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Getting a grip - Somewhere this side of a drinking problem, imbibers learn to sip

By Bob Connor - June 30th, 2002. Originally posted: 10/20/2002. Most recent minor formatting: 7/1/2004.
Copyright © 2002, Chicago Tribune

[Print version]
 

Two weeks after the events of Sept. 11, a New Yorker went out to dinner with his girlfriend and another couple. The idea was to share some meaningful conversation and good wine.

He woke up the next morning convinced he was a problem drinker. His rationale was simple.

"I opened my eyes and saw the wrong girlfriend," recalled the 33-year-old investment manager, who preferred not to be named. "I run with a fairly liberal group of friends, but I knew what happened was not OK. I didn't remember much, but it started at the dinner table."

The New York man vowed never to put himself in that position again. He first appealed to his girlfriend for a second chance. Then he went online to research the various options, including Alcoholics Anonymous.

"I stopped drinking for 3 1/2 months after the incident," said the investment manager. "But I didn't want to stop for life. I still like the thought of traveling to Italy and having a bottle of wine with a great meal."

The federal government estimates there are three to four times more problem drinkers than individuals who are "severely dependent on alcohol." Nine of 10 problem drinkers avoid traditional intervention; many experts say it is because these people do not want to be labeled alcoholics or even risk any association with the stigma.

Statistics and labels can explain only so much. Just what constitutes a drinking problem--or moderation--is a highly personal question. Its mere asking makes some people uncomfortable. Yet answering the question can improve your health and quality of life in tangible ways.

"One motivator for me is having more time in my day," said Neal Chapin, 37, a Chicago-based printing executive. "I might have a beer or two at night, then feel too tired to do any projects around the house."

For Chapin, there was no single event that prompted his decision to join a local Tuesday night meeting of an organization called Moderation Management. Instead, it was a "buildup of drinking more than I wanted" plus the opportunity for self-improvement.

"I got in the habit with friends of keeping up with the rounds of drinks," Chapin said. "I wanted to find a way to watch myself."

Moderation Management is national support organization aimed at Americans who decide to reduce their drinking. It was created in part to fill the gap between abstinence programs such as Alcoholics Anonymous and not seeking help.

"The goal of Moderation Management and our group is to say drinking is a small but enjoyable part of life," said Helen Redmond, a University of Illinois at Chicago social worker who facilitates the weekly group at the UIC Medical Center. "Initially when people come, it is about how alcohol is not working in their lives anymore. They don't want to stop; they simply want more control."

Redmond said some Chicagoans following Moderation Management guidelines will decide to quit alcohol altogether because they cannot control their urges and behavior. The national organization estimates that 30 percent of its members go on abstinence-based programs. But most participants find a happy medium.

"We're trying to intervene at earlier stages in people's lives," said Mark Kern, a California-based psychologist and co-founder of Moderation Management. "There are no cultural norms for drinking in this country except for severe drinkers and teetotalers. Our program and others like it represent a way to stop or take pause without becoming hysterical about your drinking."

At the weekly Chicago Moderation Management meeting, Chapin gathers ideas about how to control his alcohol intake. He was a founding member of the Chicago group in March 2001.

"I plan my drinking more these days," Chapin said. "If I am going out to dinner, I might say to myself, `OK, I am going to have two or three drinks tonight.' So I might wait until dinner to have wine."

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30 days without alcohol

An important Moderation Management recommendation is to go 30 days without alcohol. Another moderation program called DrinkWise--the one successfully adopted by the New York investment manager--suggests two to three weeks without imbibing. The result is re-establishing one's alcohol tolerance, said Teresa Herzog Mourad, a DrinkWise counselor and public health specialist at the University of Michigan.

Herzog Mourad said alcohol tolerance is a physical and psychological issue.

"Once you start drinking again, you relearn how your body experiences alcohol," said Herzog Mourad, who said her clients include attorneys, doctors and doctoral researchers among others. "Plus, abstaining for two to three weeks increases your long-term chances of success. It shows you are open to thinking about how you feel with or without alcohol as part of your lifestyle. You tap into your emotional intelligence."

