Let’s Talk About Alcohol
How does alcohol work?
What long-term effects of alcohol
What should therapists ask about alcohol
Alcohol is a part of most adults’ lives. We might be tempted to skip over assessing someone’s use of alcohol. Someone’s drinking habits don’t typically just come up in conversation. If we don’t ask we could be missing something. So let’s talk about the effects of alcohol and implications in therapy.
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You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.
So join me each week as we talk about all things, substance.
Welcome back. This is episode 19 of the All Things Substance podcast. Today we’re going to be starting a new series covering different substances. Each episode we’ll talk about a specific substance, the short-term and long-term effects, withdrawal potential and the overall impact on our clients. And today we’re going to start with alcohol.
One of the things I’ve said when talking about the podcast is that substances are ubiquitous. They’ve been part of our culture ever since humans had a culture. They aren’t going anywhere and it’s something that we just have to be able to understand and work with in our clients.
Let me start by saying, I think there are a lot of people who can drink normally and by normally, I mean, not problematically. If we look at the population of people who are drinking alcohol all over the world, my guess is that most of them would not be problem drinkers. For us as therapists, we’re not seeing people across that huge of a spectrum. We’re seeing people who are identifying issues in their lives.
Depression, anxiety, PTSD are all highly correlated with alcohol abuse and with other substance use. The challenge for us is trying to determine whether this person that we’re seeing might have an issue with alcohol or other substances, or if their use is heading in a problematic direction. I think at times we don’t want to ask certain questions because it feels offensive or because people might get defensive.
In our offices is the place that we get a chance to build relationships with people and have them share all of the pieces of their lives that they’re struggling with. As a therapist myself, I have found that there are times when someone’s telling me their story and there seems to be a piece missing something that if I knew it, it would put things in perspective.
One of the things I want to encourage you to start asking about is their substance use. Do they drink? And if so, how much? Are they using marijuana? Are they taking pills? Whatever it is. We’re not asking so that we can be judgmental or so that we can convince them to quit using or focusing on that. This is something we need to know as we’re conceptualizing the symptoms that are being reported.
Alcohol: A history
So let’s start at the beginning. We know through archeological and anthropological evidence that alcohol has been part of our history. There’s evidence of alcohol in ancient Egypt. There’s evidence of alcohol from 13,000 years ago in Israel. This past fall, they just found evidence of alcohol in Pompei. It’s something that has weaved throughout our history. In the United States, we’ve had an interesting relationship with alcohol.
The word prohibition springs to mind when a lot of Americans think of alcohol legislation. For those who don’t know in the early 19th century, prohibition was already on the rise. Religious revivalists and early teetotaller groups, like the American Temperance Society, were committed to seeing what they saw as the “scourge of drunkenness” curtailed in America. In 1851, they scored a major victory in the state of Maine. Many other States followed suit and called them the Maine Laws.
These laws didn’t last very long though. As opposition to them was always present and quite loud. The calls for a dry America continued through the early 1900’s. What sparked prohibition nationwide happened after WWI. The advocates for the prohibition movement proposed that the barley and wheat being used to manufacture alcohol could be used to feed starving soldiers and people abroad.
Part of this was also xenophobic against Germans and also labeled German people and people of German descent living in America as potential enemies. This was in part because of the major brewing companies that existed in Germany.
It wasn’t actually illegal to drink alcohol during prohibition. It was illegal to sell it. Now, there were some exceptions. They still allowed alcohol in religious tradition, alcohol was also allowed to be sold in pharmacies as medicine for any number of ailments, a doctor could also prescribe alcohol. You can imagine that a number of pharmacies popped up selling alcohol.
The most famous part of prohibition that we hear about are the speakeasies and bathtub gin. Speakeasies were places that people could find alcohol, but they had to operate under the radar. In a lot of States, they didn’t actually enforce the prohibition ban though. It was a national federal law, but it was left to the States to govern how it was going to be carried out and a lot of the States just weren’t willing or able to police the sale and acquisition of alcohol. So in some States it was like, it didn’t go into effect at all.
In the places it did, bathtub gin, as it’s called, became a thing. This is just where people were making alcohol in their homes and selling it. It had a notoriously terrible taste and was extremely strong. The issue though, is that a lot of the alcohol that was being produced was tainted by various chemicals and a lot of people died because of that alcohol.
