Alcohol and Problem Drinking

By Carlo C. DiClemente, PhD, and the Advisory Committee on Colleague Assistance

September 28, 2005 — Many very successful and competent individuals have found themselves in trouble with alcohol and have had to free themselves from problem drinking. Psychologists are not immune from the problem. Some may be vulnerable to the lure of alcohol to relieve stress in order to deal with the daily exposure to the toxic emotions and problems of patients. Having a drink can be a socially acceptable way to escape from the stress of patient care, the loneliness and burden of confidentiality, and the tension of an overextended work schedule.

As long as alcohol remains a beverage and does not become a drug, it does not pose a problem. However, if use of alcohol has transitioned from beverage to drug, from use to abuse, from drinking in moderation to drinking too much, the individual will likely have problems.

Alcohol is a drug with specific mechanisms of action in the brain and documented neurocognitive, behavioral, and emotional effects. Part of the problem lies in shared ambivalence and attitudes about alcohol and what we expect from it. Alcohol is viewed as a most effective social lubricant, a tension reducer, an inhibition releaser, a sexual enhancer, a courage builder, and a communication facilitator. At the same time, it is a restricted and regulated substance that one should learn to use responsibly only after reaching the age of 21.

Most problematic expectancies related to alcohol are connected with drug effects, not beverage characteristics. So a key to assessing when you are drinking too much has as much to do with why and how you are drinking as it has to do with how much you are drinking.

How will you know if you are drinking too much? Here are some key questions to ask to help you in your self-assessment:

Am I drinking alcohol as a beverage or using it as a drug? 

• Do I need alcohol to relax or relieve the stress of working with clients?

• Do I use alcohol to cope with negative reactions and emotions?

• Do I use alcohol to manage social functions or relationships?

How does alcohol fit into my life? 

• Do I make sure that there is always time for alcohol in my schedule? 

• Has drinking become an important priority?

What do I expect from my alcohol consumption?
An attitude adjustment? 
Solace and release from tension?

Can I honestly say that there are no negative consequences of my drinking? 

• No impact on family or children? 

• No physical effects (hangover, memory loss, loss of control)? 

• No risky behavior (driving after drinking more than 2 or 3 drinks)? 

• No family member or friend commenting on my drinking? 

• No impact on my professional responsibilities (lateness, forgetting, inappropriate reactions to patients, poor judgment)

Can I drink 4 or 5 drinks at a time and not feel negative effects?

Are there any occasions or circumstances when I feel I have to have a drink?

Do I have a spouse, friends, or family members who have a drinking problem?

If your answers to one or more of these statements or questions are positive for problematic expectancies, patterns or consequences, then you may be engaging either in risky drinking that puts you at risk for alcohol problems or in hazardous drinking that is already producing some negative consequences in your life. The next step would be a more thorough evaluation of your drinking.

Luckily there are some options for assessment. As all psychologists are well aware, self-assessment is not like looking into a mirror where we get a complete (even if slightly distorted) view of ourselves. It is often difficult to be objective about ourselves. Seeking feedback from someone who can be objective would be the best route to take. Paying attention and being open to the information you receive is essential. Simply because we are psychologists trained to detect problems does not mean that we can see or diagnose our own, especially when there are potent psychological and physiological reinforcers for the status quo. We need to imitate our best clients and be open to considering feedback.

If you are drinking too much and willing to admit it, there are many options available for doing something about your problem drinking. Many of these will be familiar strategies from our theories of behavior change. Creating a viable plan and making this change a priority is the next step. Every plan has to include the following:

Set a clear goal of stopping problematic drinking, reducing overall drinking, or quitting drinking altogether. Although there are differing schools of thought, moderating alcohol consumption or abstaining entirely may both be viable options.

Make sure you are convinced and committed. 

• Tell someone (a spouse, colleague, or friend) about it 

• Build in rewards and reinforcers for you goals

Use behavioral strategies to accomplish these goals. 

• Removing alcohol from your home. 

• Alternating alcoholic with non-alcoholic beverages, and pacing consumption of alcohol. 

• Substituting other behaviors to manage the situations, emotions, and behaviors that you have been medicating with alcohol. 

• Avoiding people and places where it is difficult to manage drinking, at least at the beginning.

Challenge your problematic expectancies about alcohol. 

• Alcohol does not make you a better conversationalist 

• Alcohol interferes with sexual enjoyment and performance 

• You can get as much relaxation from a long walk as you can from overdrinking. 

• Excessive drinking causes more stressors and consequences and does not make your life easier.

Make a commitment to implement the plan and stick with it.

Get support from friends or mutual help groups.

Don’t give up. Successful behavior change takes time and may require continued attempts through the stages of change in order to get it right.

Problem drinking often is accompanied by other problems in a person’s life that are precipitants or consequences of the drinking. These problems also need to be addressed once the brain and body are clear enough to deal with them.

Recognition and realization of the drinking problem and taking effective action can help anyone who drinks too much to either abstain entirely or to return alcohol to the status of a beverage that can be consumed rather than a drug to be used. For professionals (and in particular for psychologists) it can be humbling to realize that we have fallen victim to the lure of alcohol. However, we are in good company with the many medical, business, sport, and entertainment professionals whose own struggles with alcohol problems offer object lessons about the dangers and models of the courage and hope needed to confront, challenge and successfully change excessive drinking (Fletcher, 2001).

Denning, P., Little, J. & Glickman, A. Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol. New York: Guilford Press, 2004.

DiClemente, C.C. (2003). Addiction & Change: How Addictions Develop and Addicted People Recover. New York, NY: The Guilford Press.

Fletcher, Anne M. (2001) Sober for Good: New Solutions for Drinking Problems — Advice from those Who Have Succeeded. New York: Houghton Mifflin.

Miller, W.R, & Rollnick, S. Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford, 2001.

Prochaska, J.O., DiClemente, C.C., and Norcross, J.C. In search of how people change: Applications to addictive behaviors. American Psychologist 47: 1102 1114, 1992.

Prochaska, J.O., Norcross, J.C. & DiClemente, C.C. (1994) Changing for Good. New York: Avon books.

Internet-based sources of information on alcohol and both professional and mutual help include:

National Institute on Alcohol Abuse and Alcoholism

Alcoholics Anonymous

Drinker's Check-up