The Diary Of A CEO with Steven Bartlett
How Alcohol Rewires Your Brain and Increases Cancer Risk by 40%! The Alcohol Doctor, Dr. Sarah Wakeman
Thu, 22 May 2025
Are you unknowingly damaging your brain and raising your cancer risk with just one drink? Discover the alarming truth about alcohol from Dr. Sarah Wakeman, what every adult needs to know now. Dr. Sarah Wakeman is senior medical director for substance use disorder at Mass General Brigham healthcare system, the number one research system in the U.S. She is also the Medical Director of the Mass General Hospital Addiction Consult Team and Assistant Professor of Medicine at Harvard Medical School. She explains: How alcohol is hijacking your dopamine system. Why no amount of alcohol is good for your brain. The shocking truth about moderate drinking. How doctors are failing addiction patients on a daily basis. Why 1 in 3 people will struggle with alcohol. 00:00 Intro 02:23 Sarah's Mission 02:52 Sarah's Education and Experience 03:40 Issues With Addiction Treatment in the Modern World 04:31 What Is Addiction? 05:48 What Things Are Capable of Being Addictive? 06:47 Physiological Dependence vs. Addiction 07:25 Scale of the Problem: Why Should People Care? 08:59 Is Society Getting Better or More Addicted? 09:32 Substance-Related Deaths During the Pandemic 10:22 What Drives People to Use Substances? 12:24 Substances' Effects on the Brain 14:29 Does Trauma at a Young Age Increase Addiction Risk? 16:36 The Opposite of Addiction Is Connection 18:11 Why Addiction Matters to Sarah 19:02 Living With a Family Member Struggling With Addiction 20:43 Who Is Sarah Trying to Save? 22:57 Change Happens When the Pain of Staying the Same Is Greater Than the Pain of Change 25:53 Misconceptions About Alcohol 28:15 Is There a Healthy Level of Alcohol Consumption? 28:50 Is One Drink a Day Safe for Health? 30:38 Link Between Moderate Drinking and Cancer 33:23 Types of Cancer Linked to Alcohol Consumption 34:51 Cancer Risk Among Heavy Drinkers 35:31 Heavy Drinking and Comorbidities as Cancer Risk Factors 36:20 How Alcohol Drives Cancer Mechanisms 38:00 Alcohol and Weight Gain 38:54 The Role of the Liver 42:07 Liver's Ability to Regenerate 46:37 How Alcohol Causes Brain Deterioration 47:23 Other Organs Affected by Alcohol 48:00 Alcohol's Impact on the Heart 49:08 Body Fat Percentage and Alcohol Tolerance 50:05 Does High Alcohol Tolerance Prevent Organ Damage? 50:46 What Is a Hangover? 52:14 Balancing the Risks and Benefits of Alcohol 53:47 Is Rehab Effective for Addiction? 56:50 Psychedelic Therapy for Addiction 57:36 GLP-1 Medications for Addiction Treatment 59:03 Ads 59:59 Celebrity Addictions 1:02:24 Stigma Around Addiction 1:04:41 Addiction Cases That Broke Sarah's Heart 1:12:43 Is Empathy Positive Reinforcement for Addicted Individuals? 1:15:34 Setting Boundaries With an Addicted Person 1:18:57 Motivational Interviewing to Support Recovery 1:22:19 Finding Motivation for Positive Change 1:26:03 Habits to Support Addiction Recovery 1:29:12 Ads 1:30:18 Can the Brain Recover From Addiction? 1:34:55 Unexpected Sources of Addictive Behavior 1:35:35 How Sarah Copes With Difficult Addiction Cases 1:37:10 Importance of Language Around Addiction 1:41:40 How Labels Limit People's Potential 1:46:05 Sarah's Upcoming Book You can find out more about Dr. Sarah’s profile, here: https://bit.ly/4mxu191 Ready to think like a CEO? Gain access to the 100 CEOs newsletter here: bit.ly/100-ceos-megaphone The 1% Diary is back - limited time only: https://bit.ly/3YFbJbt The Diary Of A CEO Conversation Cards (Second Edition): https://g2ul0.app.link/f31dsUttKKb Get email updates: https://bit.ly/diary-of-a-ceo-yt Follow Steven: https://g2ul0.app.link/gnGqL4IsKKb Research document: https://stevenbartlett.com/wp-content/uploads/2025/05/DOAC-Dr-Sarah-Wakeman-Independent-Research-further-reading.pdf Sponsors: Ekster - https://partner.ekster.com/DIARYOFACEO with code DOACLinkedin Ads - https://www.linkedin.com/DIARY Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What is the mission of Dr. Sarah Wakeman?
