Question 1

Question 2

What does a healthy relationship with alcohol look like?

Reid Hester · Accepted Answer

A healthy relationship with drinking is one where the person drinks moderately and not in response to emotional or physical stressors. Drinking to improve one’s mood when depressed or anxious can set up a reinforcement loop that rewards further drinking. Small doses of alcohol can improve feelings of depression and reduce anxiety.  This reward reinforces the drinking. More drinking is not better though and can increase depression and anxiety, just not usually until the next day. Feeling more depressed or anxious the next day can set the person up for drinking because its immediate consequence is to lessen these negative emotions. So, a vicious circle develops.

Question 3

Can an alcoholic become a social drinker?

Reid Hester · Accepted Answer

The short answer is that most are significantly challenged to resume moderate drinking. 
The more nuanced answer is to first back up. While many people with a history of significant alcohol-related problems consider themselves “alcoholic” that term/label hasn’t been used in healthcare for decades now. The more accurate term is Alcohol Use Disorder (AUD) in the DSM-5 (https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders). AUD recognizes that drinking and alcohol-related problems lie on continua. It’s not a yes/no question. It’s more like hypertension than pregnancy.

We’ve posted a questionnaire on our web site that provides empirically-based feedback on one’s chances of success with moderation as a goal of change at: https://bit.ly/2GAh8f8

Question 4

How many drinks a week makes you an alcoholic?

Reid Hester · Accepted Answer

While many people with a history of significant alcohol-related problems consider themselves “alcoholic” that term/label hasn’t been used in healthcare for decades now. The more accurate term is Alcohol Use Disorder (AUD) in the DSM-5 (https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders). AUD recognizes that drinking and alcohol-related problems lie on continua. And the definition of AUD includes 11 criteria that include both how much/how often, tolerance, and alcohol related problems. So, the answer as to what constitutes AUD is more nuanced than your question.

There is a consensus in the field though about what is considered binge drinking and what is considered heavy drinking (https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking).

We also discuss it here with some context: https://bit.ly/3da8SOO

Question 5

Are there any benefits to drinking alcohol?

Reid Hester · Accepted Answer

This has been discussed and debated in the field for years now. There are no benefits to binge drinking or heavy drinking (defined here https://bit.ly/3da8SOO). The picture is more mixed with respect to moderate drinking though. Some studies show small positive benefits while others conclude from their data that any drinking increases risks for health problems long term. The most current criteria for low risk drinking levels are up to 1 standard drink for women and up to 2 for adults (https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/Is-Your-Drinking-Pattern-Risky/Drinking-Levels.aspx).

Question 6

Question 7

What motivates people to change their drinking habits?

Reid Hester · Accepted Answer

For the vast majority it comes down to alcohol related problems or the risk of developing alcohol related problems. But there is no single “straw that breaks the camel’s back.” For most, it’s the accumulation of alcohol problems over time that prompts people to consider changing their drinking.

The risk of developing problems, especially medical conditions and complications is also a factor for some people. There are almost 50 different medical conditions that are adversely impacted by either heavy drinking or even moderate drinking. As an example, many people develop elevated blood sugars as they age that can lead to a condition called pre-diabetes or metabolic syndrome. While this condition can be addressed with exercise, weight loss, and diet, drinking can also adversely impact it. Here is an overview of this large body of research 
(https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/Whats-the-harm/What-Are-The-Risks.aspx).

Since risks from interactions between medical conditions and drinking can motivate people to change, we ask about these medical conditions in our CheckUp (https://bit.ly/2Fb60ER) and provide feedback in the CheckUp on how drinking impacts those medical conditions the subscriber has.

Question 8

Do you agree with the disease model of alcoholism?

Reid Hester · Accepted Answer

How one thinks about heavy drinking and alcohol problems affects how one goes about addressing them. And the data is pretty clear that the biopsychosocial model is the most comprehensive (https://pubs.niaaa.nih.gov/publications/10report/chap03c.pdf). It acknowledges the biological and genetic influences as well as the internal (psychological) and external (situational pressures) that all have an impact on drinking and the development (or not) of Alcohol Use Disorders.

Question 9

Why are you promoting moderate drinking? Despite popular publications citing studies to suggest the health effects of alcohol, the most reliable research recommends that no amount of alcohol is safe, not even moderate drinking.

Reid Hester · Accepted Answer

We don’t 'promote' moderate drinking and never have. Nor am I aware of any other clinical researchers in the field of harm reduction who do this. Our position is that harm reduction is better than no reduction. And while abstaining is a positive goal to strive for, one has to start helping people by meeting them “where they are.”

The other reality is that most people with alcohol problems are not on the severe end of the spectrum. And for them, cutting back is a feasible goal for reducing alcohol-related problems. There are 4-5 times as many such people compared to those who are at the severe end of the spectrum. And for this much larger group of drinkers, moderating drinking to reduce alcohol related problems is achievable.

Question 10

Given the physiology of alcohol tolerance, how can people stop alcohol creep?

Reid Hester · Accepted Answer

If by creep, you mean a gradual increase in drinking to get the same effect. Physiology is not destiny. We all have the ability to think about our problems and concerns in a way that overrides tolerance. And for many, tolerance declines quickly with either reduced drinking or abstinence. And one of the first steps that Moderation Management recommends is “taking a 30”, a term for taking a break from drinking. This reduces tolerance while at the same time alerts individuals to their triggers for heavy drinking. We think it has sufficient clinical value that we have incorporated it into the Moderate program within our CheckUpandChoices.com program. https://bit.ly/3lnPXCX

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