Are you sober curious?

0:00 Welcome back to Sarah Has Questions. Today, we're talking sober curious. Have you ever done a dry January or sober October? I have. And did I feel better? I sure did. There are a lot of positive things it does to our bodies. Let's talk about it. I'm Sarah King, and I have a lot of questions. What exactly happens when you orgasm physically? Will popping a knuckle or a joint give us arthritis? What can we learn from our poop? The size of your body doesn't necessarily indicate your measure of health. Yes. And what are your thoughts on that? Cleansing. Do we need to do anything special to our nether regions? In this show, I get to ask all these questions to WakeMed doctors who happen to know everything about everything. Sarah Hess questions is a production of Capital Broadcasting Company and Mix 101.5. It's presented by WakeMed.

0:52 Today, I have doctor Christopher Thompson. He is an addiction medicine physician with Wake Med. Welcome. Thanks so much for coming in today. Thanks. I'm glad to be here. Sober October is something I keep hearing about and sober curious on my Instagram and, social media. I keep seeing all these, so these alcohol free liquors. Where do you think all this is coming from? Yeah. It started out, about 10 or 15 years ago out in the UK with dry January. So it's part of, like, New Year's resolution. It was, like, challenging, you know, your friends and your family Mhmm. You know, to kinda be, you know, alcohol free or to kinda live a different lifestyle Mhmm. And just being mindfulness of how much alcohol that they're using Mhmm. And how it's affecting their health and how it's affecting their well-being. And it's it feels like it's just grown exponentially. It has. Social media has really kind of pushed it, you know, out, to a wider audience. Uh-huh.

1:45 And, of course, the new generation of folks are, you know, coming up. And, some of the, teenagers that are now, you know, legal drinking age are now realizing, some of the risks and and benefits of not using alcohol, is really important to them. And these online challenges, everybody's like, oh, dry January or, you know, sober February's. And, you know, every month has some sort of Moniker? Moniker and challenge. You can turn any of them into, you know, like, favorable February. Yeah. There's some books being written. You know, Sober Curiosity is is a big one that's out there, just being mindful and just a lifestyle change. A lot of new entrepreneurs are coming out with these mocktails and these, changing lifestyles where you don't need, you know, alcoholic beverages at every event, like weddings and Yeah. You know, open bars are not Yeah. Not as big of what they used to be in the past because people are being more conscious of their health and their finances, you know, going through. So Well, yeah, finances for sure. An open bar is a pretty big price tag. Is there any benefit from having a dry Mhmm. Whatever month you wanna put in there? What like, does it even help? Yeah. Oh, absolutely. People can see a big difference in their health, in just 30 days of being abstinent from alcohol. They improve sleep, improved memory. Weight loss is a big thing. Yeah. You'd be surprised how many calories are in, you know, an alcoholic beverage. Mhmm. And then, so cutting all that out, you can drop usually several pounds in in over a

3:18 30 day period. But you sleep better. Why do you think that we that sleep is affected? What is it about alcohol that affects your sleep? Alcohol, it affects your REM sleep. It doesn't allow you to get that deep, sleep, that regenerates your body and helps with your memory and kind of processes, you know, what you did the day before, and then being refreshed the next day and being able to start your day off, in a very more relaxed way, not hungover, not having headaches. Right. So a lot of neurological effects as well. So what is it about alcohol that gets in the way of REM sleep? Do you do you know that answer? Okay. Can you tell me, doctor? Yes. We'll we'll we'll get a little scientific here. You know, this will be, that's a little bit. I'm curious. So, we have gabanglutamate in our body. That is our inhibitory and excitatory, part of our, nervous system and our way our body reacts. So when we drink alcohol, it's a depressant. Okay. Right.

