The silent crisis of alcohol and women's liver disease

Originally released on August 4th, 2022

Deaths from alcohol-related liver disease are rising sharply among women. Today's guest, Dr. Jessica Mellinger, a liver specialist at the University of Michigan, has witnessed a 60% increase in waitlisting and transplants for patients with alcoholic hepatitis. She's on a mission to raise awareness about the true definition of moderate drinking in hopes of reversing this deadly trend. You might be surprised at how small amounts of alcohol can have significant adverse health impacts, especially for women.

Transcript

[00:00:00] Dr. Jessica Mellinger: the alcohol related liver disease rates had gone up fairly dramatically, that we had 60 percent increases in waitlisting and transplants for patients with alcoholic hepatitis. Yeah. Um, 60%. 

 (MUSIC UP) 

[00:00:13] Angela Kennecke: With the number of women suffering from alcohol related liver disease rising sharply, we want to reshare an episode on this crucial topic. Dr. Jessica Mellinger, a liver specialist at the University of Michigan, is on a mission to raise awareness about what moderate drinking really means in hopes of turning this deadly trend around.

[00:00:34] Dr. Jessica Mellinger: Women are starting to kind of. Pick up the pace and they're starting to drink kind of more like men. I think there is an kind of an erroneous assumption that it's okay to drink that wine is fine. And, you know, no matter how much wine you're drinking, it's okay.

 (MUSIC UP AND OUT) 

[00:00:48] Angela Kennecke: I'm Angela Kennecke. Welcome to Grieving Out Loud. Historically, alcohol use disorder has disproportionately affected men, but recent data from the Centers of Disease Control and Prevention shows that rates among women are rising much more rapidly. We hope today's episode will shed light on this preventable crisis.

 (MUSIC TRANSITION) 

[00:01:07] Angela Kennecke: Well, Dr. Mellinger, thank you so much for joining me for this episode of the podcast. And it's a little bit different. A lot of times on my podcast, we talk about. You know, family members struggling with someone who's addicted, especially to substances such as meth or opioids, or we talk about people who've lost people through addiction.

But now we're going to talk about women and alcohol, which I think is just a, first of all, it's a huge market out there. Um, alcohol companies are marketing to women and I see almost all the women around me drinking on a pretty consistent basis. I'm 

[00:01:43] Dr. Jessica Mellinger: Absolutely. Well, thanks so much for having me on. I appreciate you, you know, shedding some more light on this topic and, and, you know, helping people understand kind of what a, what a problem this is becoming for many women in the U S too.

[00:01:54] Angela Kennecke: Well, let's talk about just the whole idea that it's such a big part of our culture now, especially for women and I think wine and maybe mixed drinks too, but especially wine. Uh, I see that with my own peer group. Like if we go out, we're going to have wine and maybe it's something that I've seen. people that I know drinking quite a bit of wine during the week.

Is that typical now in society, do you think? 

[00:02:20] Dr. Jessica Mellinger: Well, certainly just the trends overall for drinking in general have been increasing for years and, and, but they've been increasing a bit more sharply for women. Um, and we've been seeing this for, you know, 15, 20 years now where the, the bulk of people who drink are still men, the majority.

But when you look at the rate of increase, like who's drinking heavily, 

women are starting to kind of. Pick up the pace and 

they're, 

they're starting to drink kind of more like men. 

Um, 

I think there is an kind of an erroneous assumption that it's okay to drink that wine is fine. And, you know, no matter how much wine you're drinking, it's okay.

Um, because it's, you know, viewed as, I think we have views of what someone with an alcohol use problem looks like. And it's not It's not a woman with a glass of wine, right? Like that's not the vision that we have in our head of somebody who has an addiction or who has an alcohol addiction or what we call an alcohol use disorder now in, in, um, addiction research.

And so it can be. easier to overlook perhaps when that one glass of wine turns into two, turns into three, turns into the bottle, turns into a couple of bottles. You know, there's messaging around wine that it's healthy, right? That it's good for your heart. Red wine 

[00:03:30] Angela Kennecke: especially, right? Exactly, yeah. There's a lot of, there's 

[00:03:32] Dr. Jessica Mellinger: a lot of messaging around that and I think there's just a lot of, a lot of messaging and, and, uh, advertising targeted towards women to promote drinking and especially drinking of wine as.