Mm-hmm.
which for many people is very normal. So there's a lot of misinformation out there about how much should you drink, which I think people don't know. But I can take you through everything, so. Dr. Sarah Wakeman is a Harvard professor and addiction expert. Leading the charge against one of the biggest public health crises of our time. Addiction, bringing facts, empathy, and hard-earned truth.
One in three people may have a problem with alcohol at some point in their lives. And globally, 2.6 million people every year die from alcohol-related causes because pretty much every organ in the body is impacted by it. You can see here, this is a 43-year-old person where their brain looks the way a 90-year-old with dementia would look because of that brain damage over time from alcohol use.
But what drives people to use substances is probably the most important question. And if we look at studies, one is about 40% to 60% genetics. And the other half of the equation is trauma. And so we hear someone talk about alcohol gives them pain relief, whether that's emotional or physical. That's a very real thing. That's because your sort of natural painkiller system is activated by drinking.
It's an anti-anxiety and a pain medication sort of all in one.
So when you think about how we treat addiction, where are we going wrong?
The biggest problem is that people haven't been given the evidence and tools to understand addiction. But also many rehabs don't offer the things that we know are actually effective.
And what is it that people need?
That's a great question. One of the most effective tools we teach people is something called... And they found that people drank much less after it.
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Chapter 2: Why is addiction treatment currently ineffective?
Chapter 3: Is there a safe level of alcohol consumption?
And then we make the definition based on how many criteria people meet out of this 11 list of different criteria. And then based on that, people can have a mild use disorder, moderate or severe. And so moderate severe is really what we think of as addiction. But it's that use despite bad things happening to you.
And what things are capable of being addictive?
Chapter 4: How does alcohol increase cancer risk?
Yeah, lots of things. I mean, I focus mostly on alcohol and drugs. So alcohol, obviously, probably most common. I think we'll talk about that a lot today, which I'm excited about. And certainly when we look worldwide, 400 million people have an alcohol use disorder, meaning addiction to alcohol. That's a lot of people. The other are drugs.
So that can be opioids like heroin or pain pills or fentanyl. It can be cocaine or stimulants like methamphetamine or prescription stimulants. sedatives that people may take for anxiety, like benzodiazepines, cannabis. And so there's a whole sort of range of substances that can be addictive. And how addictive a substance is, is really related to sort of how much dopamine is released in the brain.
I know you've had a wonderful episode with Dr. Lemke about dopamine. So you've talked about that a bit. And there are different sort of addictive indices of different substances. So cannabis is less addictive than methamphetamine, for example. But all of those substances can cause addiction in people.
Even beyond that, I wonder sometimes in my life if I'm addicted to other things. Like, I mean, I drink coffee every day. I certainly get a craving to drink it now.
Yeah, well, there's, you know, a couple important pieces there. Is your coffee drinking causing harm in your life in any way?
No. I think it helps.
It may be helping you, right?
Okay, so it's not.
Yeah, so it's not addiction. So there's a difference between physiologic dependence, meaning, like, if you don't drink your cup of coffee, you're going to get a headache. And addiction, meaning that you're spending all your day and all your money buying more and more coffee.
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Chapter 5: What are the effects of alcohol on the brain?
Chapter 6: How does alcohol impact the liver?
Chapter 7: What are the misconceptions about alcohol?
