Alcohol Abuse: Is Cold Turkey the Only Way?

Alcohol abuse is a common problem among people with high stress jobs, and firefighters are no exception. The really hard part for all involved is determining the severity of the alcohol abuse and how to manage it.

At one time, the school of thought was that people with drinking problems were alcoholics, and the only “cure” was complete abstinence. Going “cold turkey” became a common remedy and recommendation for anyone who drank heavily, whether or not they were a true alcoholic.

Today, alcohol abuse is seen as part of a spectrum, and a recent article by Allison Aubrey for NPR points out a new perspective on drinking. Many professionals are recognizing a place for “Moderation Management”, or cutting back on drinking, as a helpful alternative to complete abstinence from alcohol.

The idea of “moderation management”, or reducing but not eliminating intake of alcohol, is listed by the Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidence-based program. In a peer supporter situation, we can observe if our peer is able to voluntarily cut back on their drinking, and if it is working for him. However, it’s also important people to recognize that while Moderation Management may work for some people, it may not work for others.

Conditions for Moderation

Peer supporters need to help drinkers do two things before Moderation Management can be successful: (1) help the drinker identify their triggers that make them drink; and (2) help the drinker identify their underlying reasons for drinking. In my counseling experience, I have encountered clients who were able to pinpoint their “trigger”, or the thing which made them want to drink. For example, one client noticed he drank more when he felt lonely. Once he identified the trigger, he was able to redirect himself to a healthy activity—like going to the gym or taking a walk— whenever he felt lonely and wanted to drink. In his case, Moderation Management was all he needed to bring his drinking under control.

Determining whether or not the drinking problem is a habit or an unhealthy compulsion is also important. According to the article, this is the struggle that remains since not enough research has been done to help us easily determine the severity of someone’s drinking problem. Aubrey’s article cited a CDC study that stated the majority of Americans who drink more than one or two drinks a day are not alcoholics and report no symptoms of dependence. The study also that found that of the heavy drinkers who discussed their drinking habits with their primary care doctor at an annual checkup, 25 percent were able to reduce their drinking on their own. Perhaps this also suggests that when peer supporters bring unhealthy drinking habits to the attention of their fellow firefighters they may also be able to increase the firefighter’s awareness and ability to moderate their drinking. Good candidates for Moderation Management drink out of habit, not compulsion, so if the firefighter appears to be a creature of habit, Moderation Management may be a good strategy for him.

Moderation as Treatment

So is Moderation Management a treatment that the drinker should try? The answer is….maybe.

Peer supporters will probably find that many heavy drinkers find the idea of “cutting back” with Moderation Management much more palatable than quitting altogether and they may be eager to try it over abstinence. Moderation Management has other advantages, too. According to the article, it can help identify people earlier on who may need more intensive treatment. If Moderation is tried but is not possible, or is unsuccessful, the drinker knows he needs to quit completely. It also addresses a “treatment gap” between the severely alcohol dependent, who traditionally seek help, and those who may have developing problems with alcohol.

Peer supporters should remind heavy drinkers that drinking out of habit bears a resemblance to the overeater who eats mindlessly. The management strategies are similar: becoming mindful and breaking the bad routines. Just as a dieter would be mindful of every bite they take and count calories or fat grams, the drinker can count the number of drinks they have every day. Being mindful of drinking “too much” is a prerequisite to Moderation Management. Sometimes people engage in “chain drinking” or drinking one drink after another. Breaking out of the routine, by perhaps alternating drinks with water or seltzer, or changing the way the drink is consumed (i.e., sipping, using a smaller glass, a different hand, etc.) can help form new “habits” aimed at reducing overall alcohol intake.

While it is perfectly acceptable to explore perspectives on alcohol abuse within the spectrum, it is important to realize that Moderation Management is still a controversial approach and is not for everyone. If you are supporting a firefighter with uncontrollable compulsions to drink or if the firefighter has tried Moderation Management and has been unsuccessful, they may need treatment for alcohol addiction.

Dan DeGryse is the Director of the Rosecrance Florian program, an inpatient substance abuse program developed especially for fire fighters. Rosecrance supports the 12-step process and an abstinence model for alcohol abuse. He believes that Moderation Management is a dangerous approach because alcoholics are always looking to continue their behavior despite the consequences. “I can see these people saying, ‘hey I can do or try this because the doctors say I can’,” he said. “However, as I say to people, if what you are doing isn’t working for you, how about trying something different? What quality of life do you have, is it the quality you want, and if the answer is no, let’s look at options, ways to change and increase that quality.” Also, he was concerned that exercising the option may simply prolong bad experiences for the drinkers and their families.

So, while Moderation Management may work for some people, it should be used with caution. The drinker may potentially have an alcohol use disorder and require specialized treatment to manage their relationship with alcohol.