Alice —

A friend says cocaine is stupid, expensive and boring. He prefers alcohol. Is this valid reasoning for getting drunk on tequila and falling asleep on the bus to Hoboken?

— I'm Worried

Dear I'm Worried,

It sounds as if your friend wants nothing to do with cocaine, yet you've hinted that he has much more than the occasional drink. As his friend, learning a bit more about moderate versus high-risk drinking and how to share your concern in a constructive way could provide you with some useful tools to support him.

The more a person drinks, the greater their chances for negative health and behavioral consequences (e.g., problems at work or school, trouble with campus or local law enforcement, physical injury). Higher-risk consumption, when these issues are more likely to occur, is defined as drinking more than 4 drinks per occasion or greater than 14 drinks for those who are assigned male at birth and more than three drinks per occasion or greater than seven drinks per week for those assigned female at birth. Further, binge drinking consists of four or more drinks in two hours for anyone over 65.

While drinking moderately is associated with some health benefits (including lower risk for heart disease, stroke, and diabetes), higher-risk alcohol consumption and binge drinking may lead to serious consequences both in the short- and long-term. More immediate health risks include injuries (including motor vehicle crashes, falls, and burns), alcohol poisoning, and unintended pregnancy and sexually transmitted infections (STIs) due to a higher likelihood of having sex without contraception. In the long run, health consequences, such as increased blood pressure, heart and liver damage, greater risk of cancers of the mouth, throat, esophagus, colon, and breast, trouble with learning and memory, interpersonal problems with family and friends, and alcohol dependence may occur.

I'm Worried, your choice to include cocaine as a comparison point to your friend’s alcohol use brings up some questions. How did the comparison come up in the first place? Was your friend critiquing the cocaine use of someone in your life? Do you use cocaine yourself? Was it a hypothetical conversation? Since you brought it up, it’s worth mentioning that cocaine comes along with its own set of risks and side effects with which to be familiar. Some potential short-term effects of cocaine are heightened blood pressure and heartbeat, muscle tremors, nausea, higher risk of contracting an STI from unprotected sex, and potential overdose. Long-term effects may include a high risk of dependence, loss of smell (when snorted), asthma and respiratory distress (when smoked), bowel decay (when ingested), and a higher risk of contracting blood borne illnesses and collapsed veins (when injected). 

Circling back to your friend, answering some questions around his relationships to alcohol might help you determine whether or not to intervene. Does he take more risks while using alcohol? Does he seem to rely on alcohol to cope with problems, negative feelings, or social anxiety? Is his alcohol use having a negative impact on his life in terms of his job, grades, relationships, etc.? Has he expressed a desire to cut down on his alcohol use? If you answered yes to some of those questions, you may want to have a conversation with him about his relationship to alcohol. Before having the conversation, it could be helpful to clarify your goals — you aren’t responsible for solving his problem, but rather, you can express concern and offer support. You can express that you care about your friend and use "I" statements to share what you've observed about their alcohol consumption. Using “I” statements that relay your concern for his well-being and clearly communicating examples of his behaviors that have worried you may help him understand that you’re coming from a place of care and reduce his feelings of defensiveness. If your friend is open to it, you also may want to suggest that he speak to a medical professional or check out substance misuse resources in his area, such as speaking with a substance abuse prevention specialist. If the conversation doesn’t go quite as you’d hoped, it might be worthwhile to rope in other friends to mention their concerns to him one-on-one as well.

After you’ve had a chance to voice your concern, you can let your friend know that you’re available to talk. Your friendship and support could help him through tough times while he sorts out his reasoning for using substances in a higher-risk manner. Reminding him that you care about him enough to be worried may help him to assess his drinking and potentially seek the help of a health care provider or a mental health professional.  

Alice!

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