Cold Turkey Isn’t the Only RouteBy GABRIELLE GLASER
Published: January 1, 2014 in the New York Times
This New Year’s, a good number of those who struggle to control their drinking will resolve to abstain from alcohol. No halfway measures. Quitting is the only way.
The cold-turkey approach is deeply rooted in the United States, embraced by doctors, the multibillion-dollar treatment industry and popular culture. For nearly 80 years, our approach to drinking problems has been inspired by the 12 steps of Alcoholics Anonymous.
Developed in the 1930s by men who were “chronic inebriates,” the A.A. program offers a single path to recovery: abstinence, surrendering one’s ego and accepting one’s “powerlessness” over alcohol.
But it’s not the only way to change your drinking habits.
Bankole Johnson, an alcohol researcher and consultant to pharmaceutical companies who is also the chairman of the Department of Psychiatry at the University of Maryland School of Medicine, puts it this way: “We are wedded to the abstinence model as the goal, despite evidence that there can be many successful outcomes.”
Because of the promise of anonymity, A.A. doesn’t track its members or conduct research. Some studies have found that many members find support for healthier habits from a like-minded group of nondrinkers. But a systematic review found “no conclusive evidence to show that A.A. can help patients to achieve abstinence.”
Research shows that many problem drinkers — those who repeatedly drink more than they intend, sometimes have physical or psychological consequences from overdrinking, and may have difficulty controlling themselves — could benefit from brief interventions and practical advice about how to set better limits and change their drinking by cutting back.
Women increasingly need help, as their drinking has escalated. Women are being stopped more for drunken driving than they were two decades ago. They’re also the biggest consumers of wine, buying the larger share of the 856 million gallons sold in the United States in 2012. These women are drinking partly because alcohol is a socially respectable way to slog through the smartphone-tethered universe of managing demanding careers, aging parents, kids’ activities and relationships at once. And while it’s not healthy to pour yourself a third or fourth glass every night, it doesn’t mean you’re powerless to do anything about it.
Elsewhere in the developed world, doctors treat drinking problems with evidence-based tools that best match the client’s needs. Many are prescribed drugs such as naltrexone, an opioid antagonist approved by the Food and Drug Administration in 1994 to treat alcohol use disorders. It blocks the signals released when consuming alcohol.
American doctors typically prescribe drugs with the goal of abstinence. Yet in Finland, the American psychologist John David Sinclair pioneered a radically different protocol for naltrexone: he instructs patients to take the drug — which is available generically — an hour before drinking. Mr. Sinclair calls his method “pharmacological extinction.”
When people drink while taking naltrexone, the drug blocks the rewards produced by drinking and the cravings diminish. In published research, Mr. Sinclair has claimed a 78 percent success rate in reducing drinking. A drug similar to naltrexone, nalmefene, was recently approved in Europe to help heavy drinkers moderate their habits.
In reporting my book on women and drinking, I found that many women were successful in changing their drinking habits by using Moderation Management, a free nonprofit support group for nondependent problem drinkers who want to control their consumption. Using the techniques of cognitive behavioral therapy, M.M. encourages members to take “personal responsibility for choosing and maintaining their own path, whether moderation or abstinence.” It instructs drinkers to abstain for 30 days, reintroduce alcohol while evaluating the effects of drinking, and then stick within limits (for women, that’s nine drinks a week, no more than three on any day).
This approach isn’t for severely dependent drinkers, for whom abstinence might be best. But it’s been empirically shown to work for those on the more moderate end of the spectrum who outnumber dependent drinkers by about four to one — including the majority of women who drink too much. While the ratio of men to women in A.A. is roughly 2:1, that figure is reversed among users of an evidence-based Internet application at moderatedrinking.com. The website helps drinkers set limits, self-monitor while they’re drinking, get feedback on their progress and identify and manage triggers to overdrinking. Reid K. Hester, director of research at Behavior Therapy Associates, which designed the program, says heavy drinkers are more likely to be honest about their consumption when they know they won’t be reproached.
Few master these skills overnight, Mr. Hester says, but most learn healthier habits within six months. And mistakes can be lessons, not failures.
We don’t treat cancer, depression or asthma with the same tools we used in 1935. We need to get away from the one-size-fits-all approach to drinking problems.
Gabrielle Glaser is the author, most recently, of “Her Best-Kept Secret: Why Women Drink — and How They Can Regain Control.”