Episode Transcript
Mindy Broden (guest):
Overall though consumption still remains up, binge drinking is also higher, much higher than what it was I would say 10 years ago. And the most notable change in that is that women actually are drinking more frequently, consuming more alcohol than in previous times.
Cassie Alvine (announcer):
This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about sober curiosity and the rise of a sober generation. Our guests are Mindy Broden and Ashley McMartin with Sanford Health Bemidji. Our host is Alan Helgeson with Sanford Health News.
Alan Helgeson (host):
Welcome Mindy and Ashley. Why don’t you guys introduce yourselves and your roles. Mindy, let’s start with you. What is your title and what is your role?
Mindy Broden:
My name is Mindy Broden, and I am a licensed alcohol and drug counselor. I have been for the last 15 years and I’m also a licensed professional clinical counselor, which is the last two years. I am the clinical lead over our substance use disorder services, including our medication for opioid use disorder clinic.
I’ve been with Sanford for seven years. I’ve got the great opportunity to work residential prior to coming to Sanford and then now do a lot of outpatient education, working on prevention, all of those fun things. So this is kind of the vein of what I do is substance use.
Alan Helgeson:
The stuff you talk about every day, right, Mindy?
Mindy Broden:
That is correct.
Alan Helgeson:
All right, Ashley, go ahead and talk about yourself and your role with Sanford.
Ashley McMartin (guest):
Absolutely. So Ashley McMartin, I am one of the directors of behavioral health for the Bemidji region. Similar to Mindy, I’m a licensed professional clinical counselor. Been with Sanford since we merged back in 2017, but really technically been with them since 2013. Then when we were Upper Mississippi Mental Health Center. I am not a licensed alcohol and drug counselor, as Mindy had mentioned that she is.
Photo by: Sanford Health
But really in mental health we see in our region a huge crossover, co-occurring disorders, which means both mental health needs and substance use disorder needs are present at the same time. And so my service lines, I work closely with those that are experiencing urgent or emergent mental health needs, and drugs or alcohol are often included in those experiences when someone’s having a mental health crisis. And so see the work ancillary through the work we do through our crisis services, but then also our long-term ongoing services as well.
Alan Helgeson:
Well, Mindy and Ashley, again, glad to have you as part of this program today. And we’re talking about “sober curious.” It’s one of those terms that it seems like you didn’t hear anything really about. It’s one of those newer things, kind of a phrase that has come about here the last few years in regards to alcohol and alcohol addiction.
So Mindy, let’s start with you. Can you maybe share a few of those current trends in regard to alcohol consumption?
Mindy Broden:
Absolutely. Current trends per capita really are actually down compared to 2022, which is kind of the last statistics that we have. And the most notable ages of that are actually that 18 to 34. And part of that is some of that sober curiosity. And I would also say the incredible increase during COVID overall though consumption still remains up. Binge drinking is also higher, much higher than what it was I would say 10 years ago.
And the most notable change in that is that women actually are drinking more frequently, consuming more alcohol than in previous times. There’s been an increase of persons that are totally abstinent from alcohol overall as well in more recent time here.
But just in terms of what people are drinking, there’s a lot of craft drinks, health drinks, organic drinks. There is some mixing now currently, especially I would say in the state of Minnesota with the legalized cannabis. So there’s THC and alcohol drinks that are being produced. And so there are some trends I would say, just in terms of what people are consuming. But overall in the last couple years we have decreased, especially since COVID.
Photo by: Sanford Health
Alan Helgeson:
So Mindy, you talked about as it’s kind of gone down, which is good news, but those rates increased during the pandemic. Let’s talk a little bit about that and why that was and what was going on there?
Mindy Broden:
We talk about addiction being a disease of isolation and when the pandemic came, isolation was a huge factor in the increase of alcohol consumption as well as the decrease in activities, which I think Ashley, I’ll reference after a little while here.
But the other part too was liquor stores were essential businesses. They remained open and increasing the amount of people that were drinking at home. So when people drink at home, sometimes they might not be as cognizant of how much they’re consuming or how often they’re consuming as they would be in a social setting like say a bar or a lounge or something, even out to dinner or something. So when working from home, having isolation, possibly boredom, lack of activity, the increase of consumption was the outcome.
Unfortunately for those who have a propensity for drinking, it moved the progress forward much quicker than if they were not isolated. For many, with the lifting of the restrictions and the return to normal life, their drinking did decrease to pre-COVID rates. But for others it began to become a problem, which we’re seeing now, and I suspect that we will still see an uptick in alcohol use disorder diagnosis based on the trends that we’ve been seeing in the treatment setting, kind of as the fallout from the pandemic.
