By Kara Pepper, MD

My first COVID vacation last year was spectacular, except that I barely remember three days because I was drinking to the point of amnesia.

I am a physician from a multigenerational family of alcoholics, and I never wanted to struggle with alcohol use disorder. Instead, I discovered that I could avoid feelings of discomfort by overworking, achieving, and staying perpetually busy. Workaholism became my drug of choice. As an adult, I worked obsessively from Sunday evening to Friday afternoon. By Friday at 6 p.m. I would think, “I just want to turn my brain off,” pour myself a glass of wine and unwind.

By the time I was an exhausted mid-career physician, drinking on Friday intensified and bled through into Saturday night. As I recovered Sunday morning, I would have overwhelming hangover anxiety, persistent worry, and self-criticism. Then I would numb with overworking until the next weekend, living in a continuous cycle of muting my feelings with work and alcohol.

Everyone I knew was overdrinking. Every social engagement with my high-achieving, workaholic friends was lubricated with cocktails. When I was intermittently sober, I was the exception to the rule of social engagement. Of note, 12.9 percent of male physicians and 21.4 percent of female physicians struggle with alcohol use disorder or dependence.

From the outside, I did not appear to have a problem with alcohol. I only drank two days per week. I did “dry January” several times. In fact, I was alcohol-free for the first six months of 2020. My marriage was happy. I was a good mom. Alcohol did not impact my work responsibilities. I had no real consequences for my drinking.

But quietly, shamefully, I worried.

I was terrified that I was really an alcoholic in denial. As an actual doctor, I would Google, “How do I know if I’m an alcoholic?” I would see that I did not meet the criteria for substance use disorder and rationalize that I was overthinking. The problem was the more I restricted my drinking, the more intense my Friday nights became. I privately worried about the blackouts in my 40s that I rarely had in my 30s.

On November 3, 2021, the day I came back from Mexico, my worry was unavoidable. The quiet whisper that I should get curious about sobriety became a roar. To be clear, there was no rock bottom in Mexico. I didn’t come back with a crazy tattoo or an STD. I simply decided, “I can’t do this anymore.”

Enough is a decision – not an amount.

Ninety percent of alcohol overusers do not meet the criteria for substance use disorder. Gray drinking is the zone between tee-totaling and substance use disorder characterized by the worry about one’s alcohol overuse. It increases one’s likelihood of substance use disorder and sounds like this:

You don’t have a drinking problem, but a problem with your drinking.

Silent worry, regret, or shame about drinking.

Drinking between two extremes – not every day, but you don’t have an “off” switch.

You can stop, but it’s hard to stay stopped.

Your drinking doesn’t look problematic to others.

No “rock bottom.”

Memory gaps when you drink.

Worsening anxiety or depression after drinking.

Alcohol use, from tee-totaling to dependence, is a spectrum. For years, I was more afraid of an alcohol dependence diagnosis than the real impact alcohol made in my life. Ultimately, where I fell in that spectrum was irrelevant. The cost of drinking far outweighed the perceived benefits, and it was time to let it go.

Newly sober, I found skills to fundamentally address the urge to turn off my brain at 6 p.m. on Friday. Coaching and therapy were and continue to be extremely helpful. Identifying a compelling “Why,” learning to tolerate and not respond to urges, finding alternative ways to have fun and relax, connecting with friends who are less reliant on alcohol, addressing my burnout and anxiety, and speaking openly about my shame and worry have been part of my continued sobriety.

November 3, 2021, was the last day I drank alcohol. By sheer serendipity, that is my brother’s sobriety date from three years prior. For me, that date is more than just a coincidence – it is an affirmation that I was right to consider sobriety.

If you would have asked me last year, “Do you ever worry about your drinking?” I would have given you a long explanation of how I was fine. Similarly, if your answer is anything more than “No,” it is worth getting curious about your relationship with alcohol. Consider a period of time away from alcohol, and see what you learn – the degree of your desire for alcohol will be very clear without it. There are many resources for support. You never know what hangs in the balance of choosing a period (or lifetime) of sobriety.

Kara Pepper is an internal medicine physician.