Controlling Your Drinking, First Edition: Tools to Make Moderation Work for Youby William R. Miller, Ricardo F. Munoz
This is a book for anyone who's worried about needing a third glass of wine to fall asleep; anyone who loves TGIF celebrations but hates missing his or her child's Saturday-morning ball game; and anyone who knows he or she won't lose weight unless martinis are given up along with the fettuccine Alfredo. Studies indicate that 10% of Americansnearly 30 million
This is a book for anyone who's worried about needing a third glass of wine to fall asleep; anyone who loves TGIF celebrations but hates missing his or her child's Saturday-morning ball game; and anyone who knows he or she won't lose weight unless martinis are given up along with the fettuccine Alfredo. Studies indicate that 10% of Americansnearly 30 million of usdrink more than we should. Based on 30 years of research, William Miller and Ricardo Mu oz argue that for many people abstinence isn't the only healthy alternative. Controlling Your Drinking shows readers how to become moderate drinkers by making small changes in everyday behavior. Miller and Mu oz avoid labels and moralizing as they outline a simple, pragmatic, and adaptable plan for achieving the results you want. With nearly three dozen trials showing a successful outcome for 63% of participants, their method has been tested like no otherand proven to be effective. Balancing a compassionate, hopeful tone with dry wit, Controlling Your Drinking is an easy-to-follow, science-based approach to moderation.
"If you want to build a healthier relationship with alcohol, this highly readable book is a gold mine of practical information based on the latest scientific studies. Filled with wonderfully detailed examples, tips, and tools, this is destined to become the guide for people seeking to make the best personal decisions about the role of alcohol in their lives. The discussions of overdrinking, "dumb drinking," harmful drinking, and dependent drinking are by themselves worth the price of the book. Finally, a book that eschews labels and just provides commonsense advice on how to drink smarter and how to figure out if you shouldn’t be drinking at all. The authors are to be commended for injecting a breath of reason into a long, acrimonious debate that has generated more heat than light."William L. White, author of Slaying the Dragon
"This book is a gem for drinkers who want to cut down. Drs. Miller and Muñoz have taken a complex topic and distilled it to its essence. Unlike many self-help books that tout how easy it is to change your behavior, Controlling Your Drinking takes an honest, balanced approach. While not everyone who overdrinks can learn how to moderate their drinking, this guide tells you what you need to know and do if you are to be successful. I wholeheartedly recommend this book."Reid K. Hester, PhD, Behavior Therapy Associates, Albuquerque, New Mexico
"Controlling Your Drinking provides something few of us are ever given: practical, nonjudgmental guidance on how to drink responsibly. The book respectfully empowers the reader with skills to take charge of problem drinking. The renowned authors offer straightforward, research-based strategies for knowing if and when controlled drinking might work, how to go about it, and what to do if the approach is not for you. This book offers a potpourri of tactics not only for managing your drinking, but also for managing your life."Anne M. Fletcher, MS, RD, author of Sober for Good
- Guilford Publications, Inc.
- Publication date:
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- New Edition
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Read an Excerpt
Controlling Your DrinkingTools to Make Moderation Work for You
By William R. Miller Ricardo F. Muñoz
The Guilford PressCopyright © 2005 The Guilford Press
All right reserved.
Chapter OneTHINKING ABOUT DRINKING
Many people drink alcohol, and most never experience serious harm or problems from it. Many others, however, find at some point in their lives that their drinking is becoming risky or creating problems, and so they decide to cut down or quit. Some find they need help to do so and seek professional consultation or attend mutual-help groups such as Alcoholics Anonymous. Many others cut down or quit drinking on their own.
Perhaps you're reading this book because you wonder whether you're drinking too much and ought to cut back. Problems related to drinking rarely spring up overnight, but rather mount up gradually over a period of months or years. Often family members or others become concerned well before the drinker does. Judging from our 30 years of research, if you (or a loved one) are wondering whether you might be drinking too much, there is probably good reason for concern.
