6 Ways to Say No to Alcohol in Any Situation

Your choice to drink less or not drink at all is something to be incredibly proud of. It’s a choice that represents self-care, mindfulness, boundary setting, and so much more. While many recognize that drinking less is a superpower, alcohol still shows up in our culture in a big way. It can be difficult to avoid drinking alcohol, whether that’s at family gatherings or within your social circle.  It can also be challenging to say ‘no’ to alcohol in a social setting. There is no shame in that. However, you can say no, and we’re here to guide you along the way.

Wherever you are on your journey, here are some practical tips on how to prepare for saying no to alcohol, and suggestions on what to actually say when it’s offered. 

How to Prepare To Stay Sober at Social Events

If you’re nervous about staying sober at an event where alcohol is present, that’s very normal. The good thing is, there are ways you can prepare in advance to make it easier for you to navigate these environments without drinking. Just the act of preparing, however you choose to do so, can give you a greater sense of control over the situation. 

Share your goals with the people you trust

A large social situation can be an intimidating time to share your sobriety or moderation goals. Instead, start small. See if you can identify one or two people you would feel comfortable talking to about your boundaries. An informed support system can help you stay accountable and steer conversations and activities away from alcohol. Honestly sharing with others in a safe environment can be incredibly empowering. Haven’t told a close friend yet? Here are a therapist’s tips for how to tell someone you’re getting treatment to change your drinking. 

Work with a therapist specialized in online alcohol treatment

Engaging in online alcohol therapy can be incredibly beneficial for many reasons. A specialized therapist can help you define your goals and build the confidence and coping mechanisms to achieve them. Your therapist will also help you identify your support network, make a plan for potentially triggering situations, and even role-play challenging conversations. Sharing your choice not to drink with your friends, family, and colleagues can be difficult to navigate alone. Your therapist will act as a consistent resource to guide you at every turn. 

Practice your answers ahead of time

If you feel nervous about how you’re going to say no to alcohol at an event, there’s nothing wrong with practicing beforehand! (In fact, it’s a great idea.) While it may feel strange at first, rehearsing your answer out loud can help you decrease anticipatory anxiety and feel more prepared to give a confident answer when the moment arises. That said, how much you want to share is completely up to you. You don’t owe anyone an explanation.

Now that we’ve identified a few ways to plan ahead, here are 6 strategies you can put into practice at events and gatherings.

"5 ways to turn down a drink: 'I'm all set with this drink, thanks!' Have an alcohol-free drink already in hand. 'I'm headed home for the night' You can always leave early or skip an event. 'No thank you' You don't owe anyone an explanation. 'I have to drive later' There's nothing wrong with making an excuse. (true or not!) 'I'm okay, but tell me about...' Try changing the subject!"

6 Ways To Say No to Alcohol

There are many ways to turn down alcohol at an event. If you’re not comfortable sharing your sobriety yet, there are other verbal and physical strategies you can use to set boundaries. You should feel empowered to use whatever tools feel most natural to you at the moment. Preparing multiple options ahead of time can help you feel more comfortable and confident when saying no to alcohol.

1. Give a simple, firm answer

Remember that you are in control of your choice to drink. You don’t need to apologize, provide a reason, or aim to make anyone more comfortable with your decision. If you receive any comments or questions, be firm in your refusal and remember that you don’t owe anyone more than a simple “No thank you, I’m all set”. Most people will accept your answer at face value. If they don’t respect your boundaries, it’s important to remember that it’s likely a reflection of their own relationship with drinking alcohol, not your personal choice. 

2. Have a non-alcoholic beverage in hand 

There are so many exciting alcohol alternatives available now, so you don’t have to miss out on having a festive and delicious drink at the event. Sipping on a non-alcoholic beverage can also make it easier to navigate an event where there’s alcohol consumption. If you’re offered a drink, you can politely respond, “I’m happy with what I’m already having, thank you” or “No thank you, I’ve already got one.” Check out Monument’s alcohol-free drink book, Delish AF, for some inspiration! If you’re not ready to build new rituals with non-alcoholic beverages, that’s totally understandable. There are many other strategies to put into play. 

