Emotional Health

Are You Worried About Your Drinking?

Alcoholism can afflict anyone, and there are as many types of “problem drinkers” as there are kinds of people. There are tests you can take online that have a series of questions designed to help you decide whether you may be one of them. The World Health Organization has a test you can take online called “AUDIT:” Alcohol Use Disorders Identification Test and the NCADD (National Council on Alcoholism and Drug Dependence) has a similar one that helps  you evaluate the pattern of your use and the effect it has on your life and health.

One of the most important measures, however, in most of these tests is how you feel about your substance use. Even if it doesn’t meet the criteria for abuse, if you are worried about your alcohol intake, it probably means that you should quit or cut down.

Many people, however, are uncertain about what to do. AA, with its 12-step program that emphasizes total abstinence, has long been the main source of help for those both in and out of inpatient rehab treatment. For many years this model was the only one available, and, importantly, the one that was the most effective.

There’s no question but that this organization is among one of the most unique and spectacular success stories of modern medicine. Though by no means 100 percent effective, for many it is literally a life-saver. Entirely free (it depends on voluntary contributions of $1 from members), the “fellowship” can be found all over the world. There is almost no place on earth where you cannot find an AA meeting, and there you will be welcomed by a group of supportive, nonjudgmental others who will treat you as a friend.

Not everyone is sure that he or she wants to try abstinence, however, and some object to the idea of group treatment. Others are uncomfortable with AA’s religious bent, found in the mantra that you must surrender to a “higher power” in order to recover—though AA emphasizes that this can be interpreted in whatever way best suits you.

New treatments have been developed in recent years that are called “evidence based”—i.e., studies have been done to demonstrate their effectiveness, such as Cognitive-Behavioral Therapy, which focuses on change through the modification of harmful ideas or beliefs. Experts such as Andrew Tatarsky, Ph.D., whose “harm reduction” therapy emphasizes that “one size does not fit all” when it comes to tackling this problem, have tried to develop new treatment models. Early on in his career he became discouraged by the insistence by most treatment programs that the client completely refrain from substance use in order to be in the program. Dr. Tatarsky likened this practice to a hospital or doctor telling someone with a medical problem that she must be entirely well before they will consent to treat her.

These days, Tatarsky and others are more willing to meet the patient “where he or she is.” While substance abuse often overwhelms people and undermines their ability to solve their other problems, they still have issues that need working on. By allowing the client to start treatment while still using, the therapist enables her to gain trust in her and, most important, begin to explore the role that using plays in her life. Even if there are underlying biological reasons why some people are more prone to use than others, most individuals find that their alcohol use serves particular purposes for them. In this view, substance abuse is seen as a “coping mechanism,” or, alternately, an attempt at “self-medication.” Four main “sectors of vulnerability” have been identified (Khantzian, 1990):

  1. problems with self-esteem
  2. problems in relating to other people
  3. problems dealing with emotions
  4. difficulties with self-care

When thinking about themselves and how substances have “worked” for them, most people can identify one or more of these as relevant. As Tatarsky says, “For any substance use treatment program to have a chance at being successful, it must begin with an effort to discover the specific reasons or motives that have made the substance so compelling . . .”

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