4:19 So it depolarizes our nerves and really relaxes everything. And we That's why people like drinking. Right. We get some those are the positive effects for alcohol. And if we use alcohol at lower amounts and and stick with our, you know, daily limits and our weekly limits, you know, there are some positive benefits to alcohol. The problem comes is when we use excessive amounts of alcohol, our body tries to compensate. So the other side of that inhibitory part is the excitatory part in the, the, glutamate part of our body. And it's kinda, neurotransmitters in our body Mhmm. Receptors in our body that kinda upregulate to kinda help with kinda all that negative effects. So what does it do to upregulate? It just over time, it it produces new receptors, and we get more receptors, you know, on our on our neurons. Okay. That when we remove alcohol and we don't drink, that's what causes the withdrawal because we have this unopposed excitatory response Interesting. In our body. That which causes the really bad side effects of using alcohol, like seizures, you know, DTs, deuterium tremors Oh, yeah. You know, for folks that, you know, really excessively use alcohol Yeah. They have this really high upregulation of these receptors. So when you remove alcohol suddenly Yeah. You get really severe withdrawal. So if you were to remove alcohol, for, like, a extended period of time, do those receptors go away? They do. Yep. Where do they go? They just disappear. They just

5:50 deregulate. That's what's so fascinating about our body. Fascinating. Our body doesn't like to be in that intoxicated state. So it really changes its structure Uh-huh. So that it you know, we still have the effects of alcohol. We're still intoxicated. It still, you know, decreases our, reflexes and our ability to to to perform. Sure. But it really tries to it doesn't like that, so it it upregulates. And then when alcohol is removed, even with that 30 days of a dry January, those receptors will start to to go back down and kinda get back into equilibrium. Interesting. When you're talking about these, these withdrawal effects. A hangover is withdrawal. Is it not? Yeah. I mean, we look at, a scale for withdrawals Okay. Called the CIWA scale. Okay. We can kinda measure, you know, what your kinda withdrawal symptoms are. Did you say CIWA or CIWA like Jojo CIWA?

6:45 Yeah. I wonder if that's where she got her name from. I'm sorry. Go ahead. But we have that those scales that we can kinda look at the withdrawal settings. And, you know, the standard hangover of, you know, headache, fatigue, upset stomach Yeah. Sometimes some diarrhea. Those are, you know, kinda common withdrawal symptoms. You know, the more severe withdrawal symptoms would be seizures and, you know, more chronic liver disease and other, properties that kind of more of a chronic, effect on your health, that can lead to more severe withdrawals. And some of it is relative to how much alcohol we consume. Okay. But everybody's a little bit different. So some people can have those severe withdrawals, which is even having, you know, a little bit overdrafting. Maybe they have, like, more receptors just pop up quicker. I noticed you said using alcohol as opposed to drinking alcohol. Is that something We're trying to change the terminology, trying to change the stigma. Okay. We're really considering, you know, alcohol use disorder as a medical condition.

7:49 So talk talk to more about that. So it used to be called alcoholism. Right? Now you're calling it alcohol use disorder. Why the change? Couple different reasons for the change, and and the biggest one is to kinda reduce the stigma so people can go get help and treatment, if they need it. But we look at alcohol as a chronic disease. When we get to the point where we, you know, use excessive alcohol Mhmm. And we form an addiction, that that is considered, you know, a chronic disease. And you need medical attention, to help, you know, reduce your alcohol and to, live a healthier lifestyle. We talk about there's genetic factors to to alcohol use disorder. Usually, somebody, if they have, an alcohol use disorder, they have a 50% chance that one of the first degree relatives also, you know, has addiction. Do we know why? There are some studies and genes and different alleles and the expression of our DNA, that lead folks, you know, into addiction and and alcohol use. And there's also some genes that actually protect people from, alcohol use disorder. Like and and what way would it would they protect it? Because if people, you know, get sick if they consume too much alcohol, some people can't process alcohol. They can't metabolize alcohol as much or as fast. Uh-huh. So the more they drink, usually, kind of the The worse they feel. The worse they feel. Yeah. Not just through the intoxication or through the withdrawal, but the actual consumption of alcohol. They get consumption of alcohol. They get they get flushed. You know, they get sick to their stomach. They just don't feel really, well, you know, when they consume alcohol. So they just tend to avoid

