Q: Is total abstinence the only way to deal with drug/alcohol problems? I have a drinking problem, and I don’t know exactly what to do. I don’t drink every day, and feel fine going for a week without alcohol. But when I do drink, I always drink to excess, complete with blackouts and horrible hangovers the next day. It seems to be getting worse and now I’m at the point where these episodes are affecting my health, relationship, and job. I don’t want to drink like this anymore, obviously, but I also don’t want to have to quit completely. Is there any option other than getting completely sober? I had a drug problem when I was younger and figured out a way to control my use so it was only once in a while, but for whatever reason I can’t seem to do the same thing with alcohol. Are there any options? Or am I just in denial?
Lance Dodes, M.D.: The answer to your question depends on how to understand the cause of your problem. Some people see excessive, out-of-control use of alcohol or other drugs as somehow due to the drug. That’s why historically we name these problems after the drug, like “alcoholism,” as if it is the alcohol that magnetically draws people to it. That is, of course, not true. Feeling compelled to use a drug (or repeat whatever the behavior is, like gambling or eating) arises from important reasons inside people, not in an inanimate bottle. The good news is that this sort of compelled (or compulsive) action is both comprehensible and treatable using a modern view of addictive behavior. This also provides an answer to your question.
When people who have compulsive drinking (“alcoholism”) have just one drink, or find it easy to abstain, it’s because their reasons for drinking at that time are just the ordinary ones that lead folks to have a drink. But when they can’t stop, it’s because the reasons for drinking are driven by emotional factors, usually feelings of helplessness (about whatever in their lives makes them feel overwhelmingly trapped). By drinking (or eating or any other compulsive activity), there is a sense of taking back control of their lives, even if only temporarily: they’re in charge of making themselves feel better. (This isn’t an effect of the drug, since people often feel better just deciding to take a drink, even before imbibing.) When people feel they’re back in control of their lives via drinking, then drinking becomes a compelled activity. After all, the need to not feel trapped is powerful. So, it provides the engine that drives the almost-impossible-to-stop urge to drink (or gamble or eat, etc.). To say this another way, drinking becomes a compulsion because it serves an important emotional function.
You said you always drink to excess when you do drink, or you do not drink at all. That suggests that you only drink when you “need” to — when you feel compelled, whether that is conscious or not. If you are like most people, there is probably some theme in your life that always makes you feel helpless or powerless, and it is this theme that appears just before you drink. If you can figure out what that theme, that issue or feeling is, then you will be in a far better position. Knowing the source of your compulsive need to drink, you will not only be able to find a new and better way to deal with it, but you will be able to predict when the next urge to drink will arise. That will allow you to avoid even getting to the point where the urge to drink feels overwhelming. How to accomplish these steps is just what I wrote my first two books about (The Heart of Addiction and Breaking Addiction).
However, until you can work this out, it is not safe for you to drink. Although I wrote my books to serve as a good head start toward this, to resolve the underlying issues the best thing you can do is engage in psychotherapy designed for this sort of exploratory work.
To find a good therapist, I recommend that you look up psychiatrists, psychologists or social workers (people with an MD, PhD, or MSW degree) in your area who describe their practice as “psychodynamic.” This means they focus on the factors, the “theme”, which produce your compulsive drinking. I would be very cautious about seeing someone who describes himself as an “alcohol counselor” however, since too often that means the person has limited training or knowledge about human psychology and is focused instead on a narrow view of addiction which does not investigate its emotional roots.
Lance Dodes, M.D., is the author of Breaking Addiction, The Heart of Addiction, The Sober Truth, and Assistant Clinical Professor of Psychiatry at Harvard Medical School (retired). Full bio.