Around 1906, the federal government required companies to denature alcohol to make it undrinkable. During prohibition however, companies were ordered to add other toxic chemicals to make it further undrinkable in order to discourage people using it.
The great depression is what ended up seeing the end of prohibition. The idea of tax revenue and sales on alcohol was too tempting to pass up. There was a ton of money getting spent on black market alcohol during prohibition and the states and the governments could benefit from the sale of alcohol.
So Franklin Roosevelt, during campaigning in 1932, had this as a major platform that he wanted to repeal prohibition and he won in a landslide. The 21st amendment was ratified, repealing the 18th amendment, which had held the rules for prohibition. Prohibition continued in many forms and still in certain areas of the country.
For instance, where I grew up, we had a dry town until probably the mid nineties. I remember when one of the restaurants was trying to get a liquor license and it was kind of a big deal for people even though other suburbs we’re smack up against our borders and had alcohol. Certainly there are other places in the country that still have dry towns, dry counties or other laws restricting the sale and consumption of alcohol in certain places.
I think a lot of people think that prohibition didn’t work at all. It did in the terms of drinking, went down. In the early years of the law drinking dropped an estimated 70%. It’s not that prohibition didn’t work to decrease drinking, it’s that it didn’t work as a public policy for the United States. It created other problems when it came to tainted liquor, black market sales, crime, those sorts of things. Ultimately it seems that alcohol being legal is here to stay.
Alcohol: How it works
Age of first use of substances across the nation is 12 years old. This isn’t when people necessarily start their drinking career. It’s a matter of experimentation. They tried something. Now, I know that that varies by part of the country and of course, different people’s families, social groups, that kind of thing is going to change that number as well.
As I said before, most people who drink alcohol as adults, they’re going to be normal drinkers. They’re not going to have problematic issues. They’re not going to have a ton of consequences from drinking. They’re going to maybe have a few experiences where they drank too much, and then they decided it wasn’t worth it and they move forward.
Alcohol, also referred to in scholarly articles as ethanol, first enters the stomach where it’s absorbed in the bloodstream. However, if no food is present, it then moves down into the small intestine where there’s a much larger surface area for absorption compared to the stomach. There are these special cells in the small intestine that act sort of like fingers that have a lot of surface area and are able to absorb a lot of the alcohol.
When somebody does have food in their stomach, there’s a mechanism at the bottom of the stomach that separates the stomach from the small intestine so that food can be digested by stomach acid. Since alcohol can’t move into the small intestine it absorbs much more slowly in the stomach. It’s estimated that a meal that is full of fat can help slow absorption by nearly 50%.
Like all internal organs, the stomach and the small intestine are lined with capillaries and this is how alcohol enters the bloodstream and can be carried to the rest of the body. As alcohol enters the bloodstream it filters through into the tissues, including the brain. . This is what causes the intoxicated feeling that people experience when they drink.
Alcohol distributes into water spaces, not fat. Part of the reason that women will have a higher blood alcohol content versus men given the same amount of drinking is because women have less percentage of water in their bodies. For women the amount of water in our bodies is about 55%; for men it’s approximately 68%. And in a lower water system, more alcohol is going to be able to reach the brain.
So alcohol moves from the GI tract through the portal vein to the liver. It diffuses into hepatic cells of the liver where it’s metabolized. Part of the function of the liver is to break down alcohol to make it more water soluble so it can be carried in the bloodstream to the kidneys so it can be processed for elimination.
You may have heard of there being a blood brain barrier. That is designed to keep things from entering our brain. However alcohol or ethanol is able to cross that barrier. There are other substances that can cross the blood brain barrier too like nicotine, marijuana and heroin.
So one of the things that I talk about a lot when I’m talking about substances is what their classification is in terms of a depressant, a stimulant or a hallucinogen. And alcohol is a depressant. This is not to say it depresses you. This is that it’s a depressant to the central nervous system. It slows things down.
So what it does is it reduces the ability of neurons in the brain to fire as rapidly. This accounts for people being clumsy, their speech being slurred, reaction time slowed when they’re drinking. And this happens regardless of tolerance. Your body can get used to alcohol, but it is still a depressant and it is still going to slow things down even if you don’t perceive that.