9:20 alcohol because they don't get those positive effects that that many people do. So So what I'm hearing you saying about, the receptor, the receptors I found very interesting. I'm glad we got in the weeds. Yeah. Yeah. Very nice. So how do you know you have an addiction? So there's a lot of different ways that we can kinda go about it. A lot of it is just kind of, if it is affecting your overall health, you know, and lifestyle. So we know what daily limits are. We know what kind of the recommended limits are for alcohol. Mhmm. And, you know, the first thing we need to look at is kinda what a standard drink is because people don't even know what a standard drink is. That's defined when we talk about how many drinks we can have in a day. Mhmm. And it's a really small amount. I bet. So yeah. What is it? So it's 12 ounces of beer. Okay. One can. One can and traditional beer between 4 5% alcohol. Not a craft beer at 9.5%. Correct. And those and those craft beers are really becoming more popular, especially in this area. And we have to be aware that they do contain a lot more alcohol. Mhmm. And they don't come in 12 ounce cans anymore.

10:20 Oh, no. They're big. They're big. You can get them 24, 25 ounce cans. Yeah. Sometimes I say it's not a drink. It's a challenge. Correct. Yeah. And, like, 40 40 ounces. Oh, yeah. Yeah. There's a lot of different sizes of beer out there, but the standard, size for a can of beer is 12 ounces. Okay. For wine for normal table wine, about 12% alcohol, it's only 5 ounces. Well, I used to work in restaurants Mhmm. For a long time, and I couldn't tell you how many times I we were we were, taught to pour a 5 ounce pour. Yep. And people would get so upset with us because they're like, you didn't fill our glass. I'm like, that's actually a serving of alcohol because you have to price it out. Yeah. So, yeah, it is. It's real small compared to what you norm like, the grandma pour most people give themselves on Friday night. Yeah. And then you look at liquor, and it's only an ounce and a half. Not even 2 ounces, which is the full jigger whenever you're making cocktails. Correct. Yeah. So it's an ounce and a half of 80 proof Oh, yeah. Spirits or or liquor. And, you know, even a an airplane bottle is, 1.7 ounces. So it's more than So it's more than Oh, interesting.

11:21 Dinner time. Yeah. Well and I know a trick to find out, what the what the proof is. And that is, like, whenever you're looking at a bottle of of alcohol and it says, you know, 40% alcohol, you just double that, and that's the proof of the alcohol. So there are some. I know there's one bourbon called JR Hirsch that I think is, like, a 100 and something proof. Yeah. Just like we talked about craft beers, you know, liquor is also getting higher proof. You know, wild turkey 101 Oh, yeah. And all the other bourbons are, you know, higher proof, and those are the ones that are sought after. Okay. Right? So now you're looking at maybe less than an ounce is considered a serving. Okay. Well, I think that a lot of people are overserving themselves. I can tell you right now in this conversation, I definitely have 2 servings of wine and one glass most often. Yeah. So you really have to define what that is to patients because they don't really know how much they are consuming, because they don't understand what that kinda So where do these serving sizes come from?

12:16 So the servings that comes from, you know, federal government regulations of what, you know, healthy consumption of alcohol Okay. Can be, and not just so now that we define what a standard, you know, drink is, then we also have to define how much we can consume. So just to where to measure it. Yeah. So for women and men older than 65 Mhmm. It's it's no more than one drink per day and less than 7, you know, drinks per week. Mhmm. And then for men, under the age of 65, it's no more than 2 per day and, no more than 14. Okay. Oh, interesting. Okay. So binge drinking. Yeah. Binge drinking. And so anything over those limits, is this considered binge drinking? Yeah. So binge drinking for men, it's, more than 5.

