Rethinking Alcohol: Can Heavy Drinkers Learn To Cut Back?

[steve2470]

http://www.npr.org/blogs/health/2015/03/23/393651417/rethinking-alcohol-can-heavy-drinkers-learn-to-cut-back

The thinking about alcohol dependence used to be black and white. There was a belief that there were two kinds of drinkers: alcoholics and everyone else.

"But that dichotomy — yes or no, you have it or you don't — is inadequate," says Dr. John Mariani, who researches substance abuse at Columbia University. He says that the thinking has evolved, and that the field of psychiatry recognizes there's a spectrum.

Problems with alcohol run the gamut from mild to severe. And there are as many kinds of drinkers along the continuum as there are personality types.

People with severe problems, such as those who keep on drinking even after they lose jobs or get DUIs, need treatment to stop drinking completely.

more at link, simply posting for discussion purposes.

[Trajan]

1. I stopped drinking at age 23 ....

.... because I was over drinking on a regular basis, and 'blacking out' the next morning, unable to recall my drunken escapades ...

I quit entirely for two years ... just straight up quit ... no 12 step - just one step ... quit.

During the two years, I slowly came to a personal revelation - my problem was not really drinking, per se ... my problem was getting and being drunk.

I decided then to adopt a new rule - I could drink, but I could only drink two drinks ... two doses, maximum ...

I didn't matter what type of drink, be it wine, beer or spirits ... I could have one drink, then another, and then I had to stop for the evening ... no more all night ...

I have had the two drink rule for some thirty two years now ... I have violated it twice, and have experienced drunkenness once ....

I like socializing with friends and family, but I hate being drunk .... the two drink rule had served me well ...

[Major Nikon]

5. The vast majority of alcoholics who quit, do so all on their own

Like you, many of them don't quit drinking altogether, they just quit being drunk all the time.

[nomorenomore08]

15. I've seen that myself, having known some pretty heavy drinkers who managed to reduce their alcohol

consumption significantly, and are happier and healthier for it.

[backscatter712]

22. I never got to the point where I got in trouble from drinking...

...but of course, I've been to college, so there have been times in my life where I drank quite a bit.

Since then, I did a similar thing as you did, Trajan. I cut back to a goal of two standard drinks a day, and usually, I meet that goal. So that puts me in that group of people that enjoys a glass of wine with dinner, or a beer after work, but don't let it get out of control.

In my system, I give myself permission to go on a "bender" every few weeks or so, say if I'm invited to a party, or I'm celebrating something. I plan ahead to do it safely, either doing it at home, or having a plan to stay the night with a friend to avoid driving, that sort of thing. When I go on a bender, I let myself have three or four drinks in an evening, and these days, I instinctually pace myself, by eating or drinking water, because I too don't like being completely smashed.

It's something that works for me.

[elleng]

2. Yes, of course 'heavy drinkers' can learn to cut back,

but 'alcoholics' CAN NOT.

Read Under the Influence, by Dr. James Robert Milam: http://www.randomhouse.com/book/114310/under-the-influence-by-james-robert-milam-and-katherine-ketcham

This is not 'rethinking' alcohol, these thoughts have been around for a long time.

[steve2470]

3. yep

If you can't cut back easily, you have a problem aka alcoholism.

[Major Nikon]

6. I don't believe that

I think it's true that alcoholics will have trouble going directly from the need to have alcohol in their system all the time to becoming a casual drinker. This does not mean they can't go through a short period of sobriety and then become a casual drinker.

Between the ages of 18 and 20, over 12% of Americans are alcohol dependent. 5-9 years later this number drops in half. Between the ages of 50 and 54, less than 2% are. The vast majority of those people never seek therapy of any sort and simply quit on their own. Certainly some of those people quit completely and stop using, but I'd have a hard time believing most of them do.


http://pubs.niaaa.nih.gov/publications/AA74/AA74.htm

[elleng]

7. Please read what Dr. Milam has found, about ALCOHOLISM.

ALCOHOLICS differ genetically from the rest of us.

[Major Nikon]

8. I don't really want to spend $8 just to read a 30 yr old opinion

I do know that many in the field of mental health just don't agree and the statistics don't support the idea that alcoholics can't cut back. Certainly alcoholics differ from most, which is true for all addicts. That doesn't mean people can't overcome them. Most simply grow out of it.

