Maintaining Healthy

Social Drinking Patterns

by Anthony R. Ciminero, Ph.D., author of the iCope Book Series

From the book:

iCope: Alternatives to A 12-Step Program: A Path To Recovery

Alcohol is one of the most commonly used substances in our society. For 85-90% of adults, some alcohol use poses no serious problems. However, there is a point where drinking alcohol increases to the point where it crosses the line from appropriate use to a pattern of alcohol abuse or even the more serious problem of alcoholism. In its worst form, alcoholism escalates to the point that has the individual physically and psychologically dependent on alcohol. This, of course, not only causes serious medical problems, but also has devastating effects on relationships, marriage, and job or school performance.

Several questions arise for those who think they may have a developing problem. Why is alcohol so popular? Who is at risk for alcohol problems? Who should be concerned? What are my options for dealing with a potential alcohol problem?

WHY DO PEOPLE DRINK?

Research has shown that there are several reasons that so many of us drink alcohol. It is easy to put these factors into three general categories. First, people drink because alcohol in limited amounts produces pleasant physical and emotional reactions. Often we will feel some relaxation or tension relief with alcohol. Second, people like to drink with others to celebrate social occasions. Whether it is happy hour, a wedding, or dinner, many individuals will report that they enjoy themselves more in these social situations if they have a drink or two. A third factor that helps explain why people drink is that alcohol seems to have some “disinhibiting” effects. In other words, we can behave in certain ways more easily when we are under the influence. Sometimes, it is easier to express your feelings, overcome social anxiety, act sexier, or vent your frustrations. Obviously, all three factors can play a role in any individual’s drinking pattern.

WHO IS AT RISK FOR ABUSE?

Genetics, your drinking history, your social network, and the current level of stress in your life can all put you at higher risk of abusing alcohol. All of these can combine to increase your risk of having a problem with alcohol. Genetic factors, or our tendency to inherit a predisposition to alcoholism, play a major role in our risk (see Supplement E). If you have a parent or grandparent with a history of alcohol abuse, then you might be at greater risk. If you have more than one close family member with an alcohol problem, then you are at an even greater risk. Second, you will be at higher risk as an adult if you had a history of frequent alcohol intoxication as a teenager. The younger you were when you first started drinking to the point of intoxication, the greater the risk. This does not mean that adolescents who have some limited alcohol use or only drink on special occasions (religious ceremonies, holidays, or special meals with their family), will be at higher risk later in life.

The network of friends who you socialize regularly with can also influence your tendency to abuse alcohol. If you have a group of “drinking buddies” who drink to excess, then you will be more likely to abuse alcohol when in their company. If you are in a significant relationship and your partner also drinks excessively, this clearly would put you at greater risk. If your friends and family drink in moderation and frown on intoxication, this will tend to minimize your chances of abusing alcohol with them.

A final factor that can increase your risk is your overall level of stress in your life. Because alcohol does relax us biologically, some individuals will drink almost as a form of self-medication to reduce their stress level or help them fall asleep at night. Clearly drinking alcohol can help us cope temporarily with high stress. The problem with using alcohol to cope is that greater alcohol use can lead to depression, as well as many other negative consequences in relationships, careers, and health. If there is a sudden increase in your life stress due to significant events, you could be at higher risk of abusing alcohol at those times.

WHEN SHOULD I BE CONCERNED?

If you are drinking too much alcohol too often, then you need to take a closer look at your alcohol use. We will soon talk about what is too much. Before that, there are some clear signs that drinking is becoming a problem. These high-risk factors include:

If friends, family, co-workers, or supervisors tell you that they see a problem in your alcohol use.
If drinking caused problems at work or at home.
If drinking caused a legal problem or a job loss.
If your drinking has become unpredictable or leads to aggressive behavior.
If your drinking recently caused any medical problems, including passing out or vomiting.
If you have had “blackouts” where you did not always know what you were doing under the influence of alcohol.
If drinking leads to poor judgment or puts you in risky situations such as driving under the influence.
If you cannot stop drinking after a few drinks even though you want to stop.
If you have been drinking so heavily over an extended time that you feel physical distress (i.e., a withdrawal syndrome) when you stop drinking for a day or two.
If you cannot stop drinking for several days in a row.

