Lets talk about doctors stress and alcohol

With it being Dry January many of us are thinking about cutting back on alcohol after the excesses of the festive season.

But for some this isn’t so easy, especially burnt out doctors who are more likely to rely on alcohol and drugs.

A recent study of 417 UK doctors by Dr Kamau, published in May 2019 in the BMJ Open, found that one in twenty doctors met the criteria for alcohol dependence and just over half binge drank on more than one occasion per week. This was the first study which examined the link between work related risk factors and drinking in doctors. Dr Kamau found that doctors stress and other job factors such as burn out and work life imbalances increased the odds of doctors abusing alcohol or having alcohol dependence syndrome.  Just over a third of doctors in the study said that they used alcohol or other substances to feel better and around one in five used alcohol or other substances to get through stressful events. Doctors who worked in a hospital were more likely to drink high amounts of alcohol on a typical day of drinking and to binge-drink.

In the 10 years since I started supporting stressed out doctors, I have heard a lot of stories from doctors about how they use alcohol to unwind after a busy day. It’s a habit that often started in medical school, where the phrase ‘work hard, play hard’ still rings true for most medical students. Or as a Junior Doctor where the mess socials revolved around parties, balls and drinking games. What starts as a pleasurable activity/behaviour can sometimes become a maladaptive coping strategy as it only provides temporary release from the doctor’s stress or anxiety and in the long term can often make the problem worse. Rather than confronting what is causing the stress the alcohol is numbing the feelings, but it does not solve the actual problems. And if the problems become too big, they can become overwhelming leading to burn out. The most recent GMC National Training Survey shows junior doctors feel increasingly burnt out, with 1 in 4 Junior Doctors struggling with workload and feeling burnt out to a high or very high degree.

Doctors coming forward for help with mental health problems often find it easier to label their difficulties as ‘burnout’, ‘anxiety’, ‘overwhelm’ - but when I dig a little deeper I often find a hidden substance issue that has either started the problem off or is keeping it going and making it worse.  What started out as a way to get through the days (and nights) has sneakily become a problem in itself.  The increase in alcohol use and change in behaviours around alcohol can be so subtle that over the course of a few months or years a doctor can easily go from drinking a glass of wine or two a week to 3 ‘large’ gin and tonics a night without even realising the significant impact this amount of alcohol will be having on their physical and mental wellbeing. Dr Kamau unfortunately found in her study that the longer you work in medicine, the greater the risk of you drinking more frequently.

Myths around addiction, and drinking in doctors...

Myth #1 – Alcohol relaxes me

Many doctors think that drinking alcohol relaxes them after a hard day at work.  However, regularly consuming alcohol changes the chemistry of the brain, which can exacerbate stress and anxiety. Over time alcohol decreases the levels of the brain neurotransmitter serotonin - a chemical required for good mental health. As a result of this depletion, a cyclical process begins where alcohol is consumed to relieve stress and anxiety, which causes serotonin levels in the brain to be depleted, leading to one feeling even more stressed and anxious, and thus requiring even more alcohol to medicate these feelings. So, what starts out as a drink at the end of the day to make you feel better, can in the long term make you feel even worse.

Myth #2 – Alcohol helps me sleep

At The Joyful Doctor I often hear doctors say they drink to help them sleep.  But the truth is, although alcohol may temporarily help you to go off to sleep, alcohol actually disrupts your sleep patterns. It interrupts your circadian rhythms and the deep sleep your body needs to refresh and repair itself, often leading to you waking up in the middle of the night. Disrupted sleep can lead to you feeling tired and that can have a negative effect on the day ahead. Lack of quality sleep is also linked to serious mental health problems such as anxiety and depression. Cutting down the amount of alcohol you regularly drink will not just improve your chances of getting a good night’s sleep, it can also improve your overall mental health too.

Myth #3 – I only drink in the evenings/ I only drink good quality wine

Other common myths I hear from doctors include “I can’t be an alcoholic because I only drink in the evenings” and “I don’t have a problem as I only drink wine, never spirits.”  Well, as a recovered alcoholic myself, I can tell you that alcohol doesn’t care what time of day it is and it doesn’t care what form you take it in.  Most of my drinking was done in the evenings, sitting alone with a bottle of good quality wine watching re-runs of a popular comedy show on TV.  Once the alcohol passes your lips it is irrelevant which bottle it comes in and whether the sun is over the yard arm or not!

Tips to reduce your drinking

If you would like to cut down on your drinking or think you have a problem with alcohol, then here are some simple tips to help you to start to cut back.