It's kind of a shame, but AA drove pretty much all the thinking on alcohol dependence for decades, and it was never based on science and it never demonstrated much, if any efficacy. The book you reference was written at least 30 years ago and a lot has changed in regards to understanding addiction. Alcoholism isn't just one thing. It's a broad spectrum of behavior. Some of them are binge drinkers, some of them need alcohol in their system all the time and to varying degrees. There is no one approach that works for all of them.

[ismnotwasm]

23. Alcoholics have a severe addiction combined with psychological factors

Alcoholics drink themselves to death everyday. Despite treatment, AA, BMT, changing their diet, psychological help, life-threatening illness (I work in transplant). They drop dead all the time. They might even stop for years then drink themselves to death.

Personally, when you have that mindset, I think abstinence is the only option. AA itself recognized the difference between "heavy drinkers" and alcoholics 75 years ago. None of this thinking is new.

One of the most humane social intervention things I've seen lately to come along are "drunk houses" --alcoholics who get in are not required to be sober, just non-violent. They get offered treatment options, community health care clinics, food etc. some of then walk away ok, some of them get booted, some of them die. But they are clothed and warm and have a chance.

[irisblue]

28. what is BMT please? not clear about the term

[ismnotwasm]

32. Behavior modification therapy

Often used for things like personality disorders

http://psychology.about.com/od/typesofpsychotherapy/a/behavioral-therapy.htm

[Major Nikon]

33. Some do, most don't

Some people do need to remain abstinent because they start drinking and can't stop, but not all people who are alcohol dependent will remain so, and most of those will turn into casual drinkers at some point. Alcoholism is not always a lifelong affliction the way AA makes it out to be. In fact, the cases where it is are the exception, not the rule.

[ismnotwasm]

36. We are talking about different conditions I think

But that's ok

[elleng]

37. 'ALCOHOLISM' IS always a lifelong affliction.

As I suggested earlier, read about it from Dr. James Milam.

http://www.lakesidemilam.com/alcohol-drug-addiction/dr-milams-position-papers/

ALCOHOLISM is a genetic condition, and differs from situations of 'casual drinkers.'

[ND-Dem]

40. Has someone identified the "alcoholic" gene" yet? Is it related the "drug addict" gene?

[Major Nikon]

43. Both of those claims just aren't that solid

The claim of a genetic predisposition to alcoholism is specious. Even if you believe it, not everyone who has such a marker becomes an alcoholic and not all alcoholics have it. The researcher who conducted the study that supposedly proved a genetic predisposition to alcoholism also markets supplements to treat it.
http://neurogenesis.com/company/neurogenesis/

Subsequent research casts serious doubt on his theory.
http://www.ncbi.nlm.nih.gov/pubmed/8095994

There isn't even a consensus whether alcoholism is actually a disease. The AMA curiously classifies it both as a psychiatric and medical condition, but I don't think many doctors consider it incurable, even if they believe it's a disease, and many don't. So despite your source, not all doctors buy into the completely unscientific AA mantra about alcoholism.
http://en.wikipedia.org/wiki/Disease_theory_of_alcoholism#Criticism

[elleng]

44. For those interested in facts:

Disease of Addiction: An Expanded Overview

Since 1956, alcoholism has been considered a primary disease by the American Medical Association. It has only been recently, however, that research has discovered the etiology of the disease of alcoholism and other drug addiction. Through animal studies as well as imaging studies of humans, scientists have concluded that addiction is a disease of the brain. The part of the brain that malfunctions is the mesolimbic dopamine system, the seat of reward system that reacts to pain and pleasure. More specifically the neurotransmission system is hijacked permanently by alcohol and psychoactive drugs. At some point in the addict’s drinking/using life a metaphorical switch is thrown that causes the flooding or depletion of neurochemicals, foremost of which is dopamine. At this point the addict has lost all voluntary control of alcohol/drug consumption and drinks/uses drugs simply to feel “normal”. The biological need for drugs leads, inevitably, to damage the rest of the addict’s life.

http://www.lakesidemilam.com/alcohol-drug-addiction/under-the-influence/disease-of-addiction-an-expanded-overview/

(The Blum guy appears spurious. I've never heard of him, fwiw, and surely haven't heard of his 'supplements. I doubt that there is ONE 'researcher' conducting studies proving genetic predisposition.)

'Briefly, the psychogenic model is based on the nearly universal belief that alcoholism is a symptom or consequence of an underlying character defect, a self-destructive response to psychological and social problems, a learned behavior. The biogenic model recognizes that alcoholism is a primary addictive response to alcohol in a biologically susceptible drinker, regardless of character and personality, or of cultural or psychosocial influences.

