‘Controlled drinking’

PSYCHOLOGIST Christine Haworth-Staines works with expats in the Gers, and says that for many people controlled drinking is the answer to drink problems. Her comments follow our June article which quoted a supporter of abstinence.

Why do you disagree with the abstinence approach?

Because in many cases it is not necessary - those involved can have a drink and enjoy it - it’s about getting back to safe drinking. Secondly, the last thing many people want to hear is that it’s all or nothing, and they may not come forward to seek help if they think this will be pushed on them.

How can you tell if you have a drink problem?

The AUDIT test, by the World Health Organisation, shows if you are drinking safely, misusing alcohol, or are alcohol-dependent [www.tinyurl. com/AUDIT-Test]

Dependency goes from mild to severe but refers to someone who drinks every day, exceeds recommended units, probably scores more than 20 on the test and has withdrawal symptoms like tremors if they go without and/or has developed tolerance (ie. reduced sensitivity to the effects of drink).

Very dependent people must stop gradually under medical supervision otherwise they risk seizures, even though the eventual aim in their case may be abstinence.

Controlled drinking is less likely to work the more severe the problem. However even for those at the severe end you should not force it on them if they don’t want it, because it might drive them away. They might also come to their own conclusion, while trying controlled drinking, that it doesn’t work.

Another issue is medical or psychological conditions: people with serious liver disease need to be abstinent as do some people with psychiatric illnesses. The decision needs to be personalised but, as a rule, research indicates a pragmatic approach, minimising harm that drinking is causing, is the way forward rather than zero tolerance.

Is it best to have medical help to cut down?
Yes, especially if you are dependent: go to your GP, who may refer you to a psychiatrist. For heavily dependent people, in-patient rehab may be recommended, though most people with a problem at the lower end can withdraw slowly under the care of their GP. If you are misusing as opposed to being dependent, work with a psychologist or with a counsellor who has experience in the field.

One UK study showed 60% of men seeking treatment for alcohol abuse had another disorder, like depression or anxiety, so cognitive behavioural therapy is recommended: identifying thinking patterns driving unhelpful behaviours. Also, couples therapy, because in a relationship one person could be inadvertently colluding with the other’s problem or exacerbating it.

How else can people get drinking under control?
Firstly, identify if you are drinking safely: 21 units a week for men (but no more than three or four per day) and 14 for women (two to three per day). Educate yourself as to what a unit is and keep a diary for a couple of weeks. Half a pint of normal beer is one; a small glass of wine (125ml) is one-and-ahalf; a bottle is about nine. Many people are not aware that they are drinking above safe limits, but they are not necessarily alcoholics [ie. dependent]. Culturally it is more acceptable to drink here, for example at lunchtime, and it is easy to slip into a routine. Have two alcohol-free days a week to allow the liver to recover. The idea that small quantities every day is not as bad as binging is not true.

Do you have any other tips?
If you drink at a certain time, on alcohol-free days, when the time comes, remind yourself that the urge will pass. If you don’t fulfil it, it will be weaker next time. In therapy we address beliefs about alcohol - like that it makes us attractive and fun. Develop interests that are not compatible with alcohol abuse: if you know you are cycling in an hour, you won’t drink a bottle of wine. Develop the ability to say “no” to drinks when socialising. Finally, some of my patients who are misusing alcohol use it to self-medicate - to deal with negative moods and anxiety. They must learn to deal with them differently.

Wine is part of what we enjoy in France but why not change your relationship to it?
Become a wine buff, appreciate it and have a good bottle once a week instead of quaffing cheap wine every day.