From Buzz to Burnout: How Alcohol Affects the Brain and Body

Major funding for The Pulse is provided by a leadership gift from the Sutherland family. The Sutherlands support WHYY and its commitment to the production of programs that improve our quality of life. This is The Pulse, stories about the people and places at the heart of health and science. I'm Maiken Scott. Charles Knowles was not a popular kid in school. He attended a boarding school in England where he grew up. It was the 1980s and bullying was rampant. I was, you know, fairly sensitive, pretty sort of studious. You know, I was in a house full of rugby players and people who were popular. You know, life wasn't all that easy. You know, it was a house where fear pervade the dormitories for people like me. When Charles was barely a teenager, he discovered what seemed like the perfect remedy for his problems, alcohol. Really from the first time I drank, it was the lights being turned on. What I liked about it was that it could convert the real version of me into one that I saw as more ideal, particularly with respect to socializing and other people. Charles became popular, no longer an outcast. the life of the party. The world just looked a rosier place after a few drinks. But in the morning, the rosy glow of a booze-filled night quickly faded. I would be the person who would wake up early in the morning with anxiety, fully awake, and go back to the fridge to get another beer. And Charles kept drinking, through college, even as he became a physician and surgeon, never touching alcohol before or at work, but binging it at other times. The booze was taking a major toll on his mental health. He felt anxious, depressed, and filled with dark thoughts. My brain goes at a thousand miles an hour, you know, without very much provocation. It is like a washing machine of hundreds of ideas going around. And, you know, alcohol temporarily suppressed that, which was one of the attractive features of it. But of course, as soon as it stopped drinking, it got very much worse. In many situations, alcohol can make us feel great, relaxed or warm and fuzzy. It can help us socialize or chat with strangers. But especially over time, drinking can become a serious problem, damaging our physical and mental health. On this episode, alcohol, why we consume it, how it affects us, and when it's time to quit. To get started, let's hear more from Charles Knowles. He's a surgeon and professor in London. His new book, A Blend of Memoir and Science, is called Why We Drink Too Much, The Impact of Alcohol on Our Bodies and Culture. For many years after his first teenage experiences with booze, Charles was able to dance on razor's edge when it came to his drinking, limit it, rein it in, but... I knew I had a problem with alcohol in my early 30s. I knew my consumption was excessive, but mainly that I knew the effect it was having on my mental health. For a while, he attended Alcoholics Anonymous meetings and replaced drinking with endurance sports like running marathons. But the changes never stuck. Fifteen years ago, he was in Florida for a family vacation. Plantar fasciitis and a knee injury had made running impossible. Charles felt low and restless. It was the classic mistake of thinking a holiday would make it better. And, you know, a holiday that started with drinking even before we'd reached the airport. and then a few days into that holiday after a lot of drinking that's where I found myself at the edge as it were. And what were you thinking about as you were on the edge? Well it's hard to say because I was drunk but I mean I remember thinking should I carry on living you know maybe the world would be a better place if I didn't and then at the same time against that really thinking about my family and, you know, and reasons why I shouldn't. It was, you know, a period really, you know, of madness. Charles knew he was done drinking. And I think that morning, kneeling on the floor of my friend's house in Florida, you know, praying to any God that would listen, I just had run out of steam. I just couldn't do it anymore. Charles attended AA meetings while still on vacation. Once he was back home, he got into therapy and he kept going to meetings. And you describe in the book how somebody said to you, you know, the good thing is you never have to drink again. And then you felt that at some moment where you were like, oh, I never, I never have to do this again. So talk a little bit about sort of the deliberating aspect of this. So I was a few months back into AA and I'd got a new sponsor and I'd really realised that I had to totally engage with the programme in a way that I hadn't done before. And, you know, this is a completely inexplicable thing. And it's sort of laid out in the AA promises. And, you know, if you had said this to me before, I would never have believed you. but it certainly came true for me in doing the program i don't know what happened or whether i just you know maybe i changed just had enough you know there was just one more time and i was doing some cognitive behavioral therapy and some other things at the time but it just was completely different the desire to drink just left and i mean it's really never come back it's extraordinary