Welcome to the Talking Total Farmer Health podcast from AgriSafe Network. At AgriSafe we work to protect the people that feed the world. We do this by supporting the health and safety professionals ensuring access to preventative services for farm families and the agricultural community. Today’s episode is brought to you by the Network of the National Libraries of Medicine Region 3.

According to a 4-year study by the CDC, there are roughly 95,000 alcohol-related deaths each year in the United States. This means that every day, approximately 260 Americans die as a result of alcohol use. Farmers, ranchers, farm workers, and agricultural producers are not exempt from those statistics. But these deaths are preventable, and we can make strides to look out for each other, and our own. I am Dr. Tara Haskins, the Total Farmer Health Director at AgriSafe and your host for this episode. I'm a registered nurse of 34 years, with a passion for rural health, and mental health lead for AgriSafe. I grew up and live in North Louisiana. The main question we’d like to start with today is how do we best address the culture of drinking within agriculture? You know, that sometimes it's part of the end of harvest and there's, you know, celebrations.

Absolutely. And you know, and I and I think the thing is nobody is really saying eliminate alcohol forever, right? That totally is not going to happen and it is a legal substance if you're 21. You know, there's been some health benefits associated with drinking wine, you know? But the key is moderation.

That was Dr. Chasek; she is an associate professor and chair of the counseling department at the University of Nebraska Omaha and associate workforce director of the Behavioral Health Care Center of Nebraska. Dr. Chasek has strong rural roots and is practicing mental health and addictions counselor with experience and behavioral health care administration. She mostly currently focuses on developing the behavioral health care workforce in rural Nebraska.

And you know, so I think if we can say, well, what is moderate, you know, for drinks in a setting for a man or no more than 14 a week and for women, we cut that in half no more than seven a week standard drinks. If you don’t have risk factors, it’s fine.

A standard drink looks like one shot of liquor (which is about one and a half fluid ounces), one domestic beer (which is about twelve fluid ounces), or one glass of wine (which is about five fluid ounces). But keep in mind, there are a lot of factors that might shift the guidelines for moderation, and there are a lot of factors that shift how severely alcohol might affect your body. You know when I was teaching nursing, I put up the photo of a person, and how alcohol affects different systems in your body and it's head to toe.

And of course, as we get older, our bodies are less able to tolerate the alcohol. So the guidelines go down for how much you can drink because of, you know, physiological changes there.

And it impacts blood pressure. It impacts so many things. While most people are aware of the short-term effects of drinking, consistent alcohol misuse can have some serious long-term effects. Some of the most notable short-term effects include lowered inhibitions, loss of coordination, decreased motor skills, slower reaction time. Long-term effects might take months or even years to show up. A few long-term effects of excessive drinking include, but aren’t limited to fibrosis or cirrhosis of the liver, pancreatitis, heart disease, stomach oral cancers, and many more. Alcohol can also affect other areas of your health and can interact poorly with other conditions you might be living with or medication you might be taking. Be honest with your healthcare providers and let them know about your alcohol use and the extent of that use. It might be the missing link to troubleshooting a lot of your health problems! And it may prevent the addition of medications or maybe the increase of dosage of medication. Now, complications, or severe long-term effects, normally arise when someone consistently drinks more than the recommended amounts of alcohol.

What we consider unhealthy, risky drinking right would be an excess, you know, drinking more days of the week than not. Binge drinking, which is drinking four or five more drinks in a setting.

And risky drinking doesn’t develop out of thin air. Dr. Chasek, recently you have been working on a research project, and have an article coming out soon about substance use among agricultural producers in Nebraska. You had mentioned that there was a gap in the literature, where it seems like they’re only discussing substance use among migrant farm workers? So what does your research set out to fill that gap with?

In Nebraska, when I think of a farmer, I think of a, you know, somebody who owns a family farm, who is a producer who's, you know, the land is their living, you know, they own it, they operate it. So we set out to understand, I guess, in the Midwest with farmer owner operators and ranchers what is happening with substances.

Well, that sounds so interesting. I can't wait till that comes out. Now, during your research, were there any trends you observed? Were there any factors or situations that you found might influence risky drinking?

Age group, gender and anxiety, were all risk factors that that would lead to an elevated or increased use of alcohol. So when we took out the younger subset right that they were at high risk for alcohol misuse. Male was the gender that was the most at risk. And then if their anxiety scores were elevated. So, you know, if we look at, well, who do we need to direct some of our prevention efforts to right, we're looking at younger male farmer owner operators who are experiencing a lot of anxiety, you know, and or even mild levels of anxiety, I should say.

