This podcast ended in July of 2021, but hundreds of episodes are still up and available to tune into. McDermott added that Spelling was a pillar of support and encouraged him to seek treatment. An administrator from the treatment business did promise to pay Ms. Antonio’s $5,000 funeral bill, Ms. Dillon said. Police reports and autopsies chronicling several deaths have ruled them to be accidents, and state officials have not filed criminal charges relating to any deaths. Several families said they were desperate for answers or some accountability, but had not been able to find lawyers to file lawsuits or even reach the people behind the now-suspended companies that ran the treatment centers. Joryan Polk, 22, a member of the San Carlos Apache Tribe, had grown so despondent during his drug treatment program that he called his mother to say that no one was listening or helping, his mother said.

• From 2015 until 2018, these two awesome women teamed up to ask the big questions of life, answered through the lens of addiction recovery.
• Although not every episode is centered on sobriety, as a sober woman of color, Jocellyn includes plenty of conversation surrounding recovery.
• His aim is to help people quit drinking and make positive changes within their homes and communities.
• As he gained support, developed new skills, and began to understand addiction, his depression lifted and drugs and alcohol became less critical in his life.

If you are new, think you are alone and don’t know the next steps to getting help, you found the right place. We speak for no 12 step program but we do try to remain anonymous. Jessica Jeboult hosts these insightful conversations https://en.forexpamm.info/sober-sayings-and-sober-quotes/ about mental health, self-development, wellness, and spirituality and their influence the recovery journey. She’s hosted fantastic guests including Taryn Strong of She Recovers and Martha Duke of Recovering Out Loud.

Top Podcasts In Education

The Addicted Mind Podcast is about understanding addiction, its impact and the latest treatment options available. This podcast aims to create an environment of compassion for individuals caught in the destructive grip of the addictive process. It works to deliver real hope to people who are suffering from addiction’s painful impact. Still, while conversations around mental health are gaining prominence, Wesolowski expressed concern that increasing calls for institutionalization of the mentally ill by some candidates in the 2024 race could stymie progress. Later that year, it allocated additional money to health programs through the Restoring Hope for Mental Health and Well-Being Act – passed with an overwhelming 402 votes in the House. They each have called for adding behavioral health specialists to every K-12 school in America and have argued that treating mental health key to reducing addiction in America.

She was left lying by the front door, where a staff member found Ms. Antonio on the ground holding a can of alcohol, the report said. The staff member let Ms. Antonio into the house, but did not call for medical help. Ms. Mayes said the treatment centers operated largely unchecked for years, taking advantage of gaps in an Arizona program that funds health care for low-income tribal members. The schemes exploited overlapping American woes — addiction, soaring homelessness and a long history of disregard for Native American health. For example, we have had episodes that address the opioid crisis and possible solutions relating to harm reduction and medical treatment.

Need recovery support while on the go? Here are eight of the best addiction recovery podcasts around.

Chip Somers was most recently described by Russell Brand in his book ‘Recovery’ as someone who has taught him that it was OK to talk about my feelings. The clever name of this podcast is uplifting and rightly so in line with its aim. “Recovery Elevator offers hope through community and connection.” How?

• I’m one of those people who joins a book club, then usually fails to read the book.
• There was Home, co-hosted by Tempest and The Temper founder Holly Whitaker and Laura McKowen.
• Robbins wrote about her experience for HuffPost… and then the comments came pouring in.
• If you, or someone you know, is an alcoholic, or simply sober curious, listening to a recovery story on a recovery podcast may be just the motivation that you need to make a decision to make some changes.
• In her podcast, which has more than 200 episodes, she invites guests on to discuss the various areas of sobriety and recovery that affect all of us today.

Less than a year later, he started That Sober Guy Podcast as a way to allow others to share their experiences and bring light to a topic that so many find difficult to talk about. Today, TSG is one of the top recovery podcasts, with millions of downloads across multiple continents. He interviews a mix of celebrity guests and everyday people who have experienced addiction or felt the impact of drug or alcohol use. He focuses on living a positive, healthy and sober lifestyle, and uses his podcast as a platform for sharing inspiration with others who want to live the same way. The Way Out is a weekly recovery podcast that offers insight from guests who have firsthand experience in the world of addiction. And aside from their stories, listeners often rave about the knowledge and humor that hosts Charlie and Jason bring to every episode.