when we drink there is a benefit often right we feel more relaxed we feel like we're funnier we're more charming we can relate to people and that goes on for a while but then there is definitely like a diminishing return on investment there right you might get slurry and sloppy and stupid and do dumb things. And then the next day you're terribly hung over. So how did you navigate the benefits and drawbacks, especially as you started out? Yeah, I mean, what you're describing is what's known as the biphasic response to alcohol. As alcohol levels go up in the blood, the first thing is the psychostimulatory effects of them, i.e. the sort of fun of drinking. And for all the reasons that you've just eloquently explained. And then as the blood level goes up, the sedative properties of alcohol come in. I mean, the first thing to say is really from the very start, I was incredibly tolerant of alcohol, which is not a positive factor for development, you know, it's a risk factor for future dependency. So, you know, having a response right from the start that's highly positive for you and being strongly tolerant of alcohol are both risk factors later on for the development of dependence. So I could, you know, remain the centre of the party for quite a long time and drink quite a lot. I mean, by the time I left school, I could drink a gallon of beer. And, you know, at the age of 18, I could drink a bottle of wine in 10 seconds from the bottle. And so, you know, those sort of sedative effects. I mean, there's never really in my life in 30 years of drinking, had there been a time where I couldn't walk home. No matter what? No matter what. You know, and there were times where I could drink two gallons of beer, and I would still not lose my memory and not, you know, to be able to walk home without falling over. So the other thing is about hangovers. At that time, there were many people who drank as much as I did, and some who drank more, and were people who did crazier things than I did and did have accidents, yet carried on drinking. But I think one of the things that did separate me from my peers, even in my early 20s, was that while other people groaned with a sort of standard hangover, the headache, the nausea, lying in bed till midday, I would be the person who would wake up early in the morning with anxiety, fully awake, and go back to the fridge to get another beer. And if you think about everything that you've learned since with your medical training and your research on alcohol, what was happening in your brain? Why was that anxiety coming through so strongly in the mornings? Well, this is an area that is very well studied in general, but less well studied in the sense of why did that happen to me and not other people? Maybe if we start with the first point. So a proportion of people quite early on in their drinking careers will experience hangovers that have features of withdrawal. That is anxiety, palpitation, sweating, shaking, etc. Whereas most people don't. Those withdrawal phenomenon, the cause of those is known. And that is really, it's the opposite of the sedative effects of alcohol in simple terms. Basically, when you're drinking heavily, your brain is trying to counter the sedative effects of alcohol. And levels of other neurotransmitters that keep you alert and awake may go up. And so the problem is that once the alcohol leaves the bloodstream, it leaves that hyper-excited state unopposed. And so some people then wake up with the effects of those changes in neurotransmitters evident as withdrawal effects. and the question though is why that happens to some people and not to other people because many people go their whole lives as heavy drinkers and never experienced that and it is all about something we call neuroplasticity which is about the rewiring of the brain and in the very short answer is that it is likely that some people have a different electrician doing the rewiring than others. What do we know about the long-term impact of alcohol on our health? Let's start with our mental health. So what happens if people continue to drink? What are some of the issues that we see? By far the two most common are depression and anxiety. I mean, to give you an example, when I was a medical student in my fourth year, we did psychiatry. And I can remember sitting in the clinic of Professor Cohen, who was the sort of main man in psychiatry at the Royal London Hospital, where we all, about 15 of us, sat and watched his consultation with some poor 50-year-old man from the east end of London. You know, this was back in the days where patients were exposed to the ridicule of having an audience of medical students. And at the end of this consultation, He told us, you know, this man's problem is depression. And in his case, as is almost always the case in men in the East End of London, the cause is alcohol. And, you know, many, many years later, you know, it is somewhat of an irony that I was sitting in the psychiatry clinic of the Royal London Hospital with a diagnosis of depression and alcoholism. And what happens in the brain that causes that depression that really brought on by heavy drinking Well the most obvious answer to that is the effect of alcohol on serotonin which is 5 which is