Alan Helgeson:
And then the good news that we’re starting to see things trend downwards, which is again, great news. Ashley, let’s switch to you now. It’s reported that binge drinking rates are highest in the Midwest, which is in Sanford Health’s footprint. Can you speak to that a little bit?
Ashley McMartin:
We find that in the Midwest we’re very rural, right? So we have smaller communities very far apart. I think about, you know, the community of Bemidji that’s just shy of 15,000 is probably one of the bigger cities within a two-and-a-half-hour radius.
And so we have to Mindy’s point about her piece of isolation, we have communities that don’t have a lot going on. So I think sometimes drinking comes as a result of boredom and then it becomes part of the culture. And so we have this combination where alcohol is present at many different events and it just becomes part of what we do and who we are.
We also have in the last couple decades seen this increase in the craft beer and the brewery and the pub idea. And so again, it’s become this trendy, enjoyable social activity. And so it is something that brings people together. And so there’s that delicate balance between engagement and connection, but ensuring that it’s in a healthy venue, and alcohol is typically present at many of the different social activities that we see.
Alan Helgeson:
We do see that as kind of a foundational thing for getting together with the social thing. You go out with friends and you have that – it’s much like food, right? We always have that around and we have it present.
So let’s pop back to you Mindy. Let’s talk about binge drinking for men. What does that look like for men?
Mindy Broden:
Binge drinking for men is actually defined as having more than five drinks on one occasion. And then heavy drinking would be defined as having 15 drinks or more per week. And for women it’s more than four drinks per occasion or eight drinks per week.
The only thing that I would add to that is that back to that cultural context of the Midwest or we talk about with young people, binge drinking is a really common thing. I don’t think if we went out and did a kind of a poll of our college campuses, most people would not think that five drinks was anywhere near a binge. But nationally that is what we identify as binge drinking is five for men and four for women.
Ashley McMartin:
I think it’s important to note, and Mindy correct me if I’m wrong, but like there’s binge drinking and then there’s also what maybe the medical field would suggest as excess. And women shouldn’t drink more than one drink a night and men shouldn’t drink more than two for the health components of things. So she’s mentioning binge drinking and how people would be like, what? Five? No, that’s not binge drinking, but if we talk about just overall health impact, like more than one a day is more than likely having a negative impact on her health.
Mindy Broden:
And our sleep and our emotional wellness and all of those things too. I agree with you Ashley. Like I said, when we talk about this, there’s different kind of schools of thought with it. From a substance use kind of context or perspective, it’s not necessarily how much a person’s drinking. It is how it’s impacting their life.
So we can’t give a substance use diagnosis on how much a person drinks by itself. There has to be other components. It has to be negatively impacting their life in some way. And so a lot of times while we do binge drinking is part of kind of the way that we assess, it also includes is it impacting you emotionally, physically, relationally, socially, employment wise? Because that’s really what determines whether a person’s having a problem.
Alan Helgeson:
Alcohol is a depressant. So then what does that mean for those who might not know? Let’s take that a step further then.
Mindy Broden:
There’s three different drug categories. We have depressants, we have stimulants, and we have hallucinogenics. And alcohol falls into the depressant category and it acts just as the name implies, it slows the central nervous system down, slows breathing, slows heart rate. The challenge is that a lot of people experience what might be called a buzz or euphoria that they feel when they start to drink, but that isn’t because the alcohol isn’t still depressing the central nervous system. It’s because alcohol also impacts the brain, primarily the prefrontal cortex that has to do with judgment and reasoning.
So when that judgment and reasoning is skewed for a person, it gives people the feeling of feeling relaxed, of not caring what other people think. And that is a lot of times the feeling that people look for when they, especially when they’re in social settings.
Alan Helgeson:
So as you talked about that then, how does alcohol affect us emotionally?
Mindy Broden:
When a person usually starts to drink, it enhances positive emotions, decreases anxiety when they’re drinking, but when alcohol begins to wear off, there’s a boomerang effect. So people often will experience heightened anxiety when they are sobering up or when the alcohol’s coming out of their system. Sometimes they might be unable to sleep, have an increase of heart rate, breathing, racing thoughts, worry, et cetera.
As a person’s drinking often continues down the road, they will maybe have more, when I say like heightened emotions, so they might have a little bit of sadness, but then when they drink they might get uncontrollably sad. Or like what Ashley talked about, a lot of the people that we see presenting in crisis situations have maybe alcohol or drugs on board is that will take maybe a little bit of a thought and it just blows it up.
