Op-Ed Contributor
Cold Turkey Isn’t the Only Route
By GABRIELLE GLASER
Published: January 1, 2014 418 Comments
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.
Anna Parini
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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.
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