OVERCOMING ALCOHOL ABUSE
CONTENTS:
If your drinking has adverse effects on your life or that of another then you have a drinking problem.
CAGE Questionnaire:
Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about your drinking?
Have you ever had a drink first thing in the morning (an Eye-opener) to steady your nerves or to get rid of a hangover?
Two or more positive answers are indicative of problem drinking.
For most people drinking is a harmless social activity but for some, drinking is a problem.
Signs of problem drinking may be:
Psychological – a preoccupation with drinking alcohol; distressful thoughts; guilt; negative emotions such as low mood and/or anxiety.
Medical – excessive drinking can lead to short-term problems (e.g. upset stomach) and long-term effects (e.g. attention disturbance, cancer, cirrhosis, ulcers). In the case of physical dependence on alcohol, withdrawal symptoms range from nausea and irritability to severe symptoms such as seizures, delirium or hallucination.
Social – suicides, homicides, accidents, crimes, fire fatalities and unemployment are all strongly linked to alcoholism.
If you drink more when alone or at a particular time; to relieve discomfort or have been criticized about your drinking – you may benefit from this program. However, if you feel very low or suicidal, it is necessary you seek immediate professional help.
Alcohol is a depressant and its rewards are short-term. Positive reinforcement is the initial ‘high’ we get from drinking alcohol, and the brief numbing of negative emotions such as anger, anxiety, low mood, are all negative reinforcement. Those dependent on alcohol need to drink increasingly more to get the same effects or to feel normal thus, the result is a vicious cycle.
Heavy drinkers often have a history of anxiety before they started to abuse alcohol. Large amounts of alcohol can cause depression which will subside when you stop drinking. Excessive drinking will result in lower mood levels in the long-term than the natural ups and downs.
See Program 1: Coping Strategies Counselling Advice – Forgiveness, Program 6: Overcoming Anger, Program 8: Overcoming Anxiety, Program 12: Overcoming Depression, Program 15: Overcoming Grief And Bereavement, Program 22: Overcoming Stress and Program 23: Overcoming Stress At Work.
2. Dealing with Problem Drinking
First you need to monitor your drinking to get a clearer picture of the problem. In a diary note for at least three weeks:
Date.
Situation.
When you drink.
How much you consume.
With whom you drink.
The recommended drinking limits are: maximum 21 units per week for men and 14 units for women.
One unit is equivalent to:
Half a pint of ordinary strength beer or lager.
One small glass of wine.
A single measure of spirits.
If you are exceeding this limit then you have a drinking problem. You may feel ambivalent about changing your drinking behaviour but need to persist despite this obstacle.
See Program 1: Coping Strategies Counselling Advice – Competitiveness and Perfectionism, Frustration, Procrastination and Persistence.
To enhance your motivation write:
The costs and benefits of continuing to drink and the costs and benefits of changing your drinking habits.
How your life could be in five years’ time if you keep drinking.
How your life could be in five years’ time if you stop drinking.
How you would advise a friend in the same position.
The most important reason to continue drinking and your primary reason to stop.
Make a list of problems caused by your alcohol abuse and write next to each, one or more realistic goals. The following coping skill can be helpful.
See Program 1: Coping Strategies Counselling Advice – Problem-Solving.
You need to realize that without drinking you will learn adaptive ways to cope with life’s problems.
Cravings will become easier to resist as you learn to drink less often and start to cope with problems via helpful strategies. When alcohol is drank while on the drug Disulfuram, it has the aversive consequence of making the drinker feel sick. It is hoped that this will dissuade the patient from drinking.
In your diary write all the advantages of changing that come to mind (e.g. positive effects on health, relationships and career). Consider immediate, medium-term and long-term benefits of change. Next, list all concerns about change: immediate, medium-term and long-term concerns about change. Write your conclusion – do the advantages outweigh your concerns? Finally, respond to your concerns – is there an alternative viewpoint? What is the evidence for and against the concern? Are the long-term benefits likely to surpass the costs? If this happens how could you deal with it? Is there anything to add to your conclusion?
Write down one concern you have and note the worst thing you expect to happen if you overcome your alcoholism. Rate how likely the worst is to happen 0-100% (where 0 is ‘not at all likely’). Consider the evidence for and against how realistic your concern is, whether you are focusing on the negatives and how a friend might advise you. Re-rate how likely the worst is to happen. Write your conclusions.
Your drinking goal may be controlled drinking or abstaining; the latter is easier and may be the preferred goal initially and for those with a long-term history of drinking problems.
3. Identifying and Challenging Unhelpful Thoughts
Consider a recent event (activating event) that led to you drinking. When, where, with whom did it happen? What were you doing? What thoughts, images went through your mind at the time? How did you feel? What emotions, behaviour and bodily changes (consequences) resulted from your thoughts?
See Program 1: Coping Strategies Counselling Advice – Modifying Maladaptive Thinking.
Make a list of activating events/triggers that start off your problem drinking (e.g. seeing a pub, being alone). It is a good idea to avoid high-risk situations for a while and any people who may cause you to drink excessively. It is likely that you drink more heavily on evenings, week-ends and special occasions. You need to have a firm limit of no drinking or moderate drinking with clear boundaries (e.g. no drinking before 8pm during the week or 10pm at the weekend). Write your target on a flashcard and keep it with you at all times.
Uncontrollability thoughts:
You need to recognize thoughts that make you believe you cannot control your drinking, for example: ‘There is nothing I can do to prevent my excessive drinking’.
List these thoughts and rate your belief in each 0-100% (where 0% is no belief/credibility). Next, write any evidence to support the thoughts, then any evidence against the thoughts. Consider if you are misinterpreting the evidence.
