How to Build a Healthy Relationship with Alcohol Dr. Nzinga Harrison on the Natalie Tysdal Podcast

Dr. Nzinga Harrison

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Are you curious about how to build a healthy relationship with alcohol? On this episode of the Natalie Tysdal Podcast, Dr. Nzinga Harrison, Chief Medical Officer and co-founder of Eleanor Health, joins Natalie to discuss practical strategies for recognizing problematic drinking, understanding the science of addiction, and prioritizing mental health. Whether you’re “sober curious,” concerned about a loved one, or simply want to understand the spectrum of alcohol use, this episode delivers expert insight and actionable steps for making informed choices and cultivating self-compassion.

What You’ll Learn:

• How to spot early signs of unhealthy alcohol use with the “CAGE” assessment tool

• Why addiction is a health condition—not a moral failing—and how stigma impacts recovery

• The role genetics and environment play in substance use disorders

• How to have effective, nonjudgmental conversations with yourself and loved ones about alcohol

• Practical tips for parents and families to prevent addiction, including Dr. Harrison’s age-appropriate scripts

• The benefits and meaning of the “sober curious” movement

• Why support systems are essential for sustainable change

• How to access resources like Eleanor Health and “We The Village” for help

Why This Episode Matters:

Dr. Nzinga Harrison’s expertise sheds light on the complex reality of alcohol use and addiction, replacing shame with compassion and knowledge. Whether you’re questioning your own habits or supporting a loved one, the actionable tools, scripts, and insights provided empower you to seek help early, reduce risk, and cultivate open, stigma-free conversations. This episode encourages listeners to view alcohol use as an opportunity for personal growth, well-being, and meaningful change—making it an essential listen for anyone interested in mental health, parenting, or holistic wellness.

Links and Resources:

Eleanor Health – Comprehensive addiction and mental health care

We The Village – Support for families and loved ones of those struggling with addiction

Dr. Nzinga Harrison's Book: https://amzn.to/3IV974F.

Transcript

Natalie Tysdal (01:39)

Dr. Harrison, so good to meet you.

Nzinga Harrison, MD (she/her) (01:41)

Good to be here, Natalie, and please call me inzingo, although thank you very much for calling me doctor first.

Natalie Tysdal (01:48)

Well, I want to refer to you as Dr. Harrison, but your name is so beautiful and Zina, I love it. I just want to say it. This topic today, I know you've spent your professional life ⁓ in this world of substance abuse. Can you start out by telling me why and how?

Nzinga Harrison, MD (she/her) (01:52)

you

interesting. I went to medical school to be a surgeon but I was raised by a pair of activist parents in Indianapolis, Indiana and so when I got to medical school, you know my activist parents had taught me you raise your voice on behalf of those who are being silenced or mistreated and in medical school you have to rotate through all of the different specialties. I was actually a huge

opponent of having to do a psychiatry rotation because I felt it was a waste of time and not real medicine. And then ⁓ as I did my psychiatry rotation, one, I learned the biology and physiology and, you know, social aspects of behaviors and feelings and emotions and learned that it was real medicine. But two, I just saw the way people with mental health conditions and especially addiction were being treated by the healthcare system.

and that it was not helping. And I think that tapped my doctor bone and tapped my activist bone and I chose psychiatry and addiction psychiatry specifically. Looking back now, as a psychiatrist, I can look at my own personal family history and it makes a lot of sense. I have a ton of substance use disorders and I'll give you Natalie just a small tweak. said substance abuse, which is common language, unintentionally stigmatizing.

like abuse is a crime and addiction is an illness or substance use disorders is the medical diagnosis. Tons of it on both sides of my family, tons of mental health conditions on both sides. And I just thought if we could have compassion and knowledge, how could things be different for people?

Natalie Tysdal (03:30)

Mm-hmm. Mm-hmm.

Mm-hmm.

