HAMS: Harm Reduction for Alcohol

The Alcohol Harm Reduction Toolbox

All of the following tools and strategies are optional elements which you may choose to use as a part of you drinking plan. We don't expect anyone to use all of them--some are even mutually contradictory. For example, people who want to reduce their drinking may choose to quit drinking at home and only drink when they go out to bars. Whereas people who want to work on safer drinking may choose to quit drinking in bars and to only drink at home. What is important is that you pick and choose the strategies and tools which are useful to you for your individual plan.

1) Having Alcohol-Free Time / Quitting Drinking

1.1) AVRT for Alcohol-Free Days

Jack Trimpey is the founder of Rational Recovery and has created a technique called AVRT (pronounced "avert") which the Rational Recovery program teaches to people who are seeking permanent abstinence from alcohol. In this section we will adapt some of the Rational Recovery ideas for people who wish to add abstinence days into their alcohol harm reduction plans. For more information on using AVRT for permanent abstinence please visit the Rational Recovery web page http://rational.org.

The letters AVRT stand for Addictive Voice Recognition Technique. AVRT recognizes that the human brain can be divided into two parts: There is the primitive animal brain which consists of the limbic system, the brain stem and so forth which is essential for basic survival, and there are frontal lobes which are responsible for abstract thought, planning, and the other things which make us uniquely human.

The animal brain is responsible for essential things like breathing and sex, but it is also responsible for the formation of conditioned reflexes including that special subset of conditioned responses which we refer to as addiction. It is the limbic system which is responsible for the voice of craving--for the idea that one must pursue alcohol or drugs or other potentially destructive behaviors for the sake of short term reward at all costs--sometimes even at the cost of one's life. AVRT calls this the Beast Brain. In contrast to the Beast Brain, it is the frontal lobes--the uniquely human part of the brain--which tell us that we sometimes need to put aside immediate gratification for the sake of more important long term gains. The frontal lobes are the rational part of the brain and the real "you".

AVRT teaches people to clearly distinguish the voice of the beast brain from the voice of their real self. AVRT teaches us to talk back to the voice of the craving. When the Beast Brain starts telling you that you "have to have a drink or a drug because you are stressed or anxious or depressed or feeling social phobia", then you need to talk back to the Beast Brain.

Telling the voice of craving to "shut the F-- up" or if you say to it "I am not gonna drink today and you can't make me! So there!! Nyah nyah nyah nyah nyah!!" can be an excellent tool to help you to abstain from alcohol.

Trimpey also talks about Enemy Voice Recognition. If you have chosen to have an abstinence day then ANY thoughts you have in your head that tell you that you need to drink are the ENEMY. No one ever puts a gun to your head and forces you to drink. Bottles of booze never jump off the shelf at the liquor store and come rolling up to your house and knock on your door and say "Drink me!" You are NEVER powerless over alcohol. It is always YOU who chooses to drink or not to drink. You either choose to listen to that mental voice or you reject it. AVRT is a tool to help you succeed at rejecting it. So recognize that voice which tells you to drink on an abstinence day as the ENEMY and CHOOSE to reject it.

The ENEMY voice will put forth irrational ideas and beliefs to try and make you drink, but you can defeat the voice of the ENEMY by disputing these irrational ideas.

Here are some examples of the voice of the ENEMY:

  • I am so depressed/anxious/stressed that I have to drink right now!
  • I can't stand one single day without alcohol!
  • My husband/wife is driving me to drink by being IMPOSSIBLE!
  • I can't do a whole abstinence day--it is too HARD!
  • It isn't FAIR that I have to do an abstinence day!

Here are some examples of how you can use your rational voice to dispute these irrational ideas:

  • Being depressed/anxious/stressed really sucks but I can deal with it for one day. Think of how proud I will feel tomorrow after I accomplish my abstinence day!
  • I didn't need to drink alcohol when I was a baby--I surely don't HAVE to drink it now that I am an adult.
  • My spouse's bad actions cannot force me to drink. I may really dislike my spouse's bad actions but I can still choose to abstain for MY benefit!
  • Can't do one day? Shut up Beast Brain! Of course I am strong enough to do one day!
  • Fair? Beast Brain--you are really clutching at straws now! False imprisonment might be unfair but an abstinence day is just a way to flex my muscles.