Just what women do to, uh, connect with other women, you know, uh, to, you know, connect with your friends, to, to have wind down Wednesdays, you know, so rosé all day, those kinds of things that, that really normalize the idea of drinking, you know, kind of all the time and drinking for, to be more sociable, drinking to put up with or cope with the stresses of being a woman, the stresses of being a mom.

You know, you'll see, you know, this is mommy juice and, and kind of tongue in cheek references to, uh, you know, wine is cheaper than therapy and kind of some of these, you know, funny, quasi funny, not really funny taglines that you might see on social media, but that serve over time to really normalize the idea of drinking in larger, larger amounts for reasons that are, that are totally unrelated to what alcohol should be used for.

[00:04:34] Angela Kennecke: So let's talk about what is considered. Well, I have a whole bunch of questions for you. First of all, the idea that wine is healthy. The idea that red wine is healthy, I think is, in my opinion, from the research I've read is a bit of a misnomer. Like you'd have to take, you'd have to have a lot of wine. I mean, to get the benefits.

of red wine, but then you have the down part about alcohol, you know, that on your system. So is it healthy or not? 

[00:04:59] Dr. Jessica Mellinger: Well, I think the data is very mixed. And so there has been some data that has suggested that wine, especially red wine can be beneficial for cardiovascular disease. That data is being questioned by kind of, greater and greater studies that are showing that in fact maybe that isn't true, um, and that also take into account the other risks of alcohol use.

So if you just look in isolation at cardiovascular disease, you're going to miss, you know, all the downsides of drinking, which could include getting liver disease, you know, kind of my area of specialty, you know. Um, cancers, alcohol use is associated with a whole host of cancers. Um, so, and then the, the kind of associated mental health issues that can happen, um, along with that, that, that, you know, increased depression, increased anxiety, insomnia problems.

Um, alcohol has a lot of downsides to it, and so I think that the, the overall message that, you know, wine is healthy is really starting to be questioned by many, you know, by many studies. Um, certainly in my clinic with, for patients with liver disease, um, it's not healthy. It's not something that, you know, we obviously want anyone with liver disease to be consuming because alcohol is alcohol, no matter how it, how it comes into your body.

[00:06:07] Angela Kennecke: Right, right. It, whether it's vodka or wine or whatever it is, at what point, um, are people at risk for liver disease? 

[00:06:16] Dr. Jessica Mellinger: So it, it depends. So there's some differences in, I think, probably one of the biggest, the biggest factors that can influence, you know, how much is too much is if you're a man or a woman. Um, when we think about the NIAAA or the National Association for the Study of Alcohol here in the U.

S. through the, the NIH, which is the National Institutes of Health, their a safe level of alcohol for people who don't have an alcohol use problem, who don't have liver disease, who don't have medical issues from alcohol is 

[00:06:48] Angela Kennecke: no more than one drink a day for women or two drinks a day for men. And then that raises the question of what is a drink, right?

So, it's one drink is about four ounces of wine. So that would fill up really only the bottom, right? You think about a typical 

wine glass. And so, you know, if I'm going to fill up a wine glass, I'll fill it up about halfway full. which is two servings, right? 

Probably two servings. Yeah. 

[00:07:11] Dr. Jessica Mellinger: And then one shot is one serving.

One standard 12 ounce can of beer is one serving. Uh, and that's of, that's of, you know, the typical kind of percentage of alcohols that we have had in the past. A lot of the newer IPAs and the, and the, and the microbrews and so forth have actually a higher concentration of alcohol in them. So you may have a beer, one serving of one of those more highly concentrated alcohol drinks and be getting two, three or more.

you know, servings of alcohol in that. So for women, for a variety of reasons, um, our body size, largely how we process alcohol, where the enzymes to process alcohol are in our body, and how many of them there are, how much of them there are in our stomachs and in our livers. We can't drink as much as men and about half as much as as men before we start to see the consequences.

So if you, from a liver disease standpoint, let's say, if you drink heavily, you know, more than three, more than two or three drinks per day for several weeks, you will get fatty liver from that. So there will be fat accumulated in your liver and like 90 percent of people will get that. Now, if you stop drinking, that can go away, that can get better.

Um, so when I drive through, you know, the University of Michigan down here around fall and I see, you know, the flurry of red solo cups and everybody's drinking and all the kids are drinking, probably all are getting fatty liver. Um, a proportion of those people, yeah, a proportion about. a quarter to a third.