If you have some of these problems associated with your drinking, then you most likely need to do something significant to deal with a potential alcohol problem. If several of these are true for you, abstinence could be more appropriate as a treatment goal even if it is not through a 12-Step Program.

IS ANY DRINKING SAFE FOR ANYONE WITH THESE WARNING SIGNS?

It has been a controversial for the past 40-50 years whether anyone who has had a serious drinking problem could learn to drink alcohol in moderation. The debate started when a major study called the Rand Report (1971) found in a large study of multiple alcohol treatment centers that 22% of the alcoholics maintained a low to moderate use of alcohol in an 18-month follow-up. This implied that some individuals could actually drink in a controlled manner without returning to their previous alcoholic pattern. This was a very upsetting notion because it was contrary to the standard belief that all alcoholics must abstain from alcohol permanently.

Various researchers including Drs. Mark and Linda Sobbel, and Dr. Alan Marlatt began to report that certain training programs could help alcoholics learn to drink in responsible ways. Later, books on Moderation Management (1995) were published that were antithetical to the rigid stance of AA. Like most treatment programs, this option of light to moderate drinking was clearly not for every alcoholic. There was some suggestion that truly alcoholic individuals with heavy alcohol use that progressed to physical addiction would not be good candidates for any kind of controlled drinking effort. However, this was not fully supported by later research implying that many more people with drinking problems could become social drinkers. It was feared that if controlled social drinking was known to be an option, no alcoholic would strive for abstinence from alcohol.

A serious decision must be made by each individual whether controlled drinking is something that should even be considered. For those who have maintained a long-term abstinence from alcohol, it could be quite risky to test whether they were able to start drinking again in some responsible way. Similarly, if someone has had a long-term physical addiction to alcohol, success might be more likely with total abstinence from alcohol.

Controlled drinking might be more feasible for those who have not been physically addicted to alcohol or have had short term bouts of problem drinking and are unsure whether they want to commit to a goal of total abstinence. The following information will give you an idea of what this type of drinking pattern would be like. However, if you are serious about trying this, it is recommended that in addition to the material in this chapter that you read one of the books devoted to learning how to drink in a controlled fashion such as Miller and Munoz (2013) or Anderson, et al. (2010). Also, check the recommendations at www.moderation.org for very specific guidelines and resources. One popular recommendation is to do your own self-assessment by being abstinent from alcohol for a full 30 days prior to trying to do any type of controlled drinking. If you cannot be abstinent for 30 days you are not as likely to be successful with controlled drinking.

WHAT IS AN EXAMPLE OF SAFE DRINKING?

Safe or controlled drinking is sometimes difficult to define. At the basic level, safe drinking is usually mild enough that it does not cause any social, family, work, health, or legal problems. If you drink heavily, but this has not caused any of these problems yet, you could still be at risk for future problems. It is also a problem when your drinking has become unpredictable where you sometimes lose control and do not stop drinking even though that is what you had planned to do. If someone is a problematic drinker, a binge drinker, or someone who abuses alcohol only under certain circumstances, the guidelines below are suggestions to help prevent any difficulties due to alcohol. However, as indicated above, you want to be abstinent for 30 days prior to doing this experiment to see whether you can maintain a healthy drinking pattern. Some general guidelines include:

