Help Clients Discover if They’re Ready to Start Moderating Their Drinking

When it comes to changing your client's relationship with alcohol, they can try to moderate their use or quit altogether. However, for most people, it is much easier to stop drinking than to temper their use. Some people can do it, but statistically, it is much easier to quit drinking entirely than to successfully moderate. Remember, alcohol is an addictive substance. Therefore, trying to moderate something that is chemically addictive is going to be inherently difficult, especially if clients have a history of overusing it.

One reason why moderation is so difficult is because it requires clients to constantly make decisions about their alcohol intake—What? Where? When? How much?—over and over again. The more decisions they make in a day, even if they are small and mundane, the more exhausted they get, and the more likely they are to make a poor choice. It’s also a double whammy in this case. Not only will clients face decision fatigue from moderating, but when they do drink, alcohol impairs their ability to think rationally and carefully weigh their options. It prevents them from being able to think about how their current actions may influence their future, making them more likely to fall back into old patterns. This is why it is so much easier to abstain completely. Clients make one decision and stick with that instead of constantly trying to estimate how they can avoid drinking too much.

The longer a client has been drinking and trying to either quit or cut back will determine how difficult moderation is. This is because the brain literally changes when a habit is created. The more the brain repeats a particular pattern, such as drinking, the deeper this pattern gets ingrained. Think about how bike tire tracks get formed in the mud. The first few times, it can be difficult to ride through the thick sludge, but if someone keeps taking the same path over and over, they are eventually going to leave such a deep groove in the mud that it becomes easier and easier to take the same path. In turn, they keep riding down those same tracks time and time again, and a habit forms.

Now a client can always decide to start forming new habits by putting new tire tracks next to the preexisting one, but that doesn’t mean the older pattern just disappears. Those old tire tracks will still be waiting for them, ready to pick up right where they left off. This is part of the reason why drinkers can have success with being abstinent, and then, all of a sudden, they get triggered and fall back into old patterns of behavior. The human brain can change, and people can develop new neural pathways, but just like someone cannot unlearn or forget trauma, the brain doesn’t forget how they used alcohol to cope. There is no reset button when it comes to habits.

Habits consist of three parts—a cue, routine, and reward—that together create a habit loop. A cue is a specific trigger that causes the client to crave a specific reward, whether this is a time of day, an emotion, or a location. In turn, the client goes through a specific routine, or a series of actions, to achieve that reward. We all fall into this habit loop. For example, we wake up in the morning, taste our morning breath (cue), and crave the minty taste of our toothpaste (reward), which prompts us to get out of bed and brush our teeth every day (routine). Habits stick because we crave the reward. If we can crave the taste of toothpaste, you can imagine how much more difficult it is to break a habit when the craving involves an artificially pleasurable substance like alcohol.

Unlike toothpaste, alcohol also causes people to need more of the substance over time to experience the same effect, and it dulls the pleasure they get from other enjoyable experiences in their lives. In addition, research shows that when it comes to addictive substances, individuals become hypersensitive to the cues associated with these habits, like seeing the clock strike 5:00 p.m., so they’re more likely to reach for that bottle of wine in response to those cues. This hypersensitivity to and affinity for the substance never goes away, even after a period of abstinence. This means that even after someone takes a break from alcohol, their brain will react with the same strong desire to drink as it did when they were at the height of their drinking. Taking a break may reset their tolerance, but it will not change how the brain has learned it should consume alcohol.

If clients do decide to try moderating, my recommendation is that they abstain from alcohol for at least 30 days. At this point, you might be wondering, What’s the point of having them quit for 30 days if they aren’t resetting their brain? Old habits may never truly disappear, but clients still have an opportunity to create new habits that give them a shot at doing something different. By repeating these new habits over time, clients can create new neural pathways in the brain that reinforce the experience of sobriety. For example, if every time a client feels stressed, they call a friend or take a hot bath instead of turning to alcohol, they are rewiring their brain. The same process occurs when clients practice socializing sober or go on a date without drinking alcohol to quell their nerves. Thirty days of practicing a new habit will not be as deeply ingrained as years of drinking, but it’s a great start that can give clients a chance to do something different.

Download these free worksheets to see if moderation is possible for your clients.

This blog is an excerpt from Not Drinking Tonight: The Workbook. Learn more about the book here!