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Not Ready to Quit? 10 Ways to Drink Less
Google the terms, “denial, addiction” and you’ll see statements such as the following:
“Denial is a hallmark symptom of addiction.”
“Denial is a core symptom of codependency and addiction.”
“We can’t discuss addiction without first discussing denial – they virtually go hand-in-hand.”
Yet I’d venture to say that most people who have substance use disorders (SUDs) are not in denial – they know that they have a problem and, in their heart of hearts, that they need to quit.
In fact, nine out of ten participants (out of more than 200 total people who had been sober for at least five years) in Sober for Good answered “yes” to the question, “Did you go through a period of time when you knew you had a serious drinking problem but couldn’t or chose not to do anything about it?” Of those who gave a time period, the average was just over six years.
I’d venture to say that most people who have substance use disorders (SUDs) are not in denial – they know that they have a problem and, in their heart of hearts, that they need to quit.-Anne Fletcher
On a much bigger and scientific scale, a study published in 2015 involving a representative group of more than 36,000 US adults participating in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) affirms that many people know they have an alcohol problem for years before seeking help. The study, published in JAMA Psychiatry, found that the average age at which people first sought help (from 12-step groups, healthcare practitioners, and formal treatment facilities) for an AUD was about 29, representing a three-year lag between the average age (26) at which the AUDs started and help was initiated. Unfortunately, most people with substance use disorders never seek help. (Not everyone with a SUD needs help – many recover on their own and, thus, don’t show up in such statistics.)
This article is aimed at people with AUDs whose problems are serious enough to warrant becoming abstinent, but for whatever reason, they’re not ready, willing, or able to pursue complete abstinence as a goal. However, they are willing to take steps in a positive direction, a practice commonly referred to as harm reduction. The suggestions below focus on ways to use less alcohol and can be helpful for someone with an AUD using harm reduction, as well as for those who just want to cut back.
However, harm reduction can also refer to lowering problems caused by substance use, including offering clean needles to people addicted to heroin and teaching college students less risky drinking habits – say, to reduce the risk of alcohol poisoning, having unsafe sex, and lowering the chance of getting into fights or driving while under the influence.
10 Ways to Drink Less Alcohol
- Tip #1 – Have a plan for the number of drinks you’ll have before you begin drinking, keeping in mind your limits for when you know you’ve gone too far. Although such steps often fall by the wayside, it can help to at least have them. I recently had a client in a long-term support group who discovered that after nearly two years of abstinence, he could occasionally have a few beers. But if he went past three, he just kept going. Having learned that three beers was his limit, he usually drank that amount or less. Also, he never went out and bought beer to keep at home. He only drank if he was in a restaurant or if one of his sons brought over a six-pack.
- Tip #2 – Measure your drinks, count them, and, ideally, keep a diary of how many you have. You can easily do this on your cell phone. One standard drink is 12 ounces of regular beer, 8 to 9 ounces of malt liquor, 5 ounces of table wine, or 1.5 ounces of 80-proof spirits. When out, you may need to ask how much alcohol is in a mixed drink. (See “9 Top Drink-Counting Apps” from Men’s Fitness.)
- Tip #3 – Tell a friend – someone who you’re often with when you drink – about your efforts to drink less, and ask him or her for support. Spend less time with friends who party a lot and drink heavily.
- Tip #4 – Pace yourself, keeping in mind how often you would normally have a drink and trying to cut that in half – ideally having no more than one drink per hour. Put your glass or container down in between drinks so it’s not constantly in your hand. Alternate alcoholic beverages with diet soda, carbonated water, or juice.
- Tip #5 – Avoid your favorite types of alcoholic beverages or at least don’t keep them in your home. For instance, if you love wine or martinis, don’t keep wine at home, stay away from martini bars, or drink beer (not the high-alcohol kind) if it’s less of a problem to control.
- Tip #6 – Buy smaller quantities at a time – not 12- or 24-packs of beer, magnums of wine, or 1.75 liter bottles of hard liquor.
- Tip #7 – Switch to a less problematic drug. While I wouldn’t suggest using hard drugs, I’ve known some people with severe alcohol use disorders who were able to drink less (or not at all) when they substituted marijuana.
- Tip #8 – Eat before you drink and/or when you drink. This will help the alcohol absorb into your system more slowly.
- Tip #9 – Consider asking your physician for a prescription for naltrexone, a medication that blocks the receptors involved in the pleasant sensations associated with drinking, making it easier to stop before intoxication. It can also reduce the urge or desire to drink.
- Tip #10 – See a therapist who will work with you using harm reduction principles. I interviewed a woman who first dealt with her longstanding serious alcohol problem by going to an outpatient program and then Alcoholics Anonymous. However, she eventually started drinking again for about 10 years until she found an addiction psychologist who specializes in harm reduction approaches. Of her experience with him, she said, “It took eight years to get to a life of happy abstinence. It was gradual, small goals sometimes achieved.” She was drinking during that time, but there were gaps when she didn’t drink. At times she saw the psychologist weekly; then there were big gaps in their visits. When she saw him, she drank less.
Finally, after a night of heavy drinking, she decided she never again wanted to feel the way that night made her feel and she quit drinking. She said, “This was the path I had to take. And I had to take it with someone who was going to allow me to do it my way. I’m very convinced I’m where I am because of the long, often winding and genuine path of self-discovery and acceptance led by a very wise and patient facilitator.”
A Pathway to Abstinence
A review of the research on harm reduction therapy published in 2010 in The Journal of Clinical Psychology concluded that this approach doesn’t mean a therapist is oblivious to consequences or potential problems with a client’s decisions and use of a substance. The authors said:
“Harm reduction means a therapist can see the client’s situation in more than black and white, all-or-nothing terms. A reduction in harm may or may not be sufficient for a client, but at least it’s a starting point to build rapport, encourage change, and support efficacy. Harm reduction therapy means not withholding services when a client can’t, or won’t, meet our treatment outcome ideals. Harm reduction therapy means we meet the client where they are and help them along for as far as they will let us.”
As the late harm reduction expert Alan Marlatt, PhD, one of the co-authors of this review and past director of the University of Washington’s Addictive Behaviors Research Center frequently said, “Harm reduction often becomes the pathway to abstinence.”
A list of alcohol harm reduction therapists can be found here, but many others who practice this way are not on the list and/or may not describe themselves as such.
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