13:04 Drinks a day? Drink drinks into one sitting and One one one. Sitting. Yep. Okay. And then for women, it's 4. Does that is that, irrelevant of the length of time? Typically, they say in one day in a 24 hour period. Okay. Typically, it is in a short period of time Yeah. In the evening or in one sitting. Okay. Well, that that's the thing. Like, if if sometimes you can have, like, one drink an hour. Say Say you're at a wedding. It's like a 6 hour event. Yep. And you're having and I've heard in the past that you can your body will digest essentially a one serving of alcohol an hour. So if you were to have one drink an hour for 6 hours, that's still considered a binge drinking session. And your body's really working overtime. And, you know, everybody metabolizes alcohol at a different rate. Okay. Women a little less than men. That's why those limits are lower. Thing that we just gotta put up with being women.

13:56 Yep. But, you know, we tend to metabolize. It's approximately one drink per hour. Okay. So but, again, if you drink that first one, your body's still metabolizing that first one as you're consuming that second one within that first hour. So you're basically stacking. Sure. And that's what causes the intoxication and those higher levels of alcohol in our body, which can be, you know, toxic to our GI tract and to our pancreas and to our liver and, can really have more effects. Plus, we really talk about risky behavior when someone consumes that much alcohol. Oh, yeah. Most certainly. When we're saying addiction, is that just trying to get back to, like, getting those receptors met and then not having seizures and terrible things. Is that, like, the definition of addiction? Like, what exactly is addiction? So, you know, you have these, social drinkers where there's social alcohol use where they kinda, you know, on the weekends, weekend warriors, you know, as long as they kinda stay below those binge, we didn't talk about We're getting there next. We're getting there next. But if they're kinda just using, alcohol socially, that's fine. Using it for those positive, feelings and those, you know, help relax and reduce stress, you know, can be, you know, beneficial for folks too. The problem is is when you do exceed those limits, you know, and you do build up those receptors Mhmm. What happens is then you start sometimes consuming alcohol all day or early in the morning Mhmm. Call it an eye opener Uh-huh. Because you're trying to prevent those withdrawal symptoms. Your body builds this physical dependence on alcohol, and if it's not there is when you get those severe withdrawals. And

15:29 that physical dependence are those receptors? Correct. Yep. And then they have to use alcohol so that they don't go into those severe withdrawals. And you get into this that's when you need medical treatment. It's really when you get to the to that severity of alcohol use. Mhmm. You can't stop alcohol. Severe alcohol withdrawals can be fatal. Why would it be fatal? Because of the seizures, because of that unopposed excitatory DTs. It really has an effect on our, on our body, again, through those mechanisms that we talked about Mhmm. To actually lead to to death. So if you're if you're an addict Mhmm. And you've gone a couple of months without addict without any a drink, and then you're you're like, I'm in a hotel room. I'm doing this. I'm gonna drink a lot. Why would that relapse? Most often, I find that, like, Amy Winehouse comes to mind. She had been sober for, like, a year, and then she had she had a relapse and she died from it. Why is the relapse so dangerous?

16:29 You have memories. You know? Again, people use alcohol for those positive effects, and those positive effects make you feel good. And if you have those pathways that are built in your brain Mhmm. Or something, again, more in the weeds. We have neuroplasticity of our brain. So when we use alcohol, you know, the mid part of our brain or the limbic system of our brain forms memories of using alcohol. Oh. And their bodies like alcohol. So even if you're in recovery Uh-huh. And it again, we talked we talked earlier about it. It's a chronic disease. It never leaves you. Right. Right. So always gonna want to somewhere. Yeah. You're always gonna have those thoughts, feelings, and memories of those positive effects of alcohol. Gotcha. So even if you're sober for months, years, decades, right, a lot of times it doesn't start with, hey. I'm gonna rent a hotel room and just Drink myself. Drink.

