Once upon a time I thought of alcoholism in black and white terms… either you’re an alcoholic, or you’re not. And if you are, time to get to some AA meetings and become abstinent.These days I think of alcohol a bit differently.
But I believe that many people develop problematic relationships with alcohol that do not necessarily progress to the point of no return. I think some folks can recognize that their alcohol patterns are unhealthy or escalating, and can reverse the trend and adopt more moderate and controlled patterns of use without necessarily having to resort to total abstinence.
I’m also aware that some folks are opposed to AA, and they need alternative models. Without knowing that alternatives exist, they might avoid getting help or looking honestly at their behaviors.
Psychotherapy, Harm Reduction, and Motivation Interviewing
Outpatient psychotherapy can be an effective form of treatment for substance abusers at mild to moderate levels of severity. It’s widely accepted that mental health and relationship issues are generally intertwined with substance abuse problems. Treating the emotional and interpersonal problems can be powerfully beneficial for the substance misuser. Treatment may take the form of 1:1 therapy and/or group psychotherapy. Therapists also help clients with behavioral modification and developing healthier habits.
Harm Reduction aims to reduce the harmful consequences of risky behaviors such as substance abuse. Examples of harm reduction related to alcohol include: using a “designated driver” when going out drinking with friends; drinking a glass of water after every alcoholic drink to reduce the likelihood of a nasty hangover; or abstaining from alcohol on Sunday nights to prevent missing work on Mondays. Harm Reduction concerns itself with safety measures and minimizing harm, rather than focusing only on abstinence.
Motivational Interviewing is a non-confrontational method of counseling and psychotherapy that takes a collaborative, accepting approach to helping clients engage in treatment. The counselor “meets the client where she is,” applying different techniques and lines of questioning that correspond to the client’s level of insight into her substance abuse problem, and her readiness to change. The counselor looks to connect with what motivates the client for change, and what the client's ever-evolving goals are.
I sometimes encourage my clients to use a workbook such as Responsible Drinking: A Moderation Management Approach for Problem Drinkers in conjunction with psychotherapy. This can be very helpful as we explore the role of substance abuse in the client's life, and set concrete goals for moderation or abstinence.
12-step and self-help programs
Below are brief descriptions of and links to some self-help programs for substance abuse. While AA is most accessible in terms of the sheers numbers of meetings and meeting locations offered daily, other self-help programs offer unique philosophies, styles, and objectives that appeal to different people.
Alcoholics Anonymous http://www.aa.org
AA is the most famous self-help method for problem drinkers. AA is truly a lifesaver for some. It plays a critical role in our society, and is accessible to even the poorest and most disenfranchised among us. It is a unique model that offers daily support, community, and a spiritual context for recovery that is replicated the world-over. AA warmly welcomes the loneliest, most ashamed sufferers of alcoholism and provides a space for them to connect with others and contemplate their path. In an era where we’re increasingly lonely and disconnected from each other, this more important than ever.
But some people reject AA. The reasons I hear most often are 1) some are uncomfortable with the spiritual aspect, or “God talk”; 2) some are turned off by the absolutism, i.e. the focus on complete and permanent abstinence as the only acceptable solution; and 3) some reject the fundamental premise that alcohol abusers are "powerless" over alcohol.
WAAFT: We Agnostics, Atheists and Freethinkers http://www.waaft.org
WAAFT is a secular offshoot of AA that aims to "eliminate the cultural bias against nonbelievers that sometimes exists in AA." WAAFT follows the Twelve Traditions of AA. Last I checked, there are meetings in San Francisco and Berkeley: search here.
Recovery 2.0 http://recovery2point0.com
Online community, book, podcast, online recovery education, and retreats/events. Builds upon the founder's interpetation of the best practices of AA's 12 steps, along with yoga and meditation. Read more about the philosophy on the website above, or in Amazon.com's description of the book Recovery 2.0: Move Beyond Addiction and Upgrade Your Life.
SMART Recovery http://www.smartrecovery.org
SMART offers in-person and online support groups, and differs from AA in several ways. It promotes itself as evidence-based (backed by scientific research); there is not a spiritual focus; and the model promotes self-reliance, in contrast to AA’s emphasis of “powerlessness.” SMART participants are encouraged to talk with each another, whereas AA participants listen and witness without any “crosstalk.” SMART discourages use of labels such as "alcoholic" or "addict."
LifeRing is an abstinence program started in 1999. Participants follow the “3S” Philosophy of Sobriety, Secularity, Self-Help.
Moderation Management www.moderation.org
This program has been around since 1993. Education, behavioral change techniques, and peer support are offered to help problem drinkers decrease their drinking or abstain from drinking, depending on the person’s needs and preferences. A Moderation Management workbook is available on Amazon.com. Local in-person and phone meetings are also offered: search here.
Refuge Recovery http://www.refugerecovery.com
“A Buddhist path to recovering from addiction”
Meetings focus on Buddhist teachings, traditions and practices that can be helpful to people recovering from all addictions. Emphasis is placed on meditation practice and waking up to the habitual patterns that drive us and our unskillful behaviors. Appropriate for anyone in recovery, or interested in recovery. No meditation experience necessary. Donation only, no registration - just drop in.
Buddhist Recovery Network http://www.buddhistrecovery.org
Promotes the use of Buddhist teachings and practices to help people recover from the suffering caused by addictive behaviors. Welcomes people of all backgrounds, and is respectful of all recovery paths. Local support meetings and online articles/resources.
HAMS: Harm Reduction for Alcohol http://www.hamsnetwork.org
A free, peer-led information and support group for those who want to change their alcohol use behaviors. "HAMS" stands for Harm reduction, Abstinence, and Moderation Support. See the website for many articles, online support groups and forums, information about live support groups, and other resources. A HAMS workbook is available on Amazon.com.
San Francisco Zen Center Recovery Meditation (SF Bay Area) http://sfzc.org/city-center/zen-meditation-practice/practice-groups/meditation-in-recovery
A drop-in meditation exploring the connections between Buddhist practice and recovery. The format is a brief meditation instruction; meditation; and a short discussion. A donation is requested.
If you have concerns about the role of substance use in your life, why not take advantage of one of these avenues of support to explore it further?