E75: The Truth About Gray Drinking, A Conversation with Dr. Kara Pepper

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I am joined by Dr. Kara Pepper, a board-certified internist and executive coach specializing in eating disorders. Dr. Pepper will share her personal journey from professional ballet dancing to medicine, her clinical practice focusing on adults, and the importance of addressing mental health among high achievers. We'll dive into the concept of gray drinking, its prevalence, and the health consequences associated with it. Dr. Pepper will discuss the impact of alcohol on cardiac and liver health, the role of stress in high achievers' susceptibility to gray drinking, and how to recognize the signs and symptoms. We'll also explore strategies to normalize non-alcoholic choices in social settings, the rise of non-alcoholic social norms, and how to approach conversations about alcohol use with patients. Finally, Dr. Pepper will provide insights on how to set a positive example for children and ways to reach out for support if needed.

Dr. Kara Pepper is a board-certified Internist and Executive Coach in Atlanta, GA. Dr. Pepper cares for all adults over 18 years of age, especially those with eating disorders. Her hybrid in-person and telemedicine practice is centered around patient autonomy, clinical excellence, compassion, and connection.  In addition to her clinical practice, Dr. Pepper provides executive coaching to organizations and individuals, leads retreats, and speaks nationally on topics surrounding clinician wellness.  Dr. Pepper is the podcast host of "It's Not Just You," stories of survival, humanism, and heroics in medicine.

0:00: Introduction and Welcome
0:28: Dr. Kara Pepper’s Background and Journey
1:39: Specialties and Executive Coaching
1:56: Introduction to Gray Drinking
2:05: Dr. Pepper’s Personal Story with Alcohol
5:05: The Concept and Prevalence of Gray Drinking
8:22: Health Consequences of Alcohol Use
10:24: Impact on Cardiac Health and Liver Health
13:44: Stress and High Achievers’ Susceptibility
15:38: Recognizing Signs and Symptoms
18:10: Setting Examples and Personal Stories
21:00: Normalizing Non-Alcoholic Choices
27:56: How to Reach Dr. Kara Pepper and Closing Remarks

Connect with Dr. Pepper
Linktree: https://linktr.ee/karapeppermd
Instagram: https://www.instagram.com/karapeppermd
Website: https://www.karapeppermd.com/
Podcast: https://www.karapeppermd.com/

Connect with Dr. Reller
My linktree: linktr.ee/kerryrellermd
Podcast website: https://gethealthytbpodcast.buzzsprout.com/
Facebook: https://www.facebook.com/ClearwaterFamily
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Clearwater Family Medicine and Allergy Website: https://sites.google.com/view/clearwaterallergy/home

Subscribe to the Get Healthy Tampa Bay Podcast on Apple podcasts, Spotify, Amazon music, iheartradio, Stitcher, Google Podcasts, Pandora.

Transcript

kerry: 0:28

All right. Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have a very special guest, Dr. Kara Pepper. Welcome to the podcast.

kara: 0:41

Thanks for having me.

kerry: 0:42

Yeah. Thank you so much for coming. I always like to ask everybody, tell us a little bit about who you are and what you do.

kara: 0:48

Well, I am Kara Pepper. I'm a primary care internist, which means I take care of adults. I actually grew up in Florida Pensacola. I went to UF and then Miami for med school. So Florida has long been home, but I'm in Atlanta, Georgia, since I did my training. And although I take care of all adults, a lot of my care is around eating disorder care. And I'm licensed in 18 states, doing telemedicine all over, and then I see people in person here in Atlanta. So, it's a little bit about my clinical practice. Mm hmm.

kerry: 1:14

So you are you licensed in Florida as well. Most, most people, I think when they have their telemedicine license or licensing in Florida, because I think we maybe need more help to give care to everybody. So that's great. Awesome. Okay. So you have a lot of, I guess, niches and specialties. And I understand you're a coach as well. So you coach other clinicians or others, but professionals too.

kara: 1:39

That's right. Yeah.

