- Rethinking Alcohol: Can Heavy Drinkers Learn To Cut Back?
- What Is Alcohol?
- How Does It Affect the Body?
- Why Do Teens Drink?
- Why Shouldn't I Drink?
- How Can I Avoid Drinking?
- Where Can I Get Help?
- What If I'm Concerned About Someone Else's Drinking?
- Recommended Alcohol Guidelines – Moderate Drinking Plan
- What is Moderate Alcohol Use?
- A Standard Drink – The Definition of a Drink
- Moderate (Social) Drinking Plan
Rethinking Alcohol: Can Heavy Drinkers Learn To Cut Back?
The thinking about alcohol dependence used to be black and white. There was a belief that there were two kinds of drinkers: alcoholics and everyone else.
“But that dichotomy — yes or no, you have it or you don't — is inadequate,” says Dr. John Mariani, who researches substance abuse at Columbia University. He says that the thinking has evolved, and that the field of psychiatry recognizes there's a spectrum.
Problems with alcohol run the gamut from mild to severe. And there are as many kinds of drinkers along the continuum as there are personality types.
People with severe problems, such as those who keep on drinking even after they lose jobs or get DUIs, need treatment to stop drinking completely.
But there are other drinkers, including some who are in the habit of drinking more than one or two drinks a day, who may be able to cut back or moderate their consumption and reduce their risk.
In fact, a recent study by the Centers for Disease Control and Prevention found that the majority of Americans who drink more than one or two drinks a day are not alcoholics. They don't report symptoms of dependence.
So what would it take for them to cut back? Increasingly there are researchers and therapists evaluating this question. And they're finding a host of strategies that may be helpful.
Another CDC study found that alcohol screening and counseling in doctors' offices — for instance, your primary care doctor asking about drinking during an annual checkup — can reduce drinking by 25 percent per occasion in people who drink too much.
And the National Institute on Alcohol Abuse and Alcoholism has a whole list of tips aimed at cutting down — everything from drinking tracker cards that you can keep in your wallet to help you track your drinking when you go out, to strategies for handling urges.
“I had these good intentions, but then every time Friday rolled around, I'd lose my resolve.”
For people concerned that their drinking may be moving towards dependence, a screening tool called the Drinker's Checkup can evaluate and give feedback.
There are also support groups such as Moderation Management, which aims to help drinkers who are trying to cut back.
Ten years ago, Donna Dierker, who lives in St. Louis, was concerned about her drinking. “When I did drink, I drank a lot,” Dierker told us. She never drank during the workweek, but on weekends were different. “Fridays would be a six-pack,” she says. And Saturdays meant more drinking. “On Sundays I'd feel awful.”
Her blood pressure was going up; her weight was creeping up. And so she resolved to cut back.
“I had these good intentions, but then every time Friday rolled around, I'd lose my resolve,” Dierker says.
She checked out Alcoholics Anonymous because that was the only alcohol support group she'd ever heard of. But she says it didn't seem the right fit.
Then she read about Moderation Management. “And I just decided to try it.”
When she connected with leaders and other people on the MM listserv, they helped her work through her issues.
The first task was to identify her triggers. Why was she was drinking so much?
She realized that she used alcohol as a reward for a hard week's work. “Getting through a Friday evening without my reward, you know, that was the tough one,” Dierker says.
But she also realized that her drinking was more of a habit than a compulsion. And the friends she drank with reinforced that habit. “That was the norm,” she says.
So Dierker set out to change her weekend routine. Instead of drinking beer on a Friday night, “I'd drink seltzer water … and dance in the playroom with my son,” she says.
“I had to consciously slow down and learn to sip instead of gulp.”
Slowly she developed a new relationship with alcohol. To pull this off, she learned tools and techniques to help her keep it in check. For instance, her old routine was to drink one drink after another, back to back — what's known as chain drinking.
“I had to consciously slow down and learn to sip instead of gulp,” Dierker says.
And just as people learn to eat less by counting calories, she learned to count her drinks and set limits. “For me, that really helps.”
Dierker says that for the most part it works for her. She has no problem just having a glass of wine with dinner or a couple of drinks with friends.