17:18 Yeah. Drink, you know, bottles and bottles of wine beer. Starts with one one sip. You know, if you're at a wedding and you have that champagne toast and you get that taste, all those memories flood back into you about all those positive effects, about all that addiction. And sometimes it just takes one sip, and they can't stop. And so then they go and they they just drink all night long. Yep. And then Or it just starts with a sip, and then the next day, they just have, oh, that was really good last night. I'm gonna have 2 tonight. I can handle it. I can handle it. And then it many times, will get out of control very quickly again for someone recovered. And and is it like the damage you had done to your body before, like, your body just can't handle it again kind of thing? Is that why they die? It's I mean, I've always wondered this, why relapses seem so dangerous. You do build a little tolerance, again, with those up regulation of receptors with, you know, your enzymes in your liver, and you kinda can process alcohol a little bit better when you are chronically using alcohol or you kinda return to use quickly. Mhmm.

18:18 Your body is not able to process as much as fast as as quickly. So you, you know, get intoxicated, faster. I see. Right? But a lot of times, there is some health, you know, liver cirrhosis and some other things if you're real heavy Yeah. User of alcohol prior to. But it's really just kinda that those same effects that have, it just kinda comes back, you know, in full force. Gotcha. So we talked a lot about early on is, you know, the receptors and and, you know, there's medications that we can use for alcohol use disorder. Mhmm. Yep. So there's 3 FDA approved medications that we can use for alcohol use disorder, that can be used to to either, limit the cravings for alcohol use, you know, to kinda help with some of those receptors.

19:05 Then, you know, there's 1, disulfiram that'll actually make you ill if you consume alcohol. Oh, okay. Like, a Pavlovian effect. Yep. Yep. A lot of people know that one, the disulfiram. It's an older medication, that you take it every day. It's a pill. And then if you consume alcohol, it just makes you really sick. Okay. But, again, we don't use that as much anymore because it does make folks ill. You know? Sounds miserable. It it does. If someone has some comorbidities, it can lead to to more health, effects if they have heart disease or So it's a little dangerous. It can be. You know, it they have to be under medical supervision if they're if they're gonna use that kind of medication. What are the other ones? Yep. So one is, acamprosate. Mhmm.

19:49 Acamprosate kinda works, you know, on the that GABA receptor system Okay. And glutamate receptors that we talked about to kinda help kinda regulate those cravings and urges, to use. Okay. So those are some big ones. And then kind of the the gold standard, is naltrexone. Okay. So naltrexone comes in a pill and also an injectable form. Mhmm. The injectable form is called VIVITROL. Mhmm. And that tends to be the gold standard now, for alcohol use disorder. I see. So that kinda helps reduce those kinda positive feelings, you know, when you consume alcohol. So you just lose the the taste. You don't feel good? No. It's you just lose the kinda the taste for it. You just when you use alcohol, it doesn't give you those positive kind of reinforcements.

20:37 Okay. And, you know, you're just like, I I can stay away from it. It it doesn't do what it used to do. The the the thrill is gone. The thrill is gone. That's a good way to put it. Yes. Yeah. Okay. I I have a couple of friends in my life who are in in recovery. And one went through AA Yeah. And one went through smart recovery. And the smart recovery person believes that addiction is something that you can mind your way out of. What are your thoughts on that? So all of those, peer run groups that are out there Great support systems. Awesome. Vital. Yep. So do you think that someone who's just a a big alcoholic can will their way out of it? So, again, those medications kinda help on that kind of midbrain, that limbic system, all that stuff, but a lot of our, judgment comes from our frontal lobe or our executive decision making of our brain. That that's where folks kinda make that decision to to continue to use alcohol or, you know, know if you talk to folks that use a lot of alcohol, they know it's harmful for them, but that they keep using. Right? And they keep drinking and they keep, you know, putting themselves at risk even if they have health problems. They just can't stop. Yeah. And part of that's that executive. So everybody has triggers, to use alcohol, and they need coping skills. They need better coping skills than reaching for a bottle or reaching for a drink. Yeah. And that's where our therapy comes in. So there's many different types of therapies. You can have therapies from a therapist and a provider run either individual therapy or group therapy. Uh-huh. I I'm a therapy proponent. I love therapy.