a neurotransmitter So a neurotransmitter for the listeners is the chemical signal that works at the switches between our nerves. so in the billions of nerves in our brain they connect to hundreds of other or thousands of other nerves by small endings nerve endings that join at what are called synapses and the synapse is a chemical switch between nerves and the the switch is switched on or off by chemicals crossing the gap and we call those neurotransmitters and there are about 80 of them in the human nervous system. And one of them, serotonin, is a neurotransmitter that has a lot to do with depression. And in fact, the common treatments for depression like Prozac work to increase serotonin. Charles says there's a lot of research showing that long-term excessive alcohol use can lead to lower serotonin levels and also make serotonin receptors less sensitive. Alcohol also negatively impacts our physical health, and in more ways than it might seem. The common misconception is that it's bad for health in terms of getting drunk and having an injury and your liver. But actually, there are a number of other body systems that are significantly affected by alcohol that are probably even more important than that. So, in brief, alcohol is bad for the cardiovascular system. in particular it increases the risk of blood pressure and stroke it has a mixed relationship with the risk of heart attack depending on where you are in the world and how you drink it increases the risk of cancer of a number of common cancers those that are directly contacted by alcohol like the mouth the tongue throat esophagus and stomach but particularly the breast cancer and bowel cancer and I mean there's a very strong relationship with breast cancer which is what is underpinning the changes in many governments recommended safety limits for alcohol. It is a cause of obesity and metabolic syndrome which of course is the epidemic of our age with the knock-on effects of increased risks of diabetes and that's just to name a few. I mean really alcohol can have effect on any area the body that has a blood supply, which is all of the body apart from cartilage. As you quit drinking, were there any health benefits you noticed? Did your overall health change? Well, vast improvement in my mood. I mean, I remain on antidepressants. I mean, I have a co-diagnosis of depression, reduction in anxiety, and physically, the interesting thing about my physical health i mean other than towards the end of my drinking and at certain times was that actually i'd never had a problem with physical health and there is a bit of a sort of um generalization perhaps that that alcoholics don't get liver disease now obviously some alcoholics do get liver disease but the reason that generalization is occurs is because most alcoholics like myself have been stopped in their tracks by their mental health problems before they got physical problems and in a sense i see people who um you know being told to stop by their doctor is really falling into two categories there are people like me who had to stop earlier because otherwise you know there would have been terrible consequences because of our addiction to alcohol. But actually the main problem societally is the number of people now in their 50s and 60s who are overweight, you know, moderate to heavy consumers of alcohol who have got all the other health consequences of that. And in fact, they are the liver transplant generation, people who have got risks of liver disease, both from obesity and from alcohol. Charles Knowles is a professor of surgery at Queen Mary University of London. His new book is called Why We Drink Too Much, The Impact of Alcohol on Our Bodies and Culture. Coming up, being sober can mean different things to different people. What she would do when she wanted to drink was she would smoke a joint. And I was like, let me try that. And it worked. We'll talk about a trend called California sober and find out what addiction experts make of it. That's next on The Pulse. This is The Pulse. I'm Maiken Scott. We're talking about alcohol and how it affects our health. For many former drinkers, being sober means complete abstinence, no alcohol, and no other substances that could potentially replace the booze buzz. But a new definition of sober is catching on among people who say less rigid rules work better for them and their lives. Andrew Stelzer has more. Here's how Ada describes her situation these days. I've been sober three years, got a couple of kids, and I am California sober. Ada asked me not to use her last name because California sober often involves consuming illegal drugs. She's 40 now, and she didn't drink at all when she was in high school. And then I heavily started drinking in college, and a lot of my friends and family were drinkers. So I didn't have a problem to them because I had a job and I had a house and I was married. But I was drinking in the morning. I was drinking by myself. I was shaking. After falling down the stairs one day in 2023, Ada checked herself into a 30-day rehab facility. The first few days of withdrawal were rough. And once she started stabilizing, Ada felt her next steps forward should include healthy foods and herbal teas. But she says the staff and