Shhh! Let’s Talk About Moderation for Mild

Alcohol Use Disorders

Cyndi Turner, LCSW, LSATP, MAC

Craig James, LCSW, MAC

Shhh! Let’s Talk About Moderation for Mild to Moderate Alcohol Use Disorders

Insight Into Action Therapy

September 16, 2017

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Overview

Types of Drinkers

Moderation Defined

Treatment & Prevention for the 22%

Positive/Negative Predictors

Moderate Drinking Plan

Moderation Tools

Four Types of Drinkers

35% do not drink at all

37% drink within normal limits

22% drinkers experiencing problems mild to moderate AUD

6% meet criteria for severe AUD/alcoholic

17 Million People Experience Severe AUD

90 Million People Experience Mild to Moderate AUD- fills Central Time Zone

Moderation Defined

Dietary Guidelines for Americans 2015-2020: up to 1 drink per day for women/older adults and up to 2 drinks per day for men

The National Institute on Alcohol Abuse & Alcoholism: up to 4 alcoholic drinks for men and 3 for women in any single day; max 14 drinks for men and 7 drinks for women per week

No more than 2-3 drinks for men; 1-2 women/older adults

Not more than once a week

Have family members’ support

Developed Moderate Drinking Plan

Insight Definition for Moderation

Why Do Men Get to Drink More?

Alcohol is dispersed through body in water…

Women have less water in their body…

Women usually weigh less than men…

Women have higher concentration of alcohol in their bodies…

Women become intoxicated faster than men

Men have stomach enzyme (dehydrogenase)that breaks down alcohol 4 times faster

DSM-IV TR

Abuse: if it causes a problem, it is a problem

Dependence: alcoholic

Encourage self-assessment

DSM-5 Diagnosis

Problematic Pattern of alcohol use leading to impairment within a 12-month period:

Taken in larger amounts than intended Desire or unsuccessful efforts to cut down or

control Time spent in activities to obtain, use, recover

from Craving or strong desire to use Recurrent use resulting in role failure

DSM Continued

Continued use despite consequences Important social, occupational, or reactional

activities given up/reduced Recurrent use in physically hazardous

situations Continued use despite problem exasperated by

use Tolerance – more needed to get effect or

diminished effect with same amount Withdrawals

DSM Continued…

Diagnosis on a spectrum

Substance Use Disorder

Mild: 2-3 symptoms

Moderate: 4-5 symptoms

Severe: 6 or more - unlikely to be able to moderate

Withdrawals

Can occur 24-72 hours after last drink and can be life threatening.

1. Sweating/high pulse2. Hand tremors3. Insomnia4. Nausea or vomiting5. Hallucinations6. Psychomotor agitation7. Anxiety8. Seizures

Spectrum of Alcohol Use

No UseExperimental

UseOccasional

UseSituational

UseBinge Use Alcohol Abuse

Alcohol Dependence

Why the 22% Avoids Getting Help

Moderation Management found 90% of drinkers experiencing problems will avoid getting help:

Afraid of being label alcoholicMade to go to rehabForced to go to 12-Step meetingsHave to give up drinking foreverLife will boring/miserable

Call for Change

Over 90% of treatment facilities require total abstinence

By removing abstinence as the main goal, people become more open to education and information

Education = Prevention

“If I had known this in my 20s and 30s, I might not be the alcoholic I am in my 50s.”

Focus on the Why

Explore WHY someone is drinking

Not just “don’t drink”

Give them Tools

Clients with Trauma

$35 Billion Industry

Heads in Beds= $1000 a day + urinalysis

Moderation more cost effective for client

Decreases industry profit

Moderate Drinking Research

Moderation training reduced consumption by 50-70%

Those with severe problems tried moderation but ultimately decided upon abstinence

Most successful moderators had less severe problems at start

1/3 of people who tried moderation stopped permanently

Easier to do all or nothing

Harm Reduction

Alcohol use seen as psychosocial problem - looks at whole person

Explores ways to reduce consequences of drinking

Views small changes as Success

Client Examples

Theoretical Stance

Motivational Interviewing Techniques

Way to get and keep people in the door

Starts a conversation

Education and Prevention

Stages of Change Model

Moderation Work Begins

Moderation Steps

Clinical Assessment

Self Assessment

Denial

Motivational Interviewing

Approach

Moderation Severe AUD

Appropriate Level of

Treatment

Treat the Why

Cost / Benefit of Drinking

You want me to do… What?!