Overshadowed by the multitude of researchers who were busy confirming that the psychogenic paradigm is devoid of any legitimate data base, many others were quietly compiling a massive amount of empirical evidence that alcoholism is a primary, biogenic disorder. As all longitudinal studies have verified, all of the psychopathology of alcoholism, as alcoholism, is of neuropsychological origin. However, this fact is disguised because alcoholism is never diagnosed until after character and personality are distorted and normal emotions are neurologically augmented to abnormal levels of chronic anguish, fear, resentment, guilt, and depression. It is these distortions that clinically identify alcoholism, not the original character and personality. The earlier effects of trauma or abuse, or of being raised in a dysfunctional alcoholic family, are complications—but not contributing causes—of alcoholism. Most often alcoholism is hereditary, but many individuals become chronic alcoholics through cross-addiction to other drugs (prescription or illicit) or as the result of other brain or liver insults.'

http://www.lakesidemilam.com/alcohol-drug-addiction/dr-milams-position-papers/more-on-the-alcoholism-revolution/

[Major Nikon]

45. Those aren't facts, they are opinions

[elleng]

38. Alcoholics do not have 'psychological factors.'

That is a fallacy.

'Ten of millions Americans suffer from alcoholism, yet most people still wrongly believe that alcoholism is a psychological or moral problem, and that it can be cured by psychotherapy or sheer will power. Based on groundbreaking scientific research, Under The Influence examine the physical factors that set alcoholics and non-alcoholics apart, and suggests a bold, stigma-free way of understanding and treating the alcoholic.'

http://www.randomhouse.com/book/114310/under-the-influence-by-james-robert-milam-and-katherine-ketcham

Abstinence IS the only option.

[Aerows]

9. They differ in physiology

as do people that are addicted to cocaine, meth, opiates or any other substance. Their physiology changes to adapt to their addiction, but that doesn't mean that addiction cannot be broken by a radical change of physiology.

Ignoring research that certain vitamins, physical exercise and other factors contribute to aiding in addiction recovery is fool hardy. Anyone addicted to anything needs to have a reality check that includes counseling, but none of it needs to be white knuckled "one size fits all" guidance out of the path of ruin.

There are things that make getting off a substance easier, and it behooves those that are dedicated to doing so to examine all of their options.

One size does not fit all.

[BrotherIvan]

13. Very much agree

A few co-workers have had remarkable success for alcohol and drugs at a treatment center using amino acids as part of their program. Because they are the precursors to things like seratonin, they actually give your body what it is looking for--and the cause of why you would turn to the substance. They even know instantly what your amino acid deficiency is by what you are addicted to. Years of drug counseling didn't take and then bam, two months of cheap aminos and it was like the craving was entirely gone.

[Skittles]

10. agreed

[elleng]

11. Glad to hear SOMEone agrees!

(Trying not to make a fuss, around this 'controversial' subject, but have to get the facts out.)

[Skittles]

12. I do agree there can be a difference between problem drinkers and alcoholics

but alcoholics must not drink - period

[elleng]

14. Exactly, and that's difficult for many to accept.

Thanks

[ismnotwasm]

26. I agree

There is, apparently, a misunderstanding gong here here on what being an "alcoholic" entails.

[elleng]

29. Yes indeed,

and some, when encouraged to read early and solid evidence on the subject, can't trouble themselves with such.

'Ten of millions Americans suffer from alcoholism, yet most people still wrongly believe that alcoholism is a psychological or moral problem, and that it can be cured by psychotherapy or sheer will power. Based on groundbreaking scientific research, Under The Influence examine the physical factors that set alcoholics and non-alcoholics apart, and suggests a bold, stigma-free way of understanding and treating the alcoholic.'

http://www.randomhouse.com/book/114310/under-the-influence-by-james-robert-milam-and-katherine-ketcham

http://www.lakesidemilam.com/alcohol-drug-addiction/dr-milams-position-papers/

In “The Alcoholism Revolution”, Dr. Milam introduces his biogenic paradigm—a treatment model which “recognizes that alcoholism is a primary addictive response to alcohol in a biologically susceptible drinker, regardless of character and personality.”

In “More On The Alcoholism Revolution”, Dr. Milam expands on his earlier work, exposing the inadequacies of the predominant “psychogenic” treatment model.

In “Drug-Crime Epidemic”, Dr. Milam addresses the link between dubious alcoholism treatments and this nation’s devastating rise in crime and violence.

Dr. Milam’s papers currently influence how treatment professionals, law enforcement, and legislators approach the disease of addiction.

