In her memoir, "The Sober Diaries," Clare Pooley details the first year of her life after deciding to stop her heavy drinking. In that same year, she was diagnosed with breast cancer. Like many people, she had no idea about the connection between the two. In this episode, Clare talks about the many, many benefits of sobriety that she's discovered — even beyond a lower breast cancer risk — and Dr. Karen Anderson provides her oncology expertise.
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Dr. Denise Millstine: Welcome to the”Read. Talk. Grow.” podcast, where we explore women’s health topics through books. In the same way that books can transport us to a different time, place or culture. “Read. Talk. Grow.” demonstrates how books can also give a new appreciation for health experiences and provide a platform from which women’s health can be discussed. At”Read. Talk. Grow.,” we use books to learn about health conditions in the hopes that we can all lead happier, healthier lives.
I’m your host, Dr. Denise Millstine. I’m an assistant professor of medicine at Mayo Clinic in Arizona, where I practice women’s health, internal medicine and integrative medicine. I am always reading and I love discussing books with my patients, my professional colleagues, and now with you.
I am thrilled today to be joined by two amazing guests. The first is the bestselling author Clare Pooley, who graduated from Newnham College in Cambridge before spending nearly 20 years in the heady world of advertising. That’s where she worked hard, played hard and drank even harder. By the time she was 46 years old, she knew she had to go sober.
She started a blog called “Mummy was a Secret Drinker” by way of her own therapy and that blog went viral and eventually became the memoir we’ll discuss today, “The Sober Diaries.” Clare then started writing fiction and following her dreams. Her debut novel, “The Authenticity Project,” is a New York Times bestseller and is published in 30 languages. Her most recent novel, “Iona Iverson’s Rules for Commuting,” is out now and is simply fabulous.
My other guest is Dr. Karen Anderson, who’s an associate professor of medicine at Mayo Clinic in Arizona. She’s a medical oncologist and researcher. She focuses on breast cancer, particularly immunotherapy, treatments to reduce risk of breast cancer recurrence and using genomics to guide treatment decisions. She received her M.D. and Ph.D. from Duke Medical School and was trained at the Brigham and Women’s Hospital, as well as Dana-Farber Cancer Institute. Welcome to you both.
Clare Pooley: Thank you. It’s great to be here.
Dr. Karen Anderson: Thank you.
Dr. Denise Millstine: I’m so excited to talk to you both about this incredibly important topic of women and alcohol. It is really a difficult one to navigate in the clinical setting as well as in the social setting. I get together with a group of women who are book geeks like myself every month, and one of my friends brought “Iona Iverson’s Rules For Commuting” and when she brought this I said: “I love Clare Pooley. I loved ‘The Authenticity Project.'”
When I read that book, I read a story about you, Clare, and it was the story of the day you decided it was time to quit drinking with the World’s Best Mom mug. Would you share that story with our audience?
Clare Pooley: Yes, of course. This was about seven years ago, actually, and I was a stay-at-home mom at the time, with three young children. They were ages 6, 8 and 11, and it was the day after my birthday party. I woke up with a terrible hangover and I went down to the kitchen and my kids were making loads of noise, as kids do, and I had this terrible headache.
I remember thinking that the only thing that would make me feel better was a drink. But it was 11 in the morning or 11:30, and I had this hard and fast rule that you never drank before midday because that would mean that you had some sort of problem, and I didn’t think I had any sort of problem.
Yet here I was thinking, “The only thing that’s going to make this feel better is a drink,” and I looked in the cupboard. I found a little bit of red wine left in a bottle, which I thought was a sign because I rarely left anything in the bottle. I couldn’t put it into a glass because my kids were there, and even they would be shocked by that sort of behavior.
I took a mug out the cupboard, poured the wine into a mug and drank it. I did feel a lot better until I looked at the mug and the mug said on it, “The World’s Best Mum,” and I felt so ashamed of myself and so dreadful about the situation I found myself in that that was the last drink I ever had.
Dr. Denise Millstine: Now this wasn’t the first time that you decided, “Maybe I need to back off on drinking or cut back.” That was a process that you had considered, but this time it actually was effective and stuck. What made the difference?