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3. Change the subject 

There are so many better topics for discussion than whether or not you’re having a drink. When asked if you want a drink, give a quick answer and then bring attention back to a more compelling conversation topic. For example: “No thank you, but I do need to hear all about your recent trip!” Not only is this a great way to move on from the topic of alcohol, but it also facilitates more meaningful conversations and connections. And remember this: Everyone is the star of their own movie. No one is thinking about you as much as you are, so it’s likely someone will be thrilled to share more about themselves. 

4. Use physical cues  

Often we can turn down a drink offer without even needing to use words. If you’re in a dining setting, you can simply remove your wine glass from the table, shake your head at the waiter, or cover your glass with your hand. If you are at a bar, you can opt to sit at a table farther from where alcohol is being served. These cues are well-understood in the service industry and can make it easier to avoid being asked repeatedly if you want a drink.

street billboard "no one needs to know what you're drinking but you"

5. Make an excuse

If you feel panicked or out of options, you can simply make an excuse. While it might feel dishonest, your sobriety or moderation goals are more important. There are many reasons why people don’t drink, like being on medication, needing to drive home, or having to wake up early in the morning. There’s nothing wrong with saying, “I’m not drinking tonight, I have to drive later.” If making an excuse feels like the best way to say no in the moment, you should feel empowered to do so. Your wellness comes first, no matter what. 

6. Skip the event or leave early

If you believe a social situation will be especially difficult for you to be in without drinking, you do not have to go. Especially in early sobriety, it can be difficult to attend events and visit venues that you closely associate with drinking. It’s more than okay to not go or to leave whenever you feel ready. You can say, “I’m headed home for the night, thank you for having me”, and there’s no need for any other reason. You are making an amazing lifestyle change for yourself, and you deserve time and space to adjust. 

Should You Avoid Social Events in Early Recovery?

Ultimately, whether or not to avoid events in early recovery is a personal decision. Many people find that they benefit from avoiding people, places, and things that remind them of drinking. It’s reasonable to give yourself space from potential triggers while you’re gaining confidence in your sobriety and working on other aspects of recovery, like building alternative coping mechanisms. Even if you skip out on the alcohol-centric events, you can still socialize while sober! You can check out local sober events in your area, opt for socializing through fun alcohol-free activities, or host your own alcohol-free event. Some people still attend alcohol-centric events in early sobriety, while others avoid them entirely. Everyone is different, and with time and experimentation, you’ll get a sense of what social events you feel comfortable attending. Plus, you can always add certain activities back in down the road.

It can be difficult to say no to alcohol consumption in the heat of the moment, especially when experiencing peer pressure. Whenever these moments arise, ground yourself in your “why”: the reasons you are choosing not to drink. This will keep you connected to your goal and empower you to make choices that align with your ideal self. You also have a supportive community here at Monument and can check in for encouragement in a support group or in the 24/7 forum. Everyone is different and we each have our own communication styles. However you feel comfortable saying no, that is 100% valid. Just remember, this decision is yours, and it’s something to be incredibly proud of. 

Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.
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The Science of Hangxiety, And What To Do About It

The word ‘Hangxiety’ might not be in the dictionary, but you’ve likely heard it and very well may have experienced it. For many, hangover-induced anxiety, or drinking-related anxiety, is very real. Many of my patients pursuing online alcohol treatment at Monument ask me why they feel anxious after drinking alcohol

What is Hangxiety?

