When people come to me seeking help for drinking issues, it often feels palpable that they are hoping I will just suggest ways they can successfully cut back and so be able to continue drinking. Some problems with drinking can be episodic in nature, however frequently the person’s history reveals patterns that are longstanding and characterized by periods of loss of control. When these conditions are present, abstinence is the treatment of choice.
When sobriety is the best course of action, I take time to prepare clients before making my recommendation. People who question whether they have a drinking probably, rarely respond to a professional’s immediate feedback with, “Oh thank you very much, I didn’t know that. Now I will stop drinking completely.”
There are many times when it is painfully obvious that there is a significant drinking problem or plain alcoholism. In other cases the drinker is well on the way to having life long problems but doesn’t realize it. If left untreated, the drinking will only get worse.
Often during an initial session I will begin educating a client about why alcohol problems need to be treated. I pass handouts with information in addition to assigning readings or internet research. I work toward getting the client to see themselves without deception or denial. Here is where the concept of “relationship to alcohol” is useful.
Having a relationship with alcohol might sound weird for a few seconds, but most people intuitively grasp what I am communicating. Everyone has a relationship with alcohol. For example, even teetotalers or non-imbibers can be said to not be on speaking terms with alcohol.
For people who drink, the best place to start is by conducting a thorough review of how much alcohol is in their blood stream during a typical month. This can be done by counting accurately how many drinks they consume and over what period of time. For example 3 shots of whiskey in an hour produces more blood alcohol concentration than 2 cans of beer over 5 hours.
Once a client and I go over their drinking current patterns and history, we can start describing the picture we see. With drinkers, who are in denial or tend to minimize the amount they drink, which is common, it is essential to get corroboration from a family member.
I find that discussing the ‘relationship’ a client has to alcohol rather placing a label quickly such as ‘alcoholic’ is much less threatening for those who fear acknowledging their drinking problem. We are on the right track when an accurate picture of drinking and its effects can be portrayed. Clients get on board with referrals to AA or LifeRing much more readily when they can self assess ie make their own diagnosis about their drinking problem.
Of course when the relationship to drinking is on the order of, “I can’t quit you,” then no amount of self assessment will be of value. In these situations referral to a 28 day program or an equivalent is be the goal.
It is often a surprise if not a challenge for many clients to have the physical aspects of their drinking emphasized. Many clients will want explore the reasons why they drink. They try to characterize their problems as resulting from a cause and effect relationship such as, “If my wife didn’t constantly nag me when I come home, then I wouldn’t start drinking so early.”
Drinkers seek to blame others or to make the problematic drinking an understandable reaction to a stressful situation. Such an attempt to rationalize their drinking is a strategy that is difficult to maintain, when I politely, but insistently, return to the physical aspects of their relationship with alcohol.
When a problem drinker or alcoholic achieves sobriety, it is much easier to address the ongoing fallout from the effects of alcohol on the life, health, work history, personal relationships etc. Afterall, there are many aspects to people’s relationship to alcohol.
According to the AUDIT: The Alcohol Use Disorders Identification Test, a harmful relationship with alcohol may be established if someone drinks 3-4 drinks almost daily, 6 drinks once a month and has ever been told by a health professional that they have concern for the client’s drinking or that they need to cut back.
By discussing the relationship a person has to alcohol I can discuss with someone whether their drinking patterns constitute a healthy or unhealthy relationship to alcohol and the effects alcohol has on the persons mind and body, and also their spirit if they are open to looking at that. There is not necessarily a need to get someone to say they are an alcoholic if they feel uncomfortable with the label. Maybe over time such an identification is something the individual can embrace for themselves because they understand how it fits then, not because I need them to be something that meets a definition I set for them.
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