And every so often she takes a monthlong break from drinking so it doesn't start to creep up.
“I feel I'm in the driver's seat again,” Dierker says. She no longer drinks habit. “I've gotten to the point where it's a treat again and I look forward to it.”
Since Donna first tried moderation, the concept of helping people try to moderate their drinking has gained traction. The Substance Abuse and Mental Health Services Administration (SAMHSA) lists Moderation Management as an evidence-based program.
And the National Institute on Alcohol Abuse and Alcoholism has reviewed one study that found that the moderation approach offered by Moderation Management and ModerateDrinking.com can help some heavy drinkers cut back.
But many experts would to see more evidence of its effectiveness. “It's only one study,” says NIAAA Director George Koob.
Moderation as an alternative to abstinence certainly doesn't work for everyone.
And the tricky part of the moderation path is that there's no way to know which heavy drinkers can learn to control their drinking rather than having to give it up completely.
“For everybody, it's really a process to figure out what's going to work and what's not.”
There isn't enough data to know if a certain person with a certain profile is going to be successful, says Koob. “The science just hasn't been done.”
And to some, the concept of moderation is controversial.
Some critics point to the story of the woman who founded Moderation Management. After leaving the organization, she struggled with drinking, caused a fatal drunk-driving crash and then committed suicide.
“For everybody, it's really a process to figure out what's going to work and what's not,” says Sarah Vlnka. She's a social worker and therapist in Michigan who has struggled with alcohol.
In her case, after about a year and a half of experimenting with moderation she realized that she wanted to quit drinking entirely.
In part, she realized she was spending too much time thinking about managing the process.
“I got tired of it,” she says. “Anything that takes [so much] brain space doesn't feel worth it.” So she stopped. In her case, moderation led her to abstinence.
Mariani says there are lots of heavy drinkers who are resistant to help or the idea of abstinence, but are open to the idea of cutting back.
“As a starting place,” Mariani says, “moderation is often a goal that everyone can agree on.”
And it also addresses what many experts see as a treatment gap. In the past, it was only the people with the most severe cases of alcohol dependence who got treatment or help.
With the moderation approach, “it's a way of reaching people earlier,” says Dr. William Miller, professor emeritus of psychology and psychiatry at the University of New Mexico and author of Controlling Your Drinking. It's a way of meeting people where they are.
And if moderation doesn't work? It may be a step on the path to abstinence.
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Just about everyone knows that the legal drinking age throughout the United States is 21. But according to the National Center on Addiction and Substance Abuse, almost 80% of high school students have tried alcohol.
Deciding whether to drink is a personal decision that we each eventually have to make. This article provides some information on alcohol, including how it affects your body, so you can make an educated choice.
What Is Alcohol?
Alcohol is created when grains, fruits, or vegetables are fermented. Fermentation is a process that uses yeast or bacteria to change the sugars in the food into alcohol. Fermentation is used to produce many necessary items — everything from cheese to medications. Alcohol has different forms and can be used as a cleaner, an antiseptic, or a sedative.
So if alcohol is a natural product, why do teens need to be concerned about drinking it? When people drink alcohol, it's absorbed into their bloodstream.
From there, it affects the central nervous system (the brain and spinal cord), which controls virtually all body functions.
Because experts now know that the human brain is still developing during our teens, scientists are researching the effects drinking alcohol can have on the teen brain.
How Does It Affect the Body?
Alcohol is a depressant, which means it slows the function of the central nervous system. Alcohol actually blocks some of the messages trying to get to the brain. This alters a person's perceptions, emotions, movement, vision, and hearing.
In very small amounts, alcohol can help a person feel more relaxed or less anxious. More alcohol causes greater changes in the brain, resulting in intoxication. People who have overused alcohol may stagger, lose their coordination, and slur their speech. They will probably be confused and disoriented.
Depending on the person, intoxication can make someone very friendly and talkative or very aggressive and angry. Reaction times are slowed dramatically — which is why people are told not to drink and drive. People who are intoxicated may think they're moving properly when they're not.
They may act totally character.