doctors' focus was keeping her on anti-anxiety medication to help with withdrawal. I just didn't want to do the pharmaceuticals. That's not really my thing. When I was in rehab and they gave them to you in the beginning, I would cry all day. When I took that step, I would cry all day. And I'm like, okay, this isn't really helping me get over my problem. Ada left rehab early after only 10 days. She established her own recovery routine, which about two weeks later included a return to using cannabis. I got the stomach virus, and I started throwing up, and I was like, I really need to smoke some weed because this is terrible, you know what I mean? I forgot that I used cannabis for things like that. Ada says since then, she's continued to smoke regularly, sometimes daily. But in terms of her sobriety, it posed a question. She had kicked a very self-destructive habit with no intention of going back, but could she claim she was sober? This is when she came across the term California sober. I think I saw it on TikTok, to be honest. I was like, what the hell is that? The idea has gone mainstream in the past few years. Are you really sober if you still smoke weed and do shrooms every weekend? Maybe. A new trend has taken over, and it's called California sober. Now, California sober usually means cutting out alcohol or hard drugs, but still using marijuana. I'm California sober, yes. I'm California sober. For the month of January. For the month of January and maybe a little bit later. Celebrities like Billy Strings and Willie Nelson are literally singing its praises. So I'm California sober as they say. And lately I can't find no other way. I can't stay out to party like I did back in the day. So I'm California sober as they say. But the real breakout moment came when singer and actress Demi Lovato began telling her story of surviving a heroin overdose and gave the controversial recovery model a shout out. Here's Lovato chatting with Joe Rogan about it on his show. And I thought, well, I live in California, you know, why not a little weed? And so I tried it and it wasn't so bad. And I began to appreciate what it could do for me. it stopped me from going to the other things. The definition is still a bit vague, but most commonly California sober or Cali sober for shorthand means no alcohol and no hard drugs, but weed and psychedelics are okay. And they're sometimes even important. The term California sober was supposed to and always meant using natural substances to overcome addiction from alcohol and hard drugs. That's W.E. Simmons, who goes by Bill, author of the book California Sober, The Science of Recovery. He's both a researcher of the method and a practitioner, having used what he calls the California Sober Remediation Therapy model to kick his own addictions to alcohol, opiates, and crack cocaine. First, psilocybin helped him break out of his normal default routine and stop using hard drugs. Quitting alcohol took a bit longer, until one day when he noticed his wife was using cannabis strategically. What she would do when she wanted to drink was she would smoke a joint. And I was like, let me try that. And it worked. If I was to ingest any form of cannabis before I drank. Now, if I ingested it after I had a beer, it did nothing. But if I took cannabis before I had anything else, I would not want anything else. I was fine. Bill also preaches meditation, breathing, and exercise, all methods of stress relief and gaining focus. We need to listen to people who use drugs and make sure they're part of the process to tell us about what they're experiencing and to believe and trust that and follow up on what we're hearing with science. That's Chris Kaler, Director of Alcohol and Addiction Studies at the Brown University School of Public Health. If people are choosing cannabis as something that they believe has less harm, it's really the obligation of researchers and public health experts to try to understand, does that reduce harm and under what conditions and for whom and are there alternatives? Chris was part of a team of researchers at Brown who wanted to find that out. A study they published in 2025 gives some credence to the theory that using cannabis can help people drink less. The experiment took place in what's called a bar lab. It's set up with what looks like a bar and the beverages that one might expect to see at the bar. And the drinks that people are served are divided into smaller doses so that we can tell exactly how much they're drinking and how fast they're drinking. Before entering the bar lab, participants had to smoke cannabis of varying strengths, including a placebo. What we saw was that when people smoked a cannabis cigarette that contained THC, they drank less than when they smoked one that had just a trace amount, essentially no THC in that. And they experienced less craving for alcohol. So they waited longer to have their first drink. Once they had that drink they drank less of it and they experienced less craving for alcohol while drinking This is just one study of course with plenty of limitations All 157 participants were already drinkers and cannabis users. And the marijuana, procured from the only government-operated cannabis farm in the U.S., was a lot weaker