- Welcome to "Healthy Minds."

(gentle music) I'm Dr. Jeff Borenstein.

Everyone is touched by psychiatric conditions, either themselves or a loved one.

Do not suffer in silence.

With help, there is hope.

(gentle music continues) Today on "Healthy Minds."

This is a major problem, the scope of this is very large, and when you talk about the binge drinking in younger people, it really is something to be concerned about.

- 29 million people over the age of 12 being diagnosed with an alcohol use disorder.

- Nikki, I want to ask you about a particular brain substance that you have done a lot of research on, somatostatin.

Could you tell us what is it?

And how does it relate to alcohol use and misuse?

- Somatostatin is what we call a neuropeptide, and it is expressed throughout the brain and it can do a lot of things.

And we know from the human brain that we think that the higher amount of somatostatin that you have, that your brain expresses, the more protected you seem to be against a very wide range of mental health-related conditions.

- That's today on "Healthy Minds."

This program is brought to you in part by the American Psychiatric Association Foundation, the John & Polly Sparks Foundation, and the WoodNext Foundation.

(gentle music continues) Welcome to "Healthy Minds."

I'm Dr. Jeff Borenstein.

Binge drinking, what exactly is it?

How does it affect the brain?

And what could be done to reduce the risk of binge drinking?

Today I speak with leading expert, Dr. Nikki Crowley about this important topic.

(gentle music continues) Nikki, thank you for joining us today.

- Thank you so much for having me, Jeff.

- I want to jump right in and ask you about binge drinking.

First of all, tell us what's the definition, what exactly does it mean?

- So when we're talking about binge drinking, we're thinking about a form of alcohol consumption that leads to a very, very high amount of alcohol in the body in a very quick period of time.

This is what people would think about when they think about feeling drunk.

And we have different sort of definitions for how much alcohol could for the average person probably lead to that level of intoxication.

So for men, we're talking about five standard drinks in a two-hour period.

And for women, we're talking about about four standard drinks in a two-hour period.

And that is enough alcohol consumed in a really fast period of time that leads to this high level of intoxication.

We also define it by the amount of alcohol in the body, and this is where that sort of well-known number of .08% alcohol comes from.

So this intoxication limit that we think of as no longer being able to drive a car is also what we're talking about when we're talking about a binge drinking episode.

- And unfortunately, this is a lot more common than people realize.

Could you speak a little bit about how often this seems to occur in our population?

- Yeah, so in the United States in particular, binge drinking is the most common form of alcohol consumption.

Binge drinking in and of itself doesn't mean that an individual has an alcohol use disorder, so you can be an individual that regularly binge drinks but not meet the diagnostic criteria and maybe are not getting advice to seek medical care.

It's extremely prevalent among adults, but it's actually extremely prevalent among adolescents as well.

So about 11% of adolescents are going to binge drink alcohol.

- That's a significant percent, and I'd like you to speak a little bit about the issue of adolescents and drinking and how it can affect their brain.

- Yeah, if it's all right, I might zoom out a little bit first.

So adolescence is a period of time when there's a lot of risk taking happening, not just binge drinking.

If you're a parent, you know that there's lots of increased risk taking related to social behaviors related to the decision to play on a sport or try a new thing, and that's really, really adaptive.

Risk taking is really important in sort of our general development of who we are as a person.

And we engage in this risk taking when we're young in part because the parts of our brain that govern the decision to take a risk, this sort of weighing of the reward versus the potential consequences of a risk taking, those parts of our brain are still developing.

So when we're thinking about risk taking, we're thinking a lot about the prefrontal cortex, and this is that part of your brain that's right in the front, it's right behind your forehead.

And it's what we sort of think about as governing our ability to make choices.

This part of our brain does not finish developing until we're somewhere in the order of 25-30.

So when you think about young students, when you think about high school students and college students, they do in fact take a lot of risks in part because the part of the brain that governs risk taking is still maturing.

And this can be a little counterintuitive to think about because we do, we know that the size of our brain seems to be done growing, right?

The size of our head is sort of fixed by that age.

But what we're actually still growing is the connections between this risk governing part of our brain and the rest of the brain.

So adolescents in particular are really primed to drink alcohol and to binge drink in part because the part of their brain that governs sort of is this a worthwhile risk to take versus all of these potential consequences, this is still developing.

- What can parents do to decrease the risk of their child overdrinking?

- Yeah, so the most important thing that a parent can do is have open communication with their child about alcohol use.

There's a lot of evidence that communicating matters.

And teens who drink between age 13 and 16, 50% increased likelihood of an alcohol use disorder as an adult.

So parents can communicate, they can monitor, and they can delay the onset of alcohol use in their children.