When large amounts of alcohol are consumed in a short period of time, alcohol poisoning can result.
Alcohol poisoning is exactly what it sounds — the body has become poisoned by large amounts of alcohol. Violent vomiting is usually the first symptom of alcohol poisoning.
Extreme sleepiness, unconsciousness, difficulty breathing, dangerously low blood sugar, seizures, and even death may result.
Why Do Teens Drink?
Experimentation with alcohol during the teen years is common. Some reasons that teens use alcohol and other drugs are:
- to feel good, reduce stress, and relax
- to fit in
- to feel older
From a very young age, kids see advertising messages showing beautiful people enjoying life — and alcohol. And because many parents and other adults use alcohol socially — having beer or wine with dinner, for example — alcohol seems harmless to many teens.
Why Shouldn't I Drink?
Although it's illegal to buy alcohol in the United States until the age of 21, most teens can get access to it. It's therefore up to you to make a decision about drinking. In addition to the possibility of becoming addicted, there are some downsides to drinking:
The punishment is severe. Teens who drink put themselves at risk for obvious problems with the law (it's illegal; you can get arrested). Teens who drink are also more ly to get into fights and commit crimes than those who don't.
People who drink regularly also often have problems with school. Drinking can damage a student's ability to study well and get decent grades, as well as affect sports performance (the coordination thing).
You can look really stupid. The impression is that drinking is cool, but the nervous system changes that come from drinking alcohol can make people do stupid or embarrassing things, throwing up or peeing on themselves. Drinking also gives people bad breath, and no one enjoys a hangover.
Alcohol puts your health at risk. Teens who drink are more ly to be sexually active and to have unsafe, unprotected sex. Resulting pregnancies and sexually transmitted diseases can change — or even end — lives.
The risk of injuring yourself, maybe even fatally, is higher when you're under the influence, too. One half of all drowning deaths among teen guys are related to alcohol use.
Use of alcohol greatly increases the chance that a teen will be involved in a car crash, homicide, or suicide.
Teen drinkers are more ly to get fat or have health problems, too.
One study by the University of Washington found that people who regularly had five or more drinks in a row starting at age 13 were much more ly to be overweight or have high blood pressure by age 24 than their nondrinking peers. People who continue drinking heavily well into adulthood risk damaging their organs, such as the liver, heart, and brain.
How Can I Avoid Drinking?
If all your friends drink and you don't want to, it can be hard to say “no, thanks.” No one wants to risk feeling rejected or left out. Different strategies for turning down alcohol work for different people.
Some people find it helps to say no without giving an explanation, others think offering their reasons works better (“I'm not into drinking,” “I have a game tomorrow,” or “my uncle died from drinking,” for example).
If saying no to alcohol makes you feel uncomfortable in front of people you know, blame your parents or another adult for your refusal. Saying, “My parents are coming to pick me up soon,” “I already got in major trouble for drinking once, I can't do it again,” or “my coach would kill me,” can make saying no a bit easier for some.
If you're going to a party and you know there will be alcohol, plan your strategy in advance. You and a friend can develop a signal for when it's time to leave, for example.
You can also make sure that you have plans to do something besides just hanging out in someone's basement drinking beer all night. Plan a trip to the movies, the mall, a concert, or a sports event.
You might also organize your friends into a volleyball, bowling, or softball team — any activity that gets you moving.
Girls or guys who have strong self-esteem are less ly to become problem drinkers than people with low self-esteem.
Where Can I Get Help?
If you think you have a drinking problem, get help as soon as possible. The best approach is to talk to an adult you trust.
If you can't approach your parents, talk to your doctor, school counselor, clergy member, aunt, or uncle.
It can be hard for some people to talk to adults about these issues, but a supportive person in a position to help can refer students to a drug and alcohol counselor for evaluation and treatment.
In some states, this treatment is completely confidential. After assessing a teen's problem, a counselor may recommend a brief stay in rehab or outpatient treatment. These treatment centers help a person gradually overcome the physical and psychological dependence on alcohol.
What If I'm Concerned About Someone Else's Drinking?