Clare Pooley: Like many people in the situation that I was in, I saw myself as a regular mum who just drank wine in the evenings to relax, and it was sort of my “me time.” It just got more and more and more to the point where I was drinking about a bottle of wine a day and a bit more at weekends, so about 10 bottles of wine a week when I added them all up, which was terrible.
I knew it was becoming a problem, but I didn’t want to quit altogether. I wanted to be able to drink sensibly or moderately. So I spent years trying to drink sensibly. I spent years giving myself rules about when I could drink, when I couldn’t drink, and how much I could drink, and it was just exhausting. I gave up for weeks and days at a time, and then I’d start drinking again.
I was just tired of it all. I was tired of thinking about drinking constantly. I was tired of this addict voice in my head, constantly talking to me about when I was going to drink, what I was going to drink, if I was going to drink. That moment, seven years ago, I just decided that I finally had enough.
Dr. Denise Millstine: Dr. Anderson, you spend a lot of time talking to women, who have recently been diagnosed with breast cancer, about quitting drinking or their relationship with alcohol. Tell us how you approach that conversation.
Dr. Karen Anderson: Well, first of all, Clare, I want to say thank you for a very brave and beautiful book. I really enjoyed it. My clinic is focused on women with breast cancer, and these are challenging conversations because there’s a social support network that comes around the use of alcohol. It’s embedded in a lot of our social systems.
Women are already dealing with the stress of a recent diagnosis of breast cancer. Then if you’re also thinking about lifestyle changes, either to reduce recurrence or to prevent the next breast cancer, or simply to improve overall health, there is so much going on at the onset of the diagnosis, so it tends to be conversations that we have over time as I get to know women,
We talk about what lifestyle changes that women can implement to impact a quality of life and their overall health and obviously the risk of their breast cancer. That’s a long term process. Alcohol is a carcinogen. It is. It’s been demonstrated to have elevated risk not just of breast cancer, but of multiple cancer types, esophageal and neck, colon cancers and others.
It’s been recognized that it is a carcinogen. More alcohol use and longer-term alcohol use is certainly associated with breast cancer risk. There’s no safe level of it in terms of breast cancer risk. Even very small amounts are associated with breast cancer risk. Less than three drinks a week, for example, or less than four drinks a week.
I think that Clare’s book speaks to a lot of the issues of not just the social impact, but also the shame that comes from this. Women are already grappling often with, “What caused my breast cancer? Where did that come from? What you know, what did I do? Was it something I did that was related to this?”
These are really difficult challenges that we’re looking at. There’s no evidence that any one thing caused a given person’s breast cancer. That’s really important. There’s population studies, but what actually happens with individuals? We know that alcohol use increases risk. More alcohol increases risk, but we will never know for a given individual.
What we really focus on is, is moving forward and what’s the impact of quality of life? What’s the impact of side effects of medications? What’s the impact on hot flashes, of menopausal symptoms, which you go into in the book. What’s the impact on recurrence rates and next breast cancers? We need to have these conversations every single time with women because we haven’t been recognizing the increased use, increased rates of alcohol use, certainly in this country.
Dr. Denise Millstine: Well, Clare, you named your blog “Mummy was a Secret Drinker,” and I think that speaks to the shame and the typical unwillingness to talk about alcohol use and struggles people have with it or even if they want it to be different. Will you comment on that as well as on the use of the word alcoholic, which I think gets us stuck because it’s often the wrong question, not are you an alcoholic, but is alcohol detrimental to your life?
Clare Pooley: Yes, absolutely. Rewinding to the point where I was still struggling with trying to control my drinking and worrying about it, I spent so much time Googling “Am I an alcoholic?” Almost everybody I’ve met who has finally quit drinking says that they did the same. A number of times, late at night. Normally, after a few drinks I typed, “Am I an alcoholic?”
This questionnaire would come up and it would say, “Do you drink in the mornings? Do you blackout?” Some of these things I’d say yes to and some I’d say no to. Then I’d press the button for the answer and it would say, “You may or may not have a problem with alcohol.”