For example, Herzog Mourad said, many clients discover they feel more "agitated than satisfied" after consuming alcohol. Deciding to drink less and skip alcohol on certain days of the week can improve everything from headache symptoms to marital spats. Moderation programs typically call for keeping a "drink diary" to help you become more fully aware of alcohol-consumption patterns and its temptations.

Herzog Mourad said there is a reason why it is easy for people to drink too much, whether that is two glasses of wine or the whole bottle.


Delayed consequences

"Alcohol has a quick and reliable positive effect," she said. "You can quickly feel more relaxed in a predictable manner. On the other hand, the negative consequences tend to delayed and unreliable. Lots of people can have three or four drinks and barely feel hung over. They drinks lots of coffee and take an over-the-counter headache pill to get over it."

Just what defines a problem with drinking is up to individual interpretation.

Herzog Mourad said many of her DrinkWise clients use a simple measure for determining a problem. "For them, it's feeling lousy and not feeling good about it," she said. "They are ready to change."

Herzog Mourad said the reasons people join DrinkWise can be summarized by gender.

"The No. 1 reason men choose our program is they don't like the way alcohol makes them feel," Herzog Mourad said. "In some cases, a wife says, `You are out of here if you don't get help.' But most guys are involved because they are not working out and they are putting on weight. The first thing these guys do after the initial phone consultation is they take a vigorous walk with their dogs or hit the gym. They decide to become more active. That's hard to do with too much alcohol in your life."

The top reason among women enrolled in DrinkWise is "quality of life," Herzog Mourad said.

"For example, women say they aren't getting through books at a normal pace," she explained. "Some of them don't remember what they read in bed the night before.

"Women report low energy, weight gain and not sleeping well. Lots of my female clients say they wake up in the middle of the night, then can't get back to sleep. Plus, they are more likely to describe their problem in emotional terms, such as feeling depressed."

Herzog Mourad said medical research shows a need for programs such as DrinkWise.

"Studies indicate the majority of people are not severely dependent on alcohol," she said. "So treating them as severely dependent doesn't work."

Better to educate people about how alcohol affects their bodies and minds. For instance, research shows alcohol disrupts the brain patterns during the second half of a night's sleep. As little as one drink per day can leave you partially dehydrated.

Other scientists, notably Claude Steele at Stanford University, have discovered the pleasant distractions associated with alcohol (friends, music) might do more to reduce "negative mood" or stress than the liquor itself. Similarly, people who are sad and angry who drink without pleasant distractions not only won't feel better, but are likely to feel worse, said Jon Kassel, a psychologist and researcher at the University of Illinois at Chicago.

Kassel said he does not favor approaching alcohol problems in a "disease model of either being alcoholic or not." He said being honest with yourself about the benefits and costs of both drinking and not drinking is a more valuable exercise.

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Assessing the costs

"Ask yourself four questions," he said. "One is what would be the cost of maintaining the status quo of my drinking. Maybe it means you will still be fighting with your spouse.

"Two is what would be the benefits of the status quo of your drinking. These are important to get out on the table.

"Next ask yourself what would be the cost of changing your behavior to cut down on your alcohol consumption or quit. Then consider the benefits of changing."

Your goal is to tip the answers in favor of making a change, Kasei said. The costs of maintaining the status quo should outweigh the benefits of the status quo, while the benefits of making a change should be greater than the costs.

For Neal Chapin, that translates to "knowing I am in control rather than the other way around."

For another member of Helen Redmond's Moderation Management group, it means no longer being so sedated by martinis that she couldn't routinely awaken to help her daughter talk about a bad dream or get a glass of water.

As for the New York investment manager, his girlfriend has stuck by him, impressed with his initial research into moderation programs and happy the two of them can still share a nice glass of wine during an intimate dinner.

He has sworn off hard liquor to make things easier and stopped going to bars where the only activity is drinking. He prefers meeting friends for dinner or a music show. He admits to still finding it hard to keep to three glasses of wine or beer on "long nights" out.

"Most of my friends can't believe I lasted a week," said the New Yorker. "But it works for me. I am much more conscious of my behavior. I'm happy I did something about it."