So somebody who can quote, “handle their alcohol” they’re not going to have reaction times as quick as they think they can have. Because this is just biology and it is acting in the body, the central nervous system, and especially in the brain.
Alcohol in and of itself isn’t causing a long term issue when it’s used in moderation. We know this. There are some studies that have proposed that some alcohol, specifically red wine, could produce protective effects. Now the protective effects of red wine, I feel like are overstated. There is some evidence that it could cause some protection for some cardiovascular diseases, but it also raises the risk of other diseases as well.
Alcohol: Effects of long-term use
With repeated exposure to alcohol, the brain undergoes a series of changes. One of the changes has to do with tolerance. Now, the way tolerance happens is that first, the receptors for alcohol decreased in number. So there aren’t as many of them and so it’s harder for alcohol to produce its effects. That’s why you have to drink more when you have a higher tolerance.
Second, the liver cells increase the number of cells meant to metabolize alcohol. Increased metabolism of alcohol means that it’s happening at a faster rate and so it’s also going to reduce the level of intoxication.
One really serious change that can happen from long-term drinking is shrinkage of the brain. Scientists think that the shrinkage is caused by a loss of neurons and cells in the gray matter and the white matter. And the shrinkage tends to happen in areas of the brain that are important in learning and memory. Like the cerebral cortex and the hippocampus.
The issue with the brain changes is that alcohol affects the adolescent brain differently than the adult brain. I know it might sound counterintuitive, but an article produced by Duke University suggests that adolescents are less sensitive to the effects of alcohol than adults, but adolescents are more sensitive to memory disruption and the neurotoxic effects of alcohol as compared to adults.
After a couple of drinks, this memory loss is detectable and the amount of memory loss is proportional to the amount of alcohol ingested. This is what leads to a blackout. A blackout is not when someone passes out, but when someone literally can’t remember anything. They’re walking, talking, interacting, driving, doing things, but will have no memory of it later.
I think we all know that drinking during adolescence can cause issues in the brain. They have a developing brain, which we know isn’t really fully developed until about age 24 and if someone’s adding alcohol to it on a repeated basis, it’s going to impact their development. And there’s extensive research showing that the earlier that someone starts drinking. That they are at much higher risk for developing problematic drinking or alcoholism as an adult.
Alcohol can kill certain cells .This is referred to as necrosis or apoptosis. Which is the death of cells which occurs as a normal part of development, but alcohol is thought to increase that activity. It can also inhibit cell growth, which has far reaching implications.
Over the long-term high levels of alcohol use can produce some very serious effects in the body. It can affect how the brain looks and how it works. There can be issues with the heart. With cardiomyopathy, stroke, arrhythmias, and high blood pressure.
It can affect the pancreas causing it to produce toxic substances that are then later referred to as pancreatitis. There is evidence to suggest that alcohol increases a risk for certain kinds of cancers, like head and neck cancers, esophageal cancer, liver cancer, breast cancer and colorectal cancer.
It’s also suggested that this kind of consumption of alcohol can lower your immune system, making you more susceptible to diseases. The most well known effect of long-term, high consumption of alcohol is issues in the liver. Cirrhosis of the liver is a late-stage scarring of the liver caused by liver diseases, such as hepatitis and chronic alcoholism.
Each time your liver is injured either by disease or excessive alcohol consumption it tries to repair itself and scar tissue gets formed. As that process continues, the liver can’t function as well to process alcohol. We talked about earlier that the liver is the primary place that alcohol gets processed and broken down.
The liver damage from cirrhosis typically can’t be reversed, , but further damage could be prevented. Oftentimes chronic alcoholics end up needing a liver transplant. There’s quite a process for that and they have to have a certain number of years, alcohol free in order to qualify. .
The problem with cirrhosis is that there are typically no signs of it until the liver is extensively damaged. And the symptoms, some of them are really obvious and some aren’t. So typically there’s going to be a lot of fatigue , easily bleeding or bruising, loss of appetite, nausea, , swelling in the legs, feet or ankles, weight loss, itchy skin,. For women, absence or loss of periods not due to menopause. For men loss of sex drive, breast enlargement and testicular atrophy.
Some of the more obvious ones are ,confusion, drowsiness, slurred speech, which is referred to as hepatic encephalopathy. Yellow discoloration of the skin and the eyes. A spider like blood vessels on the skin, particularly on the nose. So it looks like thready blood vessels and the nose seems to be a little enlarged towards the end.
