I recognize that this post may seem controversial to some people, but hear me out. I want to challenge “conventional wisdom” here- because it’s something I’ve always had a need to do, and because I’m a psychologist and I spend every day helping people think differently or to find out-of-the-box solutions to their problems.
For starters, there are a few common “truths” in our society when it comes to alcohol (and other drugs, but I’ll just be talking about alcohol here):
- A person must hit “rock bottom” before he or she can successfully quit drinking. Either things must be so terrible before they can have success, or, they must be completely falling apart for a person to even view quitting drinking as an option.
- Given #1, once a person recognizes he or she has an issue with drinking, the only solution is to quit entirely.
- Given #1 and #2, the only way to quit is to go to Alcoholics Anonymous (AA) meetings…for the rest of your life; admitting you are powerless over alcohol and that you are an alcoholic or addict; submitting to a higher power (God); getting a sponsor; avoiding all people, places, and things you have associated with alcohol; and so on.
- And for many, abstinence means a boring, miserable life of deprivation and isolation.
So if you believe 1, 2, or 3, you will probably A) not recognize or acknowledge the fact that you overdrink or have had negative consequences from drinking, and view it as a problem; or B) you will deny it because you believe #4. And given society’s subscription to these “truths”, it’s no wonder there is so much stigma surrounding alcohol abuse, addiction, or “alcoholics”. First, let’s scratch the word “alcoholic” from our vocabularies, because it’s not used professionally and has more of a negative connotation than anything. Some people embrace it, while others find it degrading. In the professional realm, a person with an alcohol issue, whether or not it qualifies for an Alcohol Use Disorder (AUD) diagnosis, is a person with an alcohol issue.
Back to “truths” 1-4, I’m here to debunk that line of thinking, and to let you know that there are other ways for a person to handle their discomfort about their use of alcohol, whether they are looking to stop drinking, or to gain a better sense of control over it. Because there are a number of ways this can be dealt with, and AA participation is only one of them.
Let me just start off, though, by saying that I think it’s great that AA and other 12-step programs exist (and if you’re not familiar, the 12-Steps are the foundation of AA and are 12 steps a person must go through in their journey of recovery…this started with AA, but has been applied to several other programs). Some people love the 12-Steps and really benefit from the structure and support that these programs provide. However, they’re not right for everybody. Some people hate 12-step programs or just won’t try them.
Here is a list of complaints I hear from people about 12-step meetings:
- “Drinking is an issue for me, but I don’t believe I’m an alcoholic”… “I don’t want to sit in a room of people and have to tell them I’m an alcoholic”.
- “I don’t like that AA is God-focused. I don’t believe in God…am not sure if I believe in God…I’m not Christian…etc.”
- “Hearing other people talk about their problems makes me depressed.”
- “Hearing other people talk about drinking makes me want to drink.”
- “I’m a private person…I’m a professional…People know me…and I want privacy.”
- “Not everyone there is sober, I hear people talking about going to use after the meetings.”
- “Meetings are boring”, or, “I just don’t get anything out of it.”
- “I’m busy, I don’t have time to go to 6 or 7 meetings a week.”
- “I shouldn’t drink and I do need support, but the 12-Steps just aren’t for me.”
- “I don’t need to go in there and talk about having been a bad person- I want to feel good!”
12-Steppers would say these are excuses and the person just isn’t ready to pursue recovery. Could be so, but to each his or her own.
As an aside, I do ask people in therapy if they have ever been to a 12-step meeting, and I recommend that they at least give it a try. And even then, if you’ve been to one meeting, you’ve been to one meeting (that may actually be an AA saying…there are many of them). The format and group composition will vary, so I encourage people to check out a few meetings before forming an opinion about AA in general. But then again, it’s just one option.
I want to emphasize that AA or any 12-step group is not treatment- it’s a support group. Most people have heard of AA, and they generally try to deal with problems themselves or via support groups before seeking professional help. A person looking to explore their substance use or to give it up may need or benefit from treatment- at least talking to a therapist on an outpatient basis. Some may require more intensive treatment, though, possibly including rehab (usually a 28-day program where you’re taken out of your home environment and kept away from substances, while having intensive group and individual therapy) or detox (being monitored by medical professionals and possibly given medication to prevent symptoms- discomfort and possibly death- as a result of stopping substance use). Do ALL people looking to cut down on drinking or quit require rehab? Definitely not, but it depends on the severity of the situation.
So what are the alternatives to AA or 12-step programs if a person is considering a change in their alcohol use? Let me start by saying there are two schools of thought here: Abstinence (the goal is to stop all substances completely- which AA/12-step programs endorse as the only way), and Harm Reduction (which seeks to help people to critically evaluate their use and cut down, in order to reduce any potential harm caused).