kerry: 1:41

Awesome. Okay. And you also host a podcast. So we have lots to talk about today, but one thing I wanted to, I don't want to use the phrase, pick your brain about, but one of your specialty things was about gray drinking,

kara: 1:55

Yeah.

kerry: 1:56

And what, what exactly is gray drinking? How does it differ from other patterns of alcohol consumption? And tell me all about it?

kara: 2:05

I'll start by just telling you a story about how I came to be familiar with it and then I'll use that kind of as the example if that's okay with you. I grew up in Florida like I mentioned, I was a professional ballet dancer before I went into medicine. So I had all this perfectionism and workaholism that followed me into healthcare, and I looked really good on paper, but really felt like I was failing and not keeping up. Lots of imposter syndrome, like many of our female colleagues struggle with. And so I think the pattern of behavior I had personally around alcohol was You know, something I did on the weekends, I went to University of Florida, so partied and did that type of thing, but really it wasn't something that impacted my life and work felt very important to protect, so I never had any functional issues. It was really confined to like Fridays and Saturdays and that's pretty much the pattern that I had through my adult life. And then the pandemic happened, as the story goes for many of us. And I was in my COVID bubble and we'd get together and let the kids run around and people sit around and drink and watch football and this pattern of like accelerating drinking and more specifically, like, I just wanted to kind of detach. I wanted to pull off, turn off my brain. I want to have some escape from what's happening. The intensity and frequency of drinking kind of increased. I drink more on Fridays and Saturday nights. But it was certainly not impacting my work and if you would have asked me, what my drug of choice was, I would have told you it was work because that was a place where I could feel really productive but not actually have to like feel my feelings. I could just take care of patients. And so I tell you that because they're really one in the same. the things that we do to try to avoid feeling or kind of check out, whether it's overworking or over shopping or over drinking or avoidance, it's all kind of hardwired in our brain in the same place. And ultimately I decided in November of 2021 to quit drinking after this kind of infamous trip to Mexico, where. I remember three out of the six days that I was there because I was just having a good time. I didn't come back with a tattoo or an STD. There was no big rock bottom moment for me. I just said, this is actually sucking my joy and that's not okay with me. And so I tell you that because gray drinking is Not a diagnosis of alcohol use disorder or substance use disorder. But it's this spectrum between teetotaling and a diagnosis where so many of us live. They think about a third of adults live in that space. Where maybe you're binge drinking or maybe you're drinking more frequently. And there's no rock bottom. There's no big moment where you say, Oh man, I'm having consequences. You look around and think, well, everyone else is drinking as much as I am. So, you know, just live a little, stop worrying about it. But it's this persistent worry that like, is this too much? And I, as an actual doctor was like Googling, like how much alcohol is too much? And like, that is a pro tip. If you're worried about your drinking, regardless of how much it is, like, That's information. So it's this gray spectrum of increased alcohol use that doesn't meet diagnostic criteria, but may increase your risk, well, it will increase your risk for having a problem later on. And so it's this kind of silent epidemic that we've just normalized in America and in healthcare.

kerry: 5:05

Oh, I definitely agree that we've definitely normalized it. There's always like social memes about it. You know, you can buy your wine glass with a little, like another meme or type thing on it as well.

kara: 5:18

that's right.

kerry: 5:18

So I wasn't expecting you to give a personal story, but I think that's so much more relatable. And also it's, you also weren't saying that you went to a doctor and they said your liver enzymes weren't elevated, right? This is just something where you thought. This is too much. So I think a lot of people can relate to that. And I mean, I spent time in college and things like that, which I probably was very similar growing up and that was the social norm. I honestly think some of the younger people growing up now are not quite doing these things that we might've done in our youth, which I find it very interesting as well. But this gray, this gray area is probably where the whole I guess name of gray drinking came up from. So how prevalent do you think it is and kind of what demographic is most affected by it?