And the most important thing that they can do here is to set rules against drinking and have very clear boundaries about not consuming alcohol.

- Nikki, I want to ask you about a particular brain substance that you have done a lot of research on, somatostatin.

Could you tell us what is it?

And how does it relate to alcohol use and misuse?

- Somatostatin is what we call a neuropeptide, and it is expressed throughout the brain and it can do a lot of things.

And we know from the human brain that we think that the higher amount of somatostatin that you have, that your brain expresses, the more protected you seem to be against a very wide range of mental health-related conditions.

So the more somatostatin you have, the more protected you are against major depressive disorder, anxiety, bipolar disorder, schizophrenia, and even things like cognitive decline as you age.

And so my lab is really interested in the why of that question.

Why is this molecule appear to be so protective as we age and against all of these different conditions that we're nervous about?

And one of the things that we have found in my lab is that we think that this neuropeptide somatostatin is really important for the prefrontal cortex to be able to make the decision to take a risk.

So part of that weighing of is the reward of this behavior sort of outweighing any potential negative outcomes?

We think that somatostatin may be one of the signals that pings the individual towards that yes decision, so, "Yes, take the risk, yes, go for the reward, this is a positive experience."

And what we've been looking at is how these patterns of alcohol consumption, this binge drinking may alter that risk signal.

So if somatostatin is really important for that decision making of, "Yes, go for the risky thing," what is alcohol consumption going to do to it?

And what we're finding is that alcohol is really dysregulating the ability for this signal to sort of get pinged out.

Alcohol consumption during adulthood seems to dampen that risk taking signal that this peptide is conferring.

So when you consume alcohol as an adult, there's less somatostatin.

But during adolescence, what we think is happening is adolescent exposure to alcohol is really engaging and bringing online that risk taking neuropeptide so that when that individual is getting older, perhaps what is happening is there's too many pings of somatostatin.

There's too many, "Yes, take the risk," signals.

- I wanna broaden it a little bit and ask you about alcohol addiction, both what is the definition of alcohol addiction and the scope of that problem?

- Yeah, alcohol addiction is defined by how alcohol is interacting with the rest of our lives.

So the negative consequences related to is your alcohol consumption interfering with your work or your social activities, your ability to engage meaningfully with your family?

And binge drinking can be a part of the patterns of behavior that lead to alcohol addiction.

But lots of forms of consumption can lead to an alcohol use disorder.

Binge drinking is very likely to lead to an alcohol disorder.

And in particular, this is really high among adolescent populations.

So about 29% of young individuals report binge drinking, and this results in about 29 million people over the age of 12 being diagnosed with an alcohol use disorder.

- So this is a major problem, the scope of this is very large.

And when you talk about the binge drinking in younger people, it really is something to be concerned about.

What can be done to decrease the risk that a young adult, a teenager binge drinks?

What can families do?

What can society do to decrease that risk?

- Yes, so a lot of that work actually comes out of the Prevention Research Center here at Penn State.

And what scientists in the Prevention Research Center have found is two really key things.

The first is that prevention matters.

What we do before a child starts drinking is really, really important to their decision to drink while they're young and also their relationship with alcohol when they're older.

And the second thing is that the role of the parent really matters.

So the parents' permissiveness of alcohol can lead to an increased rate of alcohol consumption among young people.

The Prevention Research Center through Professor Rob Turrisi has published a guide, "The Power of Parents," and this is available on the Mothers Against Drunk Driving website, which gives a lot of recommendations for how parents can talk to their children about alcohol and about the role of alcohol in their lives.

One of the top things that a parent can do is not be permissive about alcohol consumption.

The earlier that a child is exposed to alcohol or begins consuming alcohol, the more likely it is that they're going to develop an alcohol use disorder and a problematic relationship with alcohol when they're an adult.

So the best thing you can do is keep your child from consuming alcohol early on.

- I know that some of your research has looked at the brain and alcohol use and alcohol addiction, and I'd like you to speak a little bit about what you found in terms of how alcohol use can affect the brain, especially in younger people.

- So my research is really focused on how voluntary consumption of alcohol in these binge patterns in particular might change the very precise wiring and firing and activity of the brain, not only right after an adolescent is consuming alcohol, but while they're an adult, so a long time after that adolescent exposure to alcohol.

And what we've found is that consuming alcohol very early in development, sort of in this juvenile period that we think about risky alcohol taking is going to change the activity of that prefrontal cortical region of the brain potentially for the entirety of the life.

So what we find is an increased activity of some of the neurons that we think are guiding the decision to take risk.