At a very high level, ‘hangxiety’, or ‘hangover anxiety’, is a type of alcohol-related anxiety that occurs after alcohol use. Hangover anxiety occurs for two key reasons:

  1. Pre-existing anxiety is intensified by alcohol. Anxiety is very commonly co-occurring with alcohol use disorder. People with underlying anxiety disorders may consume alcohol to relieve their anxious feelings, only to find that when the effects of alcohol begin to wear off, their anxiety is even worse than before they started drinking.  
  2. When alcohol ‘wears off’, anxiety sets in. With or without an anxiety disorder, this is a common hangover symptom. Experiencing increased anxiety levels when alcohol wears off makes you want to drink more for relief and can create an unhealthy cycle.  Alcohol-induced anxiety can last for a few hours or up to a few days.  

Regardless of whether or not you’re diagnosed with baseline anxiety, there is a consistent theme in both of these scenarios: after drinking, we feel anxious, and it may make us want to drink more. (This is also related to why you may feel anxious when you get sober.) This can create a cycle of heavy alcohol use. If you’ve found yourself drinking to soothe negative feelings and uncomfortable hangover symptoms, that’s a sign that you might benefit from support to cut back. Let’s dive into what’s happening in our brain to cause these feelings and what to do to address the root causes of hangxiety. 

What Causes Hangixety?

Alcohol is a Depressant 

If you’ve ever experienced anxiety after drinking you may have wondered “is alcohol a stimulant or depressant?” To begin to understand hangxiety, we need to remember this fact: When alcohol is consumed, it acts as a depressant. Alcohol consumption results in a sedating effect on the central nervous system. The sedating sensation is a key reason people drink in excess in the first place: to find a way to relax and unwind. While alcohol may provide short-lived relief and calm, alcohol can have depressive effects as it begins to wear off. These effects can lead to other changes in mood and increased anxiety levels. Many people drink more in an effort to relieve or avoid these effects, which can perpetuate unhealthy drinking habits. Moreover, for those who already have an underlying anxiety disorder, alcohol can make medication less effective, compounding the negative effect of alcohol on anxiety. There’s also a link between social anxiety and alcohol use disorder. When socially anxious and shy individuals use alcohol consumption as a coping mechanism, they may end up experiencing even greater levels of anxiety.

Alcohol Affects Dopamine & Serotonin

When people initially consume alcohol, certain neurotransmitters increase in the brain, including serotonin and dopamine. These neurotransmitters are known as “happiness chemicals,” so their initial increase can lead to the desirable short-term effects associated with alcohol. However, with excessive alcohol use over time, normal serotonin and dopamine levels decrease. This decrease in circulating serotonin and dopamine can also lead to feelings of anxiety. 

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Let’s take a closer look at these neurotransmitters. Dopamine acts on the pleasure centers of the brain. It’s released in the brain after consuming alcohol, which causes a euphoric feeling immediately after drinking. Over time and with continued use, the brain begins to associate drinking alcohol with pleasure. If this association is strong enough, dopamine may be released when even just thinking of alcohol. Then, after drinking, even more dopamine is released. If you’ve wondered, “why do I crave alcohol?” this dopamine interaction is a key driver of cravings.

In addition to dopamine, serotonin also affects our mood. More specifically, decreased levels of serotonin can lead to various mental health conditions, including depression. This is why people with depression often take serotonin reuptake inhibitors (SSRIs) such as Zoloft and Prozac to increase their levels of circulating serotonin. SSRIs can improve mood and resolve depressive symptoms. Because serotonin is a mood stabilizing neurotransmitter, decreased levels can lead to anxiety. While excessive alcohol use can lead to a surge in serotonin, a sharp decline follows. This decline when sobering up contributes to ‘hangxiety.’ Regardless of how often you drink, whether that’s binge drinking, daily drinking, or other types of drinking habits, you’re susceptible to this common serotonin interaction. 