kara: 6:06

Yeah. So we know that alcohol use disorder, you know, people who meet criteria, it's about one in 10 Americans, depending on the population that you're looking at, but this high risk behavior, like the gray area, as we call it, where you're between worry and just live a little, may have some blackouts, but it's not impairing your function, doesn't look like a problem to outside people that's, they think it's probably around 30%, particularly in women, and we have just totally normalized that, like, Not just, you know, in mommy wine culture and like, hey, let's have a glass of wine at the end of the week. I mean, if you've ever gone to any social engagement, the first thing most people ask is, what can I get you to drink? But I will say, even for us in healthcare, you know, we are taught these kind of rules about what's too much, and I'm happy to kind of go through what we consider normal, quote, normal amount. You know, it's 14 drinks per week for a man and 7 for a woman. And no more than three to four at a time for women or five for men. But if you think about like an average football Sunday, I mean, that's like pretty standard. I think most people who are going to be at a party for at least the circles that I was traveling with, you know, that's not uncommon. And so when patients would come to me and they'd be like what do you think of this? Those were kind of the rules that I had, but I wasn't really thinking about what's the underlying question. Like they're worried about their drinking, even if it doesn't meet those rules, or maybe they're starting to see some fatigue or they're irritable or they're not showing up for their family the way they want to. And they're kind of worried about it. And many countries outside of America are now saying the right amount is zero. There is no safe level of alcohol, but culturally in America, we just accept this as normal. And I will say medically, and I know you know this, that alcohol is a known carcinogen. It causes head and neck cancer. esophageal cancer, gastric cancer, liver cancer, breast cancer, colon cancer. And what is so wild to me is like, we would never have like a skin cancer screening at the beach on a sunny day. That would just be weird. We'd say that's probably sending the wrong message, but you will absolutely go to breast cancer fundraisers and have wine there. And so there's a real cognitive gap, I think, between what we consider like, Oh, it's just what we do and the reality of how alcohol is impacting our body. And we're not. giving our patients that information to make decisions around.

kerry: 8:22

Yeah. So you mentioned cancer as a possible long term health consequence. Any others?

kara: 8:28

Yeah. Thanks for asking. We're winking at each other through the, through the mics. Yeah, of course there's plenty, right? So like dementia, which is one in eight, and certainly, you know, 15 percent of people over 70, 30 percent of people over 80, it's a huge risk factor for dementia and nerve problems in your it certainly can increase your risk of heart issues, arrhythmias, and heart failure. So when we look at like the number one reasons why people die in America, heart disease, yes, alcohol can contribute. Cancer, yes, alcohol can contribute. Dementia, which is an epidemic, yes, it can contribute. So those are just to name a few. And I don't think that we're really telling patients like, Oh, did you know even modest amounts of alcohol can contribute. can create these problems, in addition to the other things like car accidents and depression and anxiety. And we as primary care physicians see patients who are not feeling great all the time, and I don't find that that's a primary recommendation. Did you know That alcohol you're drinking, even just Friday and Saturday, is probably contributing to your anxiety and depression during the week. So, there's a lot there.

kerry: 9:25

Yeah. Absolutely. And I think obviously some people, not only is it contributing to anxiety and depression, but some people use that as their substance of choice to help mitigate anxiety and depression. I think that only, you know, circles the problem kind of even further along, which isn't not, it's not good. Yeah. But you mentioned cardiac health arrhythmias. I mean, I definitely see patients coming in, you know, holiday heart syndrome, right? Yeah. It's like one of the taglines of that you see, usually it's a fib, like atrial fibrillation. They're coming in with an abnormal heart rhythm, usually really fast. And, you know, they're having all symptoms of chest palpitations, shortness of breath, maybe some sweating. And, you know, they might've had a. I would I might define it as a quote binge drinking episode, which is probably more than you like what you said. I think you said five for men at a time. Yeah, but you know, they might not define it as that right. But that can still, you know, cause these kind of side effects and problems to happen. It's pretty actually scary, right?

kara: 10:24

Yeah, we call it holiday heart because traditionally people are enjoying themselves and imbibing on at holidays. It doesn't have to just happen on the holidays, but it's after an episode of drinking. Yeah.