Overdrinking, Dumb Drinking, Harmful Drinking, and Dependent Drinking
Why is it that it sometimes takes so long for people to realize they're drinking too much and to do something about it? One obstacle, we believe, has been the label "alcoholic." Whenthis term came into prominence in the early 20th century, the belief emerged that either you are an alcoholic or you aren't: If you are, there's nothing you can do about it except to stop drinking; and if you aren't, you have nothing to worry about and can drink as much as you please. Furthermore, because "alcoholic" is a sticky label that carries a lot of social stigma, people tend to resent it and often endure many harsh consequences of overdrinking before admitting to or accepting the label. Consequently, they take no action until their problems and dependence become truly severe.
This was pretty much the public view of alcoholism when the ideas in this book first saw print in 1976. Within that understanding, there would be no one to use a book like this: If you are alcoholic, then it's too late for moderation. If you're not alcoholic, then you don't need it. Or so popular thinking went at the time.
A lot more is known now about the many ways in which overdrinking can harm your physical, psychological, spiritual, and family health. If you're interested, Appendix A briefly summarizes current scientific reasons to be careful about alcohol. It is also clearer now just how many people are experiencing personal harm from their drinking. Those who fit the common stereotype of alcoholism account for only a minority of alcohol-related suffering and health and social problems. They are but the tip of an immense iceberg.
In any event, we don't intend to help you stick a label on yourself. There is no slick test here to tell you whether you "are" or "aren't." Instead, we want to help you think objectively about your drinking and how it may affect you.
Perhaps the most common question is simply whether you drink too much. At relatively low levels of use, alcohol has no harmful effects for most people and may even offer some health benefits, particularly with regard to certain kinds of heart disease. Drinking above these safe limits, however, results in a rather steep increase in the rates and risk of a host of health and social problems. When people exceed safe limits, their drinking may be termed "risky" or "hazardous," even if they have not yet experienced any significant negative consequences. We prefer the term "overdrinking" for its parallel to overeating. "Overdrinking" applies only to the level or amount of drinking and does not imply the presence of any harm, problems, or dependence. It applies equally to a man who most days has a six pack of "light" beer between work and bedtime, a woman who drinks a bottle of wine once or twice a week, and the person whose daily fare is a fifth of scotch.
So how much is too much? The U.S. National Institutes of Health have recommended limits of one drink per day for women and two drinks per day for men. (We define what "one drink" is in Chapter 4.) Some nations have set somewhat higher recommended limits of two to three drinks per day for women and three to four for men. A general recommendation is not to drink every day but to give your body a rest from alcohol on at least one or two days a week.
Wow! Only two drinks a day? You may view that as an incredibly small amount of alcohol. Yet there are good reasons for these medically recommended safe-drinking limits. For most of the health problems described in Appendix A, risk levels are no different at zero, one, or two drinks per day. Right around three drinks per day for men and two drinks per day for women, however, risk rates begin to climb. From there on, the more drinks per day, the higher the risk of serious health problems.
These are just averages, of course. Most people can point to an uncle or aunt, hero or grandparent who drank like a parched horse (or smoked cigarettes, or ate bacon cheeseburgers and butter-fried food) for decades and died at a ripe old age. It happens. As any life insurance actuary knows, however, mortality prediction statistics are dauntingly accurate for all of us collectively, even though it's difficult to predict the longevity of any one particular individual. Like smoking or overeating, overdrinking shortens life by as much as 10 to 15 years on average and can also detract greatly from quality-of-life years through disability, chronic disease, mental impairment, and harm done to family and other relationships.
One problem here is that these various outcomes are probabilities. It is not certain that if you overdrink it will harm you or cause your premature death. It only might do so. If you knew for certain that the very next drink would kill you, chances are you wouldn't take it, but it's not that simple. Sustained heavy drinking (or smoking, or eating fatty foods) will have dreadful consequences for some, average negative consequences for most, and no negative outcomes for some proportion of people during their lifetimes. Because there is no way to know for sure ahead of time which of these three groups would be yours, it's a matter of deciding which of the many available risks in life you would like to take.
