I felt before using it.”
Julian*, male, fourth-year student, Ontario
Why is it riskier to drink alcohol while taking medications?
- Interactions between alcohol and medication are common. Alcohol can amplify or reduce the effects of medication, and worsen your driving.
- “Alcohol does not mix well with any medication that is used to treat a psychiatric condition. The interactions are not always predictable, and they can change over time in the same person.” —SL
- Talk with your prescribing doctor or pharmacist about interactions between alcohol and medications, whether they are prescribed, over-the-counter, or herbal.
- Check here for drug and alcohol interactions.
- How Julian handles it socially
“I don’t usually drink by myself. I may drink a few beers when I’m watching sports with friends, playing games, or hanging out with my roommates. On the weekends, when I go out with friends, I drink more—but never to the point where I become belligerent. When I noticed that alcohol affected my medication, I drank less.”
Red flags for drinking while medicated
- Don’t decide to drink more than usual without close friends nearby.
- Avoid unfamiliar alcoholic beverages, which may interact with your medication in unexpected ways.
- Avoid drinking during a depressive phase, which raises the risk of self-medicating with alcohol.
Strategies that work
- Tag team with friends: “Julian needs to set limits before he goes out with friends. Drinking at a bar is still risky unless he has a non-drinking buddy to watch over him. The effects can creep up quickly.” —SL. See Practice saying no to a drink (below).
- Make a plan in advance that addresses if, when, where, and how much to drink; e.g., “Two alcoholic drinks diluted with extra seltzer, drinking only if the environment seems safe, and leave by 12:30 a.m.” —NC. See Shake up your habits (below).
- Know how your medication works: “It’s good for everybody to be aware of risk factors that might make it more likely for their drinking to become a problem. Awareness of risk factors is important for making informed choices about drinking.” —AG
- Strategize with a counsellor: Brief counselling sessions can help you decrease the frequency and amount of alcohol use, and help you strategize around the conflict between good health and risky habits. —NC
Family history of alcohol addiction: Steve’s story
“My mother’s older brother has a long history of alcoholism, beginning when he was just a teenager. My uncle has shaped my alcohol habits—I remember hearing stories of him being drunk all day, even at work. On any given week, I am not likely to drink. For me, alcohol is a once-in-a-while thing to enjoy with friends, usually for some sort of occasion.”
Steve*, male, first-year graduate student, Ontario
- Alcoholism can run in families, according to an extensive body of research.
- “If people in your family struggle with alcohol abuse, you’re not doomed. Up to 30 percent of an individual’s risk of alcoholism is genetic. The environment and your own experiences contribute 70+ percent.” —SL
- Researchers’ estimates of the genetic influence on alcohol use disorders is somewhat mixed. The National Institute of Alcohol Abuse and Alcoholism in the US says genes are responsible for about 50 percent of the risk for alcoholism. The quality of parenting, which can be impaired by alcohol abuse, also affects children’s risk of developing an alcohol use disorder later.
How Steve handles it socially
“Because I know I have classic risk factors, I have kept alcohol to an evening activity with friends only. I refuse to drink alone, and I plan ahead. I never go somewhere to drink without knowing exactly how I’m getting home.”
Red flags for people with a genetic susceptibility
- Be aware that you may be especially sensitive to environmental triggers: “The smells of preferred alcoholic beverages are the primary cues. People, places, and even events are secondary cues. Seeing a drinking buddy unexpectedly can trigger the craving for alcohol.” —SL
- Be aware of impulsive tendencies: “Other risk factors for potentially developing alcohol problems include personality traits such as impulsivity or sensation seeking. These risk factors aren’t exclusive to those with a family history of alcohol problems.” —AG
Strategies that work
- Be aware of your risk: “Students who have a family history of alcohol problems are more likely to develop alcohol problems themselves. If you have risk factors for the development of drinking problems, consider being more careful about your drinking or choose not to drink at all.” —AG
- Be aware of your cues: “Know your cues, which are specific to individuals: One person may crave beer and have no reaction to whiskey or vodka. If you used to go to a specific bar to drink, then go to a different establishment for dinner.” —SL
- Switch to a non-favourite drink: “If you can’t easily cut down, switch to a different beverage; perhaps pick one that is not so [appetizing]. This strategy will help reduce the number of drinks per night.” —SL. See Alternate and/or dilute your drinks (below)
- Put a limit on your drinking: See Shake up your habits (below).