If they keep drinking heavily, we'll go on to get inflammation in the liver. And then a proportion of those, you can think of about a quarter to a third, will go on to get scarring that can become cirrhosis. And that's what cirrhosis is, is essentially just a lot of scar tissue that has accumulated in that liver, usually over many years.

[00:08:57] Angela Kennecke: Because the alcohol is like rough on the liver, right? I mean, it inflames it, it irritates it, and causes the scars. Yeah, it's kind of just like you get 

[00:09:05] Dr. Jessica Mellinger: a cut on your hand and it gets inflamed, you get a scar. Same thing happens in your liver with alcohol. 

[00:09:10] Angela Kennecke: Are there symptoms of having a fatty, how do you know if you have a fatty liver or not?

If you've, you know, been drinking with, you know, a couple of drinks every day, two, three drinks every day, how do you know? 

[00:09:22] Dr. Jessica Mellinger: You probably won't know. You won't feel it at all. So fatty liver is, is really essentially silent clinically. Um, we pick it up, with ultrasounds imaging, we might see it or with liver enzyme elevation.

So we, if we check your blood, uh, blood tests and we see that your liver looks a little irritated, maybe your liver enzymes are up, um, that could signal us to go look for it. And then we can see it, you know, on some of our imaging techniques, but you won't feel it. Like you don't really feel anything. 

[00:09:49] Angela Kennecke: So it's not until the disease progresses.

Yeah, 

[00:09:53] Dr. Jessica Mellinger: and if you're feeling symptoms of liver disease, you're at an end stage, you're at a later stage of liver disease. So by the time someone is feeling, you know, the classic symptoms of liver disease that you would see or notice would be yellow eyes or yellow skin. Maybe your belly swells up with fluid and you look pregnant, um, or you bleed, you vomit blood, you have, you know, you're passing a lot of blood through your stool because of bleeding in your esophagus.

That's, that, the cirrhosis is there, it's been there, and now you're kind of at a, at a more, at a later stage, um, once you're developing symptoms. So it becomes really crucial for us to, you know, figure out ways to, uh, find this earlier and help people stop drinking so that we can reverse some of that liver disease before people get to the stage of feeling it.

[00:10:37] Angela Kennecke: Right. Can it, you know, I know there's, uh, there's a difference between someone who's suffering from substance use disorder and someone who may just, this may just be their lifestyle, right? Or they may, um, just look at it from, or maybe be psychologically, um, unable to stop because there's a relaxation effect to wine.

There's, um, it's can be a habit. Um, what's, how do you know if maybe if you have a problem versus, you know, You know, you just like to have wine every once in a while or beer or whatever it might be. I'm saying wine because that's what I like and I don't drink that much of it, but I try to limit it to like three to four times a week, one glass, and that might be too much.

Maybe. I don't know. 

[00:11:20] Dr. Jessica Mellinger: Well, I think if you start to, if you're asking yourself, oftentimes what I'm, what I'm hearing is if people are asking themselves the question, am I drinking too much? You know, you might be. You know, if, if you're, if it's occurring to you that you might be drinking too much, you know, or for some of these reasons, like, you know, you can't have a, you can't relax at night without it now, you know, you're, you're using it to get to sleep every single night, you know, you're trying to cut back, but it's hard to do that.

Um, if you are starting to feel guilty about your drinking, if you're needing an eye opener when you get up in the morning, you know, to get yourself 

[00:11:52] Angela Kennecke: coffee. Coffee, is that an 

[00:11:56] Dr. Jessica Mellinger: eyeopener? No, no alcohol. Yeah, a drink. Okay. So I dunno that term . Yeah. Eye open. An eye is alcohol. Yeah. So eye eyeopener would be like a, a drink in the morning to, to make you feel better, right?

Because your body make you feel better. Go 

[00:12:07] Angela Kennecke: withdrawal symptoms. Right. Exactly. You might 

[00:12:09] Dr. Jessica Mellinger: be getting tremulous if you're starting to withdraw, you know? So if you notice that alcohol is taking up a bigger and bigger portion of your life. right? Um, things that you used to like to do that didn't involve alcohol you're not doing now because you're focused on getting alcohol.

When can you get your next drink? You know, all of your social events involve alcohol and it's, you know, you don't want to give that up, you know, those types of things. I think a lot of those different symptoms of an alcohol use problem or disorder like we talk about are often really about how is the alcohol impacting your life, um, in a negative way.

and less about how much you're drinking. You know, the definition of an alcohol use disorder doesn't have anything about a dose of alcohol. It doesn't say you have to be drinking more than this amount to meet the definition. It's really about how is the alcohol impacting your relationships, your work, your school, your body.

