harm reduction

Book review: How to Change Your Drinking

We spend a lot of time researching programs that help people cut back or quit drinking, and this week we read the main book behind the Harm Reduction approach: How to Change Your Drinking, by Kenneth Anderson (see here).

It was fascinating to learn more about a program that accommodates even more goals than Drinker’s Helper. (For clarity, we help people quit drinking or achieve moderate drinking goals, but Harm Reduction also supports people pursuing goals of Safer Drinking or even Reduced Drinking that may not be moderate drinking).

Here’s what we liked and didn’t like about what we read. Overall, there’s a lot to like in the philosophy, even though we do take a firmer stance on what a desirable outcome is.

Here’s what we liked about their approach and book:

  1. Their approach emphasizes the need to give people the facts, and let them choose their own goals. We love this emphasis on the truth, as you risk rapidly lose credibility with people if you over-emphasize the severity or likelihood of health risks from drinking. We also believe people have to choose to change on their own; there is no changing someone else or insisting on a particular goal by force. It’s hard to either go sober or achieve moderation, and it requires strong internal motivation on the part of the person pursuing that goal.

  2. We love the section on confronting partners from a place of empathy. Partly for the reason above, we love that the book encourages partners to elicit their SOs’ desire to change with questions, rather than pushing hard for a specific goal. We think this is dead on. It’s nearly impossible to convince someone else to change, and you may even accidentally spur them to further drinking if they feel attacked or ashamed. Questions, empathy and understanding are easier to respond to.

  3. It emphasizes the pros as well as the cons of drinking and changing drinking. We love that the approach emphasizes the need to be honest about why drinking is appealing, and consider all the factors in choosing your course. We emphasize the same in the exercise “Roadblocks to Change.” This is important because it can severely hamper your motivation if you try to force yourself to forget or look away from the benefits of drinking for you. Instead, by acknowledging those benefits head on, and weighing them agains the costs, you can convince yourself, again and again, that sobriety or moderation is best for you, without any lingering doubt.

  4. It’s fantastic that it normalizes slips. We agree that it’s perfectly OK to go for months without drinking and then decide to have a drink on a given day to see how you feel. The book makes it perfectly clear that a slip like that doesn’t mean you’re doomed to have 20 drinks later on. It doesn’t mean you’ve relapsed and must resume your old bad habits. You can get back on track right away, and continue to feel proud of your progress. If you have been taught, on the other hand, feel as though you’ve relapsed or almost committed a crime against yourself by drinking, you may end up drinking even more.

With a lot to love, what could we possibly dislike? Well, here are our key differences of opinion.

  1. We think you need to assess why you want to get drunk. If it’s all just fun and games, that’s one thing. And for many of us, in college or graduate school, the heavy drinking is all just for fun, with no deeper meaning. But if this behavior continues after graduation, we think it’s worth examining the reason for this desire to get drunk.  It may suggest we’re trying to escape from something or cope with something. Why? Are there healthier ways to escape? Or, is there something we should change about the way we live our lives, so that we no longer want to escape by drinking? If you simply say “I like drinking,” and choose to continue, you may not learn from the reasons you drink.

  2. We don’t think safer drinking is good enough. This isn’t a matter of judgment, of course. We mean it’s not good enough as a goal for the very people who choose it, because we think they deserve better. If you’re choosing to drink, we don’t think you’re doing something immoral (unless you injure others; don’t drink and drive - ever). However, we don’t wish to make the elements of safer drinking (don’t drive drunk, don’t have unprotected sex with strangers you just met, don’t leave the house if you intend to black out and might get lost) seem optional by celebrating them as a choice. Those should always be a part of everyone’s plan. What is optional, difficult, and should be celebrated is pursuing and achieving moderation or sobriety. And, of course, it’s what we recommend to our members: either sobriety, or drinking at a low-risk level (moderation).

  3. We don’t think the book does enough to acknowledge how amazing sobriety or moderation can be. For anyone who has been addicted, achieving real freedom from craving is an amazing feeling. The balance of images we’re given by society weighs so heavily on the side of drinking, drinking heavily, and drinking for all occasions and all reasons, that we think it’s the job of programs like ours to make sure people ALSO have a good sense of the alternative. Sobriety sounds dull, but it means really feeling in control, becoming radically productive and creative, and developing a new internal strength you never knew was possible, to handle life’s battles head on. All we’re saying is give sobriety a chance!

And of course, if you have decided to give sobriety or moderation a chance, we hope we can help! We offer exercises, support groups, tracking and insights to help people cut back or quit drinking. Check out the app today!

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