One glass of cabernet to unwind after work or on the weekends can easily turn into a daily habit—especially during times of stress.

And with so much anxiety, prolonged uncertainty, loss and isolation during the pandemic, COVID-19 blurred those lines for many. Alcohol consumption rose among adults over age 30 by 14% during the pandemic, with a 41% increase in women heavily drinking, according to a September 2020 RAND Corporation study. The strain also took a toll on those already coping with addictions, spiking relapse and overdose rates.

"That unknown is when we as humans tend to want to get numb to soothe," says Dr. Colleen Ryan, a Cedars-Sinai primary care physician, who has seen the surge in her practice. "Alcohol makes you feel better when you're drinking it, although the after-effect is not so soothing."

The Department of Health and Human Services recommends adults limit their alcohol use to two drinks or fewer in a day for men and one drink or fewer a day for women.

High alcohol intake boosts your risk for a host of physical and mental health problems, including liver disease, cancer, hypertension, stroke, suicidal ideation and alcohol dependence. A family or personal history of cancer, cardiovascular disease, trauma, substance use disorder or mental illness can make you even more vulnerable to these alcohol-related harms, Dr. Ryan notes.

Have a collaborative, honest conversation about drinking with your doctor, who can assess your current habits, weigh your risks and determine how much alcohol is too much for you.

They can also develop strategies to scale back. If your doctor doesn't address alcohol intake directly, bring it up yourself, Dr. Ryan urges.

"Physicians may not have had the most robust training on how to handle alcohol abuse or may feel it's useless to bring up if a patient isn't personally motivated to reduce their alcohol use," she points out. "But I personally have seen where it might not be that visit—it might not be three visits from now—but the patient is thinking about it, and eventually, they might hit that point where they're ready."

It's worth taking a step back when you notice that you are drinking more frequently than is normal or healthy—and asking yourself why, Dr. Ryan says.

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Drinking excessively doesn't always mean you have a problem or have to quit entirely. Small steps can make cutting back seem less overwhelming—and move drinking into a healthier range for some, Dr. Ryan says. To retrain your routine, she suggests:

• An earlier bedtime. Evenings can often be triggers, when people are tired, sitting on their couch, watching TV and trying to turn off their minds. "You might not even realize you're doing anything to feel better," she says. Heading to bed early can remove the temptation to indulge and give your body a reset that allows you to wake up earlier. Use your refreshed mornings to practice healthier mood boosters such as exercise or meditation.
• Replacing alcohol with other fun beverages. Sometimes people drink alcoholic beverages just because they are looking for a treat. Instead of a cocktail, try something non-alcoholic such as herbal tea, sparkling water with lemon and mint or a mocktail.
• Alcohol-free socializing. Connect with a supportive friend over a walk or exercise class, rather than drinks.
• Saving drinking for certain special days each week.
• Using therapy, counseling or motivational apps. Therapists and counselors work on mental health, coping skills and goals. Drink-tracking apps such as Cutback Coach allow you to monitor your alcohol use and offer positive reinforcement to change.

You might also benefit from FDA-approved medications such as naltrexone that a primary care provider can prescribe to help you cut back alcohol intake and curb cravings, Dr. Ryan notes.

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If you try to reduce your drinking and realize you can't or it's more challenging than you had expected, it's time to look closer at your relationship with alcohol, Dr. Ryan says.

Reflect on whether you have become annoyed by criticism of your drinking, have ever felt guilt about your alcohol habits or had a drink first thing in the morning to steady your nerves or get rid of a hangover. These behaviors, which providers consider when screening for alcohol misuse, are signs of dependence.

Other symptoms of alcohol use disorder (AUD) include:

• Spending a significant amount of time either drinking alcohol or recovering from it
• Prioritizing drinking over previously enjoyable or important activities
• Having instances when you drank more or longer than you had wanted
• Cravings
• Ending up more than once in dangerous situations such as driving, swimming or unsafe sex while under the influence
• Having to drink more to achieve the same effect
• Trouble meeting family, work or school obligations
• Continuing to drink after memory blackouts and despite alcohol exacerbating mental and physical health challenges
• Withdrawal symptoms such as irritability, anxiety, depression, insomnia, shakiness, nausea or sweating

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While an estimated 15 million people in the U.S. have AUD, less than 10% of people with the condition get treatment, according to the National Institute on Alcohol Abuse and Alcoholism.

People who drink enough to experience physical withdrawal symptoms, whether addicted or not, should not try to quit on their own. Start with a primary care provider, who can form a treatment plan and determine whether you need medical supervision to stabilize safely.

At Cedars-Sinai, a care management team will connect patients needing alcohol support with resources for continued treatment.

Recovery often includes a combination of detox, inpatient or outpatient behavioral therapy, medications, ongoing relapse prevention and peer support such as Alcoholics Anonymous and 12-step programs, which are mostly virtual during COVID-19.

These tools put physical distance between you and a drink and help address underlying mental health challenges. They also aim to build resilience to stressors—from everyday disagreements, work pressures and fatigue to the global pandemic—without needing to escape.

"You absolutely can stop drinking alcohol," Dr. Ryan stresses. "But there are so many triggers that it takes a whole team."

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