You know, have you had a DUI? Have you, you know, had some consequences that are negative because of your alcohol use? That could signal that you're kind of in one of those, in a more, in a phase of it being a bigger problem. 

[00:13:12] Angela Kennecke: I think also it can be tough once you get into the habit of drinking to get out of the habit of it.

even if you don't have an issue with it, because I don't think alcohol is healthy at all. And I'm kind of a health nut. I work out regularly. I try to eat very healthy. And then I'm like, so why am I having this glass of wine when I think it's just putting poison in my body? I mean, I just don't think alcohol has health benefits, no matter what anybody says.

That's That's my opinion and from what I've read, but so, but I think it can be sort of a habit or a social habit. So, you know, can you, I mean, I think a lot about, we talk a lot about substance use disorder and how you can't go back to the same people, places or things, but in today's society, how do you avoid alcohol?

[00:13:54] Dr. Jessica Mellinger: Right. And I think for a lot of, for a lot of people who have an alcohol use disorder or what we might term addiction, you know, I think some, some people like that word, some people don't like that word, but, 

[00:14:04] Angela Kennecke: um, 

[00:14:04] Dr. Jessica Mellinger: I use them 

[00:14:05] Angela Kennecke: interchangeably, but interchangeable too. Yeah. Like 

[00:14:08] Dr. Jessica Mellinger: a, like a substance use disorder, it's very much the same thing.

You know, I think people with an alcohol use disorder who are practicing sobriety and practicing abstinence, um, often do have to not be around. people, places, or things where they drank for a time. Um, but they learn to practice, you know, walking through a grocery store and, you know, practicing with, okay, I, I walked past the liquor section or the alcohol section and kind of noticing like, oh yeah, maybe I'm thinking about alcohol in that, in that moment, but, you know, moving through it, you know, continuing on with their day without, you know, getting sidetracked into drinking.

Um, a lot of that, those skills come about, you know, people have practiced those skills through treatment. You know, through going through alcohol counseling treatment, going to AA or some of the other mutual aid recovery community groups that are out there that can help people manage that exact thing.

You know, how do you go through your life and not drink if it was something that you really, was really a big part of your life? It's really about learning. You're kind of unlearning the habit of using alcohol for everything, and then relearning how to do some of these other things in life, you know, that, that don't involve alcohol.

[00:15:20] Angela Kennecke: Did you see the effects of the pandemic? Did you see, I mean, what did the studies show, especially when it comes to women? I mean, I know I've heard that substance use went way up during the pandemic. Uh, now we're a couple of years into it. Are the, is the use going down or did it remain high? 

[00:15:39] Dr. Jessica Mellinger: It's leveled out a little bit, um, so it definitely spiked up, you know, in the months after the pandemic started, about 25 percent.

So roughly, roughly 25 percent more drinking occurring in the U. S. Now some of that was people who already drank, just drinking a lot more, because some people did decrease their alcohol use, right? So there's kind of a population that decreased their use and a population that increased their use, but overall there was about 25 percent more alcohol consumed, roughly.

excuse me, in the U. S. in the immediate post pandemic period. And it's come down a little bit, but it hasn't gone back to pre pandemic levels. So we're still seeing higher levels of drinking kind of continuously based on the data that we do have from the pandemic. And with that has come, you know, a lot of those consequences.

So we, we published that, you know, along with others, that the alcohol related liver disease rates had gone up fairly dramatically, that we had 60 percent increases in waitlisting and transplants for patients with alcoholic hepatitis. Yeah. Um, 60%. 

[00:16:41] Angela Kennecke: That's a phenomenal number. Don't you think? 

[00:16:43] Dr. Jessica Mellinger: It's a big number.

Yeah. It's a big number. Um, and that's, and that's kind of an, you know, an immediate consequence, you know, there'll be more and more data coming out. You know, we've seen the data on, um, suicide rates and, you know, increases in depression and anxiety. Um, and a lot of it's focused on opioids, you know, appropriately because there is so much death from that.

But a lot of times underneath that is people are drinking along with the use of other drugs. And we kind of don't talk about that as much, but I've certainly, and 

[00:17:11] Angela Kennecke: alcohol is a depressant, you know, for the brain. So it's a depressant. So you may be drinking to find relief, but you're actually lowering, you know, your dopamine.

