Shhh! Let s Talk About Moderation for Mild Alcohol Use Disorders Cyndi Turner, LCSW, LSATP, MAC Craig James, LCSW, MAC
Shhh! Let s Talk About Moderation for Mild to Moderate Alcohol Use Disorders Insight Into Action Therapy September 16, 2017 Name Commercial Interests Relevant Financial Relationships: What Was Received Cyndi Turner Sale of book $17.97 author Craig James Relevant Financial Relationships: For What Role No Relevant Financial Relationships with Any Commercial Interests x
Overview Types of Drinkers Moderation Defined Treatment & Prevention for the 22% Positive/Negative Predictors Moderate Drinking Plan Moderation Tools
Four Types of Drinkers 35% do not drink at all limits 37% drink within normal problems 22% drinkers experiencing mild to moderate AUD 6% meet criteria for severe AUD/alcoholic
17 Million People Experience Severe AUD
90 Million People Experience Mild to Moderate AUD- fills Central Time Zone
Moderation Defined Dietary Guidelines for Americans 2015-2020: up to 1 drink per day for women/older adults and up to 2 drinks per day for men The National Institute on Alcohol Abuse & Alcoholism: up to 4 alcoholic drinks for men and 3 for women in any single day; max 14 drinks for men and 7 drinks for women per week
Insight Definition for Moderation No more than 2-3 drinks for men; 1-2 women/older adults Not more than once a week Have family members support Developed Moderate Drinking Plan
Why Do Men Get to Drink More? Alcohol is dispersed through body in water Women have less water in their body Women usually weigh less than men Women have higher concentration of alcohol in their bodies Women become intoxicated faster than men Men have stomach enzyme (dehydrogenase)that breaks down alcohol 4 times faster
DSM-IV TR Abuse: if it causes a problem, it is a problem Dependence: alcoholic Encourage self-assessment
DSM-5 Diagnosis Problematic Pattern of alcohol use leading to impairment within a 12-month period: Taken in larger amounts than intended Desire or unsuccessful efforts to cut down or control Time spent in activities to obtain, use, recover from Craving or strong desire to use Recurrent use resulting in role failure
DSM Continued Continued use despite consequences Important social, occupational, or reactional activities given up/reduced Recurrent use in physically hazardous situations Continued use despite problem exasperated by use Tolerance more needed to get effect or diminished effect with same amount Withdrawals
DSM Continued Diagnosis on a spectrum Substance Use Disorder Mild: 2-3 symptoms Moderate: 4-5 symptoms Severe: 6 or more - unlikely to be able to moderate
Withdrawals Can occur 24-72 hours after last drink and can be life threatening. 1. Sweating/high pulse 2. Hand tremors 3. Insomnia 4. Nausea or vomiting 5. Hallucinations 6. Psychomotor agitation 7. Anxiety 8. Seizures
Spectrum of Alcohol Use No Use Experimental Use Occasional Use Situational Use Binge Use Alcohol Abuse Alcohol Dependence
Why the 22% Avoids Getting Help Moderation Management found 90% of drinkers experiencing problems will avoid getting help: Afraid of being label alcoholic Made to go to rehab Forced to go to 12-Step meetings Have to give up drinking forever Life will boring/miserable
Call for Change Over 90% of treatment facilities require total abstinence By removing abstinence as the main goal, people become more open to education and information Education = Prevention If I had known this in my 20s and 30s, I might not be the alcoholic I am in my 50s.