So we do think that there are specific parts of the prefrontal cortex and types of neurons that really ping the individual to engage in risk taking, to encourage the go signal of engaging in a risky behavior, whether it's a social behavior or a movement behavior, and that alcohol consumption when young is going to sort of hyperactivate those neurons.

So it's going to lead to an increased propensity for risk taking long after that adolescent period.

- One of the areas that you've looked at is differences between males and females and alcohol binge drinking, alcohol use in general.

Could you speak a little bit about that?

- Yeah, the differences in young men and young women using alcohol, there are both biological differences and there's also social differences.

So there's been a lot of attention paid recently to what we call the closing gender gap in alcohol consumption.

For a long time, men far outpaced women in their alcohol use.

This is likely not because of an underlying biological difference between men and women, but due to societal access to alcohol.

And what we've seen in recent years, particularly following the Covid pandemic, is that women are using alcohol at much higher rates than they ever have before.

This is a very prevalent women's health issue right now.

Women in particular also will drink alcohol alone, which can be problematic for other reasons.

And so while we have a societal sort of difference in alcohol consumption, in my lab we've also been investigating what some of the underlying biological differences in alcohol consumption could be, particularly in these adolescent ages when we see the onset of pubertal growth and hormones and other biological variables that might be interacting with that alcohol consumption.

And so what we find is that there are some sort of nuanced differences that can emerge, even if males and females are consuming similar amounts of alcohol, the long-term ramifications may be different across the two sexes.

- Also, the issue of when somebody stops drinking, and I know you've done research on that, and I'd like you to speak about sort of what happens when somebody finishes that binge and what occurs in their brain after that?

- There are differences in what happens immediately after we consume alcohol as compared to sort of the long-term changes that we see.

Immediately after alcohol consumption, there can be changes in our ability to make decision-making, to make decisions, to engage in social behaviors, executive control, working memory.

And I think a lot of people have experienced this, right?

We think about hangovers and we have what is often sort of casually called hangxiety, so the anxiety and social changes that we can see immediately following alcohol consumption, that can also lead to persistent changes in the long run though.

So the more cycles of sort of immediate withdrawal that you have and then layering on high rates of consumption again, going through withdrawal again can lead to sort of a long-term change in your mood.

And this is defined by the National Institute on Alcohol Abuse and Alcoholism as sort of a reward deficit stress surfeit disorder.

The idea being the more that you consume alcohol, the more you go through these withdrawals and you repeat this pattern again and again, you're more likely to have a permanent sort of dysregulation in your mood that leads to some of these depressive-like states that we can see.

- So it's almost paradoxical that sometimes people may use and misuse alcohol because they're depressed or anxious, but in doing so, it then sort of exacerbates that situation subsequently.

- Yes, exactly.

And I think that what can also happen is that people can attempt to self-medicate with alcohol, thinking it will make a problem better, and in reality it can make the problem much worse.

And a good example of that is when people can consume alcohol because they think it will help them sleep.

And it never helps you sleep, it doesn't improve the length of your sleep, it doesn't improve your sleep quality, it is going to make you feel worse the next day.

It's gonna lead to sort of a cascade of sleep problems.

But the immediate choice to try to sleep better with alcohol is a really easy one that a lot of people make.

- Where do you see the research going over the next 5-10 years in terms of understanding these issues and developing new approaches to treating them?

- Yeah, I think that there are two issues that we have to tackle when we think about the long-term trajectory of what are we going to do about substance misuse, and these are both from a prevention and an intervention standpoint.

So the first one is prevention, right?

How do we prevent people from having an alcohol use disorder to begin with?

How do we delay the onset of drinking in young people?

There is a lot of evidence out of the Center for Disease Control and Prevention and from research centers like the Prevention Research Center at Penn State that show that it does matter how we talk about alcohol, it does matter what other services we're offering individuals so that they're not turning to alcohol.

So prevention is always going to be the first step, right?

How do we tackle the idea that young people are at this heightened risk taking and might develop an alcohol use disorder?

And intervening early, intervening both with the individual, with the family and at the societal and school level is really vital from keeping an individual off that trajectory.

That's the best case scenario.

I think a lot of people though, they sit here and they say, "Well, I'm much older than that now and I did drink, so what do I do now?"

Right, and that's where this intervention question comes in of how do we tackle this problem for generations of individuals that may have already drank while they're young or drank at high levels when they were younger?

And for that, I think there's a lot of precision medicine that has to come in.

So understanding how does your past history of alcohol interact with any other health conditions you might have that could lead to longer-term health outcomes?

And understanding that we might not be able to change the past behavior or change sort of where any individual's brain trajectory has been, but how do we now put it on the best course possible?

So I think those are the two areas that we're gonna see the most important growth in is from a prevention standpoint, how do we keep people from developing substance use disorders to begin with?