Janey Lee Grace Alcohol Free Life

Episodes feature conversations on mental health, self-development, wellness, and spirituality. Further, I would say this is one of the more hip sobriety podcasts because it targets a younger demographic. Many listeners are newly sober and tuning in helps them maintain their sobriety. Her guests tell their unique recovery journey that inspires many listeners to continue on their own sober journey.

Recovery podcasts are usually hosted by someone that is a recovered addict. Each podcast has its own twist, just like with radio shows or internet blogs, you have to find the one that is right for you, a host that you enjoy and can relate to and that covers topics that help you in your road to recovery. Generally, podcasts have guests join them to share their own story or to contribute Why Some People Have A Higher Alcohol Tolerance Than Others in their professional field to discuss a specific topic. In 2018 Jessica Jeboult created A Sober Girls Guide sharing her experiences from her sobriety attempts over 10 years. No topic is off limits with Jessica, from health and fitness to relationships, dating and sober sex. Jessica features special guests each week and brings her wit and personality to subjects that are heavy.

Sobriety Rox

Hosted by recovery roach Angela, this podcast is here to offer you a fresh perspective on living sober with the support you need. Angela knows what it feels like when drinking is taking over your life and destroying everything, which is why she is here to help you get the sober life you want. Rachel Hart is a life coach who hosts the Take a Break From Drinking podcast. Addiction has been a part of host Duane Osterlind’s life from the age of seventeen. He went to inpatient rehab for depression and teen substance abuse, and receiving intensive help at this young age was a crucial moment in his life.

Hosts Kate and Mandy bring you a podcast that is a mix of handy tips, personal experience, and interviews with special guests. They speak openly about their past buying into “wine o’clock” and how it impacted them as women and as parents. They now happily “put down the Pinot” to ask themselves questions about how they feel and what they need. It’s common to have a fear of missing out when first entering recovery.

Soberful

If you follow Sober Mom, Sober Guy, Recovery Rocks, Recovery Elevator, and similar programs, you will also find our sobriety podcast to be in line with your interests as you continue on your recovery journey. We have even interviewed a top-rated recovery coach who shared motivational messages about how to address mental illness issues that come up in life, relating to addiction. The purpose of this podcast is “to bring like-minded individuals together, particularly in early sobriety, who seek a better life without alcohol through support and accountability”.

You’re probably already pretty familiar with She Recovers, amirite? Well, the SHE RECOVERS community now includes this podcast, which is a collection of audio posts, interviews, and recorded talks especially curated. This show is hosted by The Temper and HuffPost contributor, Laura Cathcart Robbins. The concept for this podcast came from being the only Black woman at Brave Magic, a writing retreat hosted by Elizabeth Gilbert and Cheryl Strayed. Robbins wrote about her experience for HuffPost… and then the comments came pouring in. Folks who have also been “othered” finally felt seen by the article.

Sobersips – Your Weekly Fix:

There are plenty of recovery resources and communities to choose from, and finding what works best for you is an act of self-care. The Brobriety Sobriety Podcast is all about the intersection between sobriety and masculinity. Hosted by VanSober, this podcast tackles conversations about substance use, mental health, and wellness in the 21st century. With new guests featured on every episode, this podcast features candid discussions and eye-opening perspectives on what it means to navigate both recovery and masculinity.

If someone’s blood alcohol content is 0.08, it would take about five hours and 20 minutes for the body to metabolize the alcohol. It typically takes a person with a BAC of 0.20 anywhere from 12 to 14 hours to reach sobriety. Women have less dehydrogenase, an enzyme that breaks down alcohol in the stomach.

• Additionally, taking vitamin B and C supplements can help to flush out the alcohol from your system.
• That’s why people who attend alcohol rehab often receive nutritional support during recovery.
• You can follow the instructions, then test yourself in preparation for drug tests.

It may be
a sign of a certain disease or condition if these amounts are not within a
normal range. If your friends or family member have any substance abuse disorders, do not hesitate to reach SAMHSA’s National Helpline immediately. Self-help support groups, such as Alcoholics Anonymous (AA), provide a safe and supportive environment to share stories and experiences. Group meetings can help individuals stay accountable while going through the recovery process. BetterHelp can connect you to an addiction and mental health counselor.