Yeah, it's that word abuse, which is what we commonly hear. So let's dive right into healthy relationships with, be it alcohol or other substances, and the biology versus the will. For a lot of us, it's like, like having a glass of wine every once in a while, should I? And that question that we get in our mind. So.

Let's talk about this in a really healthy way because I know there are people out there who are listening thinking, my relationship's fine or maybe it's not. And they're questioning that.

Nzinga Harrison, MD (she/her) (04:23)

Mm-hmm. What I always tell people is ⁓ one, substance use disorders, alcohol use disorder is a spectrum. ⁓ So there's mild, moderate, and severe. You can think about it like cancer, right? Cancer, stage one, two, three, four. You always want to intervene before you get to stage one, right? And so I tell people, if you ask yourself the question,

Natalie Tysdal (04:42)

Mm.

Nzinga Harrison, MD (she/her) (04:48)

I wonder about the way I'm using alcohol. The answer is yes, time to do something about it right now, even if you don't meet diagnostic criteria for alcohol use disorder, because we don't ever want you to meet. Right? Like ask the question, practice some prevention. But we have this concept of quote alcoholism as like lost your family, lost your job, homeless, wiping my windows on the street with a paper bag in your hand. And honestly,

Natalie Tysdal (04:59)

It's always good to ask the question, right? Yeah.

Nzinga Harrison, MD (she/her) (05:17)

That's less than 15 % of people whose relationship with alcohol is not the healthiest. And so I loved, like you said, let's be positive and give people tools. Here's the tool. It's called a cage. It's four questions. And if you answer yes to one of these questions, now is the time to take a look. One, have you ever thought to yourself, maybe I should cut back how much alcohol I'm drinking? That's the C, cut back. Two,

Have you ever been annoyed, A, when somebody else said to you, you seem like you're drinking more than you used to be drinking? G, have you ever felt guilty because you said, I'm just going to drink one glass of wine tonight and then you're a full bottle in to your glass of wine? Or E, have you ever needed an eye opener so you wake up and either alcohol is the first thing on your mind or you actually drink alcohol to steady your nerves?

If the answer to one of those questions is yes, then there's 77 % chance that you meet diagnostic criteria for at least a mild alcohol use disorder. There's 21 % chance you don't. Either way, it's an opportunity, right? And so I think that's when you ask the question, how should people think about it? I want people to think about it not as a label or not as an accusation.

but as an opportunity.

Natalie Tysdal (06:46)

I think that's important. is an opportunity. Why not understand and ⁓ at least ask the questions so that you can improve yourself or someone else? Okay, there's so many things here. I've got so many layers that I want to ask you. So say someone's listening and they think, they feel like, yes, I wake up and I think about that. Or they answer yes to one of those questions. What's next? Because for a lot of people, they're like, I'd rather deny this.

Nzinga Harrison, MD (she/her) (06:56)

Mm-hmm.

⁓ What's next is don't deny it, right? So also what's next is you don't have to immediately make a goal to never drink ever again in your life for the rest of your life.

Natalie Tysdal (07:29)

And that's important too,

because this is where people, that's, I believe you're the expert. believe that's why people deny because they're like, I don't want to give it up. Okay, good. So, so for people to really know that doesn't mean that you, it's, not an all or nothing.

Nzinga Harrison, MD (she/her) (07:38)

I endorse your belief.

That's right. That's right. It's not all nothing. And this is what we have been trained into, right? Culturally is that sobriety equals complete abstinence period dot never again ever in your life. And so like, what if I said to you, the first person you go out on this blind date with, you have to marry them and be married to them for the rest of your life. Nobody would ever go on a date ever. Nobody would try. And so.

Natalie Tysdal (08:12)

No. It's a good analogy.

Nzinga Harrison, MD (she/her) (08:16)

This is not what we're doing, right? I want you to just think about what is it that's very important to think about both sides of the equation. So if you think to yourself, you've got one out of four or two out of four or three out of four or four out of four on that cage, the first question is, what benefit is alcohol bringing me? Because as humans, we do not do anything that does not bring us benefits.