And it makes it worse. 

[00:17:22] Dr. Jessica Mellinger: It might've made you feel better in the beginning, but now it doesn't, you know, it's, you know, kind of creating more problems. 

[00:17:28] Angela Kennecke: The one thing that really concerns me as the parent of college aged kids, you know, when I was in college, the drinking was heavy. And of course I worry about other substances.

Uh, but I really worry about, I tell my kids, you know, addiction runs in your family and you have to be really careful, but. I don't know that they listen. And I just think parents also kind of see drinking as a rite of passage in a way, which I think is a mistake, especially for the developing brain. And so I really worry about that.

And I don't know if you have any advice on when it comes to that age group. 

[00:18:01] Dr. Jessica Mellinger: Yeah, I think it's, you know, I think there's a lot of work being done in the alcohol research community focused on that age group, focused on that kind of adolescent and early adult age group around the time of college, um, to normalize not drinking.

I think, you know, I mean, I, I certainly, I think normalizing not drinking and kind of trying to counteract this message that it's just what you do when you go to college and it's sort of expected that you will get, you know, blindingly drunk and that that's how you have fun, you know, and I think to the extent that you're, that kids can see their family members and their moms and dads and their parents and the people that are around them having fun without alcohol, you know, having fun without having to do that, you know, um, I think that, that really, you know, sinks into kids that, yeah, you know, I don't, I don't have to drink just to have fun.

I don't have to drink, you know, to, you know, to blend in. Finding those, you know, those, those colleagues and those friends and so forth in college who also don't really want to do that, you know, and don't, aren't really, aren't really into that scene, I think can also be helpful. And just to the extent that, you know, as families, we can really support our kids in, you know, saying, yeah, you know, it's not really, not really for me.

It's not really how I like to have fun. And, you know, it's not, and it's not necessary for me to have fun, um, I think is, is really important. 

[00:19:15] Angela Kennecke: Right. Right. And I think that some of the hazing and stuff that goes on on college campuses, all surrounding drinking, and I know it's going on to this day because I hear stories about it.

I wish that the schools would do a little better job or the fraternities and sororities would do a little better job of, of curtailing some of that. It's so dangerous. The excess, the excess, you know, 

[00:19:36] Dr. Jessica Mellinger: I mean, you hear cases of kids dying, you know, from 

[00:19:39] Angela Kennecke: all every year, every year, every year. It's 

[00:19:42] Dr. Jessica Mellinger: so, I mean, that's so sad to see those, those lives cut short because of something, you know, like alcohol poisoning or, or, you know, a hazing incident.

It's just, it's not, you know, it's not, not worth it. 

[00:19:52] Angela Kennecke: Right. So are you seeing, um, increased ways of treating or better ways of treating alcohol use disorder when patients come to see you? 

[00:20:02] Dr. Jessica Mellinger: Yeah. Well, there's a lot of different treatment options that I think people should be aware of. And I think we're often not aware of, you know, when, when I've, uh, in some of the studies that I've done where I've talked to my patients and ask them, you know, what, what.

when you hear alcohol treatment, what do you think of? They usually think of two things, residential treatment or inpatient treatment and AA. And that's it. Alcoholics Anonymous. And that's that's a lot of mostly what people have heard about. Um, but the reality is there's a lot, there's a whole range of treatments that really can be effective.

One on one group therapies, couple therapies, family therapy, residential treatment, intensive outpatient programs, which are not residential, but have you go multiple hours a day, multiple days a week to kind of get a big slug of treatment right up front. There's also medications to kind of turn down the volume on the cravings that people have for alcohol.

And these are for, you know, for those of us who don't have an alcohol use problem, I think it can be hard for us to understand just how. Just how strong that craving to drink can be for people and how frightening it can be for them as they're trying to establish sobriety, um, to, to experience these kind of overwhelming compulsions and urges to, to drink that, you know, just kind of appear to really, you know, wipe out any, you know, any rational thought.

It's just, this is, it's such a compelling urge. And those are most strong kind of right when people are stopping drinking and they do tend to level off and decrease with time and with abstinence. so much. But we have treatments, we have medications that can turn the volume down on those cravings and give people some of the mental and emotional space from that to work, you know, a program to work, you know, whether it's AA or to go to, you know, to a counselor or any of a number of the other, you know, community programs like Celebrate Recovery, Refuge Recovery, Smart Recovery that are not based on the 12 steps, but also involve you know, other people with alcohol use problems, helping other people with alcohol use problems.