Flush out your system with a detox drink

Hence, it is advisable to consume alcoholic beverages in a responsible and moderate manner. One should allow their body sufficient time to naturally metabolize alcohol before engaging in activities such as driving or operating heavy machinery. Age, weight, and alcohol tolerance affect these detection periods, which are estimates. Some alcohol tests can detect metabolites in urine after alcohol has been eliminated. In this article, we will discuss various techniques that can be employed to detoxify the body from alcohol quickly. We will explore the impact of alcohol on the body and guide how to overcome its effects.

The amount of water lost from the system increases as alcohol strength increases[3]. Activated Charcoal is actually quite incredible, and is used in emergency rooms around the world to support detoxification after the ingestion of chemical or environmental poisons. What equates to 1 drink depends on the size and type of alcoholic drink you have. You may be underestimating how much you drink because you (or your generous friend)  aren’t using standard measurements. This chart is based on a positive cut-off threshold of 100 nanograms of EtG per milliliter.

Blood

The following chart shows how likely it is for urine alcohol levels to show up in EtG tests based on how much alcohol you consume and how much time passes after your last drink. Urine tests can detect alcohol or alcohol metabolites in your urine. Generally, these are accurate for 12 to 24 hours, although you may test positive up to 80 hours after drinking alcohol.

It can also measure your BAC, which correlates to how much alcohol you’ve had. A carbohydrate-deficient transferrin (CDT) test can detect heavy alcohol use. A hair follicle test can detect alcohol use within the past 90 days.

We Level Up Alcohol Addiction Dual Diagnosis Treatment

You should also consider taking natural diuretics such as dandelion root and nettle to help clear alcohol from your system. As always, it is important to talk to a healthcare professional how to flush alcohol from urine if you are unsure of anything, or if you are worried about your drinking. With the right steps and a healthy lifestyle, you can be sure to flush your system of alcohol in 24 hours.

• Also, discover how to dilute alcohol in your urine to avoid the unpleasant odour it can leave behind.
• Yes, there are medical treatments available to help flush alcohol from your system.
• It’s important to note that reducing alcohol consumption can be problematic, and being patient with yourself and not getting discouraged if you slip up is essential.
• The longer alcohol is in your body, the stronger the effect it has.

Whether you’re struggling to pass an alcohol test or simply want to feel better after a night of heavy drinking, we can help. At our rehab center, we offer various methods to help you detoxify your body from alcohol. These include hydration therapy, nutritional counseling, and supplement support. Our goal is to assist you in expediting the elimination of alcohol from your system and promoting healthy recovery. Urine tests or hair tests may be able to confirm intoxication levels, or other effects of alcohol.How much alcohol are you drinking? If worried about your alcohol intake and your blood alcohol levels,  support is available.

How food changes alcohol processing

The greater the volume of alcohol consumed, the harder the liver needs to work to process it. Days off alcohol use can allow the liver to process alcohol metabolites and by-products without additional load of further alcohol in the system. Alcohol abuse could also be thought of, as liver abuse, indirectly. This form of tea is an antioxidant and can effectively flush toxins that have formed from the use of alcohol out of the body. Excessive alcohol intake affects eating disorder and depression. Our recovery programs are based on decades of research to deliver treatment that really works.

• But below are three common solutions that won’t get you passing a drug test anytime soon.
• If you struggle with controlling your alcohol consumption or consume excessive amounts of alcohol, it could indicate a potential addiction to alcohol.
• However, with a few simple steps, you can flush your system of alcohol in 24 hours.
• Support groups, counseling, or relapse prevention medication are all possible treatment options.
• Our aim is to be the right source of information that our readers can refer to throughout their wellness journey and to offer the most accurate content that inspires healthy actions.

Here are a few things you can do to help flush alcohol from your urine. This will help to dilute the alcohol in your system and make it easier to flush out. These can dehydrate you and make it harder for your body to flush the alcohol out.

Alcohol intolerance is caused by a genetic condition in which the body can’t break down alcohol efficiently. The only way to prevent these uncomfortable reactions is to avoid alcohol. does alcohol make you hot Others may think that sweating after drinking spirits is good to flush it out of the system. Alcohol lowers the body temperature, and sweating can decrease it further.

