Why Most Alcoholics Wait Years Before Asking for Help

If we look at the process that people go through finally coming to the realization that they may have a problem with alcohol, that their drinking may be problematic. One of the stages they go through is a stage what we kind of refer to as yes, but it's known as the contemplation stage where somebody says, "Yeah, well maybe I drink too much, but I don't drink as much as a lot of other people I know." And I wouldn't say that they have a problem. I wouldn't be so

quick to point a finger at them and say, you know, you're drinking too much and you really need some kind of help. Yes, my drinking is causing me some problems. Yes, I would like to drink less because I think I I do too much of it. I've

tried a number of times to cut back. I can't say that I've been terribly successful. But I'm not an outofc control alcoholic. So, do I really need

help? Do I really need to go see a professional to help me with this problem? That's known as the sort of in between seesaw stage where the person goes back and forth between, yes, I have a problem. Well, no, it's really not

that bad. Maybe I should get help. Well, I know other people whose problems are worse than mine and they're not involved in any kind of treatment. So, what is it

that brings people to treatment for alcohol problems? What would lead somebody to reach out for help? Well, unfortunately, it's is usually when something bad happens. That's usually

the triggering point or the tipping point for most people in extreme cases. They get a DUI or an automobile accident. Hopefully, nobody's gotten hurt and it's a fender bender. At worst,

sometimes it's the threat of losing a valued relationship. a partner or spouse says, "Listen, I can't continue living like this. We're either going to have to separate or you're going to have to go live somewhere else." It's being called

on the carpet at work by somebody because of your absenteeism or your reduced productivity. The tipping point can also be that you just get sick and tired of living your life this way. that every time you promise yourself you're not going to drink too much and don't want to wake up with another hangover or wake up feeling like you've lost control of yourself, you find yourself in that predicament time and time again. And

there's usually one occasion on which you get to the point where you feel like you've had enough. You've tried enough times to deal with this on your own. Maybe it's time to reach out for help.

It's estimated that fewer than 50% at best of people who have serious alcohol problems ever show up for treatment. And one of the reasons it's thought to be the case is because most people have reason to believe that treatment is going to require them to give up drinking entirely, even give up drinking permanently based on the 12step AA model of alcohol problems, being symptomatic of a disease for which there is only recovery and no cure, and that the only way to not suffer the consequences of that illness is to be completely absinent over the long term, ideally abstinent for life. Many people don't seek treatment because they are not interested in giving up drinking.

They're hoping to find a way to moderate their drinking and keep it within limits so it's not causing them problems. So traditional treatment programs are founded and based almost entirely on that abstinence model. It's estimated that over 90% of the programs in the United States, the addiction treatment programs in the United States are abstinence-based. It's starting to

change uh as we are incorporating new ways of working with people with alcohol problems, teaching them how to reduce the harm associated with their drinking, moderating their alcohol consumption, cutting it down at least as a stepping stone towards reducing the risk and the harm associated with drinking. Whether or not total abstinence is their ultimate goal, there's great value in teaching people how to put limits on the amount of alcohol they consume. One of the keys to successfully engaging people in treatment for an alcohol problem is to be willing to quote start where the person is rather than where you would like them to be or think they ought to be. So with regard to abstinence versus

moderate drinking, for example, when somebody first comes for treatment, I make an active attempt to flesh out with them what are their goals in terms of their drinking behavior. Do they want to learn how to be a moderate drinker? Do they think it's better for them to abstain over the long term? Do they want

to stop now with the prospect of maybe trying moderate drinking a little bit down the road? The most important issue here is to listen to what people want for themselves, what they think are realistic and achievable for themselves and not to try to impose on them the goals that I think would be in their best interest. When I see somebody who is drinking heavily has already suffered some significant consequences from their drinking, is it likely that I think abstinence is a better goal for them than moderation? Well, yes, of course.

But if I take the position that if you're not willing to abstain, I'm not sure I can help you because I think it's an unrealistic goal is a reliable way of sending somebody out the door never to return. It's more important to start where the person is at. See whether or not their goals can be realistically achieved. It's worth a try to see if

they can make any progress at all. And attempts at moderation are often the stepping stone towards abstinence. If abstinence turns out to be the preferable and the better course because somebody will see through their own experience that moderation is too difficult for them. It's just too hard

to achieve and abstinence might be worth a try. Not necessarily swearing that they're never going to drink again, but abstinence for some period of time may be worth considering. So when somebody comes into treatment and we're attempting to define what their drinking goals might be, if we're talking about harm reduction, that is strategies to reduce the harm or risks associated with their drinking, we can think of that in several ways. We can think of strategies

that will reduce the risk that is help them drink more safely. We can talk about strategies that will put them closer to what is typically defined as truly moderate drinking. Like what is moderate drinking? Do we have a good

definition of that? And where does abstinence fit on the continuum of these various drinking goals? So if we think about harm reduction strategies, strategies to reduce the risks and the harm associated potential harm associated with somebody's drinking. I

think of the case of patient, his name was Bob, who was a corporate attorney who had a habit of going to a sports bar after work every day, having a few drinks and driving home, and on more than a few occasions, you know, had some close calls on the road. I proposed to him that if he didn't want to stop drinking or markedly reduce his drinking, at least we could eliminate the possibility of driving while intoxicated. And I asked his wife if she could arrange to have his adult son, who was living at home at the time and working from home to come and pick up Bob at the sports bar uh after work and drive him home. She was kind of taken

aback by the suggestion at first cuz she wanted him to stop drinking altogether and thought it was a preposterous idea on my part that was only going to enable to him to drink further. And I said, "Listen, I agree that it would be great if Bob either cut back severely or stopped drinking totally, but he's unwilling to entertain the possibility. At the very least, we can do something to eliminate the possibility of some kind of tragedy happening by him getting into a car accident and and hurting himself and or other people by driving while intoxicated. So, let's do this as

the first step." This is a classic harm reduction intervention where the first goal is to eliminate in his case eliminate the risk of serious consequences related to his drinking that would result from driving while intoxicated.