Experts Explain How to Talk to Doctors About Alcohol

We’re taught that honesty is the best policy, but that’s not always an easy axiom to follow in a medical setting. Who among us hasn’t been tempted to be less than forthright about their actual flossing habits, for instance? Recently, people on social media have been commiserating over another question they hate hearing from their doctors: “How much alcohol do you drink each week?”

This question elicits so much anxiety, a good amount of people round their answer down. In fact, in a study of 3,000 people conducted by American Addiction Centers, 21 percent reported that they’d lied to their doctors about the amount of alcohol they consume. About 50 percent of drinkers also said they would ignore their doctor’s advice to reduce their alcohol intake.

But why do so many of us feel the need to conceal (or full-on lie about) such important information? What is it we’re so afraid of, and how can we learn to overcome this fear? Medical professionals are only ever supposed to help us — isn’t it about time we let them?

Why Do People Lie to Their Doctors About How Much They Drink?

In a 2018 review involving 4,510 people published in the JAMA Network, researchers found that 40 to 60 percent “had not been forthcoming” about information related to their health, from how much they drink to their diet and lifestyle habits. When asked why they lied, a full 82 percent of participants said they did so in order to avoid being judged or lectured. Other common reasons were not wanting to hear how harmful their behavior was (76 percent) and embarrassment (61 percent), as well as not wanting the clinician to think they were difficult (51 percent), and not wanting to take up too much of the clinician’s time (45 percent).

Many people would say that the most common reason — a fear of judgment — isn’t unfounded. In a TikTok with nearly 50K likes, content creator Brett Miller described the judgment he felt after disclosing his drinking habits to his psychiatrist. “It’s as if I told him that I had a bomb strapped to my chest,” Miller said of the healthcare provider’s reaction.

Several commenters said they had felt similar shame after disclosing alcohol with their doctor, prompting some to avoid the conversations altogether, and even making it difficult for them to seek necessary medical care. “Meanwhile I’m actually an alcoholic and when I am honest about it to try and receive proper care it’s met with so much shaming,” one commenter wrote.

Are Doctors Really Judging How Much We Drink?

Good doctors aren’t here to judge. “In general, doctors aren’t judging your morals or character. We’re simply giving you the facts as they relate to your health,” says Daniel Amen, MD, a physician, psychiatrist, and founder of Amen Clinics.

Most healthcare professionals are trained to address topics like alcohol with respect and compassion, as this is a routine part of care, adds Stacy Thiry, a licensed mental health counselor at Grow Therapy.

That said, your doctor’s advice might not be what you want to hear. As some people pointed out under Miller’s video, heavy drinking has been so normalized that many people may not understand that their “casual consumption” actually puts them at risk for health issues. Someone may feel that their drinking is unproblematic because they don’t drink daily or they don’t drink any more than their peers, but they could still exceed what’s medically considered moderate drinking (more on how much is “too much” below). In that case, a doctor’s response — of offering harm reduction resources or simply asking follow-up questions — may be surprising, and even unwelcome. But that doesn’t mean it’s out of bounds or judgmental, although it may feel that way.

The stigma that surrounds alcohol use disorders and other substance use disorders may also contribute to patients’ fear of judgment. “In many cases at Amen Clinics, I meet with patients who feel ashamed by their drinking habits and judge themselves harshly. Hearing a doctor confirm that they’re drinking too much can reinforce those feelings,” Dr. Amen says. In these cases, the worst judgment may actually come from the patients themselves.

Of course, bad doctors do exist, including physicians who haven’t worked through their own prejudice around substance use disorders (or any number of related issues) or who simply need to work on their own bedside manner. If you’re truly feeling judged by your practitioner, trust your gut and find a new doctor who makes you feel more comfortable.

“For doctors, simply saying, ‘You need to stop drinking so much,’ isn’t very helpful and can sound judgmental,” Dr. Amen acknowledges. “Healthcare providers need to do a better job of providing solutions and strategies to help patients limit or eliminate drinking.” To avoid the negative reactions some people describe on social media, Dr. Amen says providers should focus on providing patients with hope and encouragement.

“Providers should be expected to react with empathy and understanding with a non-judgmental attitude when discussing alcohol or substance use,” Thiry adds. That includes active listening and appropriate validation. “Providers should offer support and encouragement and positive reinforcement to patients while offering referrals for additional services if needed.”

How to Get Honest About Your Drinking With Your Doctor

First, consider telling your physician you’re a little apprehensive about answering the “how much do you drink?” question — or, once you’ve answered it, that you’re feeling surprised, judged, or ashamed because of their response. “It may be helpful to address your concerns directly and request a judgment-free conversation,” Thiry says.

Thiry recommends giving yourself some grace and exercising self-compassion as you work through the discomfort. “Stay connected to your value and worth, which is not determined by your coping behaviors,” she says.

She and Dr. Amen also suggest reminding yourself why you’re at the doctor in the first place. “You’re seeing a doctor to enhance your health and well-being. Lying about your drinking habits doesn’t support that goal,” Dr. Amen says. And Thiry adds, “Take pride in your health goals and frame the discussion around what you want for yourself and your well-being.”

It may be useful to acknowledge how internalized stigma may be playing a role in your nerves, as well. Alcohol use disorder is an illness and not a moral failing. What’s more, excessive alcohol use doesn’t automatically make someone an alcoholic — but it could be a result of an underlying issue or contributing to a different health condition, such as high blood pressure. Alcohol can also interact with certain medications So, it’s a doctor’s responsibility to ask follow-up questions and offer resources, and for the most part, it’s in your best interest that they do.

But again, you deserve a healthcare provider who’s respectful. If their reaction crosses a line, feel free to end the conversation and find a new physician for your next visit.

When Should You Be Concerned About the Amount You’re Drinking?

For context, if you choose to drink, the 2020-2025 Dietary Guidelines for Americans recommends two drinks or less in a day for men, and one drink or less in a day for women.

But even if your total intake averages out to about that amount, binge drinking — defined by the CDC as consuming five or more drinks on an occasion for men, and four or more drinks on an occasion for women — may still put you at risk of health issues. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines heavy alcohol use as binge drinking on five or more days in the past 30 days.

If you’re worried about your own alcohol use, some red flags to consider include: unsuccessful attempts to decrease your alcohol consumption, feeling a strong urge to drink alcohol, and experiencing withdrawal symptoms like nausea and shaking when you don’t drink — all of which point to alcohol use disorder.

Lying about your drinking habits could be considered its own red flag, according to Dr. Amen: “If you feel ashamed about your drinking habits, it may be time to rethink your relationship with alcohol.”

If you or someone you know is struggling with an alcohol use disorder, the Substance Abuse and Mental Health Services (SAMHSA) has resources available including a national 24/7 helpline at 1-800-662-HELP (4357). You can also send your zip code via text to 435748 (HELP4U) for treatment referral and information services.

Chandler Plante is an assistant editor for POPSUGAR Health & Fitness. Previously, she worked as an editorial assistant for People magazine and contributed to Ladygunn, Millie, and Bustle Digital Group. In her free time, she overshares on the internet, creating content about chronic illness, beauty, and disability.