22:09 It's the best thing ever. Who doesn't wanna talk about themselves for an hour? Mhmm. Right. And it really helps get down to the kind of the root cause about why you started using alcohol, you know, find what your triggers to use alcohol are. Mhmm. Figure out coping mechanisms. You know, when you're thinking about alcohol or thinking about picking up that bottle, what else can we do? We'll be right back because you know I have more questions. From what I understand, this is a 4 question quiz. And if you get more than 2 yeses, 2 or more yeses can indicate alcohol use disorder. I'm nervous, but I'm willing to take it. So I'm sure you do have you don't have them written down. There are only 4 questions. I probably do, but I I You've got them. And yeah. You this is what you do.

22:54 So I I I think what you're referring to is what we call the cage questionnaire. Okay. C a g e. So have you ever tried to cut down, unsuccessfully with your alcohol use? That's the first question. That's the first question. Okay. Have I ever? An yeah. I guess, yes. Is that yeah. Yeah. Alright. And then, you know, the a is, you know, do you ever get annoyed when someone kinda comments about your alcohol use or maybe tells you that you probably need to to stop using as much alcohol? I haven't had that Okay. Told to me. Okay. Do you ever feel guilty about your alcohol use? That's a trick question. I grew up Catholic. Mhmm. Yeah. So I feel guilty about everything. So yes is the answer, but I also feel guilty when I eat a cookie. So you know? That's hard. Okay. And then e is for eye opener. Like, we talked about, you know, using alcohol early in the morning to help with withdrawal symptoms or help with hangovers. I've never had a hair of the dog. Yep. I've I've tried it once. It was the grossest thing ever. I'll never do that again. Yep.

23:48 So that's your 4 questions. That's the easy screening question, and that's where most, like, your primary care doctors will kinda ask you before going in. So you had 1, maybe 1 and a half. You know? But it's something to consider and something to think about, when you, you know, especially when you've tried to cut back, you know, maybe that internally you think, you know, you may be, you know, using too much alcohol Yeah. And that you need to kinda think about kinda cutting back a little bit and cutting down. And then you try doing that, you know, through your you know, through kind of self motivation. Yeah. Right? We talk a lot about motivational interviewing and what's important to you and health and finances. So if that's something that's important to you, and that's where those kinda dry January's and and other, you know, challenges come in as you'll kinda start to see if, hey. I can cut down. Hey. It does help my, you know, overall health and well-being. Right. And that's gonna be more motivation to to not use as much alcohol in nature. Yeah. I I find whenever I have tried to cut down, the hardest part is the social aspect. Because everywhere you go It's everywhere. Yep. It's everywhere. Yep. And then every restaurant you go to has that specialty drink that's amazing. Right? Oh, yeah. Yeah.

24:53 But, again, now margaritas come in this, like, fishbowl, you know, 24 ounce margaritas. I think those are meant to share at least. Yeah. I hope so. Mhmm. Alright. I have a couple of, I have a couple of listener questions. K. Okay. Let's see. A bunch of kids at my college drink Borg's. Have you heard of this? I have not. Oh, lord. Well, let's learn together. This is where they take a gallon of water Mhmm. Like a physical gallon of water, dump some out, and then put a 5th of liquor, typically vodka, into the mix with, like, some kind of flavoring packet. Most don't finish their gallon, but what are your thoughts? Is this safer in any way? It is. I Right. You don't think so? No. We talked about those dealing with 5th of vodka. We used we used to mix all kinds of cocktails in 5 gallon buckets and, you know, and When you were in college? College and Purple Jesus is what we did around here. Exactly. Yep. Purple Haze. We had them we had them all. Yeah. And, yes, they're very unsafe. A lot of times, they have grain alcohol in them. A lot of times, they'll have several bottles, you know Yeah. Yeah. Different, mixology, portions of it, you know, and they're really, harmful to you. Again, you don't know how much you're consuming. It's mixed in a in a gallon jug. You don't know how much you're pulling out of it. Yeah.