If it has no benefits, there's like not doing it, right? So what benefits are alcohol bringing me and what negative consequences is alcohol bringing me? And then you weigh the balance. And I tell people the point to intervene is before the negative consequences start to outweigh the benefits, right?

And there are benefits, and so it makes it easier for me to be social. Makes it easier for me to fall asleep. Makes it easier for me to get up and go to this job that I don't enjoy. Makes it easier for me to deal with the stress of, like, whatever it is, before the negative consequences, I'm arguing with my spouse, I'm not showing up for my kids, I'm struggling at work, I'm tired, my anxiety is high, these are common consequences.

before they start to outweigh it as the optimal time to intervene. Like they say, the best time to plant a tree was 20 years ago. But 20 years ago is 20 years ago. So it is today. Even if the negative consequences outweigh the question to what to do next is get support. That could be a primary care doctor. That could be a friend. That could be a family member that you trust. That could be your gynecologist. That could be a person at church.

Natalie Tysdal (09:46)

Yeah.

Nzinga Harrison, MD (she/her) (10:02)

That could be a person at work. That could be employee assistance program. That could be an online community. That could be a social media room of sober curious people. Like the point is get connected.

Natalie Tysdal (10:15)

I think for

a lot of people, they think if I say this to someone, they're going to think that I have a problem. I don't know if I have a problem, but if I put it out there, then anytime I pick up a drink, I'm going to get judged. So how does one say something like that or go get that help without looking like they've got a major problem?

Nzinga Harrison, MD (she/her) (10:36)

Yeah, that sadly is exactly true. Like that is the world of the stigma that we live in. And we have the power to one, change the narrative, two, equip our support system with understanding how we want to be supported. And so ⁓ I wrote this book, it's called Unaddiction, Six Mind Changing Conversations That Could Save a Life. Literally in the book, there are scripts. And so you asked me this question from the perspective of the person who's concerned.

Maybe, I'm not even sure if I'm concerned about my drinking. I might be concerned about my drinking. There is a script in there for that. There's also a script for the person you reach out to, right? And the number one thing is, I don't know if I am concerned about my drinking, but I think I might be concerned about my drinking. Here's what I need from you. Just listen.

Right? Or here's what I need from you. When we go out on Saturday, I'm not going to drink any more than four drinks. If you see me about to pick up the fifth drink, just remind me that I said that. Here's what I need from you. Right? And so you really train your support system into where you are in the exploratory process.

Natalie Tysdal (11:54)

And that's great. It's accountability and having the guts to say that to somebody. Hold yourself accountable.

Nzinga Harrison, MD (she/her) (11:57)

Exactly.

Yeah,

yeah, and I wish we didn't need guts, but we're in a time period where we do need guts, and so I'm just like encouraging the gut.

Natalie Tysdal (12:06)

Yeah. Yeah.

Yeah, yeah. Can we talk about biology for a minute? I think a lot of people don't realize that it is the biology of some people that you have this disorder. What does that look like? How do you know if your dad's alcoholic, your grandpa, is that built into who you are? Is it a gene we have?

Nzinga Harrison, MD (she/her) (12:14)

Yeah.

Yeah, it's a collection of genes. It's actually really, as we would say, multifactorial. So lots of things are contributing to it. But if you understand alcohol use disorder as a chronic condition, just like high blood pressure, just like diabetes, just like asthma, then they always have biological, psychological, and environmental inputs. Every chronic condition does. And so what people don't usually know is that your risk

for developing trouble with alcohol is coded in your DNA the day that you're born. 40 to 60 % of your risk is coded in your DNA the day you're born.

Natalie Tysdal (13:08)

Mmm.

Is

that an alcohol combination of genes? Is it an addiction? Could it be alcohol or any addiction?

Nzinga Harrison, MD (she/her) (13:22)

Yes, it could be or any addiction, but specific addictions tend to run in families. So the same way like specific cancers tend to run in families, specific types of high blood pressure tend to run in families, but any type of high blood pressure makes you at risk for high blood pressure in general, right? So if you look at your, I call it your addiction family tree, and a lot of times families are very secretive about this.