And so somebody might be sad, once they drink, now they’re experiencing suicidal thoughts and because the prefrontal cortex is impacted by this, they now don’t have the reasoning or judgment not to do it. And so that’s a lot of times where Ashley’s service lines will get involved with our patients as well.
Alan Helgeson:
So then let’s switch over to the physical side then Mindy.
Mindy Broden:
Sure. One of the reasons why men can drink more than women is because men have an enzyme in the stomach that starts breaking down alcohol prior to it reaching the large and small intestines. Women don’t have that same enzyme and so women are more greatly impacted because of that, plus usually the weight difference between men and women, muscle mass, all of those things.
But alcohol is broken down through all those various internal mechanisms. But namely the liver’s impacted by alcohol use, especially over time. Long-term effects have resulted in liver failure, kidney problems, stomach, digestive problems, and we often do see that in the medical field as well. The negative impacts of how alcohol is affecting a person physically.
Alan Helgeson:
Mindy, let’s talk next about those warning signs that someone might have a problem with alcohol.
Mindy Broden:
Absolutely. I think some of the of the greatest warning signs are increased use, needing to have drinks more frequently, more often maybe you started with having one to two drinks and now you’re having two to four drinks. That’s usually the first indicator.
Obviously some of the concerns would be use in which it’s physically dangerous. So if you do have a medical condition or driving under the influence, being unable to control drinking blackouts is something we see, especially with binge drinking. Some of the younger crowds possibly would be experiencing blackouts. That’d be a pretty good indicator there could be a problem.
But more than anything we talk about is it impacting your relationships? Are you not being able to fulfill obligations? Change in friend group is a pretty good indicator or you’re not hanging out with friends that used to be really important to you and now your friend group’s changing to people who maybe drink more. Relationship problems due to drinking. Legal problems. Those are some of the first signs that we see that somebody might be having a problem with alcohol.
Alan Helgeson:
So knowing about these warning signs when someone might have a problem with alcohol, we’re hearing a lot these days about sober curious, Dry January and awarenesses about paying attention to maybe overuse of alcohol. Let’s talk about sober curious and what is it Ashley?
Ashley McMartin:
Ironically, Alan, you mentioned at the kickoff that it’s a relatively new term, right? Just in the last couple years and there’s accuracy in that. Sober curious has its roots going back to the late 2010s. That sounds so strange to say, right? The 2010s (laugh).
In 2018, Ruby Warrington wrote a book called “Sober Curious,” sober curiosity. She started a podcast around it, really a millennial push around this content or context of mindful approach to alcohol use. And so what that looks like is being curious or questioning what our alcohol use is having an increased awareness of what our drinking habits look like, maybe taking a break from drinking during certain times, and then doing more sober activities, engaging with others that are taking maybe that sober curious approach.
Mindy Broden:
I would just add one thing too, Ashley, and I absolutely love that answer. The additional piece I think is that there used to be a pretty harsh judgment on people who were maybe practicing sobriety or practicing abstinence, and it was very kind of almost shameful.
And so this shift of the sober curious movement I think has just brought in just a non-judgmental stance of you don’t have to be an alcoholic to go to a meeting or you don’t have to be an alcoholic to practice sobriety. It brought in just a totally different feeling to the idea of choosing not to drink.
Alan Helgeson:
Give us your expert opinion on putting some labels on different things like this in raising these awarenesses.
Mindy Broden:
I think that just these different campaigns that have came out have really done a lot to exactly what you said, raise awareness that these are issues, these are things people are doing, in some ways almost make it popular to maybe practice a month of the year that you’re going to not consume alcohol or use any substances.
But I think that the normalization of it has actually decreased the stigma as well because when you see these different campaigns for different months, I think we have a suicide awareness month, we have, like you said, Dry January, we have a sobriety month, we have all these different things and it just brings more normalcy to it and it gets people talking about it and puts out resources into the communities, which I think are just fantastic to be able to kind of all come around and reduce that stigma and judgment.
Ashley McMartin:
I think it gives permission to, right, like when we talk about the Midwest having higher rates of binge drinking and why that might be, and with it being boredom and part of our culture, sometimes we need permission to be anti-culture.
And so picking maybe a month to say, can we collectively do this or try this, gives people the OK and a reason that if someone’s going to ask, oh, why aren’t you drinking at this event? Someone can say, I’m, well, it’s Dry January and I’m trying my hand at this. It can almost create a ripple effect where it creates greater curiosity around that. Right now we have the chance for someone, our acquaintance to say, tell me more about Dry January and why you would be committed to doing that.
