Ask an Expert: Can a Problem Drinker Ever Drink Moderately?

Ask an Expert: Can a Problem Drinker Ever Drink Moderately?

By Rebecca Block PhD 02/08/16

Our expert weighs in on whether a person with a history of problem drinking should scrap the habit altogether.

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Ask an Expert: Can a Problem Drinker Drink Moderately?
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I would like some unbiased advice regarding my drinking. 

First off, I'm a 24-year-old woman and many of my friends love to drink - and drink quite a lot. 

I consider myself to be a problem drinker, however, I am unsure of whether I should keep working to further manage my issue with alcohol or if I should completely abstain from alcohol. I am rather uncomfortable discussing some of the main reasons why I believe this, and the friends I do discuss it with (both responsible and irresponsible drinkers) tell me that I don't need to go off drinking for good. 

As I am posting anonymously, I thought I should share some of the most private reasons for why I feel I should give up alcohol. 

I am/was a binge drinker. I used to drink a bottle of wine before heading to the pub, then continue to have anywhere from 5-10 drinks (pints or brandy or both) and more often than not, shots of some sort (tequila, Baby Guinness, Jägerbombs). I used to blackout every few weeks/months, never really got sick. I am a lightweight drinker (tipsy after two pints, drunk after three). Although I am a lightweight drinker, when I get drunk I will not stop drinking and can consume alarmingly large amounts of alcohol for somebody my size.

I now drink one bottle of beer or less before I head out, avoid shots and stick to pints and maybe a brandy at the end of the night. I briefly went to counseling and am on antidepressants and now feel much more in control of my drinking due to the fact that my moods are so much more stable.

Previously, I used to drink because I was so uncomfortable in how I looked or how sociable I was—I drank to escape feelings of inadequacy. I am a very funny person to be around when I'm drunk and tend to get on great with others when drinking—people love having me around for a session and much of my self-esteem is/was based on how happy I feel when drinking and how well others perceive me. 

I drink one night every second week and don't seem to crave it so much other than this, so naturally others don't assume I would be the "traditional" type of alcoholic as I don't appear to have a physical dependency. 

Although I feel much more in control of my drinking, part of me wonders if this is me deluding myself in order to continue drinking and not face facts. I know that if I continue to drink, I cannot promise myself or anyone else that I won't ever go on an absolute bender or blackout. I often feel guilty about drinking even if I have no reason to regret the previous night—I feel guilty about the past and things I have let happen and blame myself. 

When I was 18, I got blackout drunk and had vague flashbacks of being sexually assaulted by a stranger—my dress was still on and he had me in a stranglehold while he committed the act. I remember crying, saying stop and calling for my grandfather (who was dead five years at the time). After he was done, he invited his other friend into the room to also have sex with me. Needless to say, it was a traumatic way to lose my virginity, however it is hard for me to feel remorse for myself when I continued to put myself in vulnerable situations countless times since this incident. 

Years later, I fell in love but was still very much a problem drinker at the time. I again got blackout drunk, kissed another man (after a bottle of wine plus a pint of straight whiskey), told my BF (even though he would have never found out) who dumped me and has resented me ever since (and rightfully so). I had a complete mental breakdown after our relationship ended and have slowly come to terms with the guilt and anger at myself. 

These are only two examples, clearly the two worst consequences of my drinking but it is clear to see that I have no regard for my personal safety or wellbeing when I go on a binge. 

So yeah, now, I feel that I am drinking because I enjoy it and not to escape my issues as I am trying to improve myself mentally. I feel much more aware of my drinking and avoid it if I feel that I am doing it because I feel upset/down. 

I just don't know whether my drinking is only problematic because of how I feel about myself or if I should never drink again because it will always be problematic for me, regardless of my mental state or wellbeing? 

I would appreciate any advice. I know it is truly up to me to decide but I thought an outside perspective (not friends/family) might be helpful. 

Thanks

Rebecca Block: Hello, writer. I would like to start by thanking you for your letter. While your story is unique, you express some common themes that I often hear when working in the context of substance use. Many people will relate to your circumstances, and I suspect that many people will deeply appreciate your query. 

In considering your question about abstinence vs. moderation, I cannot help but think about the ways in which substance use is so often characterized by a polarized lens of blacks and whites, goods and bads. With that, it can be confusing to fully recognize a reasonable path forward. I confess that I too fall easily into polarized thinking around this disorder. Yet through my years of work, I have discovered, and can confidently say, that there are many more subtleties to be discovered when understanding the reasons and functions behind substance use. Introspection can be an opportunity to discover something meaningful that rests underneath assumptions, as well as underneath some habitual behaviors. 