I know that I may or may not have a problem with alcohol. I just want the answer. It took me a long time to realize that I was asking the wrong question. The question isn’t, “Am I an alcoholic? The question is, “Is alcohol proving detrimental to my life?” and if so, I should stop. I don’t use the word alcoholic to describe myself.
I describe myself as an alcohol addict because I think the word alcoholic is just imbued with so much stigma that it often stops people seeking help and it stops people talking about what they’re going through because they don’t want to accept that label. I like to see the situation I’m in now as a very positive one. I am a very enthusiastic nondrinker and I think that is a much more positive way of describing myself than as an alcoholic.
I didn’t really want to attach that negative label to me for the rest of my life. I quit smoking 30 years ago, but I don’t describe myself as a nicotineaholic. I’m just a non-smoker. I’ve no intention of ever smoking again. The way we treat alcohol and alcohol addiction is very different from the way we treat any other drug. Alcohol is the only drug you have to justify not taking. You quit smoking. Everyone goes, “Yeah! Well done! You’ve quit smoking!” You quit drinking and they ask, “Oh dear, did you have a problem?” No, alcohol is the problem. I am not the problem. The drug is the problem. When I quit, I felt so ashamed. I just felt I couldn’t talk to anybody. I didn’t want to tell my friends. I didn’t want my family. I didn’t want to go to AA. I didn’t want to talk to my doctor.
That’s why I started blogging about it. That was my therapy. I poured everything out onto the Internet instead, and did a whole load of research, which I then talked about in my blog. That was the way I dealt with it.
It seemed so stupid now that I should have been so ashamed about it. Rather than being proud of myself for addressing an issue that I knew would become a problem, I felt shame. That’s sad.
Dr. Denise Millstine: It wasn’t only you that created that feeling. You overheard some conversations where people basically said, “Well, she’s off my party list.” Literal comments by people you might have considered friends, or at least people you were friendly with. The book, since it covers a year, is really helpful to navigate all of the different phases that you go through when being particularly a heavy drinker and you make that clear stop, in terms of your initial pink cloud, some of the ups and downs that you ride, but I love your rules for navigating the party.
As we are approaching here, almost the holiday season, just focusing on “You don’t have to go, you don’t have to stay. You can take breaks.” One of my favorites is the benefit of watching the drunkards as if they’re wildlife, that you see their ridiculous behavior and then holding on to the morning. You say, “Alcohol steals the happiness of tomorrow.” If you wake up like you described, hungover, it’s taking that joy from that next day.
Clare Pooley: Absolutely. One of the great things about not drinking is mornings. I often say to people who ask me how to get through the early days of not drinking, a great tip is to initially go to bed as early as you can because the evenings are the hardest bit and get up as early as you can because the mornings are joyful.
Just switch up your day a bit. In the early days that really, really helped. Now, I don’t have a problem going to parties at all, but in the early days it was probably the hardest thing, mainly because of other people’s reactions. As you say that in the book, I talk about the fact that, you know, most of my friends are big drinkers and that was no coincidence. I chose them partly because they were big drinkers. They found it hard when I quit. They are completely used to it now, but initially I think it makes other people look at their own drinking and they find that uncomfortable, so it is tough socially to start with, but it becomes easy eventually.
Dr. Denise Millstine: About-two thirds of the way through the year you were diagnosed with breast cancer. Your aunt was diagnosed with breast cancer and you did a breast exam and found a lump and thought, this is the last thing I need right now. I equate Dr. Anderson to The Prof in your book. I loved how you were waiting for the question, “Ask me if I drink alcohol” so you could proudly say no.
I think we always ask patients if they drink alcohol and sometimes you do that with this sort of gritted teeth, like, “Here we go on this conversation.” But you actually were like, bring it on, and then he said, “Is that a lifestyle choice?” Then ended the visit by saying, “You know, you should toast with some champagne.” You thought, “I just said I’m not a drinker?
Clare Pooley: I was actually thrilled to hear Dr. Anderson talk so openly about the link between alcohol and breast cancer, because I was completely unaware of it. I’m an educated woman. I like to think that I read a lot about health and wellbeing and I was completely unaware of that link.