Alan Helgeson:
Well let’s talk more about those specific tips for living a sober or sober curious lifestyle. Ashley, can you share some of those?
Ashley McMartin:
Yes, Alan, great question because as people are listening, maybe they are thinking, how can this even look? What would this even be? And so I oftentimes tell people, find your people, right? If the folks that you’re hanging around aren’t welcoming to the idea of you choosing to be sober curious, maybe it’s an opportunity to branch outside that initial circle that you have and create a wider net or a greater support system that would be willing to say, “Hey, that’s cool. That’s all right. Yeah, like, you know, maybe we’ll keep drinking. But you don’t have to.”
If you are running into people that are tearing you down or continuing to reinforce that you should be, it might be time to look a different direction to find support.
Coping forward is another strategy where maybe you’re working on. I really want to commit to Dry January, but I’m also going to this work event, or I’m going this family birthday party, sports event that I know there will be alcohol at.
And coping forward means that we just plan for that. So how do I want to approach that? Maybe I even practice what I’m going to say to people in the mirror to gain confidence in explaining why I’m not going to be participating in drinking or drinking to the same extent that others might be.
And then the last piece is don’t give up. When we start to change culture, it takes time. And I just recently read that there is a section yellow at the Green Bay Packer stadium and the section yellow is a sober curious or sober section where people go to celebrate the Packers. How incredible, right? Green Bay Packers are an NFL football team, very well decorated. And there are fans that have come together that have said, we want to support a community that doesn’t want alcohol to be part of football. And we can still come and be present around other people that are doing that. We’re also going to support each other. And they have a section, they have a color, they actually hand out pins. That’s one game at a time.
And if you’re familiar with AA, NA, they talk about one day at a time, one hour at a time, one minute at a time, and have laid that over top of football to say one game at a time. And I just think that’s fantastic. And it goes to show how this movement is growing and how it’s impacting people in positive ways.
Mindy Broden:
You know, we look back 40 years even, there was never a non-smoking section in a restaurant and then we started almost like the non-smoking movement. You know, you can’t smoke in any restaurants anymore. And I think about that and how when we look at the kind of trends of people who smoke, that has decreased exponentially because it normalized that not everybody smoked. So that is so cool to kind of usher in the sober curious generation.
Ashley McMartin:
And I don’t remember if you guys recall when smoking was banned from restaurants and bars, there was a huge uproar, right? There was like, people were like, what are we going to do? People aren’t going to go out to eat, they’re not going to do these things.
And then we adjusted, right? And people, some people stepped away from smoking, others made adjustments so that it wasn’t as negatively impacting other people, children, people that didn’t have a choice whether they wanted to inhale secondhand smoke.
And so our culture evolved and I’m hoping with this sober curious movement, we’ll see this continued growth exponentially of people being curious about their use habits.
Alan Helgeson:
Mindy, let’s turn now to younger people like those middle school, high school and college students that maybe try new things. What are a few things to look for in someone that might be going through some of these changes and experiencing those changes with alcohol, and in a harmful way that they may not have previously? And how can we help a person?
Mindy Broden:
That’s a great question and I think something that every parent has struggled with and maybe a lot of different friends have struggled with. If they see some things, I’d say some of the number one things to look for if a person’s having some difficulty is you’re going to see a change in behavior. Might be a lack of interest in the things that they had before. A significant change in friends, sudden drop in grades, sudden drop in friends, all of those things. Kind of that idea of isolation over time, that’s what will happen is that isolation will kind of step in there.
I think one of the hardest things with youth is it’s much more difficult for youth to recognize that there might be a problem, even if someone that is watching them can see that it is. A lot of times youth have kind of that 10 foot tall and bulletproof mentality, not me, I can handle this, this isn’t a problem, this is normal.
And so I always just think communication is the starting point to connection with them, being cautious, not to accuse or shame and so on. Instead, using phrases like, “I’m really concerned for you because this is what I see,” or “Help me understand what this is doing for you.”
One of the greatest challenges with youth is that they’re not likely to experience the significant consequences that maybe somebody that’s further into their use disorder would, and then they also compare themselves to others. And so maybe somebody else was able to drink the same amount but didn’t have the same outcome. Like I said earlier, if a young person is blacking out from using alcohol, that’s always a pretty significant sign that they might need some help.