Fluid accumulation in the stomach and sometimes there’s a redness of the palms. So there’s a lot of different effects. This doesn’t take a lifetime to happen. Now, all of these things that happen in the body because of high consumption of alcohol, aren’t going to happen at necessarily the same ages.
In my experience and in my career, old for an alcoholic is around 55 to 60. And that’s just what I’ve noticed. That doesn’t seem that old to me anymore as it did when I was in my twenties. But for alcoholics, that’s a long time for them to be drinking and for their body to be going through this process have issues with memory shrinkage of the brain, damage to the liver, that kind of thing.
And that tends to be , when a lot of problems spring up. However, I have seen 30 year olds who needed liver transplants from cirrhosis. So it can happen at any point, just like some of you may have known someone who lived into their seventies or eighties and they were chronic alcoholics. We don’t necessarily know the reason for why someone could have cirrhosis at 30 or not have it until they’re 70.
Alcohol: Deadly Withdrawal
One of the last physical things I want to talk about when it comes to alcohol is withdrawal. Sometimes I feel like I might be a broken record about this, but I also feel like the majority of people I run across don’t always know this. Alcohol withdrawal is extremely dangerous. When we’re talking about physical withdrawal , I’m not talking about a hangover. I’m talking about someone who has been drinking on a consistent basis for a longer period of time. And they’re having physical withdrawal effects. So they’re having the shakes. They’re having delirium tremens and they’re having the sort of flu-like symptoms when they quit drinking alcohol.
When I was playing an online MMO, I used to game with a guy who was a good friend, and I would hear him on the mic cracking beers all night. It’s something that other people might not have noticed, but because of what I do, I was noticing. I just was subconsciously counting and we gamed probably three, maybe four nights a week and I would hear 10, 12 cans of beer. It was concerning.
And so over time as we talked, I did bring it up. And then at one point he told me, “Oh, I quit drinking. You know, I haven’t had a drink in four days, but I got the flu” and he was talking about this and I’m like, Oh my gosh, that is not the flu man. That is withdrawal. And so I talked to him about it and I was like, man, this is really dangerous. Like you could have a heart attack and die. Like don’t mess around with this.
Alcohol is one of those things that I think people will tend to go cold Turkey, quote, unquote, and not think about the fact that they need medical assistance to get help with quitting drinking.
I think people think that getting help for quitting drinking from a medical professional is for the alcoholic version of a junkie when really alcohol withdrawal kills people. So, if you have someone who’s drinking and they are talking about quitting, I would really encourage you to assess how much, and if there’s a withdrawal danger. If they have ever had the shakes in the morning and any of the other withdrawal symptoms, talk with them about it.
As people progress in their drinking, they’re gonna need to drink more. I have worked with people who woke up in the middle of the night and had to drink because they were experiencing withdrawal after only four or five hours. That is at the really severe end, but it doesn’t have to be that severe for withdrawal to set in.
If you have a client in your office, we’re not looking for one specific symptom. We’re looking for them in a group. So if somebody comes in and they have a lot of skin issues or redness, rosacea, those kinds of things. And they have a little bit of yellowing in the eyes, thready veins in their nose or smelling like alcohol, even though they haven’t drank that day. Those are some pretty obvious signs that there’s something going on. It’s just something that you can watch and start noticing around you.
Oftentimes changes like this happen so slowly that it is difficult for the person themselves or the people around them to really notice. I think for us as therapists, because we see people once a week or every other week, or even every month, we can notice changes a little more because we’re not as used to looking at that person and so we might be able to see them.
I think part of the trouble with alcohol is that it is legal and so there seems to be this idea that if it’s legal, therefore that equals safe. Well, that’s not necessarily the case. There is an incredible amount of money being spent on the alcohol lobby every year.
I don’t know that the term “big alcohol” is as prevalent as “big tobacco”, but it is a thing. The alcohol lobby is extremely powerful. They are really not going to love studies that show that alcohol is damaging or that it could be related to high prevalence of fatal car crashes, that kind of thing.
And they’re spending a lot of time and money trying to keep policies from getting into place that are going to hurt the industry. Most of the time this has to do with taxes. I don’t know if you’ve noticed, but cigarettes and tobacco have a crazy amount of tax. Whereas alcohol taxes rise very slowly. And part of this is because they don’t want to discourage people from using. And the industry knows that higher taxes may discourage some consumers.
