I’m Worried About My Drinking. Do I Have to Stop Entirely?
By Peg Rosen
Like a lot of things in life, the answer to whether you should stop drinking is that it depends—not just on how much you drink and if you’re physically dependent on alcohol, but also what’s realistic for you right now.
Let’s walk through some of the issues to help you figure it out.
Alcoholism vs. Alcohol Use Disorder
For a long time, experts saw “alcoholism” as black and white: You were either addicted to and dependent on alcohol or you weren’t. Treatment was also black and white. Most counselors and support communities, such as Alcoholics Anonymous, agreed you had to give up drinking entirely to avoid losing control and relapsing.
These days, the term “alcoholic” is considered so stigmatizing and extreme that most substance use counselors don’t use it.
Instead, experts use the much broader term alcohol use disorder (AUD) to describe when people have difficulty controlling their drinking, are preoccupied with alcohol, or continue drinking even when it causes problems in their lives.
AUD is not an all-or-nothing diagnosis. It is more of a spectrum that ranges from mild to severe, with a whole lot in between.
It Depends On How You Use Alcohol
Some experts maintain that if AUD runs on a spectrum, treatment for AUD should meet people where they are on that spectrum.
Someone who has started drinking on weeknights in addition to weekends, for instance, may not need to take the same steps as a person who has trouble getting out of bed and functioning because of their alcohol use. Some people use alcohol to manage anxiety in social situations, such as when they enter college or start a new job, but then notice that they have become reliant on alcohol in both social and non-social situations to feel less anxious.
It Depends On If You Are Ready and Willing
Emotionally and psychologically, some people may just not be ready or willing to stop drinking entirely. They may, however, be open to cutting back or changing their drinking behavior.
Based on that idea, the peer-led group Moderation Management was formed in the 1990s as an alternative to Alcoholics Anonymous and other abstinence groups. There are now several alcohol-management programs—and a growing number of substance use experts—that embrace this harm-reduction approach. Harm reduction essentially means making changes to reduce the negative consequences associated with a particular behavior.
The concept is somewhat controversial. Critics of harm reduction don’t think people who are physically or emotionally dependent on alcohol can overpower its pull and drink moderately or safely. They stand by their mission of helping people live healthier, fulfilled lives without drinking.
Should You Quit or Cut Back?
Which approach is right for you depends on your particular situation. It also can depend on whom you talk to and the approach they embrace.
A good first move is to talk to your doctor or a school or campus counselor. They can do a brief assessment and help you sort through your options. Moderation Management also has a questionnaire that can help you figure out how dependent you are on alcohol and how difficult practicing moderation might be for you.
Here are some general guidelines to help you start thinking about the choice you would like to make about your drinking.
Quitting drinking altogether may be your best option if:
- You do things that hurt you or someone else or that put you or them at risk, such as drunk driving or being physically or verbally abusive when you drink.
- You are physically dependent on alcohol and have withdrawal symptoms and cravings when you don’t drink. If you have severe withdrawal symptoms, you will probably need to detox in a facility where health-care providers help you do it safely.
- Your mental or physical health is being affected by drinking, including depression, liver disorders, or being pregnant.
- You take medication that can react badly with alcohol.
- You have already participated in a controlled drinking program and haven’t been able to sustain moderate drinking.
If you decide quitting is the best option, talk with your health-care provider about how you can do so safely and without serious withdrawal symptoms. Ask whether they recommend that you use medication to help.
Cutting back may be a reasonable option if:
- You feel motivated about changing your drinking and confident you can cut back.
- Your drinking issues are mild to moderate. In other words, you drink more than you think is good for you, but you are not a danger to yourself or others and you aren’t physically dependent on alcohol.
- You have a strong support network and your home life is pretty stable. If people around you have substance use issues, practicing moderation may be extremely difficult.
- You know you have a drinking problem, but you simply can’t tolerate the idea of quitting alcohol entirely right now. In other words, harm reduction is better than making no changes.
Where to Find Support
Some people who are not physically dependent can cut back on their drinking or quit without help from a counselor or support group. That is especially true if you’re simply drinking more than you’d like and want to gain control before things get out of hand.
People who seek outside support, however, have higher rates of success—with both drinking less and not drinking altogether—than those who go it alone. There are lots of options out there.
- Private or group therapy: This can be with a regular therapist or you can look for someone who specializes in substance use issues. If you’ve decided to try moderation instead of abstinence, check out Moderation Management’s directory of moderation-friendly therapists.
- Peer-led abstinence support groups: Alcoholics Anonymous is the best-known of these groups. They are based on the philosophy that people with AUD are powerless against alcohol and they must rely on some other, greater force in order to live without drinking. It can be spiritual, like God, but may also be nature, the universe, or their own recovery community.
Another great option is SMART Recovery. SMART stands for “self-management and recovery training. It focuses on self-empowerment and helps you learn how to notice and manage triggers and urges to drink.
- Moderation or “controlled drinking” programs: Moderation Management was the first of these groups. The free, peer-led program requires you to stop drinking for 30 days before easing moderate drinking back into your life. Participants range from people who want to have more control over alcohol to those who want to gradually work toward quitting altogether.
Research shows that people who cut back with the support of in-person and online meetings and forums have more success than people who try to cut back on their own. Check out this directory for other alcohol-management programs.
- You can also talk to your doctor about ways medications can help decrease your cravings to use.
This can all seem like a lot. If you’re not even sure you have a problem, there are some warning signs you can watch for. There are also many strategies that make cutting back easier. On the flip side, there’s a lot of help available to you if you are having serious issues. What matters most is that you’re willing to be curious about your relationship with alcohol and consider making changes. That’s a huge step in a positive direction.