We offer various substance abuse services that can help you or a loved one overcome this addiction and regain sobriety. No matter how long you’ve struggled with drug or alcohol abuse, we’re here to help. When you drink alcohol, it’s absorbed into your bloodstream through your stomach and small intestine. From there, it travels to your liver, where it is metabolized into acetaldehyde and then into acetate. It also reverses other reflexes that control body temperature. Others who regularly experience night sweats, especially if they have additional symptoms, should also make an appointment with their doctor to determine the underlying issue.

Why do I feel lonely after quitting drinking?

For many people, night sweats may have links to their alcohol consumption for a particular occasion. One of the most common symptoms of alcohol intolerance is facial flushing, which can also cause excessive sweating. This article covers the possible causes of night sweats and alcohol, including how to manage night sweats after drinking. We also look at the first signs of liver damage from alcohol and what cancers may cause night sweats. It is important to pay attention to details regarding symptoms of allergic reactions and when they occur.

• The deficit of the gene code required to produce this enzyme is genetic and is the main cause for Asian alcohol allergy.
• If you only have one drink in an hour, your body can break down that alcohol amount easily enough.
• This is another mechanism of thermoregulation that under regular circumstances is used by the body to lower its temperature through evaporation.
• While you’re drinking, your liver is working hard to breakdown all the alcohol that is entering your system.

Other organs that can give off heat tend to be the brain and heart. As always, it’s also important to drink in moderation and avoid binge drinking, which could make the health risks even more likely. For instance, some people with alcohol use disorder might push away friends and family and quit participating in activities and events. They might also have financial or legal difficulties that feel overwhelming and add to the feeling of being alone. It’s common for people to turn to drinking as a way to cope with a range of negative feelings. If you’re feeling alone, drinking can seem like a way to make it through a hard day.

So, Why Does Alcohol Make You Hot?

Diabetes and alcohol can lead to various conditions such as low blood sugar as well as others. Immediate treatment for alcohol use disorder is necessary for all cases of reaction to the substance. Allergies can occur from the tiniest drop to binge drinking levels. Allergy to alcoholic drink is very different than Intolerance.

Marixie Ann Manarang-Obsioma is a licensed Medical Technologist (Medical Laboratory Science) and an undergraduate of Doctor of Medicine (MD). She took her Bachelor’s Degree in Medical Technology at Angeles University Foundation and graduated with flying colors. Learn more about alcoholism treatment program features to find one that meets the needs of the individual. The hot flash will stay as long as needed to release the surplus heat.

Staff involved in treatment planning should be careful to assess the offender’s stage of change and readiness for substance abuse treatment and to consider this information when developing treatment plan goals. Ongoing review of readiness for treatment can be provided through use of self-report instruments, focused discussion with the client, observation of the client within a treatment program, and review of collateral reports from treatment staff, criminal justice staff, and family members. Several techniques for screening and assessment of readiness for change http://www.senkai.ru/eng/2007/05/08/ are discussed in Chapter 3. Although the treatment of co-occurring severe mental disorders and substance use disorders sometimes is provided in specialized, more intensive programs, less severe mental disorders that do not cause major functional impairment can be treated and managed effectively within mainstream programs. Moreover, not addressing these underlying problems can increase the likelihood of relapse. Likewise, substance abuse may mask an underlying mental disorder that may not become apparent until the offender is no longer using drugs or alcohol.

Inappropriate confrontation may even strengthen the client’s resistance to change, thereby increasing the rigidity of defenses. When strong emotions are expressed and discussed in group, the leader needs to modulate the expression of emerging feelings, delicately balancing a tolerable degree of expression and a level so overwhelming http://bunkermagazine.ru/index.php?id=1217 that it inhibits positive change or leads to a desire to return to substance use to manage the intensity. It also is very important for the group leader to “sew the client up” by the end of the session. Clients should not leave feeling as if they are “bleeding” emotions that they cannot cope with or dispel.

Main components of a treatment plan for substance abuse:

While early- and middle-stage interventions strive to reduce or modulate affect, late-stage interventions permit more intense exchanges. The leader no longer urges them to apply slogans like “Turn it over” and “One day at a time.” Clients finally should manage the conflicts that dominate their lives, predispose them to maladaptive behaviors, and endanger their hard-won abstinence. The leader allows clients to experience enough anxiety and frustration to bring out destructive and maladaptive characterological patterns and coping styles. Evaluate and identify those at-risk of or living with substance use disorder along with assessing willingness for treatment with a behavioral health specialist. This includes facilitating open conversations about unhealthy substance use/misuse with patients and gauging their readiness to change and receptivity for treatment.

