The In Between Space:  Exploring Clients’ Relationship With Alcohol

 “The man takes a drink.  The drink takes a drink.  The drink takes the man.”  ~Proverb 

As a psychotherapist in private practice with extensive training and specialization in addiction and recovery, there are a few questions I get asked all the time.  One of the top questions is this:   How do I know when my drinking is a real problem?

I know many clinicians spend hours talking with clients about their drinking.  Having clinical conversations with clients about their relationships with alcohol can be a rich and illuminating part of therapy, often shedding light on underlying thoughts, feelings, and dynamics.

First of all, for someone to be diagnosed with alcoholism, he or she has to meet some very serious criteria.  And alcohol abuse can look a lot like alcoholism.  It is important to be thorough in assessing.  This article is not a strict teaching on DSM criteria and diagnosis, but how to talk about the in-between places with clients.   

Once a cucumber turns into a pickle, it can’t turn back into a cucumber.  Once you have crossed THE LINE into alcoholism, you really can’t go back.  This article discusses how to work with clients in assessing alcohol abuse and relationships with alcohol.   

Alcohol abuse can look very similar to alcoholism.  You can have a lot of the same consequences when you abuse alcohol you might have if you are an alcoholic.  Often times, especially in certain developmental stages (think ages 18-25), it is often very hard to distinguish problem drinking vs alcoholism.

New studies report there is no amount of alcohol consumption that is safe for overall health.  Of course, there is a lot of debate around this, especially those who like to cite the benefits of “moderate drinking.”  Truthfully, I would bet the farm that those who drink moderately, feel justified to do so, and want to argue about it, may not actually be drinking moderately at all.   Alcohol has a way of blurring the facts and measurements.  No organization has ever recommended starting drinking alcohol as a health benefit.  The recommendation has always been that IF you drink, drink moderately. 

 With all that being said, finding space to talk with clients outside of diagnosis and labels can be very important, illuminating and freeing to both clinician and client.   

In my psychotherapy practice, the main, old school criteria I use to help someone explore if they are crossing the line are The 3 C’s:

  • Loss of Control

  • Compulsivity

  • Consequences

Loss of Control:  When you drink, you can’t control how much you drink or your thoughts and behaviors when you drink. 

Compulsivity:  The best description of compulsivity is the experience of drinking despite the fact that you don’t want to do so, despite the negative consequences, or despite the fact that something important is on the line.  You do it anyway.  You rationalize and justify your drinking because you feel you have to have that drink. 

Consequences:   Where have you experienced consequences from your drinking?  Have you had consequences to your financial, legal, professional, familial, marital, physical, emotional, moral, or spiritual life?  Where has drinking affected your life?  Make a list. 

Recommendations:  If someone wants to deal with his/her drinking but isn’t ready to stop: 

Stop drinking for 90 days.  Get clean and healthy, eat well, exercise, rest, educate yourself, get in therapy, learn triggers and underlying issues, awaken spirituality, get inspired.  Then, let’s see where you are after 90 days. 

Get educated.  Read all about the signs/symptoms of alcohol abuse and alcoholism.  Review your own family history. 

Explore meetings:  12 step, Smart Recovery, Refuge Recovery, Yoga for the 2 steps, and many more.  You can even download the step work and start using those worksheets to see if you connect with any of it.  Speaker meetings are great to hear other people’s stories. 

Workbooks and Daily Readings:  12 step ones, and daily inspirational ones as well.  One classic is One Day at a Time in AA.

Podcasts, articles, and memoirs:  hear other how other people have explored their relationships with alcohol.

This time away from alcohol creates some space to explore the client’s history and relationship with alcohol and makes room to consider underlying issues, stories, and pain that often accompany the need to numb, escape, or check out.  Insight leads to illumination and therapy becomes deeper and richer. 

Can some people return to “normal” drinking?  The answer is yes.  (My old school substance abuse colleagues are turning over in their graves, as this was and continues to be a big NO NO). 

 And that’s where the truth reveals itself.

Either you will return to normal drinking, more educated on your relationship with alcohol, or you won’t.  And if you don’t--and your drinking continues to progress with more serious consequences, then the cucumber may have turned into a pickle, the drink has taken the man, and it is time for the gold standard self-diagnosis and a higher level of intervention/treatment. 

Because, at the end of the day, the call has to be yours.