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by Drs. Reid K. Hester & F. Michler Bishop
Are you drinking too much? It’s a question people ask themselves when the problems they’ve been having with their drinking are affecting their well-being. At the same time, there are so many different options it can be bewildering to know what path to take or how to get started. We can help with some suggestions based on solid scientific research. Let’s get started by having you ask yourself some questions:
Q 1: What’s your motivation?
The first question to ask yourself is how motivated are you to make this change? If you’re feeling two ways about changing your drinking, then getting some objective feedback about it can help you resolve your ambivalence. Even more important, it may also increase your internal motivation for change. You can get feedback in a consultation with a mental health expert with expertise in alcohol misuse. You can also get an online CheckUp that takes about 35-40 minutes. Increasing your internal motivation to change may be all you need to get you started. Having your own reasons for changing your drinking is important, especially if they fit with what you think is important to you in life (i.e., your goals and values). If you’re only deciding to change to please someone else, your changes may be temporary—if you change at all. At the same time, if you decide it’s best for you to change your drinking, others who are concerned about you may well support you in your efforts. And your motivation for change can lead to the next steps, taking action.
Q 2: What’s the goal(s) of change?
When it comes to drinking too much or using drugs, you basically have two choices. Cut back or stop altogether.
It’s important to know that many people do successfully cut back on their drinking and reduce or get rid of their alcohol-related problems. Here again a consultation or CheckUp can give you feedback about your chances of success if you choose that goal. Yes, we actually have solid feedback available on your personal chances of success with cutting back. The bottom line, though, is that the more significant your drinking problems have been and the longer you’ve had them, the less likely you are to get rid of your problems by cutting back.
A truth often not discussed is that many people who do successfully cut back end up stopping altogether. There are many reasons why this happens. For some, their non-drinking activities and lifestyle are more rewarding than when they were drinking heavily. And they like sleeping well and waking up refreshed in the morning. It’s also well known that cutting back on heavy drinking actually improves one’s mood and sense of well-being. While drinking can initially improve one’s mood and attitude, over time it can actually worsen your depression and/or anxiety. So, over time, feeling better emotionally is rewarding.
The alternative is to stop drinking altogether to begin with. It’s not a goal that requires a life-long commitment to start. You can decide to stop for a day, a week or a month. And while it may seem more challenging to begin, for many it actually gets easier over time and takes less effort to stop at 0 drinks than after 2-3 drinks.
Q 3: What’s the best way for me to move forward?
This is a bit more challenging because there are so many options available to help you change.
There are online self-guided change apps like ours, mutual support groups like SMART Recovery spiritual guidance from your priest, pastor, rabbi or imam, support from family and friends, and varying degrees of professional treatment(s). Professional treatment can be low or high intensity and take place in different settings, i.e., inpatient, outpatient.
And inpatient treatment is not the “gold standard” that many inpatient treatment programs sometimes suggest. There have been numerous randomized clinical trials over decades now that have looked at outcomes of treatment protocols. What’s clear is that it’s not where the treatment happens (inpatient or outpatient) but what happens in treatment. In other words, the specific treatment, (for example, cognitive-behavioral treatment or Alcohol Anonymous) are what to focus on, not where they occur (inpatient or outpatient). And finally on this topic of treatment, be wary of a program that makes wild claims of superiority.
Now here’s a secret that we’ve found in both our research (RH) and from years of running SMART Recovery groups. Most people use more than one strategy! In fact, they often use multiple strategies to change. Data collected in SMART Recovery meetings has found that most people use at least 6-7 different strategies. For example: exercise, meditation, prayer, going to a meeting, using techniques or “tools” from the SMART Recovery playbook, and calling a friend when cravings hit. Others may find that adding some kind of medication may be helpful, either one that targets urges and cravings to drink (such as Naltrexone) or one that targets depression or anxiety (like Prozac). In a clinical trial we conducted, we asked participants what resources they used to help them change, in addition to the online program tools. We found similar results with a little more emphasis on seeing therapists and counselors. The full report is here (see Table 4)
This makes sense when you think about all of the different “triggers” to drink or drink heavily that can develop over years of heavy drinking. And the longer you’ve been drinking heavily, the more likely you are to have a number of different triggers.
The key here is to find what works for you to help you be successful. It is a bit of a trial-and- error process, but at the same time, one that gives you feedback as you go along.
And if you do decide to change, please remember to not beat yourself up when you slip and drink more than you’d intended. Getting down on yourself doesn’t help and actually increases the likelihood of another slip or full-blown relapse. We know without a doubt that negative feelings are a big risk factor for relapse.
So instead of getting down on yourself learn from the experience. Take a hard look at what happened in the chain of events that led to the slip up. Figure out how to decrease the chances that it will happen again. The people in self-help groups like SMART Recovery can help you figure out what went wrong and what to do instead, to prevent another lapse or relapse. Very few people change their years-long drinking habits without making mistakes.