- Consider discussing this with a counsellor or support group: Seek support from an individual therapist or a support group such as Adult Children of Alcoholics, Al-Anon, or Alateen.
Fatigue + stress + alcohol: Bianca’s story
“I often drink to ‘ease the stress,’ make myself feel better after a bad day, or to celebrate things, such as getting through midterms or doing a good job on a test. Stress is a definite factor in my drinking. The more stress I am under, the more often I feel the need to drink to deal with it.”
Bianca*, female, third-year student, British Columbia
- Alcohol is a depressant. Its effects can be exaggerated when you’re fatigued, depressed, anxious, or stressed.
- “Alcohol can reduce the ‘perception’ of stress. But with increased use, continued drinking actually dampens your stress response mechanisms, and it becomes a cycle of dependency because heavy alcohol use causes a good deal of stress (worrying about withdrawal signs, getting sick, having an accident, etc.).” —SL
How Bianca handles it socially
“Alcohol does help me relax, as long as I can manage to keep it under control and not abuse it. But I’m really bad at stopping once I have started, and I usually don’t do so until I run out. It is not a good solution to stress and fatigue. It’s circular: The more you drink for stress and fatigue, the more stress and fatigue you will have.”
Red flags for drinking while stressed or fatigued
- Be extra careful during periods of intense academic pressure, such as before or after exams.
- Be aware of the link between heavy drinking and academic disruption: “Frequent heavy drinking is often linked to academic problems, such as missing classes because of drinking the night before, falling behind, or doing poorly on exams. Even infrequent heavy drinking can lead to problems, depending on the person and the situation.” —AG
- Watch your motives: “Thoughts like ‘Having a few drinks makes my troubles go away’ predict future alcohol dependency problems.” —SL
- Seek out healthy strategies for managing anxiety: “If you have an anxiety disorder, you are more than twice as likely as someone without an anxiety disorder to develop an alcohol dependency.” —SL
Strategies that work
- Accept that alcohol is not a solution: “Alcohol’s ability to keep you calm and relaxed are short-lived. In fact, the after-effects of drinking often mimic the effects of anxiety. In addition, the use of alcohol to cope with stress or negative emotions provides fewer opportunities to learn other, more adaptive, problem-solving, or stress-reduction strategies.” —AG
- Seek out healthy supports: “If you have any concerns about your drinking, it’s a good idea to talk to someone about it. You can go to the counselling centre at your university or get in contact with a mental health professional who can give you more information about your drinking, and if you’re interested, help you come up with ways to reduce it.” —AG
- Prioritize sleep: “I know this sounds corny, but get plenty of sleep! The cycle of being tired all the time will increase stress, blood pressure, diabetes risk, depression, and a whole host of other problems that an individual might try to self-medicate with alcohol.” —SL
Drinking while diabetic: Christophe’s story
“I use insulin and check my blood sugars three or four times a day. My friends know I’m diabetic, so they always watch out for me. I drink anything, really, but I try to drink low-carb beer and mixed drinks with diet pop.”
Christophe,* male, fourth-year student, New Brunswick
- Most people with diabetes can safely consume alcohol in moderate amounts, according to the Canadian Diabetes Association (CDA).
- It is very important to monitor your blood sugar and be alert for symptoms of hypoglycemia, which can be similar to those of intoxication.
- The CDA recommends a limit of two drinks a day for women, three for men.
- “Alcohol increases triglyceride levels [a risk factor for diabetes and complications of diabetes] and can interfere with the positive effects of oral insulin products.” —SL
- Consult a doctor about managing your own situation.
How Christophe handles it socially
“I usually drink twice a week. Since alcohol brings down blood sugars, I will occasionally have a drink made with real sugar. I always carry sugar pills. My friends can tell if I look shaky and sweaty, and they come and ask if I’m OK.”
Red flags for people with diabetes
- Avoid drinking alcohol with people who may not know about your health condition and signs and symptoms of changes in blood sugar.
- Know the signs of hypoglycemia: “Blurred vision, rapid heartbeat, pale skin colour, sweating, shaking, and skin tingling. Other signs that will be apparent include: sudden mood changes, nervousness, fatigue, extreme hunger, and eventually a loss of consciousness.” —SL
- Know the calorie content of alcoholic drinks: “Drinks may have more hidden calories than Christophe realizes, and then he could be thrown into a dietary imbalance, increasing the risk of complications.”—SL
Strategies that work
- Understand the risk factors: “Alcohol lowers blood sugars, but it’s more complicated than that. Over time, alcohol can reduce the effectiveness of insulin and raise glucose levels.”—NC
- Talk to your doctor about safer alcohol use while managing diabetes: “Christophe should consult his own health care providers about his. He seems to act on good information when he has access to it.” —NC
- Make a plan in advance: “Adhere to a rule about what types of drinks can be consumed safely, and then follow a strict limit.” —SL. See Shake up your habits (below).
