The Doctor-Approved Method to Cut Back on Drinking w/ Dr. Hrishikesh Belani
Welcome back to Journey to the Sunnyside. I'm your host, Mike Hardenbrook. And today, we're continuing our 2 part theme by talking about a doctor approved method for cutting back on drinking. So whether you're trying to scale back or just make mindful choices, having a plan can make all the difference. Once again, I'm joined with doctor Rishi Keshe Pilani, medical advisor here at Sunnyside, an expert on alcohol use disorder and mindful drinking.
Mike:And today, he's going to share some simple strategies you can start using right away to cut back on alcohol in a way that fits your lifestyle. So let's jump into it with doctor Bilani. Doctor Bilani, thanks again for coming on today, and let's start with the first question. For somebody that wants to cut back on alcohol, what's a good starting point?
Dr. Belani:First Jose, thanks. My great to be back. If you wanna cut back, I think a great place to start is really knowing what are you cutting back on. Right? So how much are you actually drinking?
Dr. Belani:What are what are your reasons for drinking? And and and what are you drinking? Right? So I I think tracking, right? We, we, before the digital age, I think in medicine, for many things, we've used diaries, and now we're in, in a, in the age of where we have the Internet of Things and we have, great tools, to help us do that.
Mike:Yeah. So you think that setting a foundation of, like, actually getting honest with yourself and seeing where you're at with drinking is the first starting point?
Dr. Belani:Yeah. Exactly. Right? Like, if you you have that idea that I need to cut back, really understand what's driving that idea, and
Mike:and having a good benchmark or starting point for where you're starting from and where you wanna go. Makes sense. And so you're a medical adviser here at Sunnyside, and so there's an obvious reason why you were drawn to wanna get involved. And I think some of that has to do with this philosophy around harm reduction and what that means for people who aren't necessarily looking to quit, but want to be more mindful about their drinking. Can you explain maybe a little bit about why, first of all, you wanted to get involved here and advise and what this harm reduction actually means.
Dr. Belani:Yeah. Sure. I, you know, came into contact with the Sunnyside team at a time when, you know, I think we were seeing a lot of patients who just didn't really fit the mold of, you know, alcohol, and we were changing our views on, on what it means to have a use disorder. But also at a time when we were, the, you know, the medical field is really thinking a lot about wellness, lifestyle, and how that affects health and how that affects, you know, chronic diseases like metabolic disorders, heart disease, liver disease, etcetera. And, and so we always focused on, you know, with that alcohol and health, we really always focused on alcoholism and alcohol use disorder, and we really didn't have anything, a good framework to say, Oh, what about these people who are kind of in the, you know, healthy group, but maybe drinking a little bit too much and maybe drinking a little bit not necessarily excessively, maybe borderline excessively, but it's somehow affecting their health and we don't know how to help them.
Dr. Belani:Right? And so I think Sunnyside was that was one way, was a really good tool to kind of, compliment that, that group of people, that cohort of, of people who, from my point of view, you know, is, is something that physicians also felt challenged, by, by how to help. Right? So maybe cut back a little bit, probably help, you know, and then not being able to really do much more than that. And so, so, yeah, so I think our my goals aligned with with the Sunnyside mission.
Dr. Belani:And and so then we, you know, became partners in that from that standpoint. And so it's been really great. And I think that part of that is that harm reduction philosophy. Right? And so harm reduction, we historically think about, or, or even now we think about it for people who are, living with substance use disorders and people who are really dependent on, on substances.
Dr. Belani:And, and we think a lot about it in the, in the space of substances like heroin and, you know, where the harm reduction approach in those situations is facilitating their dependency by making it less harmful. Right. But you can take that approach and apply it to really anything in your life. Any behavior that might be causing not, not necessarily harm, but might not be leading to your optimal health and wellness kind of status or goal, I think. Right?
Dr. Belani:Like the where you wanna be in a health and wellness or, or, or physical fitness, state. And and so when we think about that with alcohol, it's it's really, hey, this is something I want to be a part of my life and it's something that's, you know, a normal part of life or, you know, in the human existence, right, for for 1000 and 1000 of years or 1000000 of years. And, right. But how do I make sure that it's not causing me actually causing me harm? Or how do I make sure that I'm, I can use it to my it can fit into my lifestyle and it won't overtake some of my other goals or won't interfere with some of my other needs and, and, and interfere with my home ecstasis.
Mike:Yeah. Well, I mean, you said something there that really hits home, which is, you know, how do we address this if it's an issue that you want to change, but you don't necessarily fit into that AUD, you know, mold traditionally. Or even if you do, you know, some of the more traditional solutions don't seem like they're they're not speaking to you for whatever reason. And, you know, I went through that myself. That's the whole reason I ended up writing a book, and this is before I knew anything about Sunnyside, and it was probably coinciding, you know, when I was changing and the guys over here and the team over here were also, like, thinking about the product.
