Question 1

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

Question 2

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 3

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 4

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 5

What is the effectiveness of digital and online tools to help people with alcohol problems?

Reid Hester · Accepted Answer

This is a rapidly expanding field and there are a large number of digital tools (web and phone apps) that have not been evaluated in clinical trials, let alone randomized clinical trials (the gold standard). So caveat emptor. Fortunately, there has been a recent review of the field.

Kiluk and colleagues (2020) have published a meta-analysis of digital tools for alcohol problems and their findings are consistent with previous reviews of this literature. They found that the different control or comparison conditions could influence the outcomes of the randomized clinical trials. The good news is that there are digital tools with evidence of effectiveness.

Read more on Kiluk and colleagues (2020).
https://pubmed.ncbi.nlm.nih.gov/31566787

Read more about digital tools for alcohol problems:
https://bit.ly/2RbwFUt

Question 6

Am I an alcoholic?

Reid Hester · Accepted Answer

Alcoholism or being an alcoholic has not been a diagnosis for decades now. The problem with the term, aside from the stigma, is that it begs a yes or no answer and assumes that heavy drinking and alcohol problems are all or nothing. That could not be further from the truth.

In 2013 the diagnosis for heavy drinkers recognized that problems and levels of dependence lie on continua and now we have the term Substance Use Disorder (SUD). With this new diagnostic system, one’s clinical picture can range from mild to severe (a function of how many symptoms one has).

The diagnosis of SUD is now on a continuum. It’s like hypertension. You can have a little elevation in your blood pressure at the low end to severely high blood pressure at the high end.

Read more about this here and there’s a link there too for a free screener. 
https://bit.ly/3mbTZja

Question 7

Is it possible to help a family member who’s drinking too much?

Reid Hester · Accepted Answer

The short answer is yes, it is often possible even if the heavy drinker isn’t interested, at least initially. If you’re asking this question you’re probably aware that heavy drinking affects not only the drinker but his or her family, friends, work and social environment.

And the old saying that there’s nothing you can do about it just isn’t accurate anymore. Yes, there is reason for hope that you, as a friend, family member or significant other, can (in most cases) influence another person’s drinking. Here are some suggestions for what to do and for what to not do:
1.	Ditch the term alcoholic. It has a lot of stigma and using the label is not productive.
2.	Tap into resources like NIAAA’s Treatment Navigator
3.	Use an approach with evidence of effectiveness. No, it’s not the “Intervention” often portrayed in movies and on TV.
4.	Carefully consider when you’re going to talk to your friend or family member. And only do it when she/he is sober.
5.	Plan and rehearse what you’re going to say
6.	If you’re concerned about domestic violence, work with a counselor who has expertise in treating alcohol use disorders. I can’t stress this strongly enough.
7.	Get social support from others both family members who are supportive and the community of concerned family members.

Read more about this here:
https://bit.ly/2GIt7a4

Question 8

How can I deal with urges to drink?

Reid Hester · Accepted Answer

There is no single best method or silver bullet. And some are more helpful early on in your efforts to change your drinking, whether it be to cut back or to stop drinking entirely. Others are somewhat more advanced strategies.
This list is based on empirical research on clinical protocols for addressing them in treatment. And the good news is that using them can improve your ability to manage and reduce them even if you’re not in treatment.

•	Keeping Track
•	Avoid Triggers to Drinking (or overdrinking)
•	Distract yourself
•	Question the Urge
•	The DISARM method
•	Learn how to effectively refuse drinks
•	Medications
•	Meditation
•	Urge Surfing
•	Studying the Urge
•	Countering the Urge

There is a more detailed discussion of these strategies here.
https://bit.ly/32hBmlI

Question 9

What is binge drinking? How is it different from heavy drinking?

Reid Hester · Accepted Answer

Binge drinking is a pattern of drinking that results in a person’s blood alcohol concentration (BAC) up to .08 (80mg%). This level usually happens after 4 standard drinks for women and 5 for men in about 2 hours. Your BAC can be higher than this though depending on your weight and the time you spend drinking.

For reference, a BAC of .08 is the legal limit for DWI/DUI in the U.S. A driver caught with a BAC of .08 or higher is automatically considered to be DWI/DUI. Most people who’ve had DWI/DUIs consider them to be negative and expensive experiences.

Heavy drinking, on the other hand is defined as 5 or more episodes of binge drinking over the course of 30 days. So a heavy drinker is a person who gets drunk on a regular basis.

Learn more: 
https://bit.ly/3m8SG4v

Question 10

I find myself drinking more during Covid and have become more flat. What can you offer to support a functioning alcoholic?

Reid Hester · Accepted Answer

This pandemic has resulted in enormous amounts of anxiety and depression and as I mention in another Q&A, these negative feelings are putting more people at risk for developing alcohol related problems.

To answer your question, consider our https://CheckUpandChoices.com online protocol. It can help you take a close look at your drinking, get objective, feedback, and then decide what, if anything to do about it. The Choices section has abstinence-focused protocols for alcohol and other drugs.

I would also recommend two mutual support groups for moderation and abstinence, respectively. Moderation Management (https://moderation.org) and SMART Recovery (https://smartrecovery.org). Both have adapted empirically supported protocols for use in a mutual support context.

Question 11

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 12

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 13

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 14

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 15

What is considered moderate drinking?

Reid Hester · Accepted Answer

There is agreement in the scientific community about what defines “moderate drinking.” It’s no more than 3-4 standard drinks per drinking episode and a total of no more than 9 drinks per week for women and 12-14 for men. Also, moderate drinking means limiting how fast you drink and, as a result, keeping your blood alcohol concentration (BAC) below .055 (.08 is the DWI limit in all states in the U.S.). This definition of moderate drinking prevents you from getting drunk.

Read more about the definition of moderate drinking here. 
https://bit.ly/32jOQNO

Question 16

How can I tell how much alcohol is in what I usually drink?

Reid Hester · Accepted Answer

All drinks are not created equal. Beer can range in the % of alcohol from 3.2 to 9+%. While the average 12 oz beer sold in the U.S. is 5%, it pays to know the alcohol content of what you’re drinking. This is especially true for craft beers that have become popular of late. (Probably because they taste better but that’s our own opinion.) And remember, a pint of beer is 16 oz so that’s already a 1.25 standard drinks at 5% beer.

Wine is easier to know the alcohol content because it’s (usually) listed on the bottle. 
Liquor and mixed drinks are a whole other “kettle of fish.” How much vodka is in that Martini? How much rum is in that Long Island Iced Tea? The number of standard drinks in a cocktail is a function of the number of ounces of alcohol and the % of alcohol.

We’ve created a searchable database that you can use to figure out how potent your typical drink really is.  Go here:

https://bit.ly/2Zqtahq

Question 17

I’m starting to wonder about my drinking: Should I quit or just cut back?

Reid Hester · Accepted Answer

People who are thinking of changing their drinking are often experiencing some alcohol-related problems or concerns. And for them, it’s normal to be ambivalent (i.e., feel two ways) about drinking. They can think of the “good things” they like about drinking and “not so good things” that concern them. The first step then is to answer the question “Should I change my drinking?” And it helps to make two lists of what you like about drinking and what concerns you. Then think deeply about the pros and cons.

How to Moderate Heavy Drinking