Drinking one drink a day might not by itself pose a problem for many people. A drink can be a 12-ounce beer, a six-ounce glass of wine, or 1.5 ounces of hard liquor preferably in a mixed drink. It is when there are multiple drinks on a daily basis where you have to be more concerned. If you drink more than two drinks a day, you could be at risk. Current guidelines suggest that men drink no more than 14 drinks per week and women 7 drinks per week. These are general guidelines, so they will be a bit more limited for those who have a history of any problematic drinking so 12 drinks per week for men would be safer.
To be safe, men should not drink more than 4 drinks or women 3 drinks in any drinking occasion, always avoiding becoming intoxicated in any drinking situation.
You should never drink to the point that you pass out, vomit, or have a “blackout” which is a loss of memory for what happened while you were drinking heavily. These are serious signs that your body/brain cannot process that much alcohol.
Drinking too much beer or wine can still be a problem, but drinking strait hard liquor such as vodka, whisky, rum, tequila, or gin is even more risky. Avoid hard liquor unless it is in a mixed drink.
Avoid drinking any alcohol rapidly.

In addition to the above guideline, the following specific recommendations might help if you are drinking too much or too often, but honestly do not have many of the high-risk factors that suggest you are an alcoholic problem that requires abstinence.

Limit yourself to no more than 7-12 alcoholic drinks per week for women and men respectively.
If you drink regularly throughout the week, once or twice a month pick at least 2-3 consecutive days per week when you do not drink any alcohol. This should be easy if you do not have a drinking problem. If this is difficult or you get irritable or “shaky” without alcohol for a day or two, then you have to begin gradually decreasing your overall alcohol use. Check with your physician if you find that the withdrawal from alcohol is physically difficult.
Test yourself occasionally to see if you can easily go 4-5 consecutive days without any alcohol. Again, this should be relatively easy to do if you are not dependent on alcohol. Try this once per month.
If you do not drink regularly throughout the week, but prefer to have a few drinks on the days when you do socialize with alcohol, keep yourself to the 7-12 drinks per week limit indicated above. Again, men should never drink more than four drinks per day, three for women. Also, do not drink your limit in a short period of less than three hours which will keep your blood alcohol level at a safer range.
To keep yourself honest, keep a diary of how much you drink each week. You can mark this on a calendar or simply record how many drinks you have each day on a blank 3×5 card. If it helps keep you honest, moderation.org has a self-monitoring system on their site for retaining longer term records. Remember, no more than 3-4 drinks per day, and no more than the 7-12 drinks per week.

If you cannot keep your social drinking to these limits, or you still go on “binges” where you get intoxicated or physically sick from drinking, then you have a more serious problem. In cases of serious alcohol abuse or alcoholism, you are most likely going to have to stop drinking completely. To do this, you may need to look at more specialized treatment for your alcohol abuse or see a therapist to help you assess what other factors might be contributing to your drinking problem. Research is showing that there are successful psychological approaches such as cognitive behavior therapy (CBT) that can help overcome other issues such as anxiety or depression that contribute to an alcohol problem. If you are physically dependent on alcohol, you might need to see a doctor to help “detox” you safely from the alcohol. There also are some medications like disulfiram (Antabuse) that will make you sick if you drink alcohol and indirectly help you stay abstinent if that is your goal. Other medications (e.g., Naltrexone) that help minimize urges to drink can also be used if necessary.

In summary, there are many individuals with alcohol related problems who could learn how to drink responsibly and not have their drinking escalate to alcoholic proportions. However, this is not for everyone. If you are successfully abstinent, then staying that way might be beneficial for other reasons (i.e., your marriage, career, health, etc.) even if there is a chance you could learn to control your drinking. If you know you have an significant alcohol problem but are not ready for the 12-Step abstinence approach, be proactive and try one of the controlled drinking strategies in the books by Miller and Munoz (2013), Anderson et al. (2010), or Moderation Management by Kishline (1995). However, if you return to problematic drinking, then you will have to limit how many failed attempts at controlled drinking you will allow yourself before committing to abstinence as your treatment goal. If you have had some concerns about your drinking and have never made any serious attempt at changing your drinking pattern, then a trial or two at controlled drinking could be a good alternative to see if this is sufficient for your situation. If you are confused about whether this is even an option, consult with a professional who has experience treating addictions.