Mike:But it was really this idea that it was all or nothing. I had to quit, and I had to do this specific route really kinda made me feel left in the lurch of not having a solution. And so my question to you is, how how many doctors out in the field other than you who's already an expert in this field are really knowledgeable about what harm reduction is and be able to communicate that with their patients?
Dr. Belani:Yeah. Not as many as we'd we'd like. Right? I think it it's not well taught in medical schools. It's not well taught in residency and really what we see is practitioners seeking it out.
Dr. Belani:I think for functionally, there's probably a lot of physicians who are practicing from a harm reduction standpoint without knowing that. Right? Because it, in some ways it just makes sense. And, you know, okay, we, you know, we just wanna reduce the the harm or, or, or reduce the damage around this behavior or around this, this disease or condition. And, and, and they might just not know that they're coming from a harm reduction approach.
Dr. Belani:But I think there's still, unfortunately, a lot, a lot of doctors who have this more all or nothing standpoint and, and add a little bit of societal judgment to, to behaviors, which, you know, we're finding out isn't necessarily as, as helpful in most cases because it doesn't really meet patients where they're at. And, and so, yeah, but I, you know, I'm on faculty at UCLA. I teach residents and fellows and it's something that, that I definitely include in, in my teaching. And it's something that I practice with my patients. Like I said, adapt adopting it or adapting it from that true harm reduction practice, you know, which we take from the substance use world and really, you know, bringing it into any aspect of a patient's health or life or needs.
Mike:So you also mentioned something there that rings towards that. A lot of people might be doing harm reduction or asking others to do it and not even giving it a label. And, you know, sometimes we sidestep the label because harm reduction, people may have heard it before associated with other maybe harder substances potentially. You know? But it's really you know, before I mentioned, it was if you wanna change, you and somebody might diagnose it as problematic.
Mike:It's really you gotta quit. That's the only solution. Do as I say. Go here. And if you don't do it, sort of, you know, you're not following and not basically, you're hopeless, you know, in some regard.
Mike:Right. So in case somebody didn't catch on to what harm reduction is, I'm gonna throw it back at you and say, you know, how would you sum it up in the context that we're speaking here, in a sentence or 2?
Dr. Belani:Yeah. It's if you take a behavior, whether the behavior is is, you know, legal or illegal or or has a health diagnosis attached to it, I think the harm reduction is there's a behavior that potentially is causing damage to my body or my life. And so how do I continue that behavior in a way that is, is safe or regulate or put parameters around that behavior to make sure that it doesn't cause damage to my life or my life. And that could be from personal interventions. It could be from, you know, societal intervention, structural intervention.
Dr. Belani:I think that's where, you know, sometimes it gets confusing because of its overlap in just everyday use and in in the policy space.
Mike:Do you think that harm reduction is only for people that are looking to cut back, or is it just sort of a, hey. I'm gonna try an experiment kinda thing, and it might lead to, you know, moderation. It might lead to moderation then, abstinence, or, you know, like, it seems like a variety of outcomes. What's your take on that?
Dr. Belani:Yeah. All invited. Yeah. Alright. I think it's a big tent and, you know, there's really no wrong answer in or, or, you know, in, in wanting to, to do right by yourself or wanting to try and improve.
Dr. Belani:And so that, I think the approach is, there's different approaches that you can take. And, and I think we encourage anybody, right? If you're whatever level of motivation you are, to, to go ahead and try, as long as your goal is improving your health, improving your life, improving your wellness.
Mike:Yes. Yeah. I actually love that. I'll probably steal it all invited. It's so good.
Mike:So and and, you know, I think one of the beauties of it is is that it doesn't require labeling. It doesn't require a set plan. It's really if it's too much to you or you have a goal in mind, you get to define what that looks like and how you get there. And then you kinda put some steps into place on on that entire journey, you know, in that, I guess, whatever level of success you want it to be the measure.
Dr. Belani:Yeah. Exactly. I think, you know, before I started working with Sunnyside team, I used to I just made up a rule for my patients who were trying to cut back. Like, I called it the 611 rule. Right?
Dr. Belani:And I was like, no more than 6 drinks, you know, in a week, no more than 1 drink an hour and, and one glass of water in between each, each drink. Right? And I was like, just try that. Right? Nothing, no data behind it.
Dr. Belani:I mean, loosely. Right? But it's just, yeah, that was the harm reduction approach. Right? You're you're drinking, 12 drinks a week, so we said, let's cut it back.
