Get­ting treat­ment for prob­lem drink­ing with­out giv­ing up al­co­hol

The Hamilton Spectator - - HEALTH - NARA SCHOEN­BERG

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.

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