- Ensure that your diabetes and blood sugar are under control: “Only individuals who have their diabetes and blood sugar well under control should consider social drinking. The calories provided by a single drink should be counted as two fat exchanges. Alcohol also stimulates appetite in many people; that can cause overeating and is a problem for people with diabetes.” —SL
Strategies for managing your alcohol intake
Practise saying “no” to a drink
- Role-play with a friend or counsellor: For example: “I’m training tomorrow—tonight I’m all about the seltzer;” “So much to get done the next few days, I’m stopping at two this evening.”
- When you turn down a drink, show that you’re having a good time: “No thanks, I need my wits tonight. I’m about to join them over there for ping pong;” “Got a cold Gatorade and an update on what happened at rehearsal?”
- Delay your next drink without seeming to reject the person who’s offering it or distancing yourself from the social scene: “I’m good right now, thanks, but I’ll get the next one;” “I’ll get it in a few—I’m going to the bathroom first.”
- Tag team with a friend: Ask each other to support your decisions about drinking limits. When the party’s underway, step in and remind each other of tomorrow’s test or workload.
Alternate and/or dilute your drinks
- We feel more comfortable when we have a cup in our hand, whether or not that cup contains alcohol, studies show. So alternate alcoholic drinks with water, seltzer, or soda.
- Ask for “lighter” alcoholic drinks with less alcohol, or in a larger glass with added seltzer or soda. Add ice to your drinks: studies show you’ll drink it more slowly, and the alcohol will be diluted.
- Refill your beer can with water or juice; this may keep others from worrying that you haven’t had enough to drink or aren’t having fun.
- Check out nonalcoholic alternatives: Cocktails made without alcohol (“mocktails”) look the same as their alcoholic counterparts.
- Drink slower: When you savour the drink, it can be absorbed more gradually, minimizing a spike in your Blood Alcohol Content.
Shake up your habits
- Make a plan in advance. Consider what you will drink; how many alcoholic drinks you will have; how you will pace those drinks through the evening or event; and whether or not you will have access to the drink of your choice (instead of ending up with the mysterious punch of unknown alcohol content, it’s worth taking your own drinks along). Impose limits; e.g., “I know I can handle one drink an hour after food, and I max out at two drinks a night.”
- Switch to a different beverage—one that isn’t your favourite; you’ll probably drink more slowly.
- Be cautious about matching your alcohol intake with someone else’s. “Avoid ‘chugging’ or drinking games. Drinking games are designed to have you fail, and they promote more drinking.” —SL
- Consider adapting drinking games so they are less regret-inducing: take sips, not shots; play all or some rounds with nonalcoholic options; take breaks.
- Always get your drinks directly from the bartender: You’ll know what you’re getting; you’ll more easily stick to your plan (because bartenders know what a standard serving size looks like); and there’s less chance of your drink being spiked.
- If managing your alcohol intake is difficult, try strategic counselling or a support group:
- Brief counselling sessions can help you decrease the frequency and amount of your alcohol use, and address specific risk factors.
- Consider a support group, such as Adult Children of Alcoholics, Al-Anon, or Alateen.
Know your cues
- Cues or triggers are specific to individuals. Know what yours are. One person might crave beer and have no reaction to whiskey or vodka.
- Avoid specific bars or other environments where you have a tendency to overdo it.
- Be aware that our alcohol tolerance is reduced in unfamiliar environments and situations; if it’s a new place or new people, you may feel buzzed sooner. Pace yourself.
If you drink, make it work for you rather than against you
Nathilee Caldeira, PhD, Staff Psychologist, Student Mental Health Center, Columbia University Medical Center, New York.
Abby Goldstein, PhD, Certified Psychologist; Assistant Professor of Counselling Psychology, University of Toronto, Ontario.
Scott Lukas, PhD, Director of the Behavioral Psychopharmacology Research Laboratory, McLean Hospital, Belmont, Massachusetts, and the McLean Imaging Center; Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts.
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