Dr. Belani:Like, this is your rule. This is what you're getting to. Just like 10000 steps a day, you know, that that was the approach. And yeah. I love that.
Dr. Belani:Somewhere.
Mike:Yeah. Definitely. So, actually, that makes me think. So you were doing a little bit of this on your own, and, you know, Sunny Side comes into the picture. What were some of the things that drew you in that you're like, yes.
Mike:I I really like what they're doing over here for this reason?
Dr. Belani:Well, I like that it was easy it's easy to use. Right? You always want something that's really easy to use so it can just fit into your daily life. Right? We think a lot about that in medicine when we have interventions.
Dr. Belani:Like how do you just make it fit into your daily life? You know? And, so that, that was great. And it utilized, you know, at first utilized the texting, which is something I already uses and it's evolved since then. And then the coaching piece of it.
Dr. Belani:Right? Just having that, feedback loop, what, you know, accountability or encouragement or adulation on on meeting goals. And that's it's another huge important part in behavior change is getting some reinforcement that you're on the right track.
Mike:Yeah. So you cited, you know, an example purposes or hypothetical around, like, 611, then you were starting point was 12. Let's say you had that patient come in. What are some of the things that you witnessed from patients? Maybe they're coming in, adjusting their habits.
Mike:They're moderating more. They're reaching their goals with the harm reduction strategy. Are there some long term benefits that you're sort of witnessing over time?
Dr. Belani:Yeah. I mean, I can say anecdotally, right, from a physician standpoint. I I I don't have a great way of monitoring your risk. Right? Like, we we use big data to say that, like, I I can't tell every day, you know, there's no blood test I can do on you every year necessarily to say and maybe there will be in the future and and maybe they're they're, you know, for some diseases it's coming out, but I I can't say like, oh, look, because you stopped drinking, I can see this this risk going down.
Dr. Belani:Right? Like, we we have to do that based on on the risk calculators we have based on the data. But what I do see tangibly is, you know, you know, people feeling better, their sleep is getting better, man, their blood pressure might be going down in some cases, like we, was talking about in the past, you know, with alcohol and effect of blood pressure and cardiovascular health. But just in general, you you you get better vibes from somebody who's actually maybe maybe not. It's, an exact because it was exactly damaging them before, right, their consumption, but they weren't happy with it.
Dr. Belani:And now they're seeing change and they're finally seeing that they can actually affect change in their own way. And so there's a little bit of autonomy and control there that actually makes them makes you more confident and makes you feel more healthy. And so I think not only just bringing the negative effects of too much alcohol use under control, but also just being able to control your own behaviors and your own habits is extremely rewarding.
Mike:Yeah. I love that. So I had Andrew doctor Andrew Chitarski on here. And from a clinical psychotherapy background, he, you know, is really trying to get the word out about harm reduction in that setting. You know, before we go here, I'd love to know if what your crest crystal ball says to you about where you think things are going in this regard having this option in the medical community moving forward.
Mike:With regards to harm reduction?
Dr. Belani:Yes. Yeah. I think the way things are going, right, like, it this is just gonna become common speak, common language. I think we're realizing the the benefits of it, the patient set patient centeredness of it. There's always gonna be detractors and, and opponents, actually in, in, regulatory government and like funding space.
Dr. Belani:But for I think for the most part, you know, the data is gonna speak for itself. And then the more data we have that's showing the benefits of these approaches, I think the more clear it's gonna be that they should be the standard of care.
Mike:Yeah. Well, let's hope so. I think that that would be amazing. I mean, I think you'd probably agree the more options that we have that are connecting with people, the better.
Dr. Belani:For sure. Yeah. Yeah.
Mike:Well, thanks so much for coming on today, sharing your time, sharing your insights. I know I got a lot from it, and anybody listening probably did too. And I just wanna thank you so much. If there's anybody that wants to learn more about you, is there any good place that they could go?
Dr. Belani:Oh, I think my profile's on, the Sunnyside website. So
Mike:Okay. Amazing.
Dr. Belani:So They'll link you to my profile.
Mike:Well, thank you so much, doctor Belani, and I look forward to talking soon.
Dr. Belani:Yep. All the best. Thanks. Bye.
Mike:Huge thanks to doctor Belani for sharing these important insights about alcohol and our health. If today's episode made you think about your own habits, head on over to sunnyside.co and take our 3 minute quiz for personalized insights on your drinking habits. And don't forget to follow us on Instagram at join sunny side for daily tips, inspirations, and real stories from people just like you. And if you liked what you heard, hit the subscribe button so you don't miss out on future episodes. So until next time, let's keep taking small steps towards a healthier, more mindful relationship with alcohol.
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