Monday, May 3, 2010

How to Stop Your Alcohol Abuse, Drug Abuse

I've thought a fair amount about how to get people to stop abusing drugs and alcohol: I used to be a drug counselor and in my 25 years as a career and life coach, I've had many clients with substance abuse problems. Here's my current thinking:

  • For some abusers, the goal should be moderation, for others, stopping completely. Some people can be functional alcohol/drug users--if they have the discipline to keep it moderate. Others cannot function well-enough using drugs/alcohol even modestly--either because their job or life requires high-level functioning or because they lack the discipline to keep their use moderate.
Dr. Michael Edelstein, a San Francisco cognitive therapist who works with addiction problems ( says, "Successful moderation usually requires abstinence for months, then moving to moderation, and defining in advance what moderation will consist of: e.g., only one drink per hour when out socially and none when alone."
  • Twelve-step programs help some people. Most likely to be helped are those who need structure, group support, aren't particularly intellectual, and consider themselves religious or spiritual.
  • Other people may be more likely to stop with cognitive therapy: correcting their erroneous thinking: e.g., "I'm more creative or likable when I'm high, "It so helps me cope with life that it outweighs drug use's liabilities," "My kids won't be affected," and most often and powerful: "I must satisfy my urge to feel good right now."

To find a non-12-step self-help group, you might try SmartRecovery.

  • Sometimes, a physician can prescribe medication to help you stop. To find one that specializes in helping people with addictions: click HERE
Note: That is merely an unscreened list of members of the American Society for Addiction Medicine. As in choosing any important health care provider, I recommend Googling prospective physicians' names plus the word reviews, for example, "Timmen Cermak" reviews. (He's a recent president of the California Society for Addiction Medicine, who, in my Google search, yielded good but not great reviews.) Then call your top three choices and ask the receptionist for the names of other excellent addiction medicine specialists. The doc most often named is usually a fine bet for a first appointment. Then use your intuition to decide whether to see that physician again or try a different one.
  • Keep front-and-center the ways your life would be better if you stopped, and the price you've paid for your substance abuse. Edelstein recommends going further: "Five times daily, without fail, vividly read and write the pros and cons of kicking. Don't stop this discipline when you're doing better."
  • Some people stop only because of a relationship: for example, they fall in love, get pregnant, or their sibling stopped using drugs and the abuser didn't want to be the only family member with a substance abuse problem.
  • Alas, some people stop only when they've hit rock bottom: they're so exhausted from the toll of living the addict lifestyle, that they just are sick and tired of being sick and tired. Edelstein urges, "Refuse to give up. You can succeed on the 100th try."

    At the risk of sounding like a goody two-shoes, there really are ways to get high on life without drugs. For example, I get real pleasure from helping my clients, writing, hosting my radio show, playing in the garden, or walking my doggie, Einstein.

    How could you fill your life with enjoyable activities that don't have negative side effects?


    N.Morgenstern said...

    Pharmaceuticals can be a very helpful tool for overcoming addiction. As a ten-year alcoholic, I'd been to AA numerous times, always relapsing shortly after. No matter how many relationships I ruined, I couldn't stop drinking excessively. Blackouts were common and the shame of my drunken behavior didn't stop me. The THIRST was just too damn strong to quell.

    Then, a very persistent (and indefatigable) girlfriend persuaded me to seek therapy, and that lead to visiting a psychiatrist. I was diagnosed with severe depression and anxiety disorder. I was prescribed an anti-depressant (Effexor). The theory being, as I understand it, I was uncomfortable with myself and around others and self-medicated with booze,

    I had never thought of having a problem OTHER than drinking. Now there was a new insight, my brain was faulty. Now, three years later, I feel completely better, and I still have drinks from time to time, but never like before. The THIRST no longer runs my life. No more nagging anxiety and shame and uncertainty of what I did the night before. The change wasn't instantaneous, the drugs don't work like that. You don't wake up happy one day. But slowly, you gain resilience. Enough to hold off on the sauce.

    I was never one to believe in "mental problems." I'm one of those guys who was raised by a Vietnam Vet and urged to be fiercely self-reliant. Pull yourself up by your bootstraps, no one's gonna help you. Even after starting medication and therapy I was doubtful. More brain mumbo jumbo to get money from me. But it has worked, at least for me. And it might for you.
    To those men out there that feel the THIRST, if you want to alter your ways, I recommend trying all the options. AA didn't work for me (it might for you), but medication and therapy did.

    To the afflicted who want to change, good luck.

    Marty Nemko said...

    Dear N. Morgenstern,

    Thank you for your excellent addition to my list of approaches.



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