Written by: Katie Krauskopf, MD, MPH, Medical Director, Substance Use Disorder Services & Heather Roose, PA-C, Lead Physician Assistant, Outpatient Substance Use Disorder Services
Charles Dickens may not have been referring to the holiday season when he wrote “it was the best of times, it was the worst of times” but for individuals in recovery or with active substance use disorders, this often is the case this time of year. The holidays, as with other stressful times, can provoke relapse or an exacerbation of chronic conditions, including substance use disorders. The season may present for many an increase in social gatherings, or evoke a time of loss, trauma, or sadness leading to heightened isolation for others. With additional stressors – including year-end work pressures, extra family obligations, and financial strain — the holidays can generate a perfect storm, instead of fostering the comfort and joy many of us associate with the season.
As medical professionals in the field of addiction, our patients and their family members, as well as our own family and friends, look to us for advice on how to approach this time of year. Even in a pandemic year, the holidays inevitably draw us in to celebrate the passing year and to ring in a fresh start for the next. In many ways, the approach to the holiday season is not any different from any other time of year. Healthy strategies regarding substance offerings at gatherings, and understanding how to support our loved ones, are essential all year long. What the holidays do present are more opportunities to put these efforts into practice.
As alcohol typically plays a large role in celebrations this time of year, we thought it might be helpful to provide a gentle reminder of the consumption levels that are considered safe. According to the Centers for Disease Control and Prevention, a serving of alcohol is considered: 12 ounces of beer (5% alcohol content), 8 ounces of malt liquor (7% alcohol content). 5 ounces of wine (12% alcohol content). 1.5 ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor such as gin, rum, vodka, whiskey. Two or fewer drinks in a day for men, and one drink or less in a day for women is considered moderate drinking. Five or more drinks on a single occasion for men, or four or more drinks on a single occasion for women, generally within about two hours, is considered binge drinking. Anyone operating a vehicle with alcohol in their system can result in deadly outcomes. We’d like to remind our community that underage drinking is also extremely risky and unhealthy, and that one of the risk factors for developing addiction is exposure to any substance at a young age, in particular less than age 25.
That being said, there are many ways to enjoy our family and holiday gatherings while promoting safe encounters with alcohol and supporting those who prefer to abstain from it. Below we have highlighted a few approaches to consider during upcoming celebrations. Many of these ideas are not ours alone but are widely supported by organizations that address addiction and recovery.
Hosting Healthy Gatherings
The Recovery Research Center estimates that 1 out of 10 people consider themselves to be in recovery. When hosting a party, it is reasonable to assume that several of your guests will not partake in the use of alcohol or other substances. It’s ok to allow alcohol to remain a secondary focus — maintain the primary intent of any gathering on connecting with others and creating positive memories without needing substances.
Other well-considered recommendations involve making decisions about different items that can be served at the event. There are many interesting non-alcoholic beverages on the market today — try to offer equal amounts of non-alcoholic and alcoholic options to ensure there is a wide assortment for your guests. Cannabis products are legal for adults in Massachusetts, and are increasingly present at public functions, but it is easy enough to make your gatherings a non-smoking event. It is also suggested that you avoid serving food items that contain substances, for example baked goods infused with rum or baked with cannabis. If these items are offered, make sure to clearly label them, and let all guests know all of the ingredients.
For those guests who have been open with you about their recovery, feel free to ask them what they would be comfortable with, as well as what they can expect might be served. This may be helpful to support their recovery.
Awareness and Safety
During this time of year, frequent proximity to friends and family may provide a window into concerning behaviors, such as recurrent intoxication, over-sedation such as “nodding off”, or simply not participating or not acting like themselves. In addition, you may observe a person whom you know to be in recovery using substances. These can prove to be challenging circumstances. Safety is clearly a priority for our guests and communities, and you should feel comfortable speaking up when someone is too impaired to drive home, or at risk for serious medical complications. Should you choose to address these behaviors, timing is essential. Generally, it is recommended to address any acute concerns ASAP, and to wait for more involved discussions when the person is calm, safe, and not under the influence, or in a party milieu.
Non-judgmental Discussions About Substance Use
Substance use disorders are chronic medical conditions, like high blood pressure or diabetes, and similarly respond well to appropriate treatment. After the event, when the time feels right and the person you care about is in a comfortable setting, ask if you can check in with them. Reassuring your loved one or friend that you care and presenting the concern without judgement can help set the stage for conversations of this nature. Leave your own emotions out of the discussion and listen. In some cases, you won’t get much farther than expressing your concern and leaving the door open for more support in the future. In other instances, someone may feel relief, and will lean on you for encouragement and possibly help initiating or re-engaging in treatment.
There are numerous resources for supporting people and helping them connect to care. The Substance Abuse and Mental Health Administration website – SAMHSA.gov including an app called “Can We Talk”, is a helpful resource for meaningful conversations about substance use. Even in the holiday season, your local substance use disorder treatment programs are still open: detoxes, outpatient treatment programs and community support programs. In the Commonwealth, the Bureau of Substance Addiction Services is an excellent resource and provides information on all of their licensed treatment programs, (www.mass.gov/orgs/bureau-of-substance-addiction-services). Locally peer-to-peer programs and harm reduction programs, such as Hope for Holyoke, The Northampton Recovery Center, and Tapestry can offer an entry point for individuals ready to take the next step.
This year is certainly unique. The pandemic has impacted all of our well-being and has brought with it an increase in mental health concerns and substance use disorders. The holidays may present a good opportunity to reach out to those you are concerned about. They also offer us all the option to choose to practice healthy gatherings and healthy conversations around substance use. We can take this season of renewal and use it to support healthy communities, those in recovery to sustain their well-being, and for those struggling to take steps to get the care that they deserve.
We wish you peace, hope and good health in 2022.
Katie Krauskopf, MD, MPH, Medical Director, Substance Use Disorder Services
Heather Roose, PA-C, Lead Physician Assistant, Outpatient Substance Use Disorder Services
MiraVista Behavioral Health Center | miravistabhc.care | Holyoke, MA