[FarPoint]

30. I agree with you...

Last edited Mon Mar 30, 2015, 07:27 AM - Edit history (1)

There is a clinical difference.. A Churchill, heavy drinker verses an alcoholic with the disease of alcoholism... The later can not take one drink...The saying goes, One is too many and 1,000 is not enough.

[elleng]

31. Yes. Thanks.

For those who want to inform themselves:

http://www.lakesidemilam.com/alcohol-drug-addiction/dr-milams-position-papers/

In “The Alcoholism Revolution”, Dr. Milam introduces his biogenic paradigm—a treatment model which “recognizes that alcoholism is a primary addictive response to alcohol in a biologically susceptible drinker, regardless of character and personality.”

In “More On The Alcoholism Revolution”, Dr. Milam expands on his earlier work, exposing the inadequacies of the predominant “psychogenic” treatment model.

In “Drug-Crime Epidemic”, Dr. Milam addresses the link between dubious alcoholism treatments and this nation’s devastating rise in crime and violence.

Dr. Milam’s papers currently influence how treatment professionals, law enforcement, and legislators approach the disease of addiction.

[phil89]

46. Absolute nonsense. Alcoholics can and do cut back.

Please stop peddling this utter garbage and research some actual cases, and some peer reviewed research.

[Egnever]

4. I drank heavily as a young man

All the way into my early 30's.then all of a sudden I just didn't feel like drinking any more. I still drink once in a while in social situations but beer or wine will sit in my fridge untouched for months.

Don't know why it all of a sudden just became something I didn't want to do any more, it just did.

[nomorenomore08]

16. Seems as if you, perhaps, were psychologically, but not physically, addicted.

That's just my speculation though.

[ND-Dem]

41. or maybe he just found better things to do. or maybe his friends moved on and he did too.

maybe it didn't have anything to do with "addiction" at all.

[backscatter712]

27. A lot of times, alcohol addiction (or other addictions) are a response to stress.

Remember that infamous experiment where lab rats were offered a choice between cocaine water and plain water, and the rats took the cocaine water until they died? Here's the thing - they were in spartan cages, and pretty stressed out. Other researchers repeated the experiment, but this time, put the rats in a bigger enclosure, let them socialize with each other, gave them lots of toys to play with, so they were happier rats. This time, the rats usually passed on the cocaine water, or took smaller amounts, and didn't kill themselves for it.

The same thing was observed with returning soldiers from the Vietnam War. Many of them were shooting up heroin while they were in Vietnam, to deal with the stresses of war. There were widespread fears that they would become an army of junkies when they returned. A few of them did become junkies, the ones that had no good support systems. But most of them had families to come home to, loved ones that gave them support, and when these soldiers came home, they stopped the heroin. They weren't in that hellish war environment anymore, so they didn't need rehab or Narcotics Anonymous. They just stopped taking the heroin. And this is fucking heroin, which is supposed to be impossible to quit.

It may be that you were in a stressful life situation, and then when something changed, or you found other ways of dealing with the stress, you no longer felt the need to drink.

[Egnever]

39. That is entirely possible

My childhood and young adult life was quite a mess. I credit my wife with saving my life and oddly enough I met her when I was 30, I stopped drinking a bout the time we got married. Had nothing to do with her wanting me to quit as she never had any problem with it. I can totally see her calming steady influence lowering my overall stress level.

[nomorenomore08]

17. As stated in the OP, alcohol dependency varies a great deal in its nature and severity.

There's also a difference between psychological (cravings) and physical (delirium tremens etc.) addiction.

I don't doubt that for many people, especially the most severe cases, the ultimate (and perhaps only) solution is total abstinence. But otherwise, there's a huge amount of gray area involved, and people need to find what works for them as individuals. And IMO the all-or-nothing approach of AA and similar programs may turn off some folks who might otherwise be helped. I myself have known several people who managed to cut down substantially on their problematic drinking without quitting entirely.

Actually, to get personal for a moment, I'm currently on Suboxone for opiate addiction, and while I've been clean off of all opiates for going on two years, I do still drink moderately and smoke weed. Certainly the all-or-nothing approach to substance use wasn't for me, and luckily I have an understanding doctor.

[ismnotwasm]

19. I use abstinence

For a lot of years now, but I don't preach abstinence--if you know what I mean. Its a correct healthy choice for some people, for others-- not so much.

[nomorenomore08]

21. Like I said, everyone should do what works for them.

[ismnotwasm]

24. Yup!

[ismnotwasm]

18. I've met many people able to quit on their own

I've seen no few buried who seemed unable to. I've always known there was a spectrum, and I'm a little surprised that anybody thought there wasn't one.