If you have tried to reduce your use of alcohol and find that it isn’t working- you either continue to use in larger amounts than you intend to, or you continue to have negative consequences (hangovers, blackouts, relationship or legal problems, to name a few), it might be time to think about abstinence, whether or not you plan to make AA part of it.
If you don’t think your problem is that bad, or you haven’t yet tried to cut back, or you just can’t imagine stopping entirely, then you might give harm reduction a try. And that is the focus of this post, since as I said in the beginning, most people either don’t know this is a thing, or they don’t believe in it.
As a psychologist and a problem solver, I don’t believe in black-and-white or all-or-nothing thinking. I like to see the gray areas or to help people to find new and creative ways to solve their problems. And in therapy, I don’t believe in a one-size-fits-all or cookie cutter approach. We’re all different and have our own strengths and preferences, so what works for you may not work for me. When it comes to substance use, especially alcohol, many people are open to cutting down, but not to quitting. If a person is able to do that, then we can say they have still made some progress. And when a person can’t, he or she may ultimately decide to quit. And some people, even if they don’t describe themselves as an “alcoholic” or don’t view their problem as that bad, they decide that they prefer being sober, and it becomes their way of life.
So with respect to harm reduction, I would first recommend you check out some good books or articles on the subject to get a feel for what it’s about and how it could relate to your life. I’ll add that I’m not being paid by any of the authors or anything like that, but do a little research and see if harm reduction might be a fit. Some of these also discuss abstinence, but the point is that only you can choose what is right for you.
- I read this book not long ago and have been recommending it to all of my clients who are considering reducing their drinking or quitting: This Naked Mind: Control Alcohol: Find Freedom, Rediscover Happiness, and Change Your Life by Annie Grace
- Annie Grace recently launched a Naked Mind podcast as well.
- Here is a website and online support forum for people aiming to cut down on drinking or thinking of stopping: HAMS: Harm Reduction for Alcohol. HAMS offers in-person meetings and a podcast as well.
- Here is an organization and website that offers information on SMART Recovery: Self-Management and Recovery Training. This is a harm reduction approach which also offers meetings in the community (check the website to see if there is one in your area), and these might be a good alternative for some who don’t like the 12-Steps. There is also a podcast, which I found recently. I’m partial to SMART Recovery, since it’s psychology-oriented and helps people to look at what may be underneath their drinking, rather than just focusing on how to avoid taking that next drink.
- And another book: How to Change Your Drinking: A Harm Reduction Guide to Alcohol.
And here are two other resources that are more abstinence-based, but that aren’t AA:
- Refuge Recovery: Resources and meetings for people in recovery or striving for recovery in the Buddhist tradition.
- I have seen a number of this guy’s videos (Kevin O’hara) on Youtube, and he started a website and podcast called AlcoholMastery.com. Though he discusses abstinence, nowhere does he say you have to go to AA or that there is only way to do it. I find them to be pretty positive. I’m not sure what exactly is in his “Quit Drinking Starter Pack”, but he’s got it for free on his website.
While some people are successful in reducing their alcohol use without much difficulty, others may require professional support. This could, of course, be some validation that you’re doing what is best for you, but this can also be through exploring issues that might be related to your drinking (anxiety, depression, or self-confidence, for instance); developing refusal skills (saying no to drinks, drinking occasions, or sticking to your limit); or making lifestyle changes or developing healthier coping skills. Seeing a therapist who is skilled at treating clients with mental health AND substance use issues (sometimes referred to as dual-diagnosis), could be invaluable in helping you to evaluate where you stand and what you do or don’t want in your life. Let me add a word of caution: When you are looking for a therapist and reach out to him or her via phone or e-mail, DO ask 1) if he or she has experience in treating people who want to deal with their alcohol use; and 2) if they are open to treating someone who is interested in a harm reduction approach. This is important, because some therapists are from the “old school” and may believe abstinence is the only way (harm reduction is a bit newer), and some therapists (particularly who work in the substance abuse field) are in recovery themselves (aka abstinent), so they may have a personal bias toward abstinence.
And of course, if seeing a therapist or doing work on your own isn’t enough, you might need a higher level of support, such as an intensive-outpatient program (usually meets 3-4 times a week and offers individual and group therapy). And if you find that you can’t stop using or can’t cut down successfully, even after being involved in therapy, you might rethink whether harm reduction is right for you. Some people try it without much success, so it ends up being a step toward quitting. But it’s up to you. Ultimately, you will have to decide what drinking is adding to your life, or whether or not the consequences are outweighing any benefits.
So if you relate to this post or have done some research on your own, and you’re ready to talk about making some changes (either cutting down or quitting), finding a therapist would be a great place to start. You can find a referral here.
Take care, Dr. Matthews