Sometimes people live in homes where a parent or other family member drinks too much. This may make you angry, scared, and depressed. Many people can't control their drinking without help. This doesn't mean that they love or care about you any less. Alcoholism is an illness that needs to be treated just other illnesses.
People with drinking problems can't stop drinking until they are ready to admit they have a problem and get help. This can leave family members and loved ones feeling helpless.
The good news is there are many places to turn for help: a supportive adult, such as your guidance counselor, or a relative or older sibling will understand what you're going through.
Also, professional organizations Alateen can help.
If you have a friend whose drinking concerns you, make sure he or she stays safe. Don't let your friend drink and drive, for example.
If you can, try to keep friends who have been drinking from doing anything dangerous, such as trying to walk home at night alone or starting a fight. And protect yourself, too.
Don't get in a car with someone who's been drinking, even if that person is your ride home. Ask a sober adult to drive you instead or call a cab.
Everyone makes decisions about whether to drink and how much — even adults. It's possible to enjoy a party or other event just as much, if not more so, when you don't drink. And with your central nervous system working as it's supposed to, you'll remember more about the great time you had!
Reviewed by: Steven Dowshen, MD
Date reviewed: September 2016
Recommended Alcohol Guidelines – Moderate Drinking Plan
Recommended alcohol guidelines can help you in a few ways: 1. Understand what is considered healthy alcohol use.
2. Decide if you have an alcohol problem.
What is Moderate Alcohol Use?
Guidelines for moderate drinking have been set by the US Department of Health and Human Services and the World Health Organization.
- The US guidelines suggest no more than 1 drink per day for women and no more than 2 drinks per day for men. A drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits.
- The WHO guidelines suggest no more than 2 drinks per day, and no more than 5 drinking days per week. They recommend 2 non-drinking days. Of course, you can't stockpile your drinks, and have them all at the end of the week.
A Standard Drink – The Definition of a Drink
A standard drink is 14g of pure alcohol according to the US Department of Health and Human Services. The World Health Organization defines a drink as 10g of pure alcohol.
Each milliliter of pure alcohol weighs 0.79 grams. Therefore, you can calculate the alcohol content of a drink with the following formula:
- 1 can of beer (330 ml, 12 oz) at 5% (strength) x 0.79 (conversion factor) = 13 grams of alcohol
- 1 glass of wine (140 ml, 5 oz) at 12% x 0.79 = 13.3 grams of alcohol
- 1 shot of liquor (40 ml, 1.5 oz) at 40% x 0.79 = 12.6 grams of alcohol
Note that a 750ml bottle of wine contains 5 drinks. Therefore 2 drinks a day is less than half a bottle of wine a day.
Moderate (Social) Drinking Plan
If you don’t have an alcohol problem, you should be able to easily follow a moderate drinking plan. This is a moderate drinking plan to help you decide.
Keep an honest journal of how much you drink every day for 6 months, and see if you can stick to moderate drinking. It's important that you do this for at least 6 months, because it's easy to control your drinking for a short period of time.
If there are days when you drink more than a moderate amount, make note of the circumstances and identify your triggers. If you're happy with your use – great. But if you're not happy, or if you can't stick to moderate drinking, then that should tell you something.
Ultimately, people who are addicted to alcohol decide to quit drinking, because they realize it's easier to not drink, than it is to control their drinking.
- Set a realistic goal for your alcohol use. Decide ahead of time how much and how often you would to drink.
- Keep an honest journal of your drinking. This helps you become mindful of your drinking.
- Start with a non-alcoholic drink to quench your thirst. When you’re at a social event make sure you have a non-alcoholic drink to start. Thirst can make you drink more alcohol than you need. This also helps you become more mindful of your drinking.
- Don’t drink on an empty stomach. Make eating part of the experience. Hunger can also make you drink more alcohol than you need.
- Alternate alcoholic and non-alcoholic drinks. Don't have all your alcoholic drinks at once, or you may be tempted to drink more than you planned. Instead have at least one glass of water before each alcoholic drink.
- Avoid heavy drinking situations. Some situations are associated with heavy drinking, and it may be difficult to stick to your plan. Learn to recognize and avoid heavy drinking situations.