GUIDE TO SOBRIETY DURING THE HOLIDAYS

Frederick Goggans, MD

If you think you are at risk for substance misuse, be realistic about how the holidays can increase your anxiety and stress and lead to dangerous behavior

It’s important for people to have a realistic attitude about the potential for anxiety or conflict during the holiday season—especially individuals who have issues with alcohol or drug addiction.

Most of us go into the holiday period hoping for a harmonious time with family, friends, and co-workers, but there may be hidden conflicts based on past experiences or expectations that may not be realized. The tension between the reality of our situations and our idealized images of holiday harmony can lead to anxiety. Many use alcohol or other substances excessively to manage that anxiety.

The imminent danger of excessive alcohol use and illicit drug use during the holidays is physical harm, such as from motor vehicle accidents and overdoses.

The US Department of Transportation reports that fatalities related to alcohol impairment account for more than a quarter of all vehicular crash fatalities in the US and that nearly 800 people lost their lives in drunk-driving-related crashes in the month of December 2016 alone.

The increased availability—and offering—of alcohol during the holidays increases temptation. Drinking alcohol with friends and family during the holidays is a longstanding tradition in our country. The Distilled Spirits Council of the United States notes that a quarter of the alcohol industry’s profits are earned during the time between Thanksgiving and the New Year—little more than a month’s time.

This period of heightened use is particularly dangerous in a country where binge drinking and alcohol use disorder continues to be a major concern for youth and adults.

According to the 2015 National Survey on Drug Use and Health (NSDUH):

  • 26.9% of people ages 18 or older reported that they engaged in binge drinking in the past month
  • 15.1 million adults ages 18 and older had alcohol use disorder (AUD)
  • Approximately 623,000 adolescents (ages 12-17) had AUD

The opioid epidemic, meanwhile, continues, regardless of the season.

  • In 2017, approximately 1.7 million people in the US had a substance use disorder related to prescription opioid pain relievers
  • An estimated 21-29% of patients who are prescribed opioids for chronic pain misuse them
  • About 68% (more than 47,000) of the more than 70,200 drug overdose deaths in the US in 2017 involved an opioid
  • 36% of those 47,000+ deaths were attributed to prescription opioids

Individuals at risk for opioid relapse should be particularly on guard during the holiday season, when parties are prevalent and holiday stresses may tempt individuals to seek relief through harmful substances.

For clinicians like myself who work on substance misuse and recovery issues, we often see individuals when the holidays are over. In January, many people enter treatment having overreacted to holiday events by abusing drugs or alcohol, having suicidal thoughts, or engaging in injurious behaviors. Some of these people may come to treatment in a quasi-emergency situation, either through intoxication or withdrawal, a suicide attempt, or an attempt to injure oneself, and they sometimes may need to be stabilized in a hospital setting.

Tips for a Sober Holiday Season
If you think you are at risk for substance misuse, be realistic about how the holidays can increase your anxiety and stress and lead to dangerous behavior. But also, realize that you can take steps before and during the holidays to avoid problems.

Be good to yourself
If you have a history of drug or alcohol misuse, it’s important to protect yourself. If you are involved in a recovery program, stay centered in your program by continuing to go to meetings. Connect with like-minded and sober individuals in your program and remain in contact with your sponsor and peers. Don’t isolate.

Be good to others
Embrace the “holiday spirit” and try not to be too self-absorbed. Be of service to others by taking part in volunteer activities. Also, take advantage of the many special events that most mutual help organizations present during the holiday season. Stay involved and engaged.

Concentrate on your overall health
By eating properly, getting enough sleep, and exercising regularly, you can keep your body sound as well as your mind.

According to a study by the Harvard T.H. Chan School of Public Health, running for 15 minutes a day or walking for an hour reduces a person’s risk of major depression by 26%.

Stick to safe environments
Keep an eye on the types of activities you’re involved in over the holidays and avoid risky situations. But, if you find yourself in an environment where drugs or alcohol are being used, know where the doors are and have an exit strategy.

Stay positive
Think about activities that make you happy that don’t involve substance use. Bake some cookies, decorate the house, or participate in some other activity that gives you joy without the prospect of a hangover.

Bring your own beverages
If you’re going to a holiday party where you think alcohol will be served, bring your own non-alcoholic beverages. There’s no shame in drinking some tasty fruit juice, soda, or seltzer in a fancy glass.

Bring enough for everyone. You never know when someone else might want to follow your lead and join you in abstaining from alcohol.

Don’t go solo
Bring a partner to your holiday event. It’s helpful to have someone with you to support your resolution to not consume alcohol or take illicit drugs.

Have a response ready
People are likely to ask you why you aren’t drinking alcohol. Simply saying “I’m driving tonight,” or “I need to get up early tomorrow morning” should suffice. Some people, however, might still try to push you to have a drink. Politely decline their offer once again and move on.

Keep triggers in mind
There may be certain things that may push you to use alcohol or another type of drug, such as thinking about a recent loss. Consider sharing these triggering thoughts with someone whom you trust. This sharing may help you to cope.

Consider yourself
Think about whether your holiday “obligations” are truly obligatory. Do you really need to go to the holiday office party? Do you have to go to that family get-together? Don’t go to an event that is going to heighten your risk of consuming alcohol or some other type of drug. It’s not worth it.

This year, you may find yourself in a better place than you were in last year. There could be an opportunity for you to take stock of your success and get validation from your loved ones. Be sure to celebrate your sobriety and be sure to celebrate soberly!

Frederick Goggans, MD, is the medical director of Borden Cottage, a McLean Hospital Signature Addiction Recovery Program located in Camden, Maine. Dr. Goggans oversees a team of expert clinicians who provide residential treatment for individuals with drug and alcohol addictions.

Addiction to alcohol, opiates, or other substances is a serious psychiatric illness, most often complicated by other mental health diagnoses such as depression and anxiety. At McLean Hospital, we are committed to providing exceptional clinical care to help individuals work toward recovery. If you or a loved one needs help overcoming addiction, please call 877.203.1211 to learn more about our Signature Addiction Recovery Programs. https://www. mcleanhospital.org/treatment/signature-addiction-recovery