Certain kinds of harm do not require years of excess but can occur with a single occasion of overdrinking. Many of these have to do with drinking too much for conditions. What may be a reasonably safe amount of alcohol in one situation can have tragic results under other circumstances. In plain language, this is dumb drinking.
A classic example is drinking before driving. The only truly safe level of alcohol in the bloodstream when driving is zero. Even relatively small amounts of alcohol can subtly impair perception, judgment, attention, and other mental functions that are crucial for safe driving. The trouble, of course, is that it is hard to perceive when your perception is impaired or to judge when your judgment is compromised. The legal limit that defines "drunk" driving has declined over the years from 0.15 to 0.10, 0.08, and now 0.05 g% (grams of alcohol per 100 ml. of blood) in some states. Even at these lowered levels, however, there is clear impairment of the complex skills needed for safe driving. Other nations have made it illegal to drive at 0.02 or 0.03 g%, and scientific evidence shows reduction in alcohol-related fatalities when impaired-driving laws enforce these lower limits.
Our counsel is that if you will be driving, plan any drinking so that the alcohol has been completely eliminated from your body before you start the engine. In Chapter 4, we show you how to do this.
Driving isn't the only activity that can be dangerously impaired by even moderate drinking. In search of a Christmas tree, one of our graduate students headed off to the mountains equipped with a chain saw. He felt completely unaffected by the two beers he drank while searching for the perfect tree, but with a small misjudgment he narrowly escaped cutting off his toes. Flying an airplane, swimming or boating, skiing, or using power tools-these are just a few examples of situations in which any drinking is hazardous. It takes only one such occasion to trigger a tragedy, and the newspapers are filled with them every year.
Rapid-paced drinking-such as occurs in drinking games, contests, or hazing-is another example of dumb drinking. Beyond the very real risk of death from alcohol poisoning, it overrides normal judgment about how much is too much and opens the door for foolish risk taking.
Unfortunately, dumb drinking can take an almost infinite number of forms. Drinking before or during certain social situations holds potential for harm. For example, a substantial majority of date rapes occur when one or both people were under the influence of alcohol, a fact that also holds for other kinds of physical violence. Under the influence of alcohol, people are generally more likely to take risks, to do things and say things they wouldn't if sober, sometimes with long-lasting consequences, embarrassment, or guilt. Again, it's a matter of probabilities. On any one occasion of drinking, the chances of a tragic outcome are usually quite small. The trouble is, it can take only one incident of dumb drinking to change a life forever.
A third question to ask yourself, beyond just how much you drink or potentially risky situations in which you drink, is the extent to which alcohol may already be causing problems or otherwise harming you or those around you. There are various inventories of the troubles that can pile up over time in relation to overdrinking. There is one in Chapter 2, and we've included a longer one in Appendix B. If you're sitting on the fence about whether you need to do anything about your drinking, an honest self-evaluation with these questionnaires can help you tally up the ways in which drinking may be causing harm, or at least starting to do so. Information is also provided in Appendix B to let you compare yourself with people seeking professional help for alcohol problems. If, on the other hand, you already know your drinking is causing harm to you or others, then there's no particular need to visit Appendix B.
Harmful drinking is also sometimes called "problem drinking" or "alcohol abuse," terms that can get in the way of taking an honest look at yourself. With regard to the first, people sometimes get hung up on whether they "have a drinking problem." What matters is not whether you deserve a label, but rather what is happening in your life with regard to drinking and what, if anything, you want to do about it. Alcohol "abuse" sounds both moralistic and odd. "Alcohol abuse," one colleague quipped, "is mixing single-malt scotch with root beer." We prefer "harmful drinking" because it describes exactly what is happening: It is drinking in a way that causes or contributes to harm.