Focus on the Why Explore WHY someone is drinking Not just don t drink Give them Tools Clients with Trauma
$35 Billion Industry Heads in Beds= $1000 a day + urinalysis Moderation more cost effective for client Decreases industry profit
Moderate Drinking Research Moderation training reduced consumption by 50-70% Those with severe problems tried moderation but ultimately decided upon abstinence Most successful moderators had less severe problems at start 1/3 of people who tried moderation stopped permanently Easier to do all or nothing
Harm Reduction Alcohol use seen as psychosocial problem - looks at whole person Explores ways to reduce consequences of drinking Views small changes as Success Client Examples
Theoretical Stance Motivational Interviewing Techniques Way to get and keep people in the door Starts a conversation Education and Prevention
Stages of Change Model
Moderation Work Begins
Moderation Steps Clinical Assessment Self Assessment Denial Moderation Severe AUD Motivational Interviewing Approach Appropriate Level of Treatment
Treat the Why
Cost / Benefit of Drinking
You want me to do What?! Recommend 4 months abstinence before moderation Deal with life on life s terms Make it through holidays, events, celebrations Develop support system Practice change Learn to manage risky situations Manage cravings Identify new coping skills
How Do I Know If I Can Keep Drinking Quiz? Gives predictions for ability to moderate Should be reviewed with someone trained in dual diagnosis and familiar with moderation/harm reduction Full quiz: www.insightactiontherapy.com or www.canikeepdrinking.com
How Long Have Been Drinking?
How Many? Daily Patterned binge drinking Remember definition of moderation Association with most events Requirement for fun Blackouts*
Medical Issues & Medications Antidepressants Benzos Weakens immune system Affects every organ in body Equilibrium Known to cause cancer, heart disease Check w/ MD (most medications follow moderation guideline) Synergistic Effect
Consequences of Drinking? Severity Learned from mistakes Personality shift Ratio of positive versus negative outcomes Impact on self and loved ones Drink alone*
Goal Regarding Drinking To be normal Truly enjoy taste Intent to alter mood* Part of celebration, not main focus Family s goals Effect on loved ones Family s trust been addressed
Genetic Predisposition Genetics are responsible for 50% No one gene 4x more likely if you have direct family member Environment Can t get addicted to something you ve never tried
Trauma 70% of adolescent SUD experienced trauma 60% of people w/ptsd develop SUDs 60-80% of vets w/ PTSD have AUDs Teens w/ physical or sexual 3x more likely Endorphin Cycle: Brain releases during trauma for protection Naturally decrease Drinking increases endorphins Interrupts what body was already doing Prolongs emotional distress Emotional withdrawal
Mental Health Alcohol is a depressant Affects sleep Medication may not be effective Need to learn alterative coping skills Over 60% people with MH have SUD
Other Drugs? Trying to alter mood* Unlikely to have developed coping skills Lifestyle
Legal Issues
Withdrawals Withdrawals* Usually signifies severe alcohol use disorder Physiology has changed Once a pickle, cannot go back to cucumber
Period Of Abstinence What does it say if you cannot go a month without? What was learned in abstinence 30% of people who go through abstinence for moderation, remain clean
Supports & Monitor Use and Be Accountable Willing to monitor amount/frequency Have family s support Has support system that gives perspective and accountability
Before Implementing Plan Understand biological, psychological, and social consequences of drinking Have not developed physical dependence on alcohol Can commit to not engaging in unsafe behavior after consuming Do not abuse other drugs Do not act destructive after drinking
Before Implementing Plan Had period of abstinence and addressed issues that arose Identified triggers and have plan to deal with them Experienced range of positive and negative emotions and dealt successfully with them Satisfied any legal, probationary, work, family, and friend obligations
Before Implementing Plan Understand why you drink and determine that it is safe to continue Identified a support person to review plan and keep you accountable Therapist Friend Moderation Management HAMS Online
Moderate Drinking Plan Why I want to keep drinking Where/when I will not drink Not drink until Not drink after Will not drive after consuming Alternate alcoholic beverages with No more than.. drinks per Review my plan with If I/we notice, I/we will
Tools for Moderation Play it through - if/then Drink only in social situations Offer to be DD Practice a one-liner Use tangible reminders Eat something Have a mocktail Alternate beverages
Levels of Risk
Preparing to Drink Again Impact of losing clean date Prepare friends and family Pick person, place, and drink Don t make alcohol the main event Have exit plan
Gut Check
Moderation Steps Take Quiz Treat the Why 4 Months Abstinence Identify & Meet w/ Support Develop Moderation Plan Implement Moderation Plan GUT Check
Donuts Drinking alcohol is like eating donuts. Having one or two occasionally is not going to hurt you but having several a day is eventually going to lead to serious problems.
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