To Cut Back on Pandemic Drinking, Understand How Your Brain Works
It’s 3 p.m. on Thursday afternoon. You’ve had a hard day and still have a long list of “to-dos” to tackle before it ends and need something to help you relax and get through. A glass of wine or a beer should do the trick. You’re working from home, so no big deal. In fact, you deserve this, right?
I’m modeling this scenario after one that several patients in my outpatient clinic (which, I might add, specializes in addiction psychiatry) have replayed for me. More and more, I’m seeing patients come in wondering if their increased alcohol use is a problem. They seem genuinely puzzled — unsure whether they can trust what their brains are telling them when it comes to choices around alcohol. Their (increased) drinking makes a lot of sense to them, justified even, given the pandemic.
They are not alone. We’ve all seen the numbers, heard the stories, and likely witnessed or exhibited this trend.
What Alcohol Does to a Stressed-Out Brain
The relationship between alcohol and stress relief is a lot more complicated than conventional wisdom holds
As far back as April 2020, in the very initial stages of the Covid-19 pandemic, a study from Poland reported that 14% of participants reported drinking more than before. A study from Australia reported that in May 2020, most commonly as a result of psychological distress, alcohol consumption was slightly and substantially higher in men and women respectively, than it had been in previous years.
Two months after lockdown started in the U.K. in June of 2020, in a study of patients with preexisting alcohol disorders, 24% reported an increase in alcohol intake. Among people who had been abstinent before lockdown (for an average of 20 months), 17% relapsed — representing a 226% increase relative to relapse rates prior to lockdown.
However, not everyone who has a relationship with alcohol has responded to the limitations of the pandemic the same way. A population survey of active drinkers in the U.K. reported that 21% increased alcohol consumption during lockdown while 35% reduced their alcohol intake.
We’re all in strange times: surviving a pandemic, working from home, removed from our usual social outlets. Many of us have decreased alcohol use by default because we’re spending less time with friends and family, or because our usual watering hole is closed. Yet, for those who have found that they are drinking more, they might also be noticing an increase in something else: the noise of their inner voice. “It’s okay, it’s a pandemic. What else is there to do? I am depleted and this is harmless.”
For many people, a drink might soften the isolation or help with the absence of clear boundaries between work and home right now. Plus, it’s so easy to simply walk to the cabinet or the refrigerator when you feel like it. There are no co-workers around to see what you’re up to.
What is the story behind that voice that is justifying these choices? It comes off sounding hyper-rational (at least to us), and always seems to know exactly how to counter any other arguments our minds might present to suggest that having that drink isn’t the best idea. While I don’t know the exact evolutionary origin of this voice, I do know we all experience some type of automatic, almost reflexive, reaction to a choice we’ve just made or something we’ve just done.
One of the most common examples of this voice in our head is the convincing call of “choice justification” (also known as choice-supportive bias or post-purchase rationalization). This manifests as a tendency to retroactively ascribe positive attributes to an option we have selected while simultaneously demoting the other options.
For those who have found that they are drinking more, they might also be noticing an increase in something else: the noise of their inner voice. “It’s okay, it’s a pandemic. What else is there to do? I am depleted and this is harmless.”
Whether making a hard choice when buying a car or a waffle cone of ice cream, once the action is selected, our brains magically flip from “Argh should I get the double fudge chocolate or the mint chip?” (as the line at the store behind us backs up further and further), to “Wow, this is amazing!” There seem to be at least 31 flavors of choice justification, ranging from fact distortion (values or features are misremembered relative to their actual value), to selective forgetting (retaining positive attributes at a higher rate than negative attributes), to frank false memory (thinking that an attribute or item was there during the original decision-making process when it wasn’t).
When it comes to justifying our choice to take that extra drink (or two), it seems our brains have a well-oiled mechanism in place — ready to remind us of all the reasons why it is fine to imbibe, and conveniently forget all of the negative consequences. Plus, if we drink too much, alcohol brings with it the extra bonus of conveniently removing a clear memory of exactly what happened.
Too many times my patients have woken up with a hangover in the morning, sworn to themselves that they’d quit (or at least cut down), only to make it to the end of the day — or encounter a stressful situation or whatever the trigger is — and repeat the process all over again.
So what can we do with this omniscient voice in our head that seems to be much smarter (and persuasive) than we are?
While willpower is a neat heuristic that comes with its own justification, it may be more myth than muscle. Perhaps here it can be helpful to tap into the power of our own brains — the parts that aren’t just trying to convince us that the choice we just made was the right one.
Older (and stronger) than the thinking and rationalizing parts of our brains from an evolutionary perspective, is our ability to pay attention, to be aware of what is happening. Awareness of the actual results of our behaviors helps us see clearly whether the choice we just made was actually a good choice. Instead of conveniently forgetting all of the negative consequences of a “bad” decision, we can learn to pay attention — without judging or justifying — to the results of what just happened. Only here can we actually learn and apply this learning to future decisions.
Why Mental Self-Awareness Is Good for Your Brain
Mindfulness, cognitive behavioral therapy, and other related practices all prioritize this form of ‘self-monitoring’
For example, a 2017 study from the University of California, San Francisco showed that mindfulness training (which helps people pay attention in exactly this way), decreased craving-related eating in obese/overweight people by 40%, and a 2009 study from my lab showed that this type of training helped individuals with alcohol (and even cocaine) use disorder not relapse.
With my addiction patients, I start by helping them understand how their minds work, so that they can learn to work with them (rather than fight against themselves). This begins with reflective listening as I try to understand what the justification voices in their heads are saying. The reflection part comes in some flavor of asking curiously what exactly the consequences — all of them — are that come from the behavior, and then comparing this accurate representation with what that voice was telling them (and conveniently leaving out of the story or forgetting). Then, I encourage them to pause before imbibing the next time, asking themselves “what am I going to get from this,” so that they can reflect back on their previous experience, rather than blindly follow that slick salesperson of a voice in their head.