Can you drink alcohol normally after having a drinking problem?
There are different models or theories that seek to explain how and why people struggle with problem drinking. The two I want to focus on in this blog are the disease model and the learning model.
The disease model tells us that problem drinking happens as a result of a disease that causes irreversible changes in the brain. According to the disease model, there is no cure, only management which consists of lifelong abstinence.
The learning model tells us that problem drinking is simply a learned behaviour or habit. Due to neuroplasticity, the learning model provides that a problem drinker can unlearn old habits and learn newer healthier habits that support drinking in a different, and less problematic way.
If you’re a problem drinker now, you’re probably wondering which model is correct so you can figure out if it’s possible for you to change your relationship with alcohol and drink in a way that isn’t problematic, or if abstinence really is the best option to save you months (possibly years) of trying and failing to moderate and then ending up quitting anyway.
Unfortunately, the answer isn’t clear cut. There are lots of very smart and highly qualified people with conflicting opinions on this subject, and I believe that there is truth to both models to a certain degree.
Below I share my opinion and what I believe to be true when it comes to your options:
The more severe your alcohol use disorder (AUD) and the longer you’ve been drinking this way, the more difficult it will be for you to successfully cut down and moderate. I’m not saying it’s impossible, but I am saying it’ll be harder for you than for someone with a milder AUD and or for someone who has been using alcohol problematically for a shorter time. As I said, this doesn’t mean it’s impossible for you, but you may have to work harder than the next person to positively change your relationship with alcohol.
For people with very severe AUDs (including, but not limited to, anyone with a physical dependence on alcohol), abstinence is widely accepted as the safest option, and I support that view.
For many people on the AUD spectrum (regardless of where they are on it – mild, moderate or severe) abstinence is easier than moderation. With abstinence they make one firm decision ‘I don’t drink’ which saves them the mental energy of having to make a lot of decisions around alcohol, and being hyper vigilant to ensure they don’t drink it in a problematic way.
Other factors that I believe play a role include: your level of motivation to change, your belief in your ability and capacity to change (self-efficacy), how effectively you address the root causes of your problem drinking, and your level of dedication and commitment to what can be a lengthy process of behaviour change.
If you’re unsure whether you can moderate and you don’t want to commit to abstinence, I believe it’s worth spending some time experimenting with different moderation techniques. Later in this blog I share our new course supporting women to do this which is a great option to support you on this path. If you find that you can moderate, great. But if you find that despite your best efforts, you can’t moderate, at least you’ve exhausted the option of moderation which makes committing to abstinence a lot easier. In this way, attempting moderation can be a helpful steppingstone to abstinence.