And alcohol is a short term patch for calming down anxiety, but it’s not a permanent fix. And it can backfire on you, sometimes very quickly. But young male farm owners are not the only people who might have an alcohol use disorder. That is just one specific area that is at high risk. And you can’t normally tell just by looking at someone if they might be struggling with a substance use disorder. It could be your neighbor, your coworker, or your family member.

Can you talk just a little bit about the producer in their role as an employer? And, you know, kind of if they were to discover that employee is suffering from excessive drinking or even worse yet, drinking on the job? Are there any resources out there that can guide a producer in what they need to do?

Oh, absolutely. You know, there there are. There are lots of resources if you think about it from a drug free workplace policy standpoint, right? so that would be number one. You know, what are the expectations? What is my policy? And then, you know, as far as signs, it's like one of the biggest, I guess, red flags, you know, somebody showing up late not being reliable. You know that that any industry that's kind of one of the things that you look for like they're showing up late a lot and that's what we look at when we were doing an evaluation. Just noticing if there's patterns that happen, maybe, you know, leaving early, you know, just talking a lot about, I can't wait to go to the bar. You know, that urgency that I need. I need a drink or I need something. If you're hearing that is kind of a red flag. And, you know, a lot of times people will become very irritable. I guess, getting to know them and learning a little bit about their life and what's happening is another way to, you know, I guess, to see if there's if there's a problem going on see if you can't be helpful. And so many places when you're talking about policy will have that second piece, which is what do we need to do to get you help, right? So rather than a punitive standpoint, you know, how what can we do? So if I can help you get better so you can be the best employee it can be, is that time off for appointments? You know, is that helping you get to a treatment place? Some people, you know, provide insurance and so does the insurance cover. It would be something to look into. And so, yeah, so those are some of the things that come to mind, I guess, as far as being an employer and substance use issues.

Sure. So those are great suggestions having the policy, setting the expectation early on in employment and kind of having some form or fashion of like an employee assistance program or like a plan, right, that if someone encounters problems that they have an opportunity to to, you know, take a different path, to get some help, to get some treatment. Yeah. But we do know that, you know, I mean, but over 90 percent of farms or family farms right in the United States. So what if that employer what if you're dealing with a family member that is part of that business? That's a tough one right?

It is such a tough one. And that's where, you know, so many boundaries get crossed and it's harder to be impartial. It's harder to be objective. You know, in some respects, you know, more. So you're probably going to see the problem quicker, right? Or you know that something is off. But then what do you do about it? And maybe you need like a neutral party to help you with that. Or, you know, there's so many resources. I know in our state we have like a hotline and it is a whole gamut of help for for farmers or rural folks. You know, you can call into this hotline, you can get legal advice, you can call in and you can get mediators you can call in and get, you know, resources for mental health. All these different things. And so we always encourage people like use that because that if if nothing, if you don't have anything formally as a business, that's a that's a great place to go, find some of those resources.

And you could probably also direct them to like treatment resources that are close to their area as well, because that's a hard thing to navigate when you don't know what's out there, you don't know what type of treatment.

Right, right. And the thing is, just like, you know, you if a family member, an employee or whoever has a broken leg, you don't you don't fix the broken leg, you know, I mean, like if they need like brain surgery, you're not doing the brain surgery, right? We've got to get people to the right place to help that problem.

So what does help look like for families in rural communities like what kind of things should they ask for?

Hmm. Well, you know, helping rural communities like I talked about earlier, like there's not a lot of access, there's a lot of barriers to access. You know, one is the stigma we talked about, the other is just a provider, right? And so you might not have a treatment center in your town. So what mostly, I think the first steps usually are is going to some kind of medical provider. So you might not have like a mental health treatment facility, but most rural places have some mechanism for physical health care, right for general health care. That's a good place to start because those doctors, nurses, those professionals, if you if you share with them that this is the problem, they can help direct you then to to the next step, right? And so and that might be telehealth. You know, if there's nobody in your particular area, maybe you maybe there's resources for telehealth and connecting into an expert, maybe from another area. Most communities, the other place where I usually tell people, OK, let's start here because they're a little bit more knowledgeable and are in most rural communities, is your your spiritual community so your churches, those kinds of things, usually they know about resources and they're trusted, right? And they hold conferences because a lot of people don't, you know, like, I'm not going to talk to everybody about this because there's some shame and stigma that goes along with it, unfortunately. But so those are really good places to start. And then, there's lots of levels. It's not a one size fits all treatment plan for people who are struggling with a substance use issue.