Finally, there is the concept of alcohol dependence. Some people think of this as being unable to stop drinking without suffering symptoms of alcohol withdrawal: shakiness, sweating, rapid heartbeat, and such. To be sure, it's possible to become physically addicted to alcohol in this way, but alcohol dependence is much larger than withdrawal. Many alcohol-dependent people do not feel sick when they stop drinking.
In the broadest sense, dependence is the process whereby a drug (in this case alcohol) gradually takes over more and more of your life. You spend more money buying alcohol, more time drinking and recovering from its effects. Consequently, people and activities with which you once spent more time begin to fall away. You spend more time with heavier drinkers and less time in places where there is no alcohol. Perhaps the idea of a dinner party without alcohol makes you uncomfortable or just seems "inconvenient." You're not sure how you would deal with certain things without alcohol, such as getting to sleep or feeling frustrated or down. From time to time you make an attempt to cut down or quit but rather quickly go back to the familiar pattern. In short, alcohol slowly becomes central to your life.
A Word about Labels
As we've said, labels such as "problem drinker" and "alcoholic" can be very sticky and can be so troubling that they get in the way of taking an honest look at what is actually happening in your life. If you haven't noticed already, we are careful not to use such labels for people. We talk about harmful or problematic drinking, but not harmful or problem drinkers. It may seem like a small difference, but it's not. Labeling people can be pejorative and can get in the way of needed change. Taking an honest look at your drinking can be hard if doing so might mean you're "alcoholic." When we ask people to tell us how alcohol has caused problems for them, they usually can give us a long list; but the same people, when asked, "Are you a problem drinker?" say "No." Taking a close look at your behavior need not invoke shame or blame. We urge you not to worry about personal labels and consider instead what is actually happening in your life with regard to alcohol.
What to Do?
One solution, if you're having problems related to alcohol, is to stop drinking altogether. Certainly this is a reasonable solution, and many people have coped with overdrinking by abstaining completely from the use of alcohol. Sometimes this is the wisest and even the easiest solution. For people whose livers have been damaged by alcohol or disease, further drinking may seriously endanger their lives and health, and abstinence would be the wisest course. Those who have already overcome a drinking problem by becoming totally abstinent are also well advised to stay that way. After all, this is a way to know for sure that alcohol is not going to harm you.
Not everyone who overdrinks, however, wants to stop or can stop drinking altogether. Abstinence can be challenging to maintain. Even after treatment with an abstinence goal, an average of three out of four people drink again. Others would just prefer to continue drinking if they can. For these and other reasons, people seek to reduce and manage their own drinking without stopping completely. Chapter 2 is designed to help you decide if this is what you want to do, and Chapter 3 offers some questions that you can answer for yourself from which we can tell you about the likelihood that moderation will work for you. If you do decide you want to give moderation a try, the rest of this book is for you. It is specifically designed to help you do five things:
1. Understand how alcohol affects your body and mind and when your risk of harm becomes significant.
2. Become conscious of factors that may be contributing to your overdrinking and the extent to which drinking may be controlling you.
Excerpted from Controlling Your Drinking by William R. Miller Ricardo F. Muñoz Copyright © 2005 by The Guilford Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Meet the Author
William R. Miller, PhD, is Distinguished Professor of Psychology and Psychiatry at the University of New Mexico. He is the author of numerous books, including Motivational Interviewing, a modern classic in the field of addiction treatment. Dr. Miller’s research, which focuses on providing a broader and more effective range of treatment approaches for people with alcohol and drug problems, has been supported by a 15-year Research Scientist Award from the National Institute on Alcohol Abuse and Alcoholism. He is a recipient of the international Jellinek Memorial Award for excellence in alcoholism research.
Ricardo F. Muñoz, PhD, is Professor of Psychology in the Department of Psychiatry, University of California, San Francisco, and Chief Psychologist at San Francisco General Hospital. His major areas of expertise include addictive behavior, the prevention and treatment of depression, and how depression affects substance use. He has coauthored several books, including Control Your Depression and The Prevention of Depression.
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