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This is the fifth of a series of posts on moderate drinking. If you’ve come here after searching on this issue, it’s likely that you’re wondering about your drinking and whether or not you should cut back to reduce alcohol-related problems or risks for problems. If you’ve not read the previous post we recommend doing so as they build on each other.
The first post covered definitions of moderate drinking based on solid empirical research over the years. It also addressed instances where moderate drinking or a goal of pursuing moderate drinking could be hazardous to your health and well-being. If you haven’t yet read it, we recommend that you do so first.
The second post focused on what’s really the first step or question to answer about your drinking? Would it be a good thing for me to change it?
The third gives you a way to compare different kinds of alcohol and encourages you to use a standard drink (Standard Ethanol Content or SEC to use research terms) and gives you a calculator for it.
The fourth post addresses your chances of success in cutting back.
The sixth post addresses your options when your efforts to cut back on your drinking aren’t working.
Now onto the topic at hand. Concrete steps for moderating your drinking.
“Chain drinking” isn’t a standard term in the clinical sense regarding alcohol consumption & its abuse. However, based on how it’s casually used amongst non-professionals, it tends to infer to “chain drinking” as a continuous or back-to-back drinking pattern, where one drink immediately follows another without substantial breaks in between. This is similar to “chain smoking,” where a smoker lights a new cigarette immediately or shortly after finishing the last one. The steps outlined below apply to most forms of alcohol abuse, be it chain drinking or binge drinking and others.
Here’s a summary of the steps we recommend you take:
For many people, especially those who drink daily, drinking is a well-established habit they’ve had for years. And one powerful way to break a habit is to avoid it entirely for a period of time. Psychologists call this “breaking the behavioral chain.” So consider taking a break from drinking for 30 days.
There are other good reasons to take a break.
Remember, your ultimate goal is to reduce or rid yourself of alcohol-related problems or risks. And not drinking is just as valid a way of getting there as moderate drinking. And if 30 days seems unrealistic to you, consider 15, or 10, or 7.
The next step in taking this break is to write out an agreement with yourself. State the start and end dates and, most importantly, print it out and sign it. And if that feels silly, counter that with the solid empirical research that says that writing out and signing an agreement to do something significantly increases the chances of it happening.
Then, consider sharing the agreement with someone who you’ll think will be supportive of your doing this. That can also increase your chances of success.
Whether you decide to “Do a 30” or not, the next step is setting limits on your drinking. It’s a critical step in achieving moderation. We recommend setting limits on:
For the number of drinks and peak BACs, we recommend setting two types of limits:
Here are some recommended guidelines for setting limits on drinks per day.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends the following limits:
Moderation Management, a self-help group supporting of moderate drinking, recommends these limits. Click here for more information on how these limits were developed.
NIAAA’s Physician Guide indicates that people may be at risk for alcohol-related problems if they exceed the levels recommended by Moderation Management. Click here for the Physician’s Guide.
Yes, these limits may seem low to you and may be unrealistic given your current level of drinking. If so, we suggest you set a limit that is higher but realistic for you, then revise it when you’ve had some success in achieving your first, higher limit.
Your peak blood alcohol concentration (BAC) affects you more than how much you drink. You’ll be much more intoxicated (and at greater risk for problems) if you have 4 drinks in 1 hour than if you have 4 drinks in 4 hours.
If you keep your BAC under .055 or 55mg%, you’re more likely to experience the things people like about drinking: feeling relaxed, etc. while at the same time minimizing your risk of alcohol-related problems.
When your BAC goes above .055, your risk of experiencing alcohol-related problems increases. The higher your BAC, the greater your risk. So to minimize your risks, consider setting your BAC limit at no more than .055.
Your BAC will vary depending on:
A personalized BAC chart that takes into account these variables is in our Moderate Drinking module of Checkupandchoices.com.
Here are some reasons to not drink every day when you’re trying to cut back.
Once you’ve made these decisions, again, write them down, print them out. That also helps you be mindful of the concrete steps you’re taking to cut back on your drinking.
We recommend creating a short and simple list of situations where you agree to abstain entirely. For instance, the only safe BAC for driving is a 0 BAC. Also, there is no safe level of drinking if you’re pregnant. Other situations should reflect your “weak spots.” Take a minute and think of situations when you’re most likely to drink heavily. These situations may take some time to learn how to manage without over-drinking.
Come up with that short list, write it down, and yes, print it out as an agreement with yourself.
Keeping track of your drinking while you are drinking is an important step in achieving and maintaining moderation. Keeping track of your drinking while drinking is the best way to tell if your efforts to cut back are working.
Also, the more you are aware of your drinking, the better your chances of staying within your limits. You’ll also know when you’ve reached the drink limit you’ve set for yourself.
We call keeping track self-monitoring because you’re keeping track of what you’re doing. Our moderate program in our app has a digital drink tracker but if you’re not subscribed you can come up with your own system. In either case, enter your drinks into your or our drink tracker each time you drink. If you subscribe to our moderate protocol you’ll be able to:
Your self-monitoring data is an important part of increasing your self-control and achieving your goal of moderate drinking.
If you’re keeping track on your own, these are the variables to track:
As you accumulate drink tracking cards or data you’ll be able to start to see patterns in your drinking that can help you identify triggers to overdrinking.
Here’s a list of potential triggers to over drinking.
Make a list of the triggers and add to them as you continue keeping track of your drinking and discover other triggers you haven’t listed.