In this case, it sounds as though your efforts to turn and listen inward have led you to wonder if a past trauma might be connected to your substance use. Indeed, many people who have experienced traumatic events in their lives end up using substances as a means of soothing themselves or as a means of coping with the confusing feelings that arise from that trauma. The two are often closely linked. And with introspection, you have already made some changes to your relationship with alcohol. And finally, it sounds as though some questions still remain. 

Over the years, I have found that a key tool in exploring this question of abstention vs. moderation is the skill of listening to one’s internal experience. Answering this question often takes time. I recommend that it be done with the help of a professional psychotherapist so that the most informed conclusion can be reached. Because I am not working directly with you, I do not feel comfortable offering any specific or definitive answer. Rather, I am advocating that you find a well-informed professional so that you can begin to explore and answer these questions for yourself.

Instead of specific answers, what I can offer is a brief overview of how I think about doing this exploratory work with others, and then descriptions of what this looks like in an actual case. The narrative below is a compilation of different people’s experiences, but I suspect it will easily resonate with your questions as well as with many readers’ experiences. Hopefully it will provide some illumination for anyone who might have related questions, as well as encouragement to seek help.

By definition, substances change a person’s own natural, physiological, internal experience. This fact is not inherently good or bad. Rather, it is simply what substances do. Certainly substances have been used for any variety of reasons, in a variety of contexts, and with a variety of effects, likely since humans have been around on this earth. In the context of psychotherapy, I find it useful to wonder about what substances do to and for each particular person. While I am interested in the answer, I am often just as interested in the asking. The asking is important because it can begin a process of internal exploration and curiosity. So I wonder aloud. I wonder about all the specific ways in which a person alters their own experiences, when they choose to do so, why they choose to do so, what are the effects. I wonder what are the costs and what are the benefits to use. I wonder what they wished for and what they actually did find when using. And I wonder what happens when they choose not to use anything. And so on.

With exploration, patient and therapist begin the process of turning a patient’s attention inward, toward listening to his or her own internal experiences. The resulting information can be invaluable. Over time and with repeated practice, the information acquired from this internal listening is further refined. Subtleties and textures about a person’s experience are discovered and defined. Familiar patterns are identified and recognized. As an example, consider a standard in the treatment of substance use: identifying and understanding triggers. In this process, the substance use itself serves as the first indicator there is something to be understood. Instead of dismissing the use as being "bad," it is seen as a clue.

From there, one can begin to ask questions about what preceded the use. What happened right before? How were you feeling before and after? What did you choose to do as a result? What happened next? With both answers and questions, a person begins to create a library of their own experiences from which they can draw upon in the future, a reference library of sorts. Then when someone encounters a previously identified trigger, they are more likely to recognize that trigger at an earlier point in the unfolding of that event. With that, a person is then more likely to understand what choices are actually before them. And with that, a person is more likely to realize which choices result in which outcomes. Ultimately, referring to one’s own past experiences begins to serve as a guide to understanding potential answers to future questions. And one question that always remains open before us no matter who we are and what we are doing is this: given the understanding that I have now, what do I want going forward? 

To illustrate some of this thinking, a case:

Ms. C was a 26-year old woman who came to me looking for help with her drinking. She, too, had a similar question about whether she should abstain or moderate. In college she drank heavily alongside her friends. During that time she would frequently blackout, but since her habits did not differ distinctly from her friends, she never questioned whether there was a problem. After graduating and moving to the city, however, she found herself in compromised circumstances as a result of too much drinking. On several occasions, she did not remember how she got herself home. On another occasion, she woke up on an unfamiliar couch, sick and sleeping with a trashcan next to her. Later, she realized it was a friend from work who brought her to his home. And finally, one night she ended up sleeping in Grand Central Station because she could not figure out which train she should take home. Following the last event, her boyfriend expressed serious concern and Ms. C finally agreed to seek help. 

We started by discussing her use history and thinking together about what she wanted for herself. Ms. C expressed that she wanted to be able to drink like a "normal" 26-year-old, but was uncertain about whether she would be able to do so. So much of her socializing and friendships revolved around drinking that she was reluctant to give it up. Yet she also did not want to keep ending up "in Grand Central" as we termed her compromised, blacked-out states. 

In discussing the question and her goals, together we agreed she would give informed moderation a try. I stated that I was unsure about whether she would achieve success in this effort. Therefore we would have to treat it like an experiment and truly listen to any results we discovered. I also informed her that moderation is difficult for reasons quite distinct from those found in abstention. With abstention, a person makes one decision, one time, and that is the end of it. With moderation, a person must make repeated decisions throughout. Should I drink tonight? If so, how much? What strategies can I use? Should I have another? Should I go home? Essentially, moderation requires the energy of constant decision-making. And, it is important to note, many of those decisions are made as one is progressively disinhibited by the use of alcohol. So with all of that information, we proceeded.