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Drinking Quiz:

1. True or false: One serving of wine is 5 ounces.

2. Drinking coffee will:

(a) Sober you up

(b) Make you more alert

(c) Both of the above

(d) Neither of the above

3. True or false: Two ounces of hard liquor represents a serving.

4. Fact: Alcohol helps you fall asleep, but it disrupts the second half of your night's rest.

5. Ask yourself: Among 10 friends and family members, where do you rank as "most frequent drinker"?

6. Ask yourself: Do people make remarks about your drinking?

7. Fact: Three drinks in 90 minutes will put you over the legal limit for driving.

8. Fact: Eighty-six percent of Americans say they do not experience a hangover in a typical month.

9. Ask yourself: Do you drink alcoholic beverages without a meal?


Here are answers to the drinking quiz:

1. True. For your information, the typical bottle of wine has 750 milliliters or five servings.

2. D. Better to drink lots of water during and after drinking to prevent dehydration. Researchers have found a caffeinated beverage might help with a hangover because it constricts cerebral blood vessels.

3. False. A 1 1/2-ounce serving of 80-proof liquor is considered a serving.

4. Alcohol disturbs and likely shortens your deep-sleep cycles.

5. Frequency is an issue that bears self-monitoring. The DrinkWise moderation program suggests that answering "true" to the statement "I drink every day" is reason enough to consider cutting down or quitting.

6. Others making remarks about a person's drinking is a primary warning sign of a drinking problem, especially if a loved one has suggested cutting down in the last year.

7. You might hear that it requires three drinks in an hour for a 137-pound woman to be over the legal limit and four drinks in an hour for a 170-pound man. But factors such as empty stomach and level of fatigue can reduce the number of drinks required. Experts always recommend drinking no more than one beverage per hour. It requires several hours or more for the body to fully metabolize alcohol.

8. It is estimated 75 percent of Americans will experience at least one hangover during a year's time, but most people don't suffer them monthly. Hangovers are one indicator of consuming too much alcohol for best health, but some people simply don't feel greatly affected the next day. For instance, some research indicates the alcohol-destroying enzymes in the human stomach lining work better in men than women.

9. Moderation counselors uniformly recommend eating something (preferably a healthy snack and some nutritionists say it should include protein) before consuming an alcoholic beverage.

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Tactics that lead to self-limits

Many strategies developed by DrinkWise and Moderation Management participants encourage moderate drinking without squelching fun.

Here are some of the ideas the programs suggest:

- Delay drinking. Don't have anything with alcohol until you sit down with dinner.

- Quit drinking mixed drinks. Stick to wine or beer.

- Alternate alcoholic drinks with water or other non-alcoholic beverages. Try sparkling water or club soda with a lime slice or splash of fruit juice.

- Substitute non-alcoholic beers or "mocktails."

- Never drink alcohol when you are thirsty.

- Don't drink alcohol after fasting. DrinkWise counselor Teresa Herzog Mourad encourages clients to make a trail mix for commuting home, including nuts, dried fruit and even chocolate chips. The snack takes the edge off your hunger and thirst.

Another idea is starting your evening with a tray of fresh veggies and low-fat dip, accompanied by mocktails. The purpose is attending to your hunger and thirst before consuming an alcoholic drink. Remember to do the same after physical activity. Some moderate drinkers vow to drink a tall glass of water before every alcoholic drink.

- More wineries are producing half-bottles. Stock some to resist the temptation of always finishing the bottle. Invest in a quality recorking device to retain flavor over days.

- Develop a plan for your drinking. Examples: No more than two drinks, or stay only two hours at a party or bar.

- Make it a point to talk to a loved one about your drinking habits. Promise yourself not to be defensive or self-conscious. You are likely to learn a lot and make a positive difference in the relationship.


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For more information about the DrinkWise program at the University of Michigan, which welcomes participants by phone consultation, call 800-222-5145 or check out www.med.umich.edu/DrinkWise/. For information about Moderation Management, contact the national headquarters at 212-871-0974, or visit www.moderation.org or attend the local weekly meeting 6 p.m. Tuesdays at the University of Illinois at Chicago Medical Center, first-floor cafeteria, Private Dining Room A.

 

 

Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., FASAM.

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Originally posted:  10/20/2002

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Most recently revised: 7/1/2004
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  hip, & Sponsorship; Advertising policy

Most recently revised: 7/1/2004
Copyright 2003 All rights reserved.