See Program 1: Coping Strategies Counselling Advice – Distorted Thinking.
It is likely you will have little evidence to support these thoughts.
Ask yourself:
Can my past experiences of drinking help me now?
Do these thoughts facilitate or hinder drinking?
How would I advise someone else?
Are my emotions misleading me?
How would a friend advise me?
Are there any similarities between past and present problem situations?
What would be the consequences of such thinking?
You may now be able to form a new alternative helpful belief that you can control your drinking. Re-rate the credibility of your initial thoughts. Finally, you need to strengthen your conviction in the new belief. You could do behavioural experiments to prove or disprove an anxious thought.
Gradually expose yourself to a hierarchy of problem situations to overcome your anxiety.
See Program 1: Coping Strategies Counselling Advice – Eye Movement Technique (EMT), Mood Induction Procedure, Rational Emotive Imagery (REI), Imago Graded Exposure and In Vivo Graded Exposure.
Permissive thoughts:
These thoughts keep you drinking once you have started, for example: ‘One more drink will not hurt’. Write down all thoughts you had before losing control over your drinking that permitted you to do so. Deal with these thoughts as you did with the uncontrollability thoughts.
Positive thoughts:
These thoughts trigger drinking episodes (e.g. ‘I socialize better after drinking’). Identify all positive thoughts associated with a drinking episode and challenge these as you did with uncontrollability and permissive thoughts. With practise the credibility of unhelpful thoughts will decrease and adaptive thoughts will gradually be strengthened resulting in a reduced desire to start to drink.
You need to realize that cravings are controllable – if unfulfilled they will naturally abate. Cravings may be triggered by passing a pub, seeing alcohol, remembering drinking in the past, negative emotions, boredom, stress, and wishing to increase enjoyment of a situation by drinking. You may have negative thoughts about cravings (e.g. ‘I will never beat these cravings’). Deal with these thoughts as you did with uncontrollability, permissive and positive thoughts. Accept that you are responsible for your actions and have some control over your behaviour.
To manage your cravings:
Write coping statements (e.g. ‘I will fight my problem drinking’).
Use distraction:
See Program 1: Coping Strategies Counselling Advice – Distraction Techniques.
When you have positive images of yourself drinking, counter these with negative images of the harmful consequences of drinking or if you prefer, positive images of the benefits of not drinking.
Make a list of the pros and cons of not drinking.
Delay acting on a craving to drink, for 20 minutes – your craving is likely to stop in this time.
Write on a flashcard a summary of how you will tackle your cravings and keep it close at hand.
When making a decision consider if it will eventually lead to you drinking. Examine past slips from abstinence and see if there are any patterns:
How were the situations similar?
When did you slip?
Where did you slip?
Who was with you at the time?
What did you decide that resulted in drinking?
Could you have acted differently?
What are the costs and benefits of changing your behaviour?
How will you act next time – what is safer?
Learn to assertively refuse drinks. Build your confidence.
See Program 1: Coping Strategies Counselling Advice – Assertiveness Training, Neuro-Linguistic Programming (NLP), Building Confidence I, Building Confidence II, Building Confidence III and Building Confidence IV.
It is necessary to be able to deal appropriately with criticism.
See Program 1: Coping Strategies Counselling Advice – Coping with the Need for Approval, Improving Your Self-Image and Combating Self-Harm, Criticism and Countering Self-Criticism.
Difficult situations can lead to drinking so effective problem-solving is often needed.
See Program 1: Coping Strategies Counselling Advice – Problem-Solving.
Anxiety, stress and anger can trigger drinking – this can be countered with relaxation, stress and anger management skills.
See Program 1: Coping Strategies Counselling Advice – Controlled Breathing and Relaxation Techniques, Program 6: Overcoming Anger, Program 22: Overcoming Stress and Program 23: Overcoming Stress At Work.
You need a good support network. Significant others and support networks can provide invaluable support. A two way relationship is more satisfying, so think about how you can also help those supporting you.
See Program 1: Coping Strategies Counselling Advice - Social Skills Training, Communication Training, Negotiation Training, Program 13: Overcoming Destructive Relationships and Program 16: Overcoming Low Self-Esteem.
When you stop or reduce your drinking you will need to fill the gap left with alternative pleasurable activities.
First monitor the pleasurable activities, excluding drinking, you engage in currently. Record your activities for six weeks rating the pleasure you get from each activity 0-10 (where 0 is no pleasure). Next, make a list of pleasurable activities not associated with drinking. Include things you used to enjoy but have refrained from for a while; new things you want to do but have never had the chance to do; activities you would like to increase in frequency. Develop an activity schedule.
See Program 1: Coping Strategies Counselling Advice – Planning an Activity Schedule.
Later compare your level of pleasure from your new activities with that derived from your old activities. This will show your progress and motivate you to continue to work at overcoming your drinking problem.
You need a balanced healthy lifestyle.
See Program 1: Coping Strategies Counselling Advice – Nutrition, Exercise, Managing Your Time and Sleep Management.
Also - See Program 4: Overcoming Addiction.
You are likely to have lapses where you succumb to drinking. Do not despair and give up the fight – use these slips to learn how to manage better in future. Make a list of high-risk situations in which you may be tempted to drink. Write on a flashcard the warning signs of high-risk situations and how you would cope successfully.
Learn to stop negative thinking and replace with neutral or constructive thoughts. Regularly review your monitoring records to keep track of your progress. Reward yourself for little successes as well as big accomplishments.
See Program 1: Coping Strategies Counselling Advice – Relapse Prevention.
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