kerry: 10:33

Yeah, exactly. You know, it's interesting because I had some patients who were coming in just regular lab work. And then I do see those elevated liver enzymes because we know that alcohol is processed, you know, in the liver, right. And it's an acute toxicity to the liver. And I am like, well, what happened? Like they made me to finish it on vacation or something like that. And I see those elevated liver enzymes. Luckily I do a little counseling and we repeat them and they're actually okay. In some cases, you know, most cases, but you know, I often talk about sugar being a toxic thing to the liver and a more chronic aspect. So this kind of like, kind of similar to that approach, but this is, you know, I think any food substance is bad. Or any substance, I should say, and things that you were talking about before we got on this call are things that people are kind of over doing. Right. So you're you can overdo the alcohol. You can overdo the sugar. And, I mean, I think you might maybe later on, we're going to relate it back to overdoing other things as well. Right. Are there any common causes or triggers for this? Do you think or might have kind of already run over that? But.

kara: 11:42

Yeah. I mean, we know for, you know, alcohol is the third most addictive chemical chemical in the world. So, you know, for us I think that we're not going to enjoy it on some level, I think is foolish. And so risk factors, certainly for alcohol use or alcohol overuse, you know, there's genetic factors. It certainly can run in families. There's environmental cues. We know in certain countries where alcohol is more prevalent, you'll see higher risks or higher rates of alcohol use disorder. There's environmental factors like socioeconomic factors and you What we call ACEs, you know, Adverse Childhood Experiences. The stress in childhood absolutely can increase your risk for alcohol use disorder as we grow up. And then there's just the cultural norm, I think, which is just like, this is what happens. I mean, I've had patients, I'm like, I'm really worried about your drinking, and they'll say, Well, look, like, I'm in sales. Like, I can't not drink when I go out with a client. And I would question whether that's really true or not, but it certainly is culturally, and in many circles felt to just be really normal. That's just what you do. It's what you have to do. So anyway, we're trying to just connect the dots very often for patients to say these are the things I will say for your non clinician listeners. If many people say, well, I got a free pass because my liver enzymes were normal when I went for my physical, it's usually the binge drinking that will cause that acute liver function test abnormality. But for folks who are drinking pretty regularly, our bodies are amazing at trying to achieve homeostasis. And so very often for people who are drinking regularly, their liver is kind of adapted and processing the alcohol, not to mean that it's doing it well, but the liver enzymes will look normal on the labs, even if people are drinking on a regular basis. So it's not a free pass. That's

kerry: 13:19

Yeah, that's a really good point too. And they could even have some like fibrosis or other problems with the liver, even if the liver enzymes are normal. Yeah. That's a really good point. Yeah. So I guess just how would you say that stress plays a role in this whole like gray drinking thing with among professionals and high achievers? Like, do you think that they're more susceptible or what would you say?

kara: 13:44

I think there's several things. We know that there is an epidemic of loneliness. Our Surgeon General has written a book about it. It's really his kind of campaign. And so loneliness certainly increases people's mental health concerns, depression, anxiety. But interestingly, loneliness they think is just as lethal as cardiovascular disease, not because people are dying by suicide, but because it has created this pandemic. On a molecular level, some issues with the vascular system that increase risk of death. Anyway, our mental health crisis, particularly in the wake of COVID, is really high right now. And so people are finding efficient, effective ways to feel better. And if opening a bottle of wine at the end of the day is accessible, a lot of people are doing that. So there's that piece. I definitely think that, particularly when we look at physician women specifically, like actually the risk of alcohol use disorder is higher than 1 in 10. I think it's closer to like 20%. Two and one and five. So for folks who are under chronic stress and high functioning stress and don't have a lot of bandwidth in their life, their risk of alcohol use can increase as well. So it doesn't discriminate. I'll just leave it at that. It can affect every gender, every socioeconomic class. every profession and because it's just so acceptable in our society. And so I'm just talking about some personal experiences on purpose because there is so much shame around drinking. Like if I admit that I'm worried about my drinking, then that may be, that may mean I have a problem. And it's totally fine to just say, I'm not comfortable with this and I want to try to find a way forward. We can talk about that if you like.