than what's sold in dispensaries these days. As for the biology of why it might work, that's a whole other question to study. So is it consistent with people who have reported that they cut down on drinking by smoking cannabis? Absolutely, it's consistent with that. What we don't know is what are the long-term effects? What's the right balance between cannabis and alcohol use? We know that both of them have risks. Those risks are part of why many in traditionally clean and sober communities are chafing at the California sober title. There's a fear it could mislead people into using other dangerous substances with a false sense of safety. Even Demi Lovato renounced the Cali sober lifestyle just a few months after giving it a rush of publicity. Demi Lovato is no longer California sober. On Thursday, December 2nd, the singer wrote on their Instagram story, sober sober is the only way to be. But people like Ada take issue with the idea that there's only one way to be sober. In particular, she points out a confusing, sometimes hypocritical view of marijuana. Just that mentality that if you do anything that doesn't come from a prescription or a bottle, from a prescription by a doctor, then you're like doing a drug and you're relapsing. With marijuana now considered medicine in dozens of states, younger people in particular, who grew up in a world of mostly legal weed, are getting mixed messages. Is cannabis a problem or a solution or both? If it's going to be medical, I'd like for it to be more medical. Like I'd like for it to be more of a tool for doctors. In December, President Donald Trump directed the U.S. Attorney General to reclassify marijuana as a Schedule III controlled substance, which means classifying it as having less potential for abuse. One of the primary reasons for the directive was to enable scientific and medical research, which has been extremely difficult to conduct since 1970 when President Richard Nixon classified it as Schedule I. It could open up a lot of opportunities that right now are just very hard to pursue. kinds of studies that would answer more directly if people use, say, edible cannabis. Would that reduce their desire for alcohol? Could you manipulate the amount of, say, CBD or CBG that's in the dose of cannabis that you're giving? And might that have better therapeutic effects? So the chances to study that would be a lot greater. In the meantime, Chris says it's important to remember that most people who quit drinking have done so without any help from a doctor. So using a word-of-mouth model like California Sober isn't really that different. The most common way that people, for lack of a better term, resolve an alcohol problem is on their own, without any kind of formal system of help. Instead, more often people make a change and they figure it out on their own. Whether it qualifies as true sobriety or not could be besides the point. Chris says there's probably a better term we could use than California sober, and he's hoping one eventually emerges. But he says anything that engages people to think about improving their own health and quality of life deserves support. That was Andrew Stelzer reporting. There are lots of things that are not cut and dry when it comes to sobriety and dependence. Physician Charles Knowles writes about something he calls gray area drinking in his new book, Why We Drink Too Much, The Impact of Alcohol on Our Bodies and Culture. I define grey area drinking as someone who relies on alcohol in a way that makes them concerned about the consequences and about their ability to change their habits. One aspect of this is when things seem to be spinning out of control, but nothing terrible has happened yet. You haven't crashed the car yet, you haven't lost your job yet, you haven't lost your marriage yet, but those things are starting to worry you. And maybe there are some soft consequences that have already happened, like, you know, you're anxious at work, your performance at work isn't as great as it should be. And then there's something Charles calls alcohol reliance. So this is to distinguish it from alcohol dependence. They rely on alcohol, particularly in certain situations, like I rely on alcohol to de-stress after work. I rely on alcohol to socialize. Taking a break from alcohol with dry January has become popular in recent years, where you commit to not drinking for the entire first month of the new year. Charles says it can be helpful, especially if you're not sure about your relationship with alcohol. alcohol. Dry January is great. It is a great idea. And it is a great idea of itself, because having a month off might be good for your wallet, your weight and a few other things, you know, after Christmas. But, you know, the thing to not do with dry January is to treat it as a punishment. So if we go through dry January thinking of it as a punishment, you know, bemoaning the loss of our favorite friend until February the 1st, then nothing will be achieved by it. And so what you need to notice is not what you're missing, but what you've gained. And this comes back to the whole learning to drink point in my book that you learn to drink as we learn to do anything through negative and positive reinforcement. You know, that