Then through the process of having all my cancer treatment, the number of times I was told by medical professionals to go and pour myself a stiff gin and tonic. I asked several people towards the end of that process, I said, “What can I do to reduce my risk of recurrence?” As a breast cancer survivor we all fret about recurrence.
It’s always in the back of your mind, and nobody said, “Don’t drink.” It’s something we do need to talk about a lot more. I am quite convinced that I wouldn’t, even if I had a genetic predisposition to breast cancer, which I believe I have, contracted breast cancer 20 years younger than anybody else in my family.
I’m quite convinced that’s because of the amount that I was drinking. Also, my breast cancer was papillary breast cancer, which I believe is more linked to alcohol use than the more common ductal breast cancer is. Is that correct, Dr. Anderson?
Dr. Karen Anderson: I know that the hormone receptor positive type of breast cancers are more associated with it, in part because alcohol can increase estrogen levels and sort of drive the cancers in that way. It’s interesting that we’ve got many excellent studies looking at the association of alcohol use and risk, of developing a breast cancer where even moderate use —as defined by 3 to 7 drinks a week — is associated with about a 23% increased risk of breast cancer.It’s fairly significant. Light use, 4%, but that heavy use of over 50% increased risk. These are significant numbers.
But the data that you asked about, the impact on recurrence, once you have breast cancer, “Will decreasing my alcohol intake or eliminating that impact risk of recurrence?” I would say that data is more mixed. I think we need more studies on this.
What’s the impact? These are hard studies to do. Imagine trying to randomize a study and say: “Okay, you’re not going to group and this half will and we’ll see what happens.” You’re not going to do that. So they’re harder studies to look at. We tend to look at the women who do drink, the women who don’t and try to match them and look at their recurrence rates.
So that link is actually not as well established, but it’s certainly, if you’ve had a breast cancer, you’re at increased risk of developing another one. As a role for prevention of your next breast cancer. Certainly reducing alcohol intake has an impact. I wanted to get back a little to your discussion about your social network. Your social network, that both kept you drinking and that shame that when you thought about stopping, but also that’s the strength that you had in it you to stop drinking.
You created a network online. You created your own support network. You had your family, you had your friends, and your friends have seen you in a different viewpoint now. In some ways, you were also leading the pack, right?
Clare Pooley: Yeah. They say that the opposite of addiction is connection, and it is really hard to quit any form of addiction if you’re trying to do it alone. That really is the strength of Alcoholics Anonymous and organizations like that is connecting you with people in the same situation as you. That day when I first quit drinking, I really felt alone.
I found my own support group through the internet. So I started this blog and people started following, and before too long I had thousands of people around the world all together with me, all going through the same sort of thing. It was an amazing support. Those times when I felt like I was about to give up giving up, I was really tempted.
What kept me going was thinking, “I can’t let these people down.” If I start drinking again, then who knows what impact that would have on all these other people who are going on this journey with me. We all supported each other. Then, when I was diagnosed with breast cancer, that support network was so valuable to me. I had so many messages from people all around the world telling me their cancer stories and just supporting me. There was a wonderful woman in Wisconsin who told me that she went to a church with a congregation of over 200 people, and they all prayed for me. That was just an amazing feeling.
These are people who didn’t even know my real name because I was blogging under a pseudonym, Sober Mummy. So, if you’re listening to this and you want to quit drinking, find a network.
It doesn’t matter whether it’s a real life network, whether it’s a virtual network, just find one that you feel comfortable with because trying to do it on your own is really hard and you don’t have to do it on your own. Nobody has to be on their own. There are thousands and thousands of women like me all over the world. You are not alone.
Dr. Denise Millstine: I loved your story of Elizabeth, who was trying to give up wine and on the day of your breast cancer surgery, she said: “Well, if you’re going to give up a bit of your boob, I can give up the wine.” I thought that was just lovely.
An important component of this book is that it’s not heavy, even though it’s a very serious topic, even though it is a topic that we often approach with trepidation, it is laugh-out-loud funny at several moments. I just encourage people to read it if they’re thinking about alcohol in their lives at all. Even if they’re not necessarily wanting to stop drinking, but just ready to examine “what role is alcohol playing in my life, and am I ready to look at that really more critically and see how it’s potentially affecting my health?”
