Insights from Dr. Sarah Wakeman (Harvard Medical School, Mass General Brigham)
Featured on Mel Robbins Podcast
Alcohol is deeply embedded in American culture, often portrayed as a way to relax, socialize, or even improve health. However, modern medical research paints a very different picture. In a recent conversation with Mel Robbins, Dr. Sarah Wakeman, an addiction medicine physician at Harvard Medical School and Mass General Brigham, breaks down what alcohol actually does to the body and brain, and why reframing how we think about drinking is essential for long-term health and prevention.
What Is Alcohol, Really?
Alcohol (ethanol) is a water-soluble chemical created through fermentation. While it may be served in a cocktail glass or wine bottle, Dr. Wakeman highlights an important fact: the ethanol in alcoholic beverages is chemically identical to the ethanol found in hand sanitizer, mouthwash, and cleaning products.
Once consumed, alcohol is rapidly absorbed through the stomach and small intestine, reaching the brain within minutes. Because it does not need to be digested, its effects on judgment, coordination, and mood occur quickly.
Is Alcohol Actually “Good for You”?
For years, headlines suggested that moderate drinking, especially red wine, could be beneficial for heart health. According to Dr. Wakeman, many of these early studies were flawed.
Older research often compared drinkers to “non-drinkers,” a group that included many people who had quit drinking due to serious health problems. When researchers now compare drinkers to infrequent or occasional drinkers, the supposed health benefits largely disappear.
The modern medical consensus is clear:
Alcohol should not be viewed as a health behavior. Instead, it should be treated as a risk-based choice, similar to activities like skiing or sun exposure: choices that carry increasing risk with increased exposure.
How Alcohol Affects the Body
Increased Cancer Risk
Any amount of alcohol increases the risk of cancer, including breast, liver, mouth, throat, and digestive cancers. Alcohol can raise hormone levels, which is one reason it is strongly linked to breast cancer risk.
Liver Disease
Alcohol causes a progression of liver damage, from inflammation to fatty liver (which may be reversible), and eventually to cirrhosis, which is permanent. Alarmingly, doctors are seeing more cases of severe liver failure in people in their 20s and 30s.
Kidneys and Dehydration
Alcohol blocks Anti-Diuretic Hormone (ADH), causing the kidneys to release excessive amounts of water. This leads to dehydration throughout the body and contributes to headaches, fatigue, and impaired concentration.
Gut Health
Alcohol disrupts the gut microbiome and increases intestinal permeability, often referred to as “leaky gut.” This allows toxins to enter the bloodstream, contributing to inflammation and immune system stress.
Alcohol, Sleep, and Brain Health
Sleep Quality
Although alcohol may help people fall asleep faster, it severely disrupts REM sleep and deep restorative sleep, leading to poorer sleep quality and daytime fatigue.
Why Hangovers Happen
Hangovers are not just “bad sleep.” They are caused by dehydration, toxic byproducts like acetaldehyde, and mild alcohol withdrawal.
Brain Changes
Long-term heavy drinking can lead to visible brain shrinkage on MRI scans, particularly affecting the hippocampus, which is responsible for memory and learning. In severe cases, this can lead to permanent memory disorders such as Wernicke-Korsakoff syndrome.
Mental Health
Alcohol is a depressant and can cause or worsen anxiety, depression, and mood disorders. Many people drink to cope with stress or anxiety, but alcohol often intensifies these symptoms over time.
Redefining “Problem Drinking”
Dr. Wakeman emphasizes that alcohol problems don’t fit a single stereotype. Alcohol Use Disorder (AUD) exists on a spectrum and may include:
- Drinking more or longer than intended
- Wanting to cut back but being unable to
- Continued use despite problems with health, work, or relationships
- Strong cravings or urges to drink
- Increased tolerance or withdrawal symptoms
Recognizing these signs early can prevent more serious harm.
Practical, Compassionate Strategies for Change
Change does not require “hitting bottom.” In fact, Dr. Wakeman stresses that people are most successful when they feel supported, not shamed.
Helpful strategies include:
- Keeping a drinking diary to identify emotional or social triggers
- Setting specific, realistic goals, such as limiting drinking to certain days
- Planning ahead for social situations, including non-alcoholic options
- Sharing goals with trusted friends or family to build accountability
Compassion, connection, and education are key drivers of long-term behavior change.
HC DrugFree’s Commitment to Prevention
At HC DrugFree, we believe that accurate information, early education, and community support save lives. Understanding the real medical impacts of alcohol empowers individuals and families to make informed choices and seek help when needed.
If you or someone you care about is concerned about alcohol use, resources and support are available. Prevention starts with knowledge, and no one has to navigate this alone.
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