Being aware of your triggers will only be helpful if you develop and use a plan to better deal with them.
Consider each trigger on your list and set up a plan for dealing with that trigger. Some triggers are easier to figure out how to deal with than others though. For instance, figuring out how to deal with depression can be a complex task. So instead of trying to have all the answers we’ll recommend other resources to help you get where you want to go (e.g., reduce or eliminate symptoms of depression). We’ve put those resources in an extensive resource list.
There are two aspects of dealing with triggers:
You can improve your external responses by learning problem solving skills, communication skills, and interpersonal skills. You can improve how you respond internally through a process called “stress innoculation.”
See our resources section for links to improve your skills in these areas.
There are 4 good reasons to keep track of your urges:
We suggest you keep track of your urges in a way similar to how you keep track of your drinking.
The next step is to develop plans to manage and reduce your urges. This is a complex bit and we refer you to that section in our Checkupandchoices.com moderation module.
People often drink to achieve some desired effects like to relax, to change your mood, or to escape. The desired effects themselves are often positive. Achieving them may help you cope with life.
What we’d like you to do is to consider how you can get some of the desired effects of drinking without over-drinking or without drinking at all. If you don’t have ways of getting these effects, other than by over-drinking, you’ll continue to be at risk for relapse when you need to relax, change your mood, etc..
When people stop drinking heavily they often have a lot of free time. Some people fill that time with more work and catching up on responsibilities. Things they’ve neglected while they’ve been drinking a lot.
This can backfire. Having a balance in your life between responsibilities and things you enjoy doing and/or are meaningful makes sober life more rewarding. The more rewarding your life is without drinking to intoxication (the original meaning of sober by the way), the less likely you are to have a lapse or relapse. Think of it as a balance between things you should do and things you want to do.
And not all activities need be for pure fun. They can be things to do that give you a sense of meaning or fulfillment. What comes to my mind are volunteer activities that help others. Giving back to your community whether it be in person or online can be rewarding and fulfilling.
In this exercise consider increasing the frequency of
To start, make a list of some fun or meaningful things you’ve done before, do infrequently and think you might like to do more of, or to try out some new things.
Now consider some additional alternatives. This list is by no means complete and reflects our biases:
Now with your list of things to try, consider that there are both rewards and costs involved. (Yes, there’s no free lunch.) Considering both sides of the coin can help you when you encounter challenges with doing the new activity.
For each activity write down answers to these questions:
If you then plan ahead on how to address the short-term costs you may find it easier to start and stick with the new activities. Now consider specifically a plan to deal with the short-term costs. Ask yourself (and write out the answers) these questions:
What specific activities are you going to try?
What are your most important reasons for doing so?
How to you plan to make this happen? What specific steps are involved? When, where and how will you take them?
How can others help?
What could go wrong or undermine your plans? How can you stick with it even in spite of them?
What good things will happen when you’re doing this new activity (both short term and long-term)?
Over-drinking can significantly affect your mood, reducing your positive mood and increasing your negative mood. The good news is that when you cut back or stop drinking, your mood often improves.
You can do this yourself as there are numerous screeners for anxious and depressed moods online. For depression, consider the Beck Depression Inventory and for anxiety, the GAD-7 (Generalized Anxiety Disorder screening). Take them weekly, score yourself and then keep track of your scores over time.
We have a mood tracker on our checkupandchoices.com moderate module that will give you graphic feedback on the changes in your mood over time. There are three things to keep in mind though:
To make it easier to track your moods, we’ve made the Mood Tracker available at the end of this section, from your dashboard, and from the main menu. Once you’ve begun tracking your moods, you can see feedback on your dashboard.
What is a lapse? What is a relapse? What’s the difference between the two?
These are not easy questions to answer but we will suggest some guidelines for how you define them.
Perhaps more important than the difference between a lapse and a relapse is what you do when one happens. How you respond during and after a relapse can have a big impact on whether you get back on track with your goals or continue over-drinking. Since goal is to moderate your drinking and be successful, consider the following view which is based on scientific research.
Lapses and relapses are mistakes from which you can learn so that you are less likely to repeat them. Learning new habits like moderate drinking is a process and takes time. You can’t learn all that you need to know to maintain moderation in just a couple of weeks.
Also, rather than focusing on one day of over-drinking, consider it in the context of the total number of days of not drinking and moderate drinking you’ve had since you’ve started making serious attempts using the steps we recommend. One day of over-drinking out of 2 weeks of not drinking or drinking moderately is a 93% success rate.
Taking this view does not mean that it’s OK to continue over-drinking 7% of the time. Every instance of over-drinking puts you at risk for alcohol-related problems. If you learn from your mistakes, you’ll be less likely to repeat them in the future.
Dr. Reid K. Hester, Ph.D. is a clinical psychologist, researcher, and the Co-Founder of CheckUp & Choices, serving as the Director of its Research Division.
Dr. Hester has published over 60 journal articles on the topic of substance misuse and digital interventions including in the Journal of Consulting and Clinical Psychology, the Journal of Medical Internet Research, and The Journal of Substance Abuse Treatment.
A leader in his field, Dr. Hester is one of the nation’s most sought-after substance misuse experts. His opinions, online resources and research have been featured in The New York Times, NPR, The Wall Street Journal, Time, Vogue, and Men’s Health among others
Dr. Hester received his masters and Ph.D. in clinical psychology from the Washington State University in 1979.