I'm glad you brought that up because I think I think that's a lot of misunderstanding in the public. That treatment looks the same across the board and it really doesn't. It really depends on the individual circumstances and and you know what can be done clinically safe for that individual?

Absolutely. What can be safe? That's so true. And you know, the other thing it looks like is just support, you know, which are called anonymous, right? So Alcoholics Anonymous, the AA meetings the NRA is Narcotics Anonymous. GA is gambling is anonymous. They have all these different things where if you're caught up in that, you can go to those meetings. They're free, they're confidential, they're anonymous. They're people in your community who can help you support you, walk that path with you. And so those are also really good resources, you know? We could even get into what we call halfway houses or sober living environments, where you just need extra support after treatment. There are just so many ways.

And I'm glad you brought that up about the AA meetings because those that I've known that have engaged in those, you know, it's worked really well for them. There are so many other types of AA meetings, though it's not a one size fits all. And I think for rural communities, when it's small, when those meetings happen in rural areas, I'm sure there could be some hesitancy for your. It's more difficult to be anonymous. You know, but but there's I think there's been some opening up with virtual meetings. I've seen them do those right. How well do you think people living and working in ag understand the potential and and quite frankly, sometimes deadly consequences of stopping drinking without reaching out to their health care provider? That's what scares me the most is when people try to do this on their own.

Stopping use is very medically dangerous. And that's why we have detox. Your body becomes reliant on it. And when that is gone, it kind of goes into shock and out, and you can definitely explain the medical aspect a little bit better. But I get real scared when somebody says I've been drinking for a long time and I'm just going to quit and I'm like, You go to your doctor.

I've seen some, unfortunately, some tragic cases where people try to do that on their own. And no one, I mean, their blood pressure goes crazy and they're at risk of having a seizure. I mean, it's it's almost like their brain is is experiencing an electrical storm and it can't stop on its own. And so that's that can be very, very scary. So yeah, I always want individuals, you know, if if they drink on a regular basis and have dependent signs of dependency, then they certainly need to seek a health care provider and see how do we need to do this so I can do it safely. So can you give some examples of messaging in your experience that seems to resonate with people in agriculture? Or are we are we still trying to figure that out?

Oh yeah. So definitely, I think we'll always try to figure that out, right? What is the best way to communicate this or for people to hear it? And and it is kind of individualized. And so I think, you know, when I hear the word messaging, how do I talk to somebody about this so that they hear and they understand and and earlier we were talking about families and how difficult it is. If you're working with somebody, right, maybe it's a family member or you're or you're concerned about one of your family members? And what do I say? What do I do? Families need just as much help with with all of this as the person who is, you know, struggling with the substance use disorder. So I think the message really is I love and I care and I'm concerned about you. And number two, here's what you need to do, and here's what I'm willing to to help support that, right? So and here's what I'm not willing to do anymore. You know, it is OK and it's OK to say, I just I care about you too much to love you to death. On a larger scale, the messaging, I think the messaging is in my in my opinion and and not only opinion, but based in science and in fact, substance use disorders is a disease, a medical disease, much like diabetes, much like cancer, any of those things that that we as a society say, You know what? It's not OK. We got to figure out how to help people, how to make people better, how to talk about this, how to get them the help they need. And I think we need to make substance use disorder that, you know, it is a something that's happening in people's brains and in their bodies, and yes, in their choices. But the brain gets hijacked and so choices become less and less over time when you're dealing with a substance use disorder. So we need to normalize that conversation and activate our communities to say it's OK to get help. And we've got a long ways to go.

So, if you leave this episode, and only take one thing with you, take this:

But if you see something concerning to say something and say it in great kindness and care and love.

Come from a place of caring. You've said that more than once. I think that's really a strong message. So, overall, as individuals and members of the community, we can make a difference by reaching out. We can make a difference by our willingness to discuss or acknowledge alcohol use and misuse. And above all else, know that there is hope, there is recovery, there is a light at the end of the tunnel. And you are not alone.

Thank you for listening. If you’d like to hear more from Dr. Chasek, join us for her webinar on December 8th. If you are listening to this after December 8th, the recording is available in the AgriSafe Learning Lab. The webinar link, along with additional resources on alcohol use, are listed in our show notes!

And That’s all for today’s episode of Talking Total Farmer Health. Be sure to subscribe to this podcast to hear more from AgriSafe on the health and safety issues impacting agricultural workers. To see more from AgriSafe, including webinars and our newsletter, visit www.agrisafe.org. This episode was created by AgriSafe Network with the Network of the National Library of Medicine Region 3. Script arranged by Laura Siegel. Hosted by Tara Haskins. Edited by Joel Sharpton.