Getting treatment for problem drinking without giving up alcohol
She no longer drinks seven days a week. She doesn’t lose entire Saturdays to hangovers.
She doesn’t have to worry that her kids always see her with a wine glass in her hand.
But Adrienne, an Indiana therapist who asked to be identified by only her first name, does drink. With the help of an Evanston, Ill., “harm reduction” support group for people who want to reduce their alcohol intake, as well as private therapy with the social worker who runs the group, she’s cut her drinking to about half of what it was a before she sought help. She drinks socially and enjoys an occasional drink or two with her partner.
“I feel like I’m on the right track,” she said. “I needed the help, and I’m getting the help, so I feel good.”
Harm reduction or controlled drinking, in which problem drinkers reduce their alcohol intake but don’t necessarily embrace abstinence, remains rare and controversial in the face of a strong tradition of alcohol-free 12step recovery programs such as Alcoholics Anonymous (AA). But a growing body of research indicates that harm reduction works.
A 2013 review of previous studies in the Journal of Psychopharmacology found that treatment focused on reducing drinking is “probably just as effective as abstinence-oriented approaches” for at least a subset of problem drinkers. And a January article in Alcohol, Clinical and Experimental Research found that problem drinkers who reduced their alcohol intake during treatment experienced significantly fewer alcohol-related consequences, as well as better mental health.
“Harm reduction is an effective way to tackle problem drinking,” said Katie Witkiewitz, the lead author of the 2017 study and an associate professor of psychology at the University of New Mexico. “It’s as effective as other approaches, in some cases more effective, especially when you consider most people don’t want to quit drinking, and so if we offer them tools to reduce their drinking, then that’s going to reduce harm, and that’s a good thing.”
Harm reduction skeptics include Constance Scharff, director of addiction research at the abstinence-based Cliffside Malibu treatment centre in Malibu, Calif. Attempting to drink less is fine if you’re trying to figure out whether you have an alcohol problem, Scharff said, but if cutting back is difficult, that’s your sign that you need to abstain. Similarly, she questions the value of therapy that’s tightly focused on reducing, or “moderating,” your drinking.
“If we have to focus that much support to get you to moderate, you’ve already crossed the line, and you need to be in an abstinencebased program,” she said.
Adrienne, who is in her 30s and has three kids under age 14, tried abstinence. She completed a year of sobriety with AA, but she wasn’t happy with the experience.
She went online to try to find an alternative. There were 400 weekly AA meetings in her area, she said, but the closest harm reduction support group was an hour and a half away in Evanston at the Chicago Harm Reduction Therapy Center. She went to her first meeting there about three months ago. She also started individual therapy with Colin Peters, a social worker at the centre.
They talk about her values and how they relate to her drinking goals, she said, as well as some of the reasons she drinks too much, and the situations where that tends to happen. Peters gives her practical tips and helps her formulate strategies.
She says she’s had one slip-up since therapy started, but for the most part, moderation is going well. She’s drinking four days a week as opposed to seven, she said, and having maybe 15 drinks a week, as opposed to about 30. She’s also taking the prescription medication naltrexone, an opioid antagonist that can block the buzz from alcohol and reduce cravings.
Another of Peters’ clients, a Chicago-area physician who didn’t want to use his name, is further along in his moderation journey. When he sought help, he’d gone from drinking a glass of wine with dinner, to two glasses, to three, he said. He wasn’t keeping track of how much he was drinking, but one night he realized he’d finished a bottle of wine.
He knows AA works for some people, he said, but it wasn’t the right fit for him. So three years ago he started attending Peters’ harm reduction support group meetings in Evanston. He also embarked on a year and a half of individual therapy sessions.
He now abstains from drinking every January, and generally keeps to his goal of no more than 14 drinks a week and no more than two drinks a day. He sleeps better, feels better and finds it easier to control his weight.
“I’m quite happy with it,” he said of harm reduction. “It’s not simple — admitting it, doing it, reading the book (“How to Change Your Drinking”), shlepping up to Evanston on a Monday night when you’re tired — all those things are hard. But my behaviour toward alcohol wasn’t what I wanted it to be, and I wanted to take some steps to change it.”
Some say they’ve found success with the "harm reduction" approach to problem drinking, where the goal is to cut back consumption without giving up alcohol completely.