Alan Helgeson:
Well, as we switch now talking to both of you, which we know are great resources, what other resources does Sanford Health have?
Ashley McMartin:
I think there’s many different starting spots for patients that are receiving care at Sanford or maybe they haven’t ever received care at Sanford. First and foremost, reaching out to your primary care provider and just asking questions and seeing what referrals that they can make for specialized care if you’re concerned about your drinking or really any substance use habits. And that can include things like binge eating, gambling, different addiction habits.
I know oftentimes we think of addiction as just alcohol or drug related, but really we have a wide spectrum of what addiction can look like. Many of our regions have specialty care in the form of behavioral health services, and that can include mental health services, but also substance use disorder services. It might be outpatient, it could be residential, it could be inpatient. And so really kind of getting a good lay of the land of what is close to you or what services are offered virtually.
We’re talking about rural health care, right, where we know that it might be a long drive in and a lot of resources for someone to receive inpatient or in-person care for a substance use disorder. And so also recognizing that we have virtual options that can help support people living anywhere to receive services that might be vitally important to their well-being.
And then the last resource I want to call out that isn’t Sanford specific, but that has been a huge push in the last two years since its rollout in 2022, is the phone number 988. 988 mimics 911 in the sense of when someone is in need of emergency services, whether it be an ambulance or law enforcement, you can call 911 and they will respond. 988 is linked to the national suicide hotline, so someone calling 988 can receive support as it relates to mental health services, mental health crisis, and that includes substance use disorder services as well. This is a national number, so you can call it from any state at any time. It’s answered 24 hours a day. And when people are like, where do I even just start? 988 is a great starting spot.
Alan Helgeson:
Someone listening today that might be struggling with alcohol, those final thoughts to share with them?
Ashley McMartin:
I think we can mirror the one game at a time concept and say, let’s take it a minute at a time. And that’s relative to maybe sobriety, but also trying to figure out what your next steps are. When we have difficulty or a problem present, we don’t have to solve the whole thing today. And so breaking it down into bites that we feel like we can digest is very important. And so what is in the next minute or hour, something that you can do to support yourself?
And then along that same line, don’t hesitate to reach out for services, whether that’s formal or informal. There are many people that want to support you in this process. And hopefully as this sober curious culture shift takes hold, people will find more and more places to connect with others to say, I think I want to change my alcohol use habits.
Mindy Broden:
I was just going to add in addition to that too, and what Ashley said is absolutely accurate, and we do have a lot of resources. But I think sometimes a person might be scared. “Well, maybe I’m not ready to quit. Maybe I just want to cut down,” or whatever. And most places – I can speak specifically for our teams – we really meet patients wherever they’re at.
And so if somebody’s having a problem, they just want to have a conversation about it, or maybe they just want to identify, am I having a problem or what am I getting from it? Or what is it giving to me? Alcohol isn’t prejudiced. It impacts any person, any color, any age, any culture. Some people’s bodies are more primed to have issues of substances than others. That’s a fact.
Like I said before, addiction thrives in isolation. So we have a saying in SUD (Sanford substance use disorder team) that says, you’re only as sick as your secrets. So the number one thing is to talk about it with someone. So just like Ashley says, 988, talk to your primary care provider, case manager if you need to, but just talk to somebody about it. That is the number one thing.
Alan Helgeson:
Well, let’s move on to somebody that may have a loved one, a family member, friend, coworker that is struggling. What would you say to someone that’s listening that might be going through that?
Ashley McMartin:
I think reiterating what Mindy said, that addiction doesn’t discriminate. When we look at supporting people that are experiencing addiction, some of the best ways to do that are to set really healthy boundaries for ourselves as those that aren’t experiencing addiction, to keep ourselves healthy for that other person oftentimes.
And Alcoholics Anonymous even has a parallel group for children of alcoholics because it’s not uncommon for a loved one colleague to feel responsible or like they did something or should have done more to help someone through addiction.
And addiction is just, it’s beast. And it takes many different people, a lot of different connections. And so keeping yourself healthy through self-care and also setting boundaries with that loved one or that colleague is very important. And even though it might feel at times like those boundaries are harsh or that person with that addiction is responding with words that are hurtful, knowing that maintaining those boundaries are extremely important for our own well-being because we can’t help those when we’re ourselves are unwell or struggling.
Alan Helgeson:
Wonderful information that you’ve both shared today. Mindy and Ashley, we so appreciate your time and being part of this podcast and talking about sober curious and living a sober curious lifestyle.
Cassie Alvine:
This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org.
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