And that's a very sort of societal level question.

And then from an intervention standpoint, that's a very biological question.

Once we've already altered the brain and altered sort of the trajectory, how can we jump in from here to improve brain health?

- What do you say to somebody who says, "You know what?

When I was younger I did this, all kids do, and it's not so bad, it's a part of growing up."

How do you answer that statement?

- That's such an interesting one.

I think one of the most important things that we can do here is de-stigmatize it, right?

It is true, it is true that lots of young people drank alcohol and that that was a rite of passage and part of their generational sort of activities.

You could say the same thing about sun exposure, right?

That it was a rite of passage to not use sunscreen and to use oil and to bake yourself outside all summer, but we have tackled that as a society, right?

We have improved our understanding of skincare and of protecting ourselves from skin cancer.

And so yes, that is a past behavior that many of us have engaged in, and that we can acknowledge it and still improve the outcomes going forward for other individuals.

- I think that's a great example, the putting the sunscreen and sunburns.

- Yeah.

- And all of us having better habits with that.

- Yes, and it's not anyone's fault that culturally tanning was the way to go, but we have very much moved on as a society from that being an acceptable behavior.

- I wanna ask you about the related issue of other substance misuse with alcohol.

Could you speak about the risks associated of other drug addictions when people are misusing alcohol?

- Yeah, there are particular substances that people will consume while they're drinking.

A lot of people, again generationally would have a cigarette while they drank alcohol.

And a lot of people now will even say when they drink, they remember having a cigarette while they drank when they were younger.

I think that this is going to be an increasing problem as we see this shifting towards e-vapes and other forms of nicotine consumption, where co-abusing those drugs can set some really bad habits.

- Another related issue is the issue of mood disorders, depression, anxiety, other psychiatric conditions.

Could you speak about the comorbidity of alcohol misuse with those other conditions?

- The comorbidity of alcohol use in particular with depression, anxiety, and other mood disorders is very, very high.

This is in part because people will self-medicate, right?

They will cope with a social situation or a party or a work activity that they don't wanna go to by drinking alcohol as sort of this social lubricant, and this is a really unhealthy pattern to get into, right?

So it can come from the direction of alcohol as a self-medication, then setting up these bad habits across the lifetime.

And also from the direction of somebody developing a mood disorder or having a really increased exposure to stressors and then layering on alcohol after the mood disorder has sort of already had its onset.

I think we saw this a lot during the Covid pandemic and when we saw these really skyrocketing rates of women drinking alcohol.

A lot of what we hypothesized happened was women were drinking alcohol at home to cope with this immense amount of stress that was being put on them, right?

That they were, everyone was working from home, many people were also parenting from home.

And so coping with these stressors with alcohol was sort of a natural course that people took.

The number one recommendation I give people when people ask me, "What is the the best thing I can do for my own drinking?"

Or, "How do I make sure that I'm drinking healthy?"

I say, "You should never drink to cope with stress."

Drink when you're happy, if you're going to consume alcohol, consume alcohol when you're happy, when you're out with your friends, when you're celebrating.

Do not consume alcohol as a means of coping with stress.

- Very important advice.

And I'd like you to say a few words for people who may be addicted to alcohol and need help, what should they do?

- I think that they should be open about their need to reduce their drinking.

So much of this is socially defined by "Is my individual drinking behavior, again, interfering with my family, my work, my life?"

There are many treatment options out there.

They are effective.

And I think that's something that people need to understand too, is that we do have ways to help individuals if they have an alcohol use disorder.

There are cognitive behavioral therapies that are really effective.

There are medications that are effective, there are changes that can be made in your general life or to help you in a domain that's not necessarily just your alcohol use, like you're coping with stress or another mental health disorder.

So the number one thing you can do is seek help and seek assistance.

And then with your doctor, you can find the path that's best for your alcohol consumption.

- All right, don't suffer in silence, seek help.

- Yes.

Yeah, yes.

De-stigmatizing substance use as a problem is very, very important.

- Nikki, I wanna thank you for the work that you're doing for joining us today to share this important information.

Thank you for all that you're doing.

(gentle music) - Jeff, thank you so much for having me.

(gentle music continues) - Binge drinking and other types of alcohol misuse are unfortunately extremely common.

If you or a loved one are experiencing these problems, don't suffer in silence, seek help.

Remember, with help, there is hope.

(gentle music continues) Do not suffer in silence.

With help, there is hope.

(gentle music continues) This program is brought to you in part by the American Psychiatric Association Foundation, the John & Polly Sparks Foundation, and the WoodNext Foundation.

(gentle music continues) (gentle music continues) (gentle music continues)