26:06 Exactly. And, again, if you're drinking and consuming just that much, you know Bad news bears right there. Exactly. What about drinking water in between drinks? Is that at all, you know, have an advantage? So some folks do get dehydrated. And when you drink alcohol, it is a diuretic. It does cause you to urinate. Yeah. Water does help keep you hydrated, but it doesn't help metabolize alcohol any faster. Mhmm. What it does do, it takes longer to kinda drink a glass of water, and it's just time that can sober you. Gotcha. Okay. Alright. The the last one, just 2. My parents were both alcoholics. Does that put me kinda covered this earlier. Does that put me at a higher risk for alcohol abuse? It does. Is it only I'm I'm gonna add on. Is it because it like, you're gonna socially see them drinking or, like, physically see them drinking as opposed to physiologically or both? Both. So, genetically, you're you have a genetic disposition for alcohol use, especially with 2 first degree relatives having alcohol use disorder. So, again, you kinda have that that genetic component and those genes can be expressed when you're exposed to to alcohol. There's a lot of studies out there Mhmm.

27:13 On the genetic components of it. But if she never uses alcohol, then her brain will never be exposed to it and maybe never become addicted to alcohol. So maybe if you have alcoholics in your family, the best thing to do is never touch a drink. Correct. Yep. It's absolutely correct. So there's mom and dad. Yeah. There there is, you know, nature versus nurture. We hear those terms a lot when we come to addiction, and that, you know, part of it is what we see our parents do, you know, socially. And we find that socially acceptable, and we, know, do that as we as we get older. That makes sense. But also, you know, once we do get exposed, you know, to those substances, if we have those genetic dispositions, those that that switch flips in our brain Mhmm. And then, you know, we, you know, have a a very high risk of of substance use and for, alcohol use disorder. Okay. So if for anyone who has any inkling that they might need help, where should they go? It's always best to start, you know, with your primary care physician. Most family practice and internal med, doctors outpatient, can provide support for alcohol use disorder Mhmm. And and prescribe those 3 medicines that we talked about. Many psychiatry and mental health and well-being providers will also do, alcohol, you know, management. A lot of times, they have more resources as far as the therapy aspect goes. But, again, if you start with your primary care, a lot of times, they'll refer you and vice versa if you have medical conditions from your alcohol use.

28:41 If you have severe alcohol use disorder and maybe struggle with those withdrawal symptoms that we mentioned, sometimes you need kind of more acute care. And, you know, a hospital is not a bad place to to to start if you really have, you know, severe alcohol or you have a history of, like, withdrawal seizures, and it's something that you can't necessarily stop just in the outpatient. Even if they don't have a rehab center, if you're not sure that they have a rehab center in that hospital, just go to the hospital. That's true. Yeah. And then there's our, in this area, there's Holly Hill, there's Triangle Springs, and there's some other kind of places you can kind of self report to. Okay. So you can go to those locations. You can, you know, Google search, and there's lots of different alcohol rehab centers, that you can just go and self report, and they'll do an assessment to you. And if you are medically stable enough to be admitted, they can admit you there. And if not, they feel you might need more higher level of care. They'll send you to the hospital. Okay. Well, what I hear from you is that there's hope, and I love that. Like, it it may seem like it's the hardest thing, and it may be very hard to get through. But at the end of the day, you can do this. And if you have any ink inkling that you might have issue with alcohol, wanna get dealt with, do it. It's gonna be worth the worth all the work you put into it.

29:54 Thank you so much. Thank you so much for having me. Of course. I find it so interesting that even a short break from drinking can make a big difference in our mental clarity and how we feel. Remember, the recommended daily limits. One drink for women and anyone who's over 65 and 2 for men under 65. And one drink is 5 ounces of wine, 12 ounces of beer, or 1 and a half ounces of liquor. It's not that much. Doctor Christopher Thompson was my guest today. You can find him at wake med dot org. There's a link to his quiz and an article he wrote about the sober curious movement in our show notes. If you have any thoughts in this episode, please share them with us. We'd love to hear from you. Go to wralfm.com/sarahhasquestions.

30:35 Thanks for listening, watching, and most important, sharing this show with all your friends. See you next time.