To help Ms. C structure her choices, we started with the reference provided by standard moderation guidelines: one drink per day, no more than seven drinks total per week for women. Then we turned to her own experiences to determine specific guidelines for herself. I asked about her drinking, wondering about times she had enjoyed her drinking experiences. I wondered what it was that she enjoyed about those experiences. I also asked when she noticed her experience tip beyond enjoyment. To her surprise, she realized that she only enjoyed drinking between two and three drinks before she started feeling overly emotional and out-of-control.

Later, she additionally noticed that she felt the best about herself overall when she only went out one or two nights a week. Otherwise, she regretted the way in which nights out effected other aspects of her life, such as work, the quality time spent with her boyfriend, or importantly, her sleep. In thinking about the whole of her life, Ms. C began to create a clearer picture of what she actually wanted for herself with respect to her drinking.

Over the next several months, Ms. C and I kept listening carefully to the choices she made around alcohol use, as well as to the results. We kept using her experiences to help her adjust and shape choices going forward. In the beginning, Ms. C found it challenging to stop herself at three drinks. But with some thought, we were able to help her develop a few tricks to improve her chances of creating the kind of evening she actually enjoyed. She drank more club soda when out; she stopped ordering shots; she made sure to eat a meal while out; and she identified specific friends with whom she could check in when needed. 

Perhaps more important, however, was that we continued our project of helping her learn to listen to herself. On nights out, Ms. C began to note certain internal experiences caused by alcohol that indicated she was reaching her "tipping point." Essentially, she had identified a subtle understanding of what "reaching her limit" actually felt like in her body. With this, Ms. C was able to know more accurately where she was at any given time; therefore she was better able to stop herself from drinking more than she wanted. Importantly, too, Ms. C discovered valuable information by making some big mistakes.

One Friday night she unintentionally drank herself into brown-out territory and stayed out too late. She was registered for a half-marathon race the next morning, and in an attempt to manage both her excitement and her nerves about the event, she had too many drinks. Unfortunately, she slept through the race and was utterly disappointed with herself. She has been training for months. When she relayed the incident to me, Ms. C started by chastising herself for the slip. I did my best to redirect her thinking to see if there was anything worth learning from the experience. To her surprise, she made a profound discovery: running was something that she liked and cared deeply about. While this may not appear to be an astounding revelation, for Ms. C it was.

She told me that over the course of her growing up, she rarely felt allowed to have anything of her own. Over and over, she had been directed to put others before her and acquiesce to their wants or needs. After so many years of this, she was left with understandable conflicts around being connected to others and about being alone. She had come to believe that the only way to stay connected to others was to sacrifice all of her own wants or needs. In doing so, she developed a quiet resentment and anger when feeling connected to others. And she felt a fear that if she did address her own needs, she would surely be abandoned. Drinking came to serve a double purpose. It had become a way to quiet her frustrated sense of obligation to others so she could remain connected to them. At the very same time, drinking provided a means of rebelling against those obligations so that she could break free of others and have space of her own.

By developing an interest in running, however, she allowed herself something new. She discovered an activity that belonged just to her. And with that, she realized that she had not lost anyone. Rather she found that the time spent alone rejuvenated her, which then allowed her a greater sense of connection when she did spend time with others. She began to realize that there was room for her own needs as well as the needs of another. 

With time and lots of work, Ms. C was able to figure out how to successfully manage her drinking. She felt more empowered as a result, discovering that she had more choice and control in all areas of her life, more than she previously imagined. Through the process of learning to moderate, she discovered an additional new space just for her: psychotherapy. She has made the choice to continue even though she is no longer focusing on the question of moderation.

Returning to the writer’s query. The above was a description of how one person learned to moderate her alcohol use. I have worked with an equal number of people who arrived at very different conclusions, some who have ultimately decided to abstain from use. Despite having proceeded in relatively similar fashions, different people discover different answers for themselves. Even further, I have worked with people for whom I recommended abstinence from the beginning of our work together. For those people, it was clear that their use had already caused far too much damage to risk an attempt at moderation. In all cases, however, it is important that the choice is felt to be each person’s own. Over the course of this process, it becomes a discovery, of his or her own choice, but also of his or her own self. And so in this way, people begin to learn a valuable tool that can be applied any and everywhere: how to listen to and trust their own experiences. 

Rebecca Block, Ph.D. is a licensed clinical psychologist working in private practice in New York City. She is the 2016 President of the New York State Psychological Association’s Division on Addictions. Contact her at [email protected] Full bio.

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Rebecca Block, Ph.D. is a licensed clinical psychologist working in private practice in New York City. She is the 2016 President of the New York State Psychological Association’s Division on Addictions. Contact her at [email protected]. You can find her on Linkedin.

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