Recommend 4 months abstinence before moderation

Deal with life on life’s terms

Make it through holidays, events, celebrations

Develop support system

Practice change

Learn to manage risky situations

Manage cravings

Identify new coping skills

How Do I Know If I Can Keep Drinking Quiz?

Gives predictions for ability to moderate

Should be reviewed with someone trained in dual diagnosis and familiar with moderation/harm reduction

Full quiz:

www.insightactiontherapy.comor

www.canIkeepdrinking.com

How Long Have Been Drinking?

How Many?

Daily

Patterned binge drinking

Remember definition of moderation

Association with most events

Requirement for fun

Blackouts*

Medical Issues & Medications

Antidepressants

Benzos

Weakens immune system

Affects every organ in body

Equilibrium

Known to cause cancer, heart disease

Check w/ MD (most medications follow moderation guideline)

Synergistic Effect

Consequences of Drinking?

Severity

Learned from mistakes

Personality shift

Ratio of positive versus negative outcomes

Impact on self and loved ones

Drink alone*

Goal Regarding Drinking

To be normal

Truly enjoy taste

Intent to alter mood*

Part of celebration, not main focus

Family’s goals

Effect on loved ones

Family’s trust been addressed

Genetic Predisposition

Genetics are responsible for 50%

No one gene

4x more likely if you have direct family member

Environment

Can’t get addicted to something you’ve never tried

Trauma

70% of adolescent SUD experienced trauma

60% of people w/PTSD develop SUDs

60-80% of vets w/ PTSD have AUDs

Teens w/ physical or sexual 3x more likely

Endorphin Cycle: Brain releases during trauma for protection

Naturally decrease

Drinking increases endorphins

Interrupts what body was already doing

Prolongs emotional distress

Emotional withdrawal

Mental Health

Alcohol is a depressant

Affects sleep

Medication may not be effective

Need to learn alterative coping skills

Over 60% people with MH have SUD

Other Drugs?

Trying to alter mood*

Unlikely to have developed coping skills

Lifestyle

Legal Issues

Withdrawals

Withdrawals*▪ Usually signifies severe alcohol use disorder▪ Physiology has changed ▪ Once a pickle, cannot go back to cucumber

Period Of Abstinence

What does it say if you cannot go a month without?

What was learned in abstinence

30% of people who go through abstinence for moderation, remain clean

Supports & Monitor Use and Be Accountable

Willing to monitor amount/frequency

Have family’s support

Has support system that gives perspective and accountability

Before Implementing Plan

✓Understand biological, psychological, and social consequences of drinking

✓Have not developed physical dependence on alcohol

✓Can commit to not engaging in unsafe behavior after consuming

✓Do not abuse other drugs

✓Do not act destructive after drinking

Before Implementing Plan

✓Had period of abstinence and addressed issues that arose

✓Identified triggers and have plan to deal with them

✓Experienced range of positive and negative emotions and dealt successfully with them

✓Satisfied any legal, probationary, work, family, and friend obligations

Before Implementing Plan

✓Understand why you drink and determine that it is safe to continue

✓Identified a support person to review plan and keep you accountable

• Therapist

• Friend

• Moderation Management

• HAMS

• Online

Moderate Drinking Plan

Why I want to keep drinking

Where/when I will not drink

Not drink until…

Not drink after…

Will not drive after consuming

Alternate alcoholic beverages with…

No more than.. drinks per…

Review my plan with…

If I/we notice…, I/we will…

Tools for Moderation

Play it through - if/then

Drink only in social situations

Offer to be DD

Practice a one-liner

Use tangible reminders

Eat something

Have a mocktail

Alternate beverages

Levels of Risk

Preparing to Drink Again

Impact of losing clean date

Prepare friends and family

Pick person, place, and drink

Don’t make alcohol the main event

Have exit plan

Gut Check

Moderation Steps

• Take Quiz

• Treat the Why

• 4 Months Abstinence

• Identify & Meet w/ Support

• Develop Moderation Plan

• Implement Moderation Plan

• GUT Check

Donuts

“

“Drinking alcohol is like eating donuts. Having one or two occasionally is not going to hurt you but having several a day

is eventually going to lead to serious problems.”

CanIKeepDrinking.com

@CanIDrinkBook