Yeah, it's a great question because we use that term colloquially a lot. You know, I'm addicted to Netflix or whatever. So addiction is really defined by use despite consequences. So continuing to do something in your life despite bad things happening to you because of it. So we talk of addiction, we talk of the four C's as a way to remember it.
So one C is loss of control, meaning like you've tried to change and you haven't been able to. So you've tried to cut back or you've tried to stop and you couldn't. The other is compulsive use. So your use is like spiraling out of control that you're kind of using in a way that isn't really attached to your rational thinking. The next is consequence.
So continued use despite negative consequences either in your life, your job, your relationships, your health. And then the last C is craving, which is this sort of strong psychological urge to want to use. Like you can't get the idea of having a drink out of your mind. And so it's really those four Cs that we think about.
And then we make the definition based on how many criteria people meet out of this 11 list of different criteria. And then based on that, people can have a mild use disorder, moderate or severe. And so moderate severe is really what we think of as addiction. But it's that use despite bad things happening to you.
And what things are capable of being addictive?
Yeah, lots of things. I mean, I focus mostly on alcohol and drugs. So alcohol, obviously, probably most common. I think we'll talk about that a lot today, which I'm excited about. And certainly when we look worldwide, 400 million people have an alcohol use disorder, meaning addiction to alcohol. That's a lot of people. The other are drugs.
So that can be opioids like heroin or pain pills or fentanyl. It can be cocaine or stimulants like methamphetamine or prescription stimulants. sedatives that people may take for anxiety, like benzodiazepines, cannabis. And so there's a whole sort of range of substances that can be addictive. And how addictive a substance is, is really related to sort of how much dopamine is released in the brain.
I know you've had a wonderful episode with Dr. Lemke about dopamine. So you've talked about that a bit. And there are different sort of addictive indices of different substances. So cannabis is less addictive than methamphetamine, for example. But all of those substances can cause addiction in people.
Even beyond that, I wonder sometimes in my life if I'm addicted to other things. Like, I mean, I drink coffee every day. I certainly get a craving to drink it now.
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Chapter 8: Can the brain recover from addiction?
So first, if you look at only one health condition, there are some health conditions where a moderate amount of alcohol actually improves your health. But it was also how people were conducting the studies. So in most of the studies, what people do is they take like a massive population, tens of thousands of people, where we have some data where they're reporting how much alcohol they used.
And then we look at health risks over time. And scientists would lump people into sort of non-drinkers versus light drinkers, moderate drinkers, or heavy drinkers. And what they were finding is that people who were drinking even up to the moderate level were actually doing better than the people who weren't drinking at all.
And so that was where that concept that drinking is good for your health came from. And so people talk about this like J-shaped curve, meaning that moderate drinkers actually have lower risks of health problems. And then it's really only when you start drinking very high levels that you start having more risk of health problems than people who don't drink at all.
What they realize is wrong with that is that in the people who don't drink at all, many of those people are not drinking because they're actually really unhealthy for another reason. Like they might have heart failure and they like don't want to drink because they don't want it to mix with their medication. Or they might have had a history of alcohol use disorder and they're actually in recovery.
So they've already had some damage from alcohol and they are not drinking because of that. And so when you change the reference group, you actually make the sort of group that you compare people to, to people who very rarely drink. So it's not that they're not drinkers at all, but they drink, you know, very, very light levels.
Then you start to see that those like health benefits of alcohol go away, especially if you look across all conditions.
Are you telling me that there's no healthy level of alcohol consumption?
Yes, I would never say drinking alcohol is good for your health. That doesn't mean that drinking at what we call low-risk levels can't be a part of a healthy lifestyle. So it's a slight shift that, like, don't fool yourself into thinking that drinking that glass of wine is, like, going to exercise for 30 minutes. Like, it's not something that's going to promote your health.
I think of it more like having dessert, eating bacon, going out in the sun. There are risks associated with all those activities. It doesn't mean that I would say you can never do any of that, but you need to understand what the risks are and then make choices for yourself.
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