In addition to the cancer risk, you talk about going through menopause and how another area that women and people don’t typically talk about a ton, but all of us eventually go through, the menopause transition and that can be with a variety of symptoms and alcohol can make that so much worse. Whether it makes your hot flashes worse or something, I think is very underrecognized and you comment on, is the mood changes that come with menopause, and when you layer alcohol on top of that, that can be a very tricky road to navigate.
Clare Pooley: Absolutely. Alcohol makes all of the things we go through with menopause that much worse. It’s like pouring petrol on flames. To give you an example, I always thought that alcohol helped with anxiety. I thought if you’re feeling anxious about something, have a drink, make you feel better. Actually, alcohol increases anxiety.
If you’re suffering from anxiety with menopause, drinking is just going to make that worse. It’ll make hot flashes worse. It’ll make your sleep worse. It’ll make your weight gain worse. If you’re struggling with menopause rather than immediately reaching for HRT, I would suggest you try cutting down on alcohol or giving up alcohol altogether first, because you might find that actually that has an even bigger impact than taking additional hormones.
For me that’s a real added benefit. Also, I have to say, quitting alcohol makes you look younger. It’s great for your skin, and your energy levels. I looked at least five years younger after I quit drinking, so that’s an additional bonus. Free Botox.
Dr. Karen Anderson: You know, you talked about a couple of things. One is the effect on insomnia and sleep disturbance, which is a big problem for our patients, especially in breast cancer care, when women are taking anti-estrogens. I call it extreme menopause. Not only are you having menopausal symptoms, but you’re having them much more profound on these medications.
It’s a big challenge. You’re on these medications; you talked about tamoxifen or aromatase inhibitors. You may be on those for 10 years. You need to have a quality of life that is livable on this, and the insomnia, the temperature dysregulation obviously, hot flashes and also the weight gain associated with menopause in general, some weight gain associated between dealing with the stress of diagnosis in others that also sort of feeds into this, and alcohol obviously contributes to that. It all sort of accumulates into difficulty with sleep, which then is a terrible circular pattern with weight gain and lethargy and difficulty during the day. That is one approach in impact on quality of life where the cutting down or reducing alcohol intake can really have a profound effect on the quality of life for our patients.
Clare Pooley: Absolutely. I found one of the fastest and most miraculous impacts for me of quitting alcohol was the quality of my sleep, because alcohol helps you get to sleep because it relaxes you and you fall asleep more easily. But then what happens is you tend to wake up at about 3:00 in the morning with a very active brain that is often berating you for having drunk too much, fretting, going round and round and round.
Then you typically don’t get back to sleep again until half an hour before the alarm goes off. That is a typical sleep cycle of somebody who’s drinking too much and almost, within a couple of weeks, of course, in drinking, I found that I was sleeping seven hours a night without a problem, which was extraordinary because, again, it was one of those things I hadn’t really associated with my alcohol intake. I thought it was just one of those things.
Dr. Denise Millstine: In talking about that berating voice you actually named that voice, the Wine Witch, which I think is brilliant. She’s the one that tells you, “Oh, you’re at the party, just have one,” or, “You’ve had one, go ahead and have another,” or “The bottle’s almost empty. Go ahead and finish it.” Talk about how you came to name her the Wine Witch and how your relationship changed with her over the year.
Clare Pooley: This really helped me, and I believe it’s really helped hundreds, thousands of other people as well, because that addict voice in your head can make you feel like you’re going slightly crazy. It often feels like you’re constantly having a dialog with yourself. You have that, “I’m going to drink! No, I’m not going to drink! Oh, go on, just have one!”
It goes on and on and on. It feels like this internal battle and it is so much more helpful to see that voice, that negative voice as somebody other than you. So I called her the Wine Witch. She was the voice that was constantly trying to get me to drink and trying to knock me off the straight and narrow.
My battle was not with myself, it was with her, because she was evil and she was trying to get me to do something I knew I shouldn’t do. The minute I gave her a voice, a name, a face, I found her so much easier to deal with. People give that voice different names, different faces. They’ll talk about the wolf or the monkey or, in my case, the witch.