"reminder: your last hangover can be your last hangover." Black static-y background

Alcohol Affects Natural Endorphin Levels 

The same ‘boom and bust’ of dopamine and serotonin that can lead to ‘hangxiety’ also applies to endorphins. The body uses endorphins to manage stress and pain. So, when alcohol is first consumed, and endorphin levels increase, people may feel less stress. This is why alcohol can have a calming effect and is a key reason why many people drink. However, when these endorphin levels become depressed and decrease after blood alcohol levels decrease, the drop-off of endorphins can lead to anxious feelings. The decrease in endorphins not only causes hangxiety, but also makes us feel less equipped to handle the normal stressors of the upcoming day. Work stress, family stress, social anxiety, and other influences can feel even more overwhelming and can make us want to drink even more to seek relief. This is an unhealthy coping cycle that can be broken with the support of online alcohol treatment.  

Alcohol-related Dehydration Affects Our Mood

If you’ve experienced thirst, a pounding headache, and dry skin after drinking, you’re likely familiar with alcohol-induced dehydration. Excessive alcohol consumption causes hangover symptoms like dehydration, especially if you didn’t adequately hydrate when drinking. What you may not know is that dehydration and decreased water intake can also affect our mood. Research shows that decreased water intake can negatively affect people’s sleep cycles, positive emotions, calmness, and satisfaction. Thus, decreased water consumption and the resulting dehydration can also contribute to day-after-drinking anxiety. On the other hand, better hydration, glowing skin, more restful sleep, and more energy are among the benefits of sobriety that I get to witness firsthand in my patients. 

How to Address Hangxiety 

Now that we’ve discussed the ‘why’ behind “hangxiety”, let’s get to the ‘how.’ How does one get rid of hangover related anxiety? The most important thing to remember is that drinking more will not make it better. (In fact, it will make it worse!) When experiencing increased anxiety after drinking, it’s beneficial to:

  1. Hydrate to address the negative effects of dehydration and other physical hangover symptoms
  2. Increase endorphins by doing an activity like exercise, hiking, or walking
  3. Combat stress and low serotonin by seeking calming activities such as meditation, deep breathing, art, or walking. (This can overlap with #2!) 
  4. Rest. Alcohol negatively affects sleep and wake cycles, so getting adequate rest after drinking is very important
  5. Take action to change your relationship with alcohol

Number five is both the most challenging and most impactful step you can take to address alcohol-related anxiety or “hangxiety.” Outside of the chemical interactions that contribute to anxiety, people often feel worried or regretful after a night of heavy drinking because of what they may have done or said while drinking. Excessive alcohol use affects relationships and all dimensions of overall wellness. If alcohol is negatively impacting your physical self, mental health, or social wellbeing, you are not alone, and you can make a change. At Monument, you can access therapist-moderated online alcohol support groups to discuss your relationship with alcohol and hear how others navigate similar challenges. You can also explore personalized care including medication to stop drinking and online alcohol therapy. In my work on the Monument platform, I meet with patients to discuss how medication can play a role in changing their habits. I also advise on how to safely cut back based on their unique needs, goals, and medical history, including guidance on if they are at risk of withdrawal symptoms. 

Title: "Drank more than you wanted to? Tips for managing 'hangxiety':" Four white boxes with yellow circles with numbers. "1. Hydrate. Drink water to address the negative effects of dehydration and other physical hangover symptoms." "2. Move around. Increase endorphins by doing a physical activity like exercise, hiking, or walking." "3. De-stress. Combat anxiety and low serotonin with calming activities like yoga and meditation." "4. Rest. Alcohol negatively affects sleep quality, so getting adequate rest after drinking is very important."

As you continue on your journey, remember this: There is no shame in having used alcohol to cope with anxious feelings or to ‘feel good.’ If you’ve felt anxious, embarrassed, worried, or regretful, know that so many others have too and you don’t have to continue feeling this way. You deserve relief, and cutting back on alcohol can increase self-esteem, provide a clearer sense of self, and reduce overall anxiety. Seeking information is a meaningful step, and that’s something to be proud of.

Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.
people at sunset

How Does Disulfiram Work?

Disulfiram, also known as Antabuse, is one of the FDA-approved medications used to treat alcohol use disorder (AUD). Medication to stop drinking can make an incredibly meaningful difference in the recovery journey, especially when paired with specialized alcohol therapy. The effects and recommended uses of disulfiram are specific to each individual, and it’s best to consult your physician to see if getting a prescription for disulfiram online is the right fit for you. To help you learn more about disulfiram and arm you with information to bring to your physician, I’ve answered frequently asked questions about disulfiram from my patients on the Monument platform. 

How does disulfiram work?

Disulfiram works by changing how your body responds to alcohol. Disulfiram inhibits the metabolism of alcohol, and as a result, it makes you sick if you consume alcohol. Knowing that you will be sick if you drink can act as a psychological deterrent to prevent alcohol consumption. Given disulfiram’s effect, it is suitable only for those looking to abstain entirely from alcohol. 

Some people say that taking disulfiram is like removing the choice to drink. However, unlike naltrexone, another FDA-approved medication to help people reduce their  alcohol consumption, disulfiram is not shown to decrease cravings. If your physician prescribes you disulfiram, it should be seen as one tool to help you stop drinking alcohol. Developing new behavioral patterns and coping mechanisms is critical for long-term sobriety. Engaging in specialized alcohol therapy is an effective way to work on making these sustainable changes. Modalities like cognitive behavioral therapy (CBT) can help you cope with cravings, build drink refusal skills, develop healthier coping mechanisms, and address co-occurring mental health conditions like anxiety and depression. That’s why Monument’s online alcohol treatment plans include customizable options for both therapy and physician care with medication management.

people at sunset

How does disulfiram react with alcohol?

Normally, alcohol breaks down to acetaldehyde, otherwise known as ethanol, after consumption. Without the presence of disulfiram, enzymes then break down the ethanol into acetic acid. Disulfiram works to inhibit these enzymes. Therefore if you were to consume alcohol while taking disulfiram, ethanol would not get broken down. Accumulated ethanol in the body causes uncomfortable and unpleasant symptoms, such as flushing, headache, nausea, vomiting, sweating, shortness of breath, dizziness, fainting, confusion, blurred vision, abdominal and chest discomfort, low blood pressure, etc. This is called the disulfiram-ethanol reaction. Many of these unpleasant symptoms (which can even be dangerous at times) can be explained by the fact ethanol increases histamine levels in your body. Since histamine is also released in allergic reactions, you can think of disulfiram as making you allergic to alcohol. 

The severity of the disulfiram alcohol reaction depends on the dosage of disulfiram and the amount of alcohol ingested. For some people, these adverse effects last about 30-60 minutes and resolve on their own. However, in some cases, a severe reaction can last longer than several hours and result in more severe symptoms such as heart failure, seizure, and even death.

If you consume alcohol while taking disulfiram and experience symptoms such as trouble breathing, seizures, loss of consciousness, and chest/jaw/left arm pain, you should seek medical attention immediately. 

What should I expect when taking disulfiram?

When you are taking disulfiram, you should avoid anything that contains alcohol. People taking disulfiram can accidentally consume alcohol and become sick. Products that may contain alcohol include mouthwashes, cough mixtures, sauces, vinegars, and lotions. Be especially careful when you eat out. As I mentioned previously, the disulfiram reaction with alcohol can be severe and dangerous. Do not test the effectiveness of the medication by drinking alcohol.

Any side effects or factors to consider when taking disulfiram?

In most cases, disulfiram can be taken long-term without significant side effects if alcohol is not consumed. You do not build a tolerance to disulfiram, and there are no withdrawal symptoms associated with the discontinuation of disulfiram. However, you should follow up with your treatment provider regularly to assess whether it is safe for you to continue or stop using disulfiram. 