Um, there's just a lot out there and it's effective. You know, this is the, these things work to help people reduce and stop their drinking. So 

[00:22:09] Angela Kennecke: medication really saved a cousin of mine really saved his life. And he had started drinking at 13 and nearly died at about 50, was in the hospital and started on a medication.

And also, you know, went to meetings. I had got some outpatient tech treatment, but it was really the medication, I think, that made all the difference in the world. And in that case, I think the medication he took was if he drank, he would get sick. So, yeah. 

[00:22:34] Dr. Jessica Mellinger: Yeah. So yeah, there's definitely a lot out there in our, in our liver clinic.

So we, started at Michigan, University of Michigan, a kind of novel liver clinic where we have myself, a liver disease doctor, but also a psychiatrist, an addiction psychologist, and an addiction social worker in the same clinic. So that we can kind of treat people together, come up with a, you know, a plan for people that, that, you know, works with their medical issues and whatever psychological and addiction issues they're dealing with, because the liver metabolizes a lot of these medications.

So almost everybody that comes into our clinic, when they stop drinking, discovers that they have some other stuff going on. They've got depression, they've got anxiety, maybe bipolar disorder, eating disorders, a lot of trauma, a lot of people, particularly women who have had emotional, psychological, sexual trauma in their past.

Um, and so that, We need to help them with that. And sometimes medications are an important part of that antidepressants, anti anxiety medicines, anti craving agents, but knowing how to, how to prescribe those in the setting of advanced liver disease, how to dose them, what to use, what not to use is really important.

And so that clinic that we've established, um, that are kind of cropping up around the country now, different, different hospitals are doing this, which is great. Can really, that's what I was going to ask 

[00:23:51] Angela Kennecke: you. Are you, uh, Are you a model for other places? You know, because that sounds amazing. 

[00:23:56] Dr. Jessica Mellinger: Yeah. It's, it's been a wonderful, we've been doing it as our fourth year.

Um, I think we were, we were either the first or one of the first in the nation to do this outside of a transplant clinic. So transplant clinics often have a lot of resources for patients who are able to get a transplant, but there's a lot of patients who can't get a transplant or don't qualify one or don't need one.

We just weren't doing anything for them. So we were really frustrated by that and said, Well, let's start a clinic. You know, it's like, I'll grab my friends who do psychiatry and psychology and and we, you know, love taking care of these patients. And so we've published some of the results of our clinic.

And that has, I think, inspired some other centers to say, Yeah, we need to do this too. And University of Wisconsin has one, MassGen Hospital in Boston has one, Cleveland Clinic is starting one, and, um, Rush in Illinois is going to start one soon. So there's other, there's other places where that are kind of using this model of, multidisciplinary integrated care for liver disease patients with alcohol use problems.

And it's really, it's really great. I think our patients love it. We love taking care of them. And I think it's a step in the right direction. 

[00:24:55] Angela Kennecke: Oh, it sounds like it. I love it that it's under the medical umbrella, right? So you're treating the whole person. And I think we need so much more of that in the addiction field in general.

Absolutely. Because Anybody can really hang up a shingle and say they're treating addiction. There's very little regulation out there regarding that, but I feel it really is a medical condition. It's the disease of the brain. And so we need to approach it from that standpoint of the whole person as well.

[00:25:20] Dr. Jessica Mellinger: Absolutely. And that's always our message is that, you know, it's liver, alcohol related liver disease. If you have ALD, the, the kind of abbreviation for it, you have two problems. You have an alcohol problem and you have a liver problem, but treating the alcohol use is medical treatment for your liver disease.

It's not a different optional thing. One of the only things, we don't have a lot of medical treatments to reverse or really any to reverse the liver disease from alcohol use, but what does keep people, keep people alive is stopping drinking. like that's very clear, is if you stop drinking, even if you have advanced liver disease, even if you have cirrhosis or acute alcoholic hepatitis, which is an even more advanced inflammation of the liver from alcohol, stopping drinking reduces your risk of death dramatically compared to those who keep drinking.

So to me it was a no brainer, like this is what we need to focus on, like we really need to focus on ways to help people, you know, reduce and stop their drinking because that's what saves their lives. 