kerry: 15:17

Yeah. I mean, that's definitely an important thing to note. Like if you're not comfortable, you have to, you know, find somebody that you're willing to, I guess, bring it up with as well. So how does someone, you know, Think that maybe, okay, I might be in this gray drinking area. How do I bring it up? What are signs or symptoms I'm looking for to be like watching out for it?

kara: 15:38

Yeah. So the gray drinking. I'll just kind of go through what we think that is, and then what I would tell you is helpful with that as well. Like, gray drinking is, again, not clinical criteria for alcohol use disorder, but there's no rock bottom. It's like, not a drinking problem, but you have a problem with your drinking, if you will. You want to stop drinking, and maybe you've done dry January. But you always kind of end up going back to what you were drinking before. Like, Oh, I took a break and now I'm back at it. You kind of vacillate between like worrying and just living a little. You may have some blackouts, but it's not impairing you in terms of a DUI or impairment at work. So it's in that, that behavior. And so my first, I guess I have two pieces of advice. One is if there is even a small part of you, that's like, Maybe I should drink less. Just listen. There may be a thousand reasons why you don't want to do that, but there's a part of you that's a little worried. So just acknowledging, even if that's privately, that this is something on your mind I think is a great first step because we often want to just shove it under the rug and not acknowledge it. And then the second would be, what would it take to just not drink for the next four weeks? Like, what does that even bring up in the thought of that? You know, does it feel embarrassing? How are you going to tell the people around you? Does it feel really scary? Just acknowledging what that experience might be like, and then practicing. What would it be like to stop drinking for four weeks? And if you cannot wait till the end of four weeks to, to pick it back up again, that's information. Like, wow, there's really something that's going on. Do I have anxiety? Do I have depression? Do I have social pressures? Like, what is Encouraging me to get back at it. And just, you never know what hangs in the balance of these decisions. I'll just tell you again, you know, once I quit drinking, which there's a lot more detail to that story, but once I did, it's opened a conversation with my teenage kids that I don't know that I would have had the credibility to have before this both of my kids have ADHD and we know that half of kids with ADHD have substance use issues. And so for me to kind of lead by saying you have a brain that's primed for addiction and I recognized that I was having a problem and I wanted to quit and my son will now tell you these stories like, Oh, remember that time you're on vacation and you were being silly and whatever, like our kids know. And I think many parents worry about what hangs in the balance for their children. And your decision to, to maybe get sober for four weeks may open up conversations that you don't even know you could be having as a great parent for your kids and leading by example with them. So if not for you, it's okay to do it for someone else.

kerry: 18:10

Yeah, I love that. I think that's super important. Like setting an example. I liked your comment about dry January because people always like them to start over. You had your New Year's Eve party. And then, you know, the next day january comes and they kind of use that as a stepping stone. So I think it's a great opportunity to do that. But like you pointed out, that could be any four weeks of the year to do right. Yeah, absolutely. So you mentioned well, one thing I wanted to comment on was the loneliness. So you mentioned how it was like a risk factor for some things and maybe even like shorter lifespan or medical problem. Well, it's funny because like all the longevity studies say the exact opposite, right? That all the people with social support and everything tend to live longer. So I think that was a really interesting thing. I just wanted to comment

kara: 18:56

Yeah.

kerry: 18:57

And then you also said something the brain is primed for addiction, So what Other like patterns or things could be going on with someone who's kind of already quote primed for these habits.

kara: 19:11

Say more about your question. I want to

kerry: 19:13

Well, are they going to be substituting one thing for another? Like if they stop drinking, like what are the fears of what could be happening and things like that?

