RENEE MONTAGNE, HOST:
A few months ago, we did a story about Americans' drinking habits that got a lot of people thinking. The bad news was that many Americans are drinking more than one or two drinks a day, which is the upper limit of what experts think is safe. And this means that many who think of themselves as social drinkers actually fall into the category of excessive drinking. Today in Your Health, NPR's Allison Aubrey follows up on this story asking a new question - if you're drinking too much and want to cut back, where can you go for help?
ALLISON AUBREY, BYLINE: The thinking about alcohol dependence used to be very black and white. There was a belief that there were basically two kinds of drinkers - alcoholics, who needed treatment, and everyone else whose drinking was OK.
JOHN MARIANI: But that dichotomous yes-no, you have it or don't, is inadequate.
AUBREY: That's John Mariani, an addiction expert at Columbia University. He says the thinking among researchers has evolved.
MARIANI: The field recognizes that there's a spectrum.
AUBREY: Alcohol problems run the gamut from mild to severe. And to some, people do need treatment to stop drinking completely because alcohol is ruining their lives. They keep on drinking even after they lose jobs or get a DUI.
MARIANI: For them, the only solution is to abstain.
AUBREY: But do all excessive drinkers need to go this far? A recent CDC study found that the vast majority of Americans who drink more than one or two drinks a day are not alcoholics. They don't report symptoms of dependence. But many do want to cut back because they know it's not good for their health or they're concerned about their drinking progressing.
MARIANI: It's very common for people to want to moderate, to drink less, and see if that will work. And some people will be able to do that.
AUBREY: Take the story of Donna Dierker. She's the mom of two kids and she works as a scientist in St. Louis. About 10 years ago, she began to think she had a problem.
DONNA DIERKER: When I did drink, I drank a lot.
AUBREY: Not ever during the work week, but come the weekend, she and her husband would go out or drink with friends.
DIERKER: Like, Fridays would be, like, a six-pack and Saturdays probably split a pitcher of margaritas and then have a few beers after that. And then Sunday morning I would feel awful
AUBREY: Her blood pressure was going up. Her weight was creeping up, and so she resolved to cut back.
DIERKER: I had these good intentions, but then every time Friday would roll around, I would, you know, lose my resolve.
AUBREY: She checked out AA because that's the only group she'd ever heard of, but she says that that didn't seem right. Then she read about a group called Moderation Management. The organization has a national presence and is often the first alternative people find out about if they search online for help. It's basically an online support group to help people cut back.
DIERKER: And so I just decided to try it.
AUBREY: Now, through the group she connected with leaders and other people on the listserv who helped her work through her issues. The first thing she had to do was to identify why was she drinking so much? And what she realized is that she used alcohol as a reward for a hard week's work.
DIERKER: Getting through a Friday evening without my reward, you know (laughter) that was the tough one.
AUBREY: But she also realized that for her, drinking was more of a habit than a compulsion, and her friends, whom she drank with every weekend, reinforced that habit.
DIERKER: It was almost like not having ever grown out of college, you know (laughter)? That was the norm.
AUBREY: So she changed her weekend routine. On a Friday night instead of drinking beer...
DIERKER: I would drink seltzer water and dance in the playroom with my son.
AUBREY: And when she did drink, she learned tools and techniques to help her keep it in check. Her old routine was this...
DIERKER: As soon as one drink's gone getting the next drink - it's like habit; it really is. And I had to consciously slow down and drink-sip instead of gulp.
AUBREY: And just like people learn to eat less by counting calories, Donna learned to count her drinks and to stop when she reached her limit.
DIERKER: For me, that really helps.
AUBREY: Now, it's been 10 years, and Donna says for the most part it works. She has no problem just having a glass of wine with dinner or a couple of drinks with friends. And every so often she takes a month-long break from drinking so it doesn't start to creep up again.
DIERKER: I feel like I'm in the driver's seat. I don't feel like it's habit anymore. I think, you know, I've gotten it to where it's a treat again.
AUBREY: Now since Donna got started, the concept of helping people try to moderate their drinking has gained traction. Researchers have evaluated everything from cognitive behavioral therapy to motivational counseling to the self-help group like the one Donna uses, Moderation Management. So the question is how typical is Donna's success?
GEORGE KOOB: There's only been really one study that we know of that's evaluated Moderation Management, and they did find significant reductions in alcohol consumption and alcohol-related problems, but it's only one study.
AUBREY: That's George Koob. He's the director of the National Institute on Alcohol Abuse and Alcoholism. Now, other studies have also shown that moderation techniques can help some people, but Koob says what's important to remember is that there are as many kinds of drinkers as there are people. Everyone is different. And the tricky part of the moderation path is that there's no way to know which heavy drinkers can learn to control their drinking rather than giving it up completely.
KOOB: We don't have enough data to suggest that a certain person with a certain profile is going to go back to being a moderate drinker. The science has not been done.
AUBREY: It certainly does not work for everyone. It's controversial. Some critics point to the story of the woman who founded Moderation Management. After leaving the organization, she struggled with drinking, caused a fatal drunk driving crash and then committed suicide.
SARAH VLINKA: For everybody, it's really a process of trying to figure out what's going to work for you and what's not going to work.
AUBREY: That's Sarah Vlinka, a social worker in Michigan who has struggled with alcohol herself. In her case, about a year-and-a-half after experimenting with moderation, she realized that she needed to quit drinking entirely. In part because she was spending so much time thinking about and trying to manage the process.
VLINKA: I got tired of it. I said anything that is going to take this amount of my brain space doesn't really feel worth it to me right now.
AUBREY: So she stopped.
VLINKA: Yeah, I just said I think I'm done.
AUBREY: In her case, moderation helped lead her to abstinence, and some experts see this as an advantage of the moderation approach. Columbia University's John Mariani says there are lots of heavy drinkers who are resistant to help or the idea of abstinence, but are open to the idea of cutting back.
MARIANI: I think as a starting point, moderation is often a goal that everybody can agree on.
AUBREY: And if it doesn't work, it may be a step on the path to abstinence. Allison Aubrey, NPR News.
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