Many patients will learn living habits that promote sobriety and develop relationships within the sober community. In addition, many recovering addicts need to re-learn how to establish and maintain friendships or develop socialization skills. Patients should also be encouraged to develop long-term education and/or career goals. It should be fully tailored to your situation and will change over time as your needs change. A great treatment plan should evolve and adapt alongside your progression through the recovery process.

Treatment Planning

Of the sources, 20 of 62 argued for the importance of a standardized procedure, including standardized measurement, timing, and for some sources, the nature of the discussion about the data (e.g., topics discussed, length of discussion, tools used; e.g., Kearney et al., 2015; Law & Wolpert, 2014). Several sources emphasized how standardization facilitates comparison across cases and clinicians as a means of tracking outcomes at the clinician or agency level (Lambert et al., 2002; Ottenbacher & Cusick, 1990). While this is an attractive concept consistent with the noted ideal of accountability, standardization is also a means for promoting consistency, which is vital to successful goal pursuit.

• These categories of interest in treatment are not necessarily separate in practice.
• This contrasts with the traditional deficit-based approach to treatment planning for adults involved in the criminal justice system.
• In different stages of treatment, some of these therapeutic factors receive more attention than others.
• These changes are vital since interventions that work well early in treatment may be ineffective, and even harmful, if applied in the same way later in treatment (Flores 2001).
• In this sense, a therapist can rely on the client’s own view of their strengths rather than being effusive in noting positive qualities in the client as a means of boosting their efficacy and esteem.

Many people who are discouraged by their behaviors use quotes as tools to build motivation and encouragement. A second major improvement needed if people who have addictions are to benefit from group therapy is a clear answer to the question, “Why is group therapy so effective for people with https://durancevile.com/books/Women.html addictions? ” We already have part of the answer, and it lies in the individual with addiction, a person whose character style often involves a defensive posture commonly referred to as denial. Groups allow a single treatment professional to help a number of clients at the same time.

The Late Stage of Treatment

For example, in the beginning of the recovery process, it is extremely important for group members to experience the therapeutic factor of universality. Group members should come to recognize that although they differ in some ways, they also share profound connections and similarities, and they are not alone in their struggles. Some enter treatment due to health problems, others because they are referred or mandated by the legal system, employers, or family members (Milgram and Rubin 1992).

Often, in as little as a few months, institutional and reimbursement constraints limit access to ongoing care. People with addiction histories, however, remain vulnerable for much longer and continue to struggle with dependency. They need vigorous assistance maintaining behavioral changes throughout the middle, or action, stage of treatment.

In this sense, a therapist can rely on the client’s own view of their strengths rather than being effusive in noting positive qualities in the client as a means of boosting their efficacy and esteem. Opioid agonist therapies are effective in stabilizing the lives of individuals with severe opioid use disorders. However, many important clinical and social questions remain about whether, when, and how to discontinue medications and related services. This is an important question for many other areas of medicine where maintenance medications are continued without significant change and often without attention to other areas of clinical progress. Motivational Enhancement Therapy (MET) is a counseling approach that uses motivational interviewing techniques to help individuals resolve any uncertainties they have about stopping their substance use.

The nurse explains that this is due to the presence of sulphites, which preserve many alcoholic drinks. “For some people with sensitive airways, such as asthmatics, consuming sulphites in alcohol may cause wheezing,” she explains. “The amount of sulphites contained in alcohol will vary between products, but sulphur dioxide is one of the fourteen major food allergens that are required by law to be included on labels.”

• To avoid experiencing such allergic reactions, it is important to consult with a doctor and identify any allergies before drinking red wine.
• About 5 percent of children have a food allergy, but many outgrow those allergies by adulthood.

It’s the result of hereditary genes that cause a deficiency in the enzyme ALDH2. Your body needs this enzyme to properly metabolize alcohol and eliminate it from the body, so there’s nothing you can do to prevent or cure alcohol intolerance. If you’re wondering how to prevent a stuffy nose after drinking, try drinking water before, during, and after consuming alcohol. Hydration may help alleviate this symptom, but it won’t eliminate your stuffiness completely. An allergy is when your immune system has an unusual reaction to a substance, like dust or nuts. Alcohol intolerance is linked not to your immune system, but to your metabolic system.