kara: 19:21

Yeah. So often, um, and as I mentioned, I may have mentioned that, you know, 90 percent of my, my clinical practice is eating disorder care. And so I see that I think even in that, that patient population where when you're trying to let go of one thing that's not serving you, it can sometimes feel like whack a mole. So you may quit drinking. But then you may realize that you're having increased cravings for sugar, for example, or like you say, okay, great. I'm going to give up alcohol and I'm going to watch my sugar intake. But now I'm finding that I'm just like really antsy. And I'm like finding all this busy work to do. And I'm just busy all the time. Like, or maybe I'm like doing more window shopping all of a sudden. And I'm like more Amazon boxes are showing up at my house. We as humans do things that either make us feel better or avoid feeling bad. And without getting into like the. You know, neurotransmitters in our, in our brain. I mean, the truth is like we all want to try to feel better. And so if alcohol is at least temporarily relieving some anxiety, even though it's absolutely contributing to your anxiety, you may find that it's going to show you're going to find other solutions for that problem. So that is also information. If you're like, great, I'm sober. But now all of a sudden I'm, you know, doing, doing something else. It's worth just noting and solving for the underlying problem.

kerry: 20:36

mentioned I guess how anxiety gets better with alcohol. Some people often mistake that their sleep gets better with alcohol. Why? Because they can fall asleep pretty quick. But the problem is, is the sleep, you know, restorative process is Terrible. Like you're usually they're tossing and turning and they're not getting good sleep. It's just that they were able to fall asleep easier. So usually that's something I really bring up and make sure that they're not doing if we're talking about sleep as well. So that's

kara: 21:00

yes, because as the alcohol gets metabolized, it causes this rebound effect. And so that's one of the, there's many reasons why I decided to quit. But one of those was that I was like having all this sleep problems and I was like, Oh, I'm probably just perimenopausal. It's probably all this stuff. And once I quit drinking, my sleep is like rock solid because I wasn't having that like early, like, 2 or 3 a. m. wakening. And like I mentioned, I was only drinking Fridays and Saturdays, but I was, like, recovering through the week from those, like, two really bad nights of sleep. And so, I just thought, Oh, I just have insomnia. But in fact, it was just the alcohol.

kerry: 21:34

Yeah. Well, I will share a little bit of my journey, I guess, with the alcohol. Like I said, you know, I went to in college, we definitely had fun. And then even maybe in And then my migraines started getting out of control. So I think, I mean, I get migraines for many reasons. I still do, but like that was definitely one that would put it over the top and I'd have to use injectable medicines to survive from that. So I kind of stopped for that reason. And then, you know, I had I was pregnant for like the last 10 years of nursing or something. So that was always a good excuse. Right? So, Oh, I'm not drinking. Oh, it just gives me a headache or, you know, or I'm nursing or whatever. So I always had that nice excuse, but how do we move forward and create like the social norm of, you know, it being okay, not to have alcohol at every event or say, Oh no, I don't need that. So how do we make that. How do we move forward and making it more normal?

kara: 22:29

Yeah. So several things, like one is if you are someone who is trying dry January or your next four weeks, I think pre planning and having some, some comebacks, if you will, like, Oh, I'm just doing dry January. I want to do that for my health or, Oh, I'm taking a break or, Oh, cause you may not want to disclose that you're pregnant, for example, like, Oh, I'm doing it in support of a friend who's also getting sober. Like you, you don't even have to like own it for yourself, but I think having some. Pre planned things, especially if it's a high pressure environment that you're used to drinking in. I think coming prepared with non alcoholic beverages to a party is also really helpful, or if you're hosting an engagement, to have something besides water there. We can just normalize that not everyone wants to drink alcohol or water. But And then I think the more that we just get curious about it, like, what does it mean and talking about this socially, it's not this big stigmatized thing. I think people talk about their blood pressure, they talk about their diet, they talk about their exercise patterns, but somehow alcohol feels like a kind of a no go. We can't talk about, oh, I I don't really like what it does for me. So I think the more that we just normalize these conversations, especially for those of us in health care with our patients, then that can be really helpful. And I think really knowing your why behind any behavioral change, whether you're trying to start a new exercise program or quit drinking, really kind of tapping into that thing that matters most to you is really important because we often will have these big goals like, I want to be healthy. which is nice, but that doesn't really mean anything. But if you're like, I have got to stop drinking because I'm so worried that I'm going to end up with dementia like my mom, like that feels a lot more personal, a lot more immediate, a lot more tangible. And so really tapping into something that feels meaningful to you can really help you stay motivated. And as an aside, I personally had done dry January many years. In fact, the first six months of COVID, I did not drink for six whole months. And the fact that eventually I would always kind of return to my Friday and Saturday patterns when 2021 came around for me and I decided to quit. I knew that I needed to quit permanently because I had quit so many times in the past. We say on average, you know, it takes quitting smoking seven times before you actually quit smoking. It's no different with alcohol. So even if you quit for four weeks and go back, that's information in your back pocket that you can use later if and when you decide this is actually not serving me, I want to quit for good.