And this is the reason why the book is called Six Mind-Changing Conversations. And this is a lot of what we're doing at Eleanor Health as well. It's just like making it safe to have the conversation. We'll just save lives. Your addiction family tree, if you look at your generation, so yourself, your siblings, is anyone struggling with anything? If yes, you're probably on the higher end of that 40 to 60 % biological.

Natalie Tysdal (14:19)

So is anyone struggling with anything? mean alcohol, drugs, porn? Like, is that any of these addictive behaviors?

Nzinga Harrison, MD (she/her) (14:23)

drugs, sex, behaviors, money, social media, technology, all

of it shares the same neurobiology, the same brain pathways. Yeah.

Natalie Tysdal (14:36)

Okay, I'm going down a rabbit hole, but I'm interested.

Are these things like, I just did a genealogy test because I wanted to know what vitamins I need more of. it's, I am so fascinated by all of this and it's so helpful because I know where those weaknesses are to support myself. Some people don't want to know that. I love the data. Are these things we would see in this major gene testing type thing we can do now?

Nzinga Harrison, MD (she/her) (14:48)

you

you

It's,

yeah, it's not that clearly laid out because it's so many genes and it's so, yeah, it's so multifactorial. But what you will see, if you look at your sibling generation and you look at your parental generation, both sides, if you have that information available, and you look at your grandparent generation, both sides, if you have that information available, three generations gives you that information.

Natalie Tysdal (15:08)

combination.

yeah. Yeah.

Nzinga Harrison, MD (she/her) (15:29)

Right? And so if you see three generations of substances, behaviors of addiction, then you know you're at risk, but also you know your children are at risk. And so I started this podcast, which I like, definitely have all three generations stacked on both sides, mental health conditions, substance use disorders. So from the time my kids were four and this script is in the book by age from the time they were four, was like, guys,

Natalie Tysdal (15:42)

Yeah.

Nzinga Harrison, MD (she/her) (15:58)

It changes by age of course by the time they got to high school They had already had tons of addiction prevention empowerment education. You're going to your first party. I'm like listen

Here's the information you need. Your friend might be able to take a couple of drinks based on the risk in our DNA. This is the risk that that represents for you. Your friend might be able to do a line of cocaine and just fun. This is what it turns into in our family. Your friend might be able to smoke some weed and have a good time. This is what it turns into in our family. So if you choose to try it out, here's how you recognize.

when it's crossing over from just having fun to becoming a thing. And that's where we started this conversation. That's where we started this conversation with the cage, right? With the cage. As soon as you get to one on the cage, it's crossing over from just being something I do to becoming a thing. And you want to catch it as soon as it's becoming a thing and get people connected to.

Natalie Tysdal (16:44)

What is that? How do you recognize? that's a... Wow.

That is so important. I mean, yes, I work in a high school too. And so these conversations are so important, but to actually just have that script, I love that. I can't wait to get a hold of your book and use these conversations.

Nzinga Harrison, MD (she/her) (17:09)

Yeah.

That's right. That's yay. When my kids were in

high school, every year I went to each of their high schools, did a, what do you call it when they bring all the kids together, symposium.

Natalie Tysdal (17:29)

yeah, like we call it a community event, but yeah.

Nzinga Harrison, MD (she/her) (17:33)

okay, yeah, like a community event with the

kids. They were optional. I was amazed how many kids would come. And I would be like, I know your principal wants me to stand on the stage and say, just say no. And I'm like, trust me, as a mom, I want you to say no. I also know you're gonna make your own decision. So here's information to try to help you make the decision that's best for you in the moment.

Natalie Tysdal (17:57)

Yeah. Yeah.