goes back to the work of people like BF Skinner in the 1930s, you know, in behavioral psychology. And what we need to do here, you can't unlearn to drink you know any more than you can unlearn to ride a bike you know it's just not possible so you know because memory will retain it but what you can do is to learn to not drink and so the key is to notice how much better we feel you know that's positive reinforcement all the things that are possible now you're not got a hangover or you've spent all that time in the pub You know, the clarity of thought, increased energy, mood and less anxiety, all of those things are examples either of positive or negative reinforcement. And so it is possible to learn to not drink. And things like journaling that experience or joining a community group to share that journey will help you notice it. I also asked Charles about language, what terms he prefers and how he describes his own history with alcohol. I use the term recovering alcoholic because I believe it says what's in the tin. And so at a bar, when someone says, oh, go on, have a drink, you'll be all right. I say, no, I'm a recovering alcoholic, which does tend to stop the conversation dead. And, you know, not lead to any discussion further of the subject. But it does sort of have a ring to it that, for instance, walking into a bar and saying, no, I won't have a drink because I've got a severe alcohol use disorder, does it? Charles Knowles is a surgeon and a professor at Queen Mary University of London. His new book is Why We Drink Too Much, The Impact of Alcohol on Our Bodies and Culture. Coming up, where can you go when you no longer drink, but you miss the social fabric of a bar? Zero-proof bars offer an alternative. It scratched that itch that I had and had been missing for years since I got sober. That's next on The Pulse. This is The Pulse. I'm Mike and Scott. We're talking about alcohol and how it affects our health. Many social events for adults involve drinking, and a lot of it. Weddings, sports games, birthday parties. Alcohol helps us socialize. It can make us feel more relaxed and at ease. So like if you go to a bar, you just sit down, you chat with the bartender or other guests. It's sort of an instant little community. When people quit drinking, this is often what they miss, the social aspect of drinking. Alan Yu has this story on finding alternative spaces to hang out. Annie Fogarty was almost 21, living in New York City, when she had her first drink. New Year's 2011, and I remember going home on the subway in New York and feeling tingly all over. And the, as I call it, the bad part of my brain, the bad brain, said, this is exactly what I've been needing. Before that, she had never thought that someone needed to get drunk to have fun with other people. But now she realized what that was about. I remember when it was the greatest feeling in the world. It felt like everything I'd ever wanted in friendship. It was a feeling of closeness that I'd always needed. She says around other people, drinking helped numb negative emotions and pain she was feeling about things in her life, like dropping out of college. Alcohol also helped her make new friends. I got invited to things more, and people were more excited to call me up and go out. They knew that I was always gung-ho to go out and get wasted on a Tuesday. But then she says it became an addiction. I started staying in all the time because I literally needed to drink from the time that I woke up until the moment I couldn't keep my eyes open. She used to work on film sets and had to quit her job. She went to inpatient rehab twice, detoxed at least three times, and stayed in the hospital a few times. She kept returning to alcohol, and her health deteriorated dramatically. She lived in her parents' house for a while because she was too weak to walk. My face was swollen to like six times as natural size. I was unrecognizable. I was losing my hair. Just, it was awful. I was just like living in their recliner chair because I was too weak to go upstairs to my bedroom. Eventually, sick as she was, she realized that she wanted more out of life. She got sober after seven years of drinking and has stayed that way. Her health improved, her life improved in many ways, but her social life changed. There was this one Halloween party she went to. I just brought my own seltzer water and I realized how socially awkward I had become because it had been so long since I'd been around people and especially around people without any alcohol in my system. And I remember leaving the party and having an absolute anxiety attack on the platform on the way home and just crying because I didn't feel like myself and I didn't know if I'd ever feel like myself again. She was looking for the easy social connection that she used to find in bars. I used to go to bars a lot by myself and just sit up at the bar. If they had food, I would have a meal there and a couple of drinks and just make friends with the bartender. Annie says she found that space in Bar Palmena a zero cocktail bar in Philadelphia Bar Palmena looks and feels like a cocktail bar You can sit at the bar and watch the bartender make your drinks. There's a projector that shows sports games on a large