I happen to live in a part of the U S that has a very strong alcohol policy group, it’s called the Tavern League. And they are responsible for influencing policy, by lobbying and supporting different things in the state.
Since in the State of Wisconsin, it’s legal for you to go into a bar and drink with your parents. You can get drunk as long as the bartender is willing to serve you. That puts a lot of pressure on bartenders to have the responsibility to decide whether they’re going to serve a minor or not.
I’ve had students that have gone to bachelorette parties or bar crawls or those kinds of things. Alcohol in the state of Wisconsin is something that is just part of the culture. Now, not everybody in Wisconsin has difficulty with drinking. It is something that’s really interesting to me when I moved up here, is that what people consider normal drinking here is really a lot higher than people in other parts of the country.
Growing up in Chicagoland, we had alcoholics for sure. Alcohol wasn’t as part of the culture as it is here. Drinking a six pack, a 12 pack watching a Packers game, that’s not unusual. Now, a six pack or a 12 pack I’d be passed out. And part of that’s because I haven’t drank in an incredibly long time and so I have zero tolerance, but still, even when I was drinking, 12 beers would have been way enough for me.
That brings me to talking about what constitutes a drink. So when we say a drink, I’m not sure we’re talking about what the health experts mean as a drink. So we’re talking about 12 ounces of beer. We’re talking about four ounces of wine. We’re talking about a one and a half ounce shot in a mixed drink. Those are the amounts that they’re talking about when they say one drink.
I remember long islands when I went to Michigan State that were certainly probably four drinks if not five. Those were definitely not one drink. And for beer when you go to a bar, there might be a 12 ounce pint glass, but that’s not what a lot of people are going to go for.
In the wine culture, and I’m not talking about wine connoisseurs, I’m talking about the wine culture that is all over social media and a lot of it’s the mom wine culture. So this idea that we as moms should relax with wine at night and that it’s our deserved reward or something for parenting.
And it’s not that I think that people shouldn’t reward themselves or that being a parent isn’t hard because it totally is. It’s just, is it really wine? When is it too much wine? Is it every night? Alcohol at night is not going to be great for your quality of sleep. If someone’s drinking too much of alcohol at night, it’s going to be pushing them further down into the sleep stages. So they’re not getting as much reparative sleep as their body needs.
And so they’re not going to feel as rested and able to tackle the day. This in turn leads to shorter patience, less ability to handle problems. It’s not that they’re terrible at it. It’s just that their resilience isn’t going to be as high. And then that night they’re going to drink some more because they need to relax and they’re feeling stressed out and it’s just a cycle.
And there is this idea that we deserve it. It’s the way we should relax. And the thing is, is that it’s effective. You can drink and forget about stuff pretty quickly. Now that doesn’t necessarily work for everyone. Some people get really happy and some get really nasty and mean some get really sad. Alcohol is a depressant. It’s going to slow down the central nervous system. And it’s going to have effects in the brain. And over time, these effects are going to add up.
The question is how much is someone drinking? Not I have a couple beers. What does that mean? Are those cans? Are those bottles? Is that a 40. How many nights a week is that? How many weeks a month is that? What happens if you can’t have it? Does anyone criticize you about your drinking? Do you ever feel like maybe it’s too much?
Have you ever woken up in the morning and needed to have a little bit to kind of deal with the hangover? This isn’t a judgment. I don’t think that there’s anything inherently evil or immoral about alcohol. There is a subset of the population though, that can’t drink normally.
I have worked with a ton of clients who had no idea they were developing an alcohol use disorder. It just sort of happened over time. They were drinking in high school, just like their friends. Then they went to college or they started a job after school and they were drinking and everyone else around them was drinking. So it didn’t seem like a big deal.
It isn’t until pretty far down the line that you start to notice that other people are stopping around you and you are still going. We know that alcohol lowers inhibitions, we know that alcohol changes our decision-making. A lot of people end up making choices that they wouldn’t normally, if they weren’t drinking and that stuff starts to snowball.