And then they actually understand it and they're not just doing what they're told, which is great. Like do what you're told. They have to think for themselves. That's our greatest goal as a parent, right? Is to teach them to think for themselves. Yeah. Let's talk about this sober curious movement. I, some people might not know what it is. They might hear it. Like, is it good?

Nzinga Harrison, MD (she/her) (18:05)

which majors are not going to do anyway, right? Yeah, that's right. That's right.

I'm sorry.

Natalie Tysdal (18:24)

Are you as in your position? You're happy about this and what is it?

Nzinga Harrison, MD (she/her) (18:24)

Yes.

Yes,

it's better than good. It's amazing. So I absolutely love the Sober Curious movement. It is not for people even who only think like, maybe I have trouble with alcohol. Like it is for everyone. Alcohol is such an integral part of the cultural fabric of this country that like the minute you say I don't drink, people like treat you like a leper. Like you're such a weirdo. Why would you not? I can't imagine that you don't drink. Like it's just so ingrained.

Sober curious is like, yeah, what's it like to live my life and have fun without drinking? And so you can just, my husband and I got sober curious two years ago. Now we haven't drank, neither of us had any trouble with alcohol, but we were just like, yeah, maybe we're not gonna drink. And now we sleep better and now we feel better when we exercise. And now we are on a mission to get restaurants to have non-alcoholic cocktails on the menu, right?

It's just making it safe to say I cannot drink and still be cool and social and have fun with people. So I absolutely love it. Five stars.

Natalie Tysdal (19:35)

Yeah, yeah.

Yeah. I

like it that it's labeled, that it's actually has it because I've done it, but to actually have a word to use like, precarious. Okay. Let's see what this like. And I've talked about this on past podcasts and this movement of like, I'm just going to experiment with something. I'm just going to try it for a couple of weeks and in any goal in your life. Like, let me just, let me just see what happens if I actually take vitamins for two weeks and if I feel better. Yeah.

Nzinga Harrison, MD (she/her) (19:41)

I did so.

Yeah.

Yeah.

Exactly. Collect some data, right? It's the

same thing as the blind date. Like, do not make a life commitment the very first time you're trying anything that, you know, like for the most part. And so it's like, this month I'm going to see what it's like not drinking. How do I feel?

Natalie Tysdal (20:20)

Yeah.

For someone out there who is listening right now and they know they have a problem, they answer yes to two, three, four of your cage questions. What do you have for them?

Nzinga Harrison, MD (she/her) (20:28)

you

Just get started. So I'm gonna say the exact same thing to them that I'm saying to everybody. You do not have to make a lifetime commitment to never drink again ever again in your life because that might not seem possible in the place that you're in right now. And that might not even be what's right for you in the long term. It may be what is right for you. Give yourself the opportunity to explore and figure out what is right. The number one.

dangerous thing for anyone with a 234 on the cage is not having a support system that they can talk to honestly about what they're worried about. And so get a support system in place period and then just try it. If you're drinking more than the equivalent of a bottle of wine a day,

then please do not cold turkey. It actually can be like physically dangerous to cold turkey off of alcohol. So cut back to, you know, cut back to a quarter of what you're drinking the next day, a half of what you're drinking the next day, cut back three quarters of what you're drinking, like take it off over a five day to seven day ⁓ period, but get help. Find somebody you trust that you can talk openly to.

Figure out what are the benefits alcohol is bringing so you can figure out another way to get those benefits in your life. Catalog the negative consequences that alcohol is bringing so you can appreciate when those negative consequences start to go away.

Natalie Tysdal (22:12)

Yes. Yes. What about for someone who is dealing with a spouse or someone they love and they're watching it happen to them? That's a hard thing.

Nzinga Harrison, MD (she/her) (22:24)

Yeah, it's so hard.

It is so incredibly hard and our treatment system really is built for the person, right? Like the family and the loved ones so often get left out. This is an important part of at Eleanor Health. What we try to make sure is like even people in the support system of the person we're caring for that we're caring for them also. My commentary is exactly the same. Get support.