AVRT can be a very helpful technique to help you to abstain on your designated abstinence days and to reserve the drinking for the designated drinking days where it can be an enjoyment instead of a BEAST!

1.2) CBT for Alcohol-Free Days

Cognitive Behavioral Techniques (CBT) and Rational Emotive Techniques (RET) are ways of using your rational mind to combat various forms of irrational negativity--including cravings for alcohol. Please visit our CBT Page for more info.

1.3) Wallop Your Cravings with Psychic Jiu-Jitsu

Next time you get a craving to drink don't just sit there with your fists clenched saying "I won't drink, I won't drink" over and over. This just keeps the thought of drinking in your head. Instead, get out a piece of paper and start writing about your craving. Go into every detail of the good and the bad and the ugly of the thing. Pull no punches--say why you like booze and why you hate it both. Exhaust the craving completely by writing till you are blue in the face. Facing up to it will take the wind out of its sails. This is how you use psychic jiu-jitsu. Stop being afraid and face it down.

Get silly with your craving--write a Dr. Seuss rhyme about it

Would you drink me with a mouse?
Would you drink me in a house?

I would not drink you with a mouse
I would not drink you in a house
I would not drink you here or there
I would not drink you anywhere
I will not drink you booze-I-am
I do not like you boozy man

If you manage to get totally silly about your craving and laugh at it you will find that it is greatly weakened.

Rate your craving on a scale from one to ten

How bad is your craving? Could it be worse? If you rank it you might find that it is not so bad after all. Surf the urge and watch it fluctuate. Cravings only last about five minutes then go away. Just watch it rise and fade and rate it again.

1.4) Smack Down The Witching Hour With A Club Sandwich

Lots of people find that they have a craving for a drink after they get home from work and before they eat dinner. Some people call this time "The Witching Hour." An empty stomach and lowered blood sugar are a large part of this craving. Having a snack when you get home can make this craving go away completely for some people. Sweets are not usually as good as a nice sandwich or a salad if you prefer that.

1.5) Drink Refusal Strategies

How do you turn down drinks at a party of from your friends if you are doing some alcohol-free time? Here are some suggestions for refusing drinks:

  • I'm taking a vacation from booze
  • My liver is on vacation this month
  • I can't drink on my new medications
  • My stomach feels queasy--I better give it a pass
  • I don't want to go off my diet

Feel free to think up some more of your own and make a list of them to use the next time that you need them. You might want to rehearse your drink refusals in front of a mirror if you aren't used to doing this.

1.6) Marijuana Maintenance for Quitting Drinking: Cannabis as a Substitute for Alcohol

A growing body of evidence suggests that Medical Marijuana is the single most effective cure for severe and otherwise intractable cases of Alcohol Dependence. Many late-stage heavy drinkers undergo major, life-threatening withdrawal symptoms such as seizures and withdrawal delirium after drinking even relatively small amounts of alcohol because they have undergone kindling and reverse tolerance. Others who suffer from severe Alcohol Dependence feel compelled to continue drink the morning after and may go on benders which can last anywhere from days to weeks to months. These people also often go through life-threatening withdrawals when they stop drinking, not to mention the health ravages and accidents and loss of employment or marriages which can occur during these benders.

For people with late-stage Alcohol Dependence, quitting alcohol completely is often the only viable solution; however, statistics show that abstinence-only programs such as AA or twelve step treatment programs fail to help the majority of these late stage chronic drinkers. The good news is that there has been an extremely high success rate when these late stage chronic drinkers are treated with medical marijuana.

  • When late-stage heavy drinkers are allowed to get high by smoking marijuana they no longer have a need to get high by drinking alcohol.

Using cannabis as a substitute for alcohol is referred to as Marijuana Maintenance. The late Dr. Tod Mikuriya, MD was one of the first pioneers in the use of Medical Marijuana to treat Alcohol Dependence. Mikuriya prescribed Medical Marijuana to ninety two patients who were suffering from severe Alcohol Dependence (Mikuriya, 2004). All ninety two patients reported major reduction in alcohol consumption and major reductions in alcohol related harm. All reported that using Medical Marijuana caused far fewer life problems than did using alcohol.