• Dry January is a one-month booze free challenge that aims to help lots of people reset their relationship with alcohol each year. If you’d like to sign up for the challenge visit https://alcoholchange.org.uk/get-involved/campaigns/dry-january
• If a whole month without alcohol feels like a step too far, then try building some drink free days into your week. Stopping drinking on just a couple of days a week can have huge health benefits, gives you a chance to cleanse your system and gives your liver a rest.
• Try only drinking when you are having a meal. This often means that you drink less and enjoy it more. Rather than grabbing a beer or glass of wine as soon as you come through the door, try waiting until you are sat down having your dinner. Drinking with food also slows down the rate that alcohol enters the bloodstream and if you stop drinking when you finish eating it gives your body time to process the alcohol before you go to bed meaning you also get a better night’s sleep.
• Try some low alcohol alternatives which are a great option when you’re drinking at home or pacing yourself on a night out. The increase in demand for low alcoholic drinks means that there is no shortage of options now for great tasting options whether you prefer beers, wines or spirits. And if you love a cocktail, the drink aware campaign have some great recipes for mocktails https://www.drinkaware.co.uk/advice/how-to-reduce-your-drinking/how-to-cut-down/mocktails/
• Try alternating – one alcoholic drink, one non-alcoholic and so-on.
• Both men and women should drink no more than 14 units of alcohol per week to limit the chance of health problems such as mental health issues, some cancers, liver disease and heart disease. Tracking how much alcohol you drink using an app such as Drinkaware can easily add up how many units you drink and provide motivation and encouragement to stay within the governments healthy drinking levels.

You should see some immediate benefits of cutting down such as feeling better in the mornings, being less tired during the day and feeling more energetic. This can really help you to cope with the pressures of a demanding job and balancing family life. You may also see some additional benefits such as better looking skin and better weight management, which appeals to many of us.

If you think you may be addicted to alcohol or other substances, or you are struggling to control your intake with steps like those mentioned above, there are a range of confidential and free professional services available including:

Alcoholics Anonymous

Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. They have weekly meetings right across the UK which welcome alcoholics and those with an alcohol problem who have a desire to stop drinking. They also have meetings for alcoholics, family or friends affected by alcoholism.

Free national helpline 0800 9177 650 or email: help@aamail.org or visit https://www.alcoholics-anonymous.org.uk/

British Medical Association Wellbeing Support Services - Counselling and Peer Support

The British Medical Association (BMA) has a wellbeing support service that is open to all doctors and medical students. They are confidential and free of charge and can help with issues such as stress, workplace bullying, substance abuse and alcohol issues.  

Tel: 0330 123 1245 or email: wellbeingsupport@bma.org.uk

British Doctors and Dentists Group

British Doctors and Dentists Group (BDDG) is a self-help group of doctors and dentists, from all levels within the professions, who are addicted to alcohol and / or drugs and who wish to live in a recovery programme free of alcohol and drugs. There are 17 BDDG active groups, 16 groups in the UK and 1 group in Eire, who generally meet once a month to share experiences, strengths and hopes in order to understand their common problems and to help, and encourage, other colleagues into recovery from their alcoholism and/or drug addiction.

Tel: 07825 107 970. Email: bddg@btinternet.com Visit http://www.bddg.org/

NHS Practitioner Health

NHS Practitioner Health (NHSPH) is a free and confidential self-referral NHS service for all doctors across England. NHSPH can help you with issues relating to a mental health concern, including stress or depression, or an addiction problem, in particular where these might affect work. The service is provided by health professionals specialising in mental health support to doctors and is available in various locations across England.

Tel: 0300 0303 300 (8-8 Mon-Fri, 8-2 Sat). Email: health@nhs.net​. Visit https://www.practitionerhealth.nhs.uk/

Sick Doctors Trust

The Sick Doctors Trust operates a 24 hour confidential helpline for Doctors who think they may have an addiction issue. Callers may remain anonymous and they frequently also receive calls from colleagues or members of the family of a doctor who is experiencing problems.  Through their helpline they encourage doctors, dentists, medical & dental students to accept that they have a treatable condition and to offer advice about treatment options. They facilitate introductions to other doctors & dentists who are in recovery from active addiction and can give advice on adopting a lifestyle that will minimise the chances of relapse.

Tel: 0370 444 5163. Email: help@sick-doctors-trust.co.uk. Visit http://sick-doctors-trust.co.uk/

At the Joyful Doctor we offer 1:1 support; therapy and coaching, online courses, in person training and workshops and can point you in the direction of resources which can support you. Please just get in touch by emailing teamjoy@joyfuldoctor.com or calling us on +44 (0)1932 922 100

Thank you for taking the time to read this article.  Please do share far and wide, with anyone who you think may benefit from hearing this message; your colleagues, your friends, or a family member.   

It is our mission, here at The Joyful Doctor to reach as many doctors as we possibly can.  No doctor needs to suffer in silence.  We are here to help.