[00:26:18] Angela Kennecke: Right. And that's what, that's what it's all about when you're in your profession is keeping people alive, saving their lives.

If you, if you had a magic wand and you could just wave it and change society in general, and these trends that you've seen, you know, women drinking more and women drinking as much, if not as much as men. And I think about all the merchandise that's out there, you know, like the t shirts and I mean, we're just marketed to, and we're sold this idea that in general, can be really unhealthy for so many people.

So if you had a magic wand and you could wave it, what would you do? What would you change? 

[00:26:53] Dr. Jessica Mellinger: I would love to see kind of our thinking about alcohol use and excessive drinking be similar to how we think about smoking today. Similarly, you know, years ago we thought smoking was healthy. We didn't think it was a big deal.

We didn't, you know, we, we encouraged it, you know, ashtrays everywhere. Doctors encouraged smoking, but, but over time we learned how dangerous it was. And over time society really changed to now it's, you know, much less people still smoke, obviously, but there's a lot more societally to try to prevent people from smoking, to help people stop.

And that's what I would love to see. I would love to see that around, you know. alcohol use, excessive alcohol use, et cetera. I don't think we're ever going to, you know, not, not have alcohol in our society. You know, we've had it since the dawn of time, you know, since people figured out how to ferment corn.

Um, and so it's, we're never going to eliminate it. And I think the majority of people do drink and in a light to moderate way and don't experience, you know, ill health because of it. But we do have such a big chunk of our society that are really you know, dramatically and negatively impacted by it in a way that also influences their use of other drugs like opioids and marijuana and so forth.

These often co occur that I would love to see us focus on that portion of the population and try to try to do some things at a public health level to reduce the consumption and help people get better from that sense. And I think a good model is that smoking model of what happened with tobacco use and how we came to understand the, the, dangers of that.

And really as a society move towards trying to, you know, discourage and stop that use and then help people stop. I would love that. I'd also love to see the alcohol paraphernalia be out of hospital gift shops, which I always see there. 

[00:28:31] Angela Kennecke: Yeah. Hospital gift shops. Right. And like people are in the hospital with liver disease and they're selling wine purses.

I know 

[00:28:38] Dr. Jessica Mellinger: the wine person. Can you believe that? It's just, it's insane. There was like a wine bean bag that I saw on Amazon or something. It was like a bean bag chair and it had like a, like a thing you could. Sip your wine like directly out of the beanbag chair. I was like, this is insane. So . 

[00:28:51] Angela Kennecke: Right, right.

Because really we have to not glamorize it. We've seen Hollywood, we've seen, we've seen it glamorized and I think that it's, it's not glamorous and, and being drunk isn't glamorous and waking up hung over the next day isn't glamorous. No it's 

[00:29:04] Dr. Jessica Mellinger: not. You know, , you know, and know how much you're drinking, I think is the big thing, you know, I see all the time.

like alcohol containers, you know, cups and, and, you know, portable wine glasses to take to your picnic or whatever that look like, you know, the top of a wine goblet. But when you look at how much it holds, it holds half a bottle of wine. So somebody could easily grab one of those, drink two, think that they just had two glasses of wine when what they really had was a full bottle.

right? And that would get somebody's attention, I think. Somebody who thinks that they're drinking moderately finding out, no, you actually just drank a bottle of wine. You drank five glasses of wine instead of two, um, I think would get people's attention too about how much they're using. 

[00:29:44] Angela Kennecke: Right. It's just being conscious of how much you're really drinking.

If you think you're having a glass, it could be three, right? 

[00:29:49] Dr. Jessica Mellinger: Exactly. Yeah. So we do this with food too, you know, like food. Yeah, of course, of course, you know, right. Enormous amounts. And we don't think it is. Yeah. 

[00:29:58] Angela Kennecke: Well, I just appreciate you sharing your wealth of information with our audience today and thank you so much for being on the podcast.

[00:30:06] Dr. Jessica Mellinger: Well, thank you for having me. I really appreciate you shining a light on this topic. 

[00:30:11] Angela Kennecke: Thank you for joining us. Check out our other episodes of the podcast and read my blog on our website, emilyshope. foundation. If you like what you're hearing, please consider giving us a positive review on Spotify, Apple Podcasts, or wherever you listen.

Until next time, wishing you faith, hope, and courage.

This podcast is produced by Casey Wonnenberg King and Anna Fey..