I stopped to get gas after work, and I saw these three guys walk out of a gas station, probably late twenties, early thirties, and all wearing coveralls. And they were smiling and laughing. I mean, pretty normal looking guys and they were each carrying a 30 pack of beer. And this was a Friday at about 4 O’clock. That is not an odd sight. And I’m pretty sure that each of those guys, that those 30 packs were each for them. A 30 pack over a weekend, still a lot of beer. And if they have a pretty high tolerance, they can drink 10 cans of beer, not a problem.
Here’s how this works out for us as therapists. Most adults have some experience with alcohol. There are going to be people who’ve never touched a drink in their life. That’s going to be few and far between; most people have an experience with alcohol.
Most people have been intoxicated at one time or another in their lives. So this is a really normal part of life that it’s really okay for you to be asking about. If they start to get defensive, if you notice that they’re trying to cut the conversation short, these are just things for you to note and to pay attention to.
I think the key is for us not to make it awkward and for us to make it just part of our natural assessment of their lives. You could preface it by saying that, you know what most of the adult population drink alcohol and so I’m just wondering about you. Do you drink alcohol? What kinds of alcohol do you drink? How often do you drink?
It’ll feel a little awkward at first, if you don’t usually ask, but it’s one of those things that people aren’t going to typically volunteer. You might get someone someday who comes in and is like, I think I drink too much. That is something that is so much easier when someone just comes out with it.
Typically they won’t. It is our nature as humans to minimize things that we think might be a problem. And that is just because we struggle with the idea of getting rid of things in our lives that might be helping us deal with pain or emotions or social situations, any number of things.
When someone comes in and they have depression, they have PTSD and anxiety. This is something that we should be looking at. Not just for those who are depressed or who are dealing with PTSD, but a lot of people use alcohol to deal with social anxiety. I worked with a client who had gone to college and flunked out in the first semester because he was drinking so much to handle his social anxiety.
This young person was having so much social anxiety. It was so brave of them to even go to college because it was incredibly scary. Some medication and some skills later and they’re able to not drink and they don’t need it anymore. But coming from an environment where anxiety was not something that was talked about, and especially not for men, that was really hard.
One of the other things that I would note is that I have found in my career that men especially have a difficult time quitting drinking, at least in this area of the country. This is not to say that women don’t have a hard time because they do.
The issue is that women have an easier time having a reason to get together without alcohol. It’s perfectly normal for a woman to see another woman in a park. And let’s say, they’re just taking a walk or looking at flowers or just sitting and thinking it’s normal for another woman to walk up to another woman and start talking.
It would be normal to be like, “Hey, I’m going to grab some lunch at that restaurant over there, come with me”. And we don’t know each other. That isn’t seen as anything out of the ordinary. For men though, imagine a man meeting another man somewhere in public and being like, “Hey dude, you want to get some lunch?”
The culture for men is a lot more restrictive in those ways .Where I am in the country the things that men do together tend to involve alcohol. Whether that’s watching, or engaging in sports, hunting, fishing, those kinds of things. It is difficult for the men that I’ve worked with up here to find ways to connect with other men.
Now they can connect at AA, Alcoholics Anonymous, but for a lot of guys, that’s not their thing. And if they’re not going to a church or a faith community, where are they going to meet other men to have friends. There’s this incredibly homophobic culture that exists that men’s gender roles get stuck in.
And it’s really hard to move out of them if there aren’t other guys who are also trying to move out of them. It can be pretty isolating. And so when you’re talking with someone about their use and what changes they want to make, be aware of some of the things that are going to be challenges for them, just so you can help plan around it.
I know at the end of every one of my podcasts, I have an announcement about the treatment planning tool that I created. And the reason it’s there is that. It can be hard to know when you should talk to somebody about their use, how to talk about it, and some of the challenges that are going to come up, if that person decided to make changes.
So if you haven’t had a chance yet, I really encourage you to go to my website betsybyler.com and click on resources. And there’s a treatment tool there that you can download. It’ll ask you for your email and it’s all free and I hope you get a chance to use it and think about some of the clients that you see .
The bottom line for alcohol, it is something that is going to be here. No matter what happens in legislation, alcohol will exist. People want a way to relax and to celebrate. It’s just part of our human nature. It’s something that we need to pay attention to so that we can better help our clients.
Next week, we’re going to talk about marijuana. This is a really controversial subject in some areas and especially some areas of the internet. I hope to see you next week.
Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to email@example.com. I’ll see you on next week’s podcast. And until then have a great week.
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