Some people know when they are drinking too much. They feel it in their bodies or notice alcohol is starting to affect their work and personal lives. Having that level of awareness is very fortunate because it is easier to turn things around, before life spins out of control.
This is where “low-level interventions” can be helpful. Most people try cutting back or quitting on their own before committing time and money to rehab. Research shows that low-intensity interventions can be highly effective in reducing the risk of alcohol-related disease by getting people to drink more moderately or stop drinking completely. Methods range from self-motivated interventions such as “dry challenges” to those administered at the primary care or public health level. Here are six approaches that can help identify or combat drinking problems at early stages:
1. Education and awareness. The journey of healing begins with understanding that there is a problem. There are many ways to become educated, including books, articles and documentaries on the topic. One of the most historically popular ways people have gotten help is through Alcoholics Anonymous. Being in the room with others sharing stories about how drinking impacted their lives can help people identify where they are on the spectrum between social drinking and alcohol abuse. It is also a place to find support and guidance on next steps.
2. Mindfulness techniques. Research has shown that mindfulness helps with anxiety, depression and stress, and it has been successful as a lower level intervention in addiction recovery. It is low or no cost and can be done without a therapist so learning these techniques ― widely available in workshops, manuals and books ― can be useful to anyone trying to quit or cut down on drinking.
Two cornerstones of mindfulness are learning to stay present in the moment and developing a new skill set for dealing with unpleasant feelings. Rather than trying to soothe uncomfortable feelings with alcohol, mindfulness encourages the use of specific techniques such as breathing, visualization and meditation.
3. Motivational interviewing. Outside of therapy or drug rehab settings, this is often a single session intervention offered by primary care physicians, nurse practitioners and EMS professionals. People who are seen in an emergency room after a motor vehicle accident and are evaluated for alcohol use, for example, may be helped by brief interviewing combined with motivational interviewing. Research shows it has significant mitigation in people who binge drink. This approach includes several steps, including empathetic listening to a client’s experience, paying attention to the way they communicate, working with client resistance, negotiating a new approach to the problem and consolidating their commitment to making change.
4. Screening, Brief Intervention, Referral, and Treatment (SBIRT). Research shows this approach can reduce alcohol use when offered in medical settings. Medical schools are now training doctors in emergency medicine and other specialties on how to intervene by screening for alcohol problems, offering a brief intervention as well as brief treatment, and then giving a referral to specialty treatment.
Here’s how it works: A healthcare professional assesses a patient for substance abuse. A brief conversation with the patient follows. If needed based on the first two steps, the patient is referred for therapy or drug rehab where they can receive further screening and help. As an example of SBIRT, the Los Angeles Fire Department recently launched an experimental Sober Unit to help the homeless and keep them out of emergency rooms, bringing them instead to a Sobering Center. SBIRT is applicable for all substance use but seems to have significant benefits for alcohol.
5. Diversion programs. The majority of people arrested for driving under the influence are not alcoholics, but participating in mandated alcohol diversion programs has been shown to significantly mitigate the risk of driving drunk again. Many states and cities have implemented this approach, especially with first-time offenders, in an attempt to curb further alcohol use. They often require people to attend a class in which alcohol problems, poisoning and related accidents and deaths are discussed and slides of accidents are shown to deter participants from driving under the influence. There is usually a fine or payment involved and participants write a reflective paper on what they learned. Community service is also a component. Diversion programs have proven effective with many populations, from college students to health professionals to prison inmates.
6. Sobriety challenges. Some people are drawn to the idea of voluntarily abstaining from alcohol for a certain amount of time. The idea is if you can get people to stop drinking for a set time, it may help them minimize drinking and improve their health long term. If they cannot stop drinking for a short period of time, the challenge encourages people to take an honest look at their alcohol use and get help. In one “Dry January Challenge,” which is gaining popularity among resolution makers who want to start the year out healthier, participants were given audit tests that showed they consumed fewer drinks months later. Keep in mind alcohol craving gets worse over time so additional support may be needed, such as support group meetings or alcoholism treatment.
Some people wake up one day and know they’ve had enough. But more commonly, it is an accident, illness, job loss, divorce or arrest that acts as an intervention. When alcohol use is more severe, several approaches may be needed to break through the person’s denial. A formal intervention by a trained specialist can sometimes help families overcome this hurdle.
Alcoholism destroys lives and families. It is a progressive disease and if not treated early enough, it requires professional intervention and treatment. While the year is new and the slate is clean, low-level intervention offers a useful starting point for those who can see that their drinking is starting to spiral out of control.