In 2009, Dr Amanda Reiman, PhD published the results of a survey of 350 users of Medical Marijuana. Forty percent of those surveyed reported that they used Medical Marijuana as a substitute for alcohol. The main reasons were that Medical Marijuana led to fewer negative outcomes and had less potential for withdrawal syndrome. Use of Medical Marijuana did not increase the likelihood that people would drink alcohol--on the contrary it helped to greatly reduce alcohol consumption among people who had previously had problems with Alcohol Abuse or Dependence.

As of the time of this writing, Medical Marijuana is available legally in fourteen states: Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington.

If you are suffering from severe Alcohol Dependence and nothing else seems to help, a Marijuana Maintenance program just may be a life saver for you.

1.7) More about Quitting Drinking

At HAMS our main focus is on safer drinking and reduced drinking because there are already some fine books and programs out there which concentrate on quitting drinking. We do have an Alcohol-Free Hamsters group online for people who quit drinking using a harm reduction approach, though. However, if you would like additional support for staying off alcohol we recommend the following support groups:

  • SMART Recovery - SMART teaches cognitive behavioral strategies for dealing with urges to drink.
  • SOS - Seculars On Sobriety - SOS offers religion-free support groups for those who do not like the "spiritual" approach of AA.
  • WFS - Women For Sobriety - WFS is a support group for women which concentrates on empowerment rather than the AA approach of indoctrinating powerlessness

We also recommend the following books as helpful:

2) Double-Barreled Harm Reduction Strategies

Some harm reduction strategies can help you to both drink less and to drink in a safer manner. We call these "Double-Barreled Harm Reduction Strategies". You can kill two birds with one stone.

2.1) Eat first and hydrate

Quantity: this helps you to drink more slowly so that you will drink less alcohol overall

Safety: this helps to keep your BAC from spiking so you can avoid blackouts and other forms of drunken craziness

Eat first and be well hydrated before you start drinking alcohol. Your stomach has only a few square feet of surface area to use to absorb liquids, but your small intestine has many thousands of square feet available to absorb liquids. The stomach is built to mash food and mix it with digestive juices, whereas the small intestine is built to be an extremely efficient liquid extraction device. This is because the inside of the small intestine is covered with tiny hair-like extensions called villi which exist for the sole purpose of increasing the surface area to make the small intestine more efficient at the absorption of liquids.

When you eat food, a valve closes between the stomach and the small intestine to hold the food in the stomach so that the stomach can mash it up and mix it with digestive juices. So long as this valve is closed, only small trickles of liquid can pass from the stomach into the small intestine. Therefore, if you eat before drinking, the alcohol will pass into your bloodstream much more slowly than if you do not. The larger the meal the longer it is held in the stomach. Additionally, fats are held in the stomach longer than proteins, and proteins are held there longer than carbohydrates. This is why bluesman Charlie Patton would say "Eat a lot of fat meat when you play a dance so you don't get too drunk." A large meal with plenty of fat can remain in the stomach up to six hours.

Drinking plenty of water before you drink any alcohol prevents you from being thirsty. You will drink more slowly if you are not dehydrated and don't feel thirsty. Remember, alcohol causes dehydration--this is why alcoholic beverages do not quench your thirst and why the more beer or booze that you drink the thirstier you actually feel. People often feel sated after drinking a single non-alcoholic beer, but are still ready to keep going after drinking half a dozen real beers.

Therefore, eat well and be well hydrated before you start drinking alcohol.

2.2) Choose your drink

Quantity: drinking more slowly helps to reduce the overall quantity one drinks. Once your BAC spikes you may stop caring how much you drink.

Safety: preventing BAC spikes helps prevent blackouts and alcohol poisoning.

What you choose to drink can have a lot to do with how quickly you drink. Sometimes "alcoholism experts" can be heard to declare, "It does not matter what you drink--alcohol is alcohol and the effect is always the same." The reality is that nothing could be further from the truth. While it may be true that alcohol is still alcohol regardless of what drink it is in, your choice of drink can have a tremendous impact on how quickly you consume it. Moreover, factors other than alcohol itself can determine how quickly the drink is absorbed into your bloodstream. Spikes in your BAC (Blood Alcohol Concentration) are what lead to problems like blackouts. And the speed with which the alcohol gets into your bloodstream is a major determinant of your BAC. The more slowly the alcohol enters the bloodstream, the lower the BAC. Since your choice of drink can have a significant impact on both how you choose to drink it and how it is absorbed, it is