FROM THE ALCOHOL USE DISORDERS CLINICAL KNOWLEDGE CENTER
Holiday Drinking

by Anne Lambert, MS

The holiday season, between Thanksgiving and New Year’s Day, can be a time of good cheer, and also a time of binge drinking or increased heavy drinking. Many people don’t drink often, which makes them more vulnerable to the effects of alcohol. On the other hand, people with alcohol dependence may experience the holidays as a time to drink more frequently and with less inhibition.

It’s important for healthcare practitioners to help patients manage their alcohol use during the holidays by asking some of the following questions, "Do you tend to drink more during the holiday season?" “Are you depressed during the holiday season?” “Do you have a support system to help you through this season?”

Marcia Goin, MD, PhD, in her article, “What is it about the holidays?” reminds us that, “lonely patients are more aware of their loneliness and grieving patients are more sensitive to their losses.” She also states that the personal impact of life’s hardships seem more difficult when patients are surrounded by what appears to be the joy and happiness of others. Many patients find the holidays so stressful that they miss their appointments and forget their medication.(1)

When mental disorders are co-occurring with alcohol dependence, it is especially important to help patients adhere to their treatment plan including psychosocial interventions and pharmacotherapy. Rick Rosenthal, MD, Professor of Clinical Psychiatry at the Columbia University College of Physicians & Surgeons and Chairman, Department of Psychiatry St. Luke’s Roosevelt Hospital Center reminds us that within the treatment context, both co-occurring disorders—mental disorders and alcohol dependence—are considered primary and both need to be effectively treated.(2)

Binge or heavy drinking can affect the bioavailability of regularly prescribed medications, for psychiatric conditions as well as other medical conditions.(3,4) It is estimated that alcohol-medication interactions may be a factor in at least 25% of all emergency room admissions and an unknown number of less serious interactions may go unrecognized or unrecorded.(5,6)

Drinking too much, at parties or chronically, can also lead to major health problems including liver damage and heart disease. Dr. Robert E. Fromm, Jr., an associate professor of cardiology at Baylor College of Medicine in Houston, said Holiday Heart Syndrome, is a condition that can be seen in people who drink excessively during a short period of time. "Patients often come in with complaints about the heart rhythm itself […] they believe they are having palpitations or recognize that their heart is racing or skipping. Some will have chest discomfort, feelings of shortness of breath or become faint."(7)

In 1978, Ettinger and colleagues coined the phrase Holiday Heart Syndrome to describe an acute cardiac rhythm and/or conduction disturbance, most commonly supraventricular tachyarrhythmia, associated with heavy ethanol consumption in an individual without other clinical evidence of heart disease. Typically, the symptoms resolve within 24 hours.(8,9)

“Holiday Heart Syndrome is seldom life-threatening, but it can be scary,” Fromm said. "People need to realize the dangers of binge drinking. They also should know that heavy drinking over time could lead to irreversible heart damage."(7)

Healthcare practitioners can proactively manage their patients during the holiday season by repeated screenings for alcohol use and co-occurring mental disorders. Frank discussions about the impact of binge drinking and increased heavy drinking during the party season are imperative for quality patient care.

Additionally, patients can be offered a checklist to enhance their awareness of how and when they drink alcohol.

• Limit your consumption of alcohol. Space your drinks at least 1 hour apart
• Eat something before drinking; eating after you've started to drink doesn't help
• Try alternating alcoholic and non-alcoholic drinks throughout the party to cut down on the amount you drink
• Drink only if you want to; don't be pressured into accepting a drink
• Don't drive; take a taxi, public transportation, walk or decide who is to be designated driver before the party starts(10)