kerry: 24:56

Yeah, you have to have that. Why? I mean, even like you mentioned, like the, for the kids example or something like that, I think that's really important. And obviously if you keep bringing it up and trying to quit, like clearly there's a pattern there that you want to not be reintroducing it. I think that's great that you were able to find that. How do you help patients do the same?

kara: 25:17

I just, again, normalized this conversation, like, hey, you seem like you're under a lot of stress. A lot of people who are in your situation are finding ways to feel better. What does that look like for you? And that will open a door to all kinds of things that I may not have expected. I asked very directly, tell me about your relationship with alcohol. What's that like? Do you ever worry about it? And that question, do you ever worry about your drinking, is, I think, so much more indicative than anything else that we could ever ask our patients because that really kind of gets into the stages of change. Anyone who's coming in for any mental health disorder, I will tell them, like, this is a chemical that's causing, you know, imbalances in your brain, and I think getting into a place of sobriety, at least temporarily, is going to be really helpful for your mood. And just kind of talking very candidly, I mean, you know, you may have a lot of women patients, just like I do, and, you know, people are seeing me for breast cancer prevention, and they're so worried about breast cancer, I'm like, have you thought about quitting drinking? Like, you're doing all the stuff to try to prevent cancer, like, have you thought about not drinking alcohol? So just naming it neutrally without shame and being open ended, I think, can be very helpful for our patients

kerry: 26:20

Yeah, that's a great, great, great point. Obviously tying it back into the health risks as well. You know, it's funny, there is a new, I want to call it a bar, but I don't know what they're calling themselves bar in like St. Pete area. That, They're not providing alcohol, but they have some sort of fun thing. Yeah. It's like a mocktail thing, which I think is a really neat thing. They're trying to make a new social norm for that. I wish I remember the name of the bar. I'll have to look them up and link them to here or something and recommend it, but I haven't been, but yeah, I thought it was a really neat concept that I think things are turning a point really for some we're creating a social norm, which I think is good. Yeah. Yeah. And obviously in the doctor's office, we should be not stigmatizing and obviously just keeping an open mind. Great. Is there anything else that you'd like to add on this topic?

kara: 27:09

No, I, I think, well, yes, one is you and I are talking about alcohol, but this can happen for any kind of escapist behavior. I mean, THC is legal in Florida. It's medically get a medical card, I think, for,

kerry: 27:21

easily. Yeah.

kara: 27:22

yeah. So you know, if you are having similar thoughts about THC use, Like, it doesn't actually matter what the substance is, it can be any other habit or behavior. It can be, like, smoking, it can be over shopping, it can be, you know, overworking. Any of these behaviors can, can be part of that. So you can substitute your behavior in for alcohol and just listen to this podcast with that reflection. And ultimately just having some compassion that our amazing brains are trying to make us feel better at all times. And so this may be something that's no longer serving you.

kerry: 27:51

Yeah. And how can they reach out to you if they want some help on that?

kara: 27:56

Yeah, so if you can remember my name, which is Kara with a K, K A R A, last name Pepper. Yes, I'm Dr. Pepper so karapeppermd. com is my website, and you can find me there.

kerry: 28:07

I didn't even think about it until you said it, but I do love it. There's a personal story behind it. I'm not going to share. That's really funny. Okay. I'm sorry. Well, yeah, thank you so much for joining us on the podcast. We will put all the links to socials and things like that in our show notes. And I mean, I'm, this has been such an enlightening conversation and I'm glad that I know what great drinking is now, so I can bring it up with patients and anybody else and try to make everything seem more normalized. So I think that's great. I really appreciate it.

kara: 28:39

Thanks for having me.