Why Do I Feel Like Throwing Up After Drinking Alcohol – But I’m Not Drunk?

And if you have any sort of allergies, frequent alcohol consumption can worsen your symptoms. More often than not, these kind of symptoms represent an intolerance and not a true allergy to the alcoholic beverage or ingredients. If you’re not sure about your symptoms, make sure to visit your doctor or allergy specialist before drinking alcohol again.

Although not a true allergy, in some cases, what seems to be alcohol intolerance might be your reaction to something in an alcoholic beverage — such as chemicals, grains or preservatives. Combining alcohol with certain medications also can cause reactions. The other side of the study investigated whether or not consuming food or water directly after drinking helped to protect against a hangover.

Dying thief who stole ‘Wizard of Oz’ ruby slippers from the Judy Garland Museum gets no prison time

Alcohol consumption can lead to a stuffy nose due to the effect it has on your body. Alcohol is metabolized by enzymes in your liver, which convert ethanol into acetaldehyde. This is then broken down further into acetate and other byproducts.

Symptoms of alcoholic hepatitis may include jaundice (yellowing skin or eyes), fatigue, nausea, and abdominal pain. Treatment for alcoholic hepatitis usually involves lifestyle changes such as abstaining from alcohol, eating a healthy diet and exercising regularly. In addition to filtration, the use of fresh fruits and vegetables in cocktails can pose a risk for those with oral allergy https://accountingcoaching.online/what-if-being-sober-sucks-4-tips-to-boost-your/ syndrome (OAS). OAS is an allergic reaction to certain proteins found in raw fruits and vegetables, which are also present in many alcoholic drinks. As such, it is important for those who suffer from this condition to be aware of the potential risk that drinking certain cocktails may pose. If you have symptoms of an allergy after drinking beer, you should see your doctor.

Alcohol Intolerance Symptoms

It is important to seek medical advice as soon as possible if you experience any of these symptoms after drinking wine. A doctor will be able to determine the cause of your symptoms and provide appropriate medical treatment. In some cases, it may be necessary to discontinue drinking wine altogether to avoid further complications. If you experience any symptoms after consuming alcohol, it is important to speak to a doctor to ensure your health and safety. They will be able to provide the best advice for treating any underlying medical condition. This inflammation can trigger a wide range of symptoms like nausea, vomiting, muscle aches, heartburn, and even headaches.

However, some people may experience allergy-like reactions after consumption. If people experience symptoms after drinking alcohol, they should speak with a doctor for further advice. People may also have an allergic reaction to specific ingredients in alcoholic drinks rather than the alcohol itself. However, for people who are reacting to other ingredients in wine, tracking what they drink and their reactions Step 1 of Alcoholics Anonymous: What Is Step 1 of AA? may make it possible for them to enjoy some alcoholic beverages in moderation. Alcohol intolerance is a temporary, but pretty uncomfortable, reaction to alcohol — with nasal congestion and flushed skin being the two most common side effects. It happens if your ALDH2 enzymes (remember those?) aren’t particularly effective at their job, or if your body just doesn’t make enough ALDH2 enzyme in the first place.

People should note, however, that its authors do not propose that this means that alcohol causes allergies. Ask your doctor for more information about your diagnosis and treatment options. Quercetin is a plant pigment that has been shown to cause sneezing in some people.

Next to flushing, a stuffy nose is the most commonly reported symptom of alcohol intolerance. Your nose may run or feel congested, and some people also sneeze after drinking. However, some people do experience true allergic reactions after drinking alcoholic beverages. In this case, the ethanol isn’t the culprit, but rather another ingredient in your beverage, such as a fermented grain, preservative or other chemical. Additionally, some people may experience swelling of the lips, tongue and throat. Besides wines, fruits like bananas, kiwi, melons, and grapes can also contain sulfites, though in much smaller amounts.

It could be a sign that you actually have an allergy, or an intolerance. If you have any severe or painful symptoms after drinking alcohol, don’t just brush it off as alcohol intolerance. These side effects could be caused by a serious allergy and warrant a visit with your doctor to address your symptoms. What’s more concerning, however, is that some medications can lead to uncomfortable (even dangerous) side effects when combined with alcohol.