As noted above, you should not have alcohol in your system when starting disulfiram. To be safe, you should consult with your physician about your plan to begin treatment, which will include waiting at least 24 hours before beginning disulfiram to avoid the disulfiram-ethanol reaction.

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When you plan to stop drinking, regardless of if you plan to use medication or not, you should consult with a medical professional to find a safe course of action. Quitting alcohol cold turkey can be dangerous for alcohol dependent patients, and a physician can provide next steps to ensure your needs are safely met. 

Ifyou believe you are experiencing acute alcohol withdrawal symptoms, you should contact your health care or treatment provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. Quitting cold turkey can be life-threatening, and proper withdrawal management is critical for your safety.

man on street

Who does disulfiram work for?

Due to its chemical interactions, disulfiram treatment is for people committed to complete alcohol abstinence. If your goal is to drink in moderation, disulfiram is not the right choice. Also, if you have a history of heart disease, diabetes, hypothyroidism, epilepsy, kidney disease, or liver disease, you may not be a good candidate for disulfiram. After signing up for Monument’s online alcohol treatment program, you will connect with a physician to discuss your medical history, needs, and goals. They will then prescribe either naltrexone or disulfiram if they deem it safe and appropriate for you. 

Disulfiram treatment is most effective when consistent. However, it’s not uncommon for people to either forget to take it or stop taking it once they feel more confident in their sobriety. For these reasons, I recommend to patients that they ask a family member or friend to help keep them accountable. Attending therapist-moderated alcohol support groups and engaging in alcohol therapy are also effective ways to receive meaningful accountability and support in tandem with medication. 

Medication assisted treatment for alcohol use disorder is becoming more widely known. It is especially effective when combined with other treatment modalities, such as therapeutic and community-based support. This holistic approach is broadly considered the ‘gold standard’ in alcohol use disorder treatment among medical professionals. The first step is to meet with a physician to discuss your specific history and goals and to create a treatment plan tailored exactly to you. Exploring changing your relationship with alcohol is a brave step in itself, and there are many different tools to help get you from where you are to where you want to be.  

Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.

Important Safety Information

Naltrexone has the capacity to cause hepatocellular injury (liver injury) when given in excessive doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use in patients with active liver disease must be carefully considered in light of its hepatotoxic effects. In the treatment of alcohol dependence, common adverse reactions include difficulty sleeping, anxiety, nervousness, abdominal pain/cramps, nausea and/or vomiting, low energy, joint and muscle pain, headache, dizziness and somnolence. This is not a complete list of potential adverse events associated with naltrexone hydrochloride. Please see Full Prescribing Information for a complete list.

The most common side effects of Disulfiram may include drowsiness, tiredness, headache, acne, and metallic-like taste in the mouth. Call your doctor if you have signs of serious side effects such as decreased sexual ability, vision changes, numbness of arms or legs, muscle weakness, mood changes, seizures, or confusion. Do not take Disulfiram if you are allergic to any of the ingredients. If you begin to have signs of an allergic reaction, then seek immediate medical attention. Avoid consumption of alcohol while taking this medication, as it may lead to adverse side effects. Talk to your doctor about the history of your medical conditions including if you have or have had diabetes, underactive thyroid, brain disorders, liver or kidney disease, personal or family history of regular use/abuse of drugs. Certain drug interactions may lead to serious adverse side effects. Let your doctor know about any other medications you are taking. This is not a complete list of potential adverse events associated with Disulfiram. Please see Full Prescribing Information for a complete list.*Monument Inc. provides administrative and business support services to independent medical and clinical practices and providers. Monument Inc. does not provide medical or clinical services and does not own medical or other clinical practices. All medical services are provided by Live Life Now Health Group, PA d/b/a Live Life Now Medical Group. All counseling and therapy services are provided by independent licensed practitioners including licensed clinical social workers (LCSW) and licensed mental health counselors (LMHC). Individuals should contact their physician or therapist with any questions about their treatment.