[backscatter712]

20. My view may be unpopular with some: I am not a fan of Alcoholics Anonymous.

It's a stepchild of the Temperance Movement, with a lot of puritanical baggage. Here we are in the 21st century, treating substance abuse with techniques from the 1930's. You can see its puritanical roots in the demands to submit to a higher power, and to commit to absolute abstinence.

The first big problem I have with AA is that it doesn't work. It has a success rate of 5-10 percent, which is horrible.

What's worse is that if you're one of the 90-95% of people that don't succeed in beating their substance abuse problem with AA is that AA isn't what's considered to be the failure, even though it should. AA doesn't fail you, you fail AA. Kind of like Republican ideology. This attitude has millions of people with alcohol abuse issues banging their heads against the wall, when they should be trying other options. AA is very cultish, and relies on that 5-10% that do manage to beat their addiction to go out and proselytize for the AA cult. This is why AA is such a fixture in American society despite its miserable success rate.

Give me other treatment options. There's medications like Naltrexone, which has a 78% success rate in getting people to stop drinking or moderate their drinking. There's psychotherapy. There's all sorts of options that are based on modern science instead of outmoded puritanical nonsense. See some of the theories on addiction from Gabor Mate.

And the funny thing about modern addiction treatment science: yes, it is indeed possible to get people to moderate alcohol use, so you don't always have to demand that a problem drinker swear off all booze for life. In fact, demands for absolute abstinence are often counterproductive.

An interesting article on Salon:

http://www.salon.com/2014/03/23/the_pseudo_science_of_alcoholics_anonymous_theres_a_better_way_to_treat_addiction/

[nomorenomore08]

25. I agree with a lot of what you say. AA may help some, but it does seem outdated and unscientific IMO

"What's worse is that if you're one of the 90-95% of people that don't succeed in beating their substance abuse problem with AA is that AA isn't what's considered to be the failure, even though it should. AA doesn't fail you, you fail AA."

Another symptom of their all-or-nothing ideology, I suppose.

[Ghost in the Machine]

34. I was drinking before I was in my teens, but started the heavy drinking after I turned 18...

I quit in 1996 and at that time I was drinking a fifth of Jim Beam and a 24 pack of beer a day... and that was just a normal day! We has cases and kegs and multiple bottles of different liquors when we partied, which was every weekend from Friday after work until Sunday evening. I quit cold turkey October 1st 1996 and never had to go to rehab and didn't even have cravings or withdrawals.

In 1992, I quit a $1000/day cocaine habit cold turkey also with the same results... no rehab, no cravings or withdrawals, just the will and desire to quit.

The only time I had withdrawals was from opioids after being in pain management for a little over 4 years. I was on 6 oxycodone 30's per day for 2 1/2 years until I built up a tolerance to them, then got put on 2 40mg oxymorphones (generic opana) per day, with 2 oxy 30's for breakthrough pain. When they started to become ineffective, I just quit going to pain mannagement. Before the first 24 hours was up after I took my last pill I started getting sick to my stomach and getting the runs. By the second day I was having hot and cold flashes, couldn't sleep and my body was wracked with pain. A friend brought me a bag of pot and told me to smoke a joint and it would help. Before I even finished the first joint, I could actually feel the cells in my brain changing, then it went down my body in a wave. I felt better immediately and could not believe it! I had noticed a change in my personality after the 2nd or 3rd month of being on the oxy 30's, and after that first joint I felt like my old self again for the first time in over 4 years. Of course that was just *MY* experience, but I would recommed it to anyone dealing with an opioid addiction who doesn't want to go the Suboxone or Methadone route. I'm no doctor, so this isn't to be considered medical advice, it's just something that worked for me.

Come to think of it, I was also smoking weed when I quit the cocaine and when I quit drinking too!

Peace,

Ghost

[fizzgig]

35. my heavy drinking was self medication

before i had the proper dx and treatment, dinner was a fifth and most of a 12 pack. i haven't stopped drinking, but i no longer feel the urge to drink to the point of oblivion every night. a 12 pack lasts me a week rather than a night and there's been tequila sitting on the counter, untouched, for two weeks.

i think it is good to recognize that this is not a black and white issue, but we also need to recognize and respect the paths people follow when dealing with this issue.

[RedCappedBandit]

42. It's very convenient, you see

if you can 'cut back', you can't possibly be an alcoholic. Therefore, alcoholics CAN NOT EVER cut back!