But defining that voice as somebody other than you really helps beat them. I used to picture the Wine Witch getting weaker and weaker over time, and I knew the longer I went without drinking, the more I’d sap her power. The greatest thing, the most wonderful thing about not drinking is the peace and quiet.
I don’t have that voice in my head anymore, which means I have so much more time for other things. There’s no way I could have written two novels if I still had that voice taking up all that space. Think what you could do with the room that that creates.
Dr. Denise Millstine: That’s when focus, when people start to think about not drinking alcohol, is the not doing something, but for you this cracked open your world and now you’re a bestselling author and living this creative dream.
Clare Pooley: I honestly thought, when I had to quit drinking, I thought my life was over. I thought, “Okay, I’ve had my fun bits and now I’m going to have to be good, and it’s all going to be very dull and very boring, but so be it. It’s my own fault, and I’ve got to suck it up and deal with it.”
That’s how I felt. What I didn’t realize is that my whole life was going to be utterly transformed in a really positive way. I have more energy, I have more creativity. I have a whole new career. I’m a better mother, I’m a better wife, I’m a better friend. I can’t tell you how many ways it’s impacted my life.
I think if you are a heavy drinker, then the single thing that you can do that will transform your life the most is cutting out alcohol because it transforms not just one thing but everything.
Dr. Denise Millstine: We have to talk, at least for a moment, about “Iona Iverson.” I think the middle-aged woman as a protagonist is something we have not typically seen in fiction, and you bring to life this incredible woman and talk about how important connections are. One of her rules on the train is don’t talk to anybody, and of course she breaks that rule, and her whole world and the world of many others cracks open. I think it’s just delightful.
Clare Pooley: I’m a bit in love with Iona myself. She’s the sort of woman I want to be. She is 56 and she is suffering from terrible ageism at work. She’s a magazine therapist. She describes herself as, although everyone else calls her an agony aunt. She discovers that her editor, who is much younger than her, wants to fire her because she thinks she’s out of date.
This means a lot to me as a topic because I get very angry with the way that women over the age of 50 are made to feel invisible, whereas men grow gravitas with gray hair. Women tend to be seen as irrelevant. That has to change. I think we all deserve a triumphant second act, and that’s what we see with Iona is what you can achieve after the age of 50. Should you seize the opportunity? My first novel was published when I was 50. So, as far as I’m concerned, this is a whole second act for me.
Dr. Denise Millstine: We recorded an episode with Kirsten Miller, who wrote the book “The Change,” which is a thriller about women undergoing the menopause transition and developing superpowers, changing the narrative around middle-aged women because it is not a time of our lives where we crumble. It’s a time where we are better resourced, we are wiser than we were when we were younger. We traditionally have fewer family responsibilities and it’s just a time to shine, and I love how Iona does exactly that.
Clare Pooley: I’m a big fan of Taylor Jenkins Reid, who wrote “Seven Husbands of Evelyn Hugo” and “Daisy Jones and the Six.” Her latest novel has just come out. It’s called “Carrie Soto is Back.” She’s not that old, actually. Carrie Soto is, I think, 36. But for a professional tennis player that is very old and it’s all about her comeback and again, about women being written off after a certain age and fighting against that. So hurrah for us.
Dr. Denise Millstine: Well, thank you both for joining me. This has been an amazing conversation about approaching alcohol in our lives and the lives of women, understanding the journey of looking at alcohol, as well as its role in cancer and menopause, and we touched on ageism. It’s been a marvelous conversation. Thank you again for joining me.
Clare Pooley: Thank you for having us. It’s been fabulous chatting to you guys.
Dr. Karen Anderson: Thank you so much.
Dr. Denise Millstine: Thank you for joining us to talk books and health today on “Read. Talk. Grow.” To continue the conversation and send comments, visit the show notes or email us at readtalkgrow@mayo.edu. “Read. Talk. Grow.” is a production of Mayo Clinic Press.
Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
The podcast is for informational purposes only and is not designed to replace the physician’s medical assessment and judgment. Information presented is not intended as medical advice. Please contact a healthcare professional for medical assistance with specific questions pertaining to your own health if needed. Keep reading everyone.