Can Problem Drinkers Cut Back?
Absolutely, they can and do. But abstinence may be the better goal.
Posted Sep 06, 2020
Once my partner and I took a stunning walk along a peninsula while on vacation. Mid-afternoon, after hours of walking, we had reached the scenic highlight, surrounded on three sides by ocean. I was thrilled, but his mood fell. “What’s wrong?” I asked. “We don’t have a reservation for dinner,” he said. This was in the era before cell phones. “Oh we’ll find something to eat,” I said. “Isn’t it beautiful here?” He said, “I’m going back now.” We had been there at most 10 minutes. “Why?” “We don’t have a reservation for dinner,” he repeated.
As he walked away from me I began to shout but he kept going. I knew he couldn’t enjoy my company and the beauty of the spot because he was worried about how he’d get his next drink. It was Sunday, so liquor shops were closed. A restaurant with a liquor license was essential.
I let him walk away. It was hours later when we found each other again in our hotel room and I called him an “alcoholic.”
The word “alcoholic” is important because it suggests that you need treatment and, most people think, that you need to stop drinking entirely.
Are you an alcoholic? More than a quarter of U.S. adults report that they drank more than four or five drinks within about two hours in the past month--but less than 7 percent say they did this on five or more days. Let’s say you’re in the 7 percent and drink this much every Friday and Saturday night. Now let’s say it’s causing problems at your job and in your marriage. Alcoholic or not, you have an issue. You're a problem drinker, at least. Many problem drinkers are resistant to help or the idea of abstinence but are open to the idea of cutting back.
If you attend an Alcoholics Anonymous (AA) meeting and say you’d rather cut back than go sober, the answer you’ll probably hear is, “It won’t work for long.” To quote a 2018 AA pamphlet, “If you are an alcoholic, you will never be able to control your drinking for any length of time. That leaves two paths open: to let your drinking become worse and worse with all the damaging results that follow, or to quit completely and to develop a new pattern of sober, constructive living.”
So how do you know if you’re an alcoholic? The same AA pamphlet declares, “There is no such thing as being a little bit alcoholic. Either you are, or you are not. And only the individual involved can say whether or not alcohol has become an unmanageable problem.”
Do heavy drinkers cut back? Absolutely. Most heavy drinkers cut back even without treatment.
One study using data from a large, general population sample of more than 22,000 U.S. adults who drank found 512 very heavy drinkers: The men consumed more than 7 drinks a day on average and the women four. Three years later, 26 percent were still at it, but 66 percent had cut back, although only 7 percent had become abstinent. The numbers were similar for another 1600 people with a milder drinking issue: 60 percent or more had cut back and few had become abstinent.
Were any of these drinkers alcoholic? Only half of the very heavy drinking group had a diagnosis of alcohol dependence. But again, most of the dependent group cut back.
Did cutting back help them? Yes. The researchers concluded that drinking less cut their chances of developing a dependency.
AA meetings are full of stories of people who quit drinking for a spell or cut back. The question is how long you can keep up a more moderate drinking style.
Will a moderation group help you? If you want the group peer support you get in AA, but don’t want to aim for abstinence you can try another non-profit called Moderation Management (MM). In a MM group, you’ll start by keeping a record of your drinking and scoring yourself on a test with questions like “Do you plan your day around when and where you can drink?” (My partner’s focus on his dinner reservation was a serious sign.)
If you decide that moderation could work for you, you’ll go alcohol-free for 30 days. In that time, you’ll have a lot of thinking to do, learning skills to manage your drinking, starting new activities that will displace drinking and setting your own rules for moderation. A 2003 study found that most MM members have mild alcohol problems and had never participated in alcohol treatment.
Why would you choose abstinence? Abstinence isn’t easy for drinkers to achieve. Most people relapse into at least some drinking within the first year of finishing treatment. But research has shown that people who enter alcohol treatment with abstinence as their goal are drinking less two and a half years later than people who only aim to cut back.
When I called my partner an alcoholic, he denied it, pointing out that he sometimes stopped drinking for long spells (this is actually evidence you’re struggling with alcohol, but I didn’t know this at the time). He eventually died at 55 of liver damage after an intense drinking spell. He had lost his job, and alcohol was how he coped.
People would ask me, “Was he an alcoholic?” After hearing this dumb question over and over — in my head I was thinking, "He died. What else do you need to know?” — I came to realize that it really meant, “How did you know he was an alcoholic, because I’m wondering whether I [or someone I love] has a problem that could be serious.”
The label of “alcoholic” isn’t worth fighting or dying over. The real question is whether “alcohol has become an unmanageable problem,” to quote AA. Anything you do to drink less is worth doing.
A version of this story appears on Your Care Everywhere.