Get support, one of my favorite resources for people who have a spouse or a loved one or an adult child or even adolescent child that they're worried about is called We The Village. WeTheVillage.co. Founder and CEO is Jane Mackey. Her partner was really struggling with severe addiction. He went into treatment, there was nothing for her.

She created We the Village, evidence-based, based in the family support literature that we have. And We the Village shows even as your person is using and not quite ready to get support, you having your own support supports your piece, increases the chance that that person actually will get connected to support, increases the chance that that person will finish treatment.

It's incredible. Like, I cannot say enough. Get support in place for yourself right now.

Natalie Tysdal (23:54)

I'm going to link that. I will link your book a little more on Eleanor Health. Tell us about it and how it can help people. I really love what you're doing.

Nzinga Harrison, MD (she/her) (24:03)

Yeah, I'm so proud of Eleanor Health. So I'm co-founder and chief medical officer at Eleanor Health. I've been practicing ⁓ addiction medicine, or I'll say caring for people and their loved ones that have addiction for over 20 years now. And so six years ago, we started Eleanor Health, one, understanding that addiction, alcohol use disorders included are multifactorial. And so...

Most often come with depression, anxiety, other mental health conditions, often come with psychological stressors, social stressors with the family, at work, with raising children. And so at Eleanor Health, we're in 14 states and we virtually prescribe for addiction. We have physicians, nurse practitioners, we have individual couples, family therapy with licensed therapists.

We have peer support. Peers are people who have their own experience with addiction and are in recovery, so have walked the walk. We have health coaches for sleep and healthy eating and nutrition. We have nurse care managers to help with physical health conditions. It's this really whole person approach grounded, one, in compassion, two, in the autonomy of the people we're taking care of. So like I said earlier, when you say,

I don't even know if I'm concerned about the way I'm drinking alcohol, but I might be concerned about the way I'm drinking. And you tell your support system, this is what I need from you, we have that same approach. We're like, what do you need? We're on your team. How do we help you also get a team outside of

Natalie Tysdal (25:40)

Well, and the virtual element is less scary for people. I think that's what attracted me to it when I saw it in the first place. was like, that's just, I don't have to go somewhere.

Nzinga Harrison, MD (she/her) (25:46)

Good boy, Jerry. ⁓

You don't have to go somewhere. It's less scary. You don't have to go somewhere. But also, you don't have to leave work for 30 days to go to a rehab. You don't have to leave your family. And it's longitudinal care. So most treatment programs are like three months, and then good luck with that. And we're like, no, we want you to stick with Eleanor as long as possible. We're not going to make you come every week. We're not going to connect to you every week. But people are like, yeah, let's schedule that my lunch break.

Natalie Tysdal (26:20)

Yeah,

yeah.

Nzinga Harrison, MD (she/her) (26:22)

You know, so we're really just about, one, you will always be met with compassion. You will not face the judgment that we talked about that's kind of like floating around in the world. But like, we are here to help people carve their own path to recovery as they define it.

Natalie Tysdal (26:38)

at any level, so someone who might not be, they're not sure they're even someone with a problem, but they can step into this and get help figuring that out.

Nzinga Harrison, MD (she/her) (26:48)

Yeah.

Yeah. Cause there is something going on. If you ask the question, if you ask the question, there is something going on. And usually the inputs to that something like alcohol is usually the out

Natalie Tysdal (26:52)

Yeah, if you're thinking about it, there's something going on.

Yeah.

Nzinga Harrison, MD (she/her) (27:04)

So what are all those inputs? we just, we help you figure out those inputs and start to address those inputs.

Natalie Tysdal (27:10)

Yeah. Thank you so much for your time today. I know we could talk longer, but I think that this is just a great conversation to have, a friendly conversation for people to have to get the support they need to.

Nzinga Harrison, MD (she/her) (27:22)

Yes, yes, thank you so much for having me. Yeah, same.

Natalie Tysdal (27:25)

All right, look forward to talking to you again soon.

I'll put all the links in for anyone who wants more information.