blank wall and comfortable seats for people who want to watch. And of course, there are the drinks. owner and bartender Nikki Graziano like Annie used to have a serious drinking problem so serious she had a liver transplant in 2022 had about a year of recovery from that because I was on life support for about two weeks in the ICU all my muscles atrophied so I had to learn how a walk again, which took about eight months in total. Once she got sober, she wanted to have a good non-alcoholic drink to celebrate. I quickly found out that everything was lemonade, some form of lemonade. She learned how to make non-alcoholic cocktails that were not just lemonade. She made me a non-alcoholic version of a drink called a French blonde, which has grapefruit juice, elderflower, non-alcoholic gin, non-alcoholic wine, and bitters. After opening a pop-up location, she realized there was a market for non-alcoholic drinks. So she opened Bar Palminer more than a year ago as a social space for people who, for whatever reason, do not want a drink with alcohol. We have drinkers, we have people in recovery, we have pregnant women, people training for marathons, we have a really big Muslim community that comes in, people just on medication for a few weeks. She says she is still learning the delicate dance of whether people want to sit quietly with their drink or if they want to have a conversation. She hosts events like a recent New Year's Eve party, football and baseball games, and trivia nights. All right, it's about that time, Tuesday, 7 p.m. at Bar Palmino. That means it's time for some trivia with WizWit Trivia. Nikki has some regular loyal customers. Annie is one of them. It scratched that itch that I had and had been missing for years since I got sober, where you kind of feel like you're not able to interact like a real person anymore. So Nikki kind of answered that emptiness, that loss in life and socializing. Annie says Nikki is the kind of bartender who knows everybody and can introduce people. When Annie needed help with her computer, Nikki knew who to ask. Annie says even if you are not making a conscious effort to stay sober like she is, you could try socializing without the alcohol to soothe you. I have a big philosophy about looking at things in your life and asking yourself, is this making my world bigger or smaller? Sometimes habits of ours that we keep doing, they're actually keeping us very stuck and stagnant and preventing us from doing new things that could be better for us or helping us to progress in some new way that could be scary, but could be great. She quotes a line from George W. Bush's memoir, where he recalls his wife asking him, when was the last time he did not have a drink? And I think that more people should ask themselves that, not to suggest that they have a problem, but to wonder, when was the last time that I just let myself be and not have to have alcohol or just like something to hold my hand. And what would it be like if I just like tried to be calm and like sit with some discomfort for a while and figure out making it comfortable? That story was reported by Alan Yu. When people quit drinking, it can be challenging to develop healthy habits, to find new ways to spend time and to connect to other people. For Doran Lam, extreme sports seemed like a perfect outlet. Until it wasn't. Nicole Curry has more. Growing up, Doran and her parents hiked pretty large mountains. She remembers wandering through trails in the Snowdonia National Park in the UK and trudging her way through the snowy Larigrew mountain passes in Scotland. These mountains were so high that their peaks grazed the clouds. And I can remember that, like, being amazed that I was in the clouds. And that being, like, a key moment for me as a child. Doran grew older and she stopped hiking. She doesn't recall when it happened or why. But in her 30s, Doran developed an addiction to alcohol. After a breakdown, she went to rehab. When she finished her program, she was determined to stay sober. During the last few days at the facility, people talked a lot about life after rehab. What are you going to do when you come out? You need something which is going to replace that thrill. A lot of people who get into addiction are thrill seekers or enjoy the kind of the ups and downs of addiction to a certain extent. There isn't sort of an element of like pushing yourself to the limit of life and then enjoying the feeling that you've done that. Extreme sports were among those recommendations. And these kinds of activities were familiar to Dorian because of her upbringing. So when she moved to China to teach there, a few months later, a friend invited her on a hiking trip to a nearby mountain. Once her feet met the ground and she began hiking with her friend, a powerful mix of joy, pride and exhilaration consumed her. I think when I got into it, I realized that it was giving me something more than just the exercise side of it. Like it wasn't just about, oh, wow, isn't this beautiful? There was another level to that enjoyment. Like there was definitely more of a thrill involved in it than just, oh, this is beautiful. And wow, look at the surroundings, you know. The enjoyment mainly came from how difficult it was. Doran started to hike a lot and sought out more and more challenging paths. She went on an excursion to Four Sisters Mountain, a series of four snow-capped peaks in Tibet. Together with 10 other climbers, she was going to hike a mountain with an altitude of more than 5,000 meters or 16,000 feet at the peak. This climb would take a few days, so she packed her gear, different layers of clothing, and a large stash of chocolate that she couldn't do without. So you started the climb like at 1,000, where it was like really, really hot. and then you're just adding layers and then base camp. A lot of people already sick at base camp. The altitude was already affecting climbers. Altitude sickness is sometimes referred to as mountain sickness. It's when the body has difficulty adjusting to reduced oxygen levels at a higher altitude. It makes people dizzy, nauseous, or it just feels like you can't breathe. So when this happened, members of Doran's hiking group were calling it quits. But she kept going. It was only as we started the climb in the morning that I just, I realized how much the altitude was having an impact on me. And I think other people could see too, because I just, I was, with breathing, I was struggling quite a lot more than the other people. And Doran kept pushing. She was so close to reaching the top of the mountain. it was just in the last bit that I realised that I wasn't sure how much further I was going to be able to make it I didn't say that but I just got this feeling that I wanted to get back down quite quickly and then it was only the last couple of very small section where you can see the top that I just went into I can't really remember anything I went into complete meltdown and I just I didn't want to do it I do vaguely remember saying to the leader I don't think I can do this last bit and he was like it's just there I had this sort of gray kind of like dazed look on my face and he kind of was like come on you know let's just do it and I pushed myself to go up and then as I got to the top for me it's a complete blackout. When Doran came to her senses she was puzzled and lost about what had happened. Her climbing group helped her put the pieces back together. First, she told the group that she didn't feel well. Then she felt very warm and began taking her coat, hat, and jumper off. The group tried to stop her, but she resisted until she began falling asleep in their arms. And then they had no choice but to carry her down the mountain and supply her oxygen. Doran's blackout was a severe case of altitude sickness. Fortunately, the condition can resolve itself when you return to a lower altitude. So Doran did that and she felt a lot better after returning home. But after I did it and after I was sick, that was something that was appealing to me. Instead of being scared by her close brush with disaster, that exhilarating and thrilling feeling returned. She wanted to go on her next adventure. I spent my whole day in a kind of like a real, I don't know, like in a real like addiction mode through my phone for hours looking for the next climb and when I could do it. Right. This behavior started to feel oddly familiar and not in a good way. I think it was after that one that I realized the fact that I wanted to do another climb as soon as possible. Why would I want to do that? And I couldn't tell anyone that I was planning to do another climb because they were all so concerned anyway that I'd been so ill. The idea that it was really quite dangerous appealed to me as much as doing the activity did. It was the possibility of danger that was driving her, the thrill of it all. After this realization, she began writing about this experience and wondered, was this just another addiction for her? I remember it being talked about in rehab as a problem, that some people replace it, but they go too far, but a little bit of it is okay. So it's sort of like, well, actually, you are better to be, you know, climbing a mountain or bungee jumping than shooting up heroin. However, I think the concern is that, you know, you can just be replacing one thing with another, which is also what you're taught a lot about in rehab is that you have to be very careful with cross addiction or like secondary addiction. Doran is climbing mountains again, but she's learned to be more mindful and careful about her experience. experience. I think now if somebody said to me, oh, do you want to climb a mountain? I think, yeah, and it wouldn't be yeah, because I might die doing it. And wouldn't that be fun? It's, yeah, because I'd really like to go and experience. I'd like to get up in the snow and I'd like to, to, you know, feel alive, right? That story was reported by Nicole Curry. That's our show for this week. The Pulse is a production of WHYY in Philadelphia. You can find us wherever you get your podcasts. Our health and science reporters are Alan Yu and Liz Tong. Charlie Kyer is our engineer. Our producers are Nicole Curry and Lindsay Lizarski. I'm Mike and Scott. Thank you for listening. Behavioral Health Reporting on The Pulse is supported by the Thomas Scattergood Behavioral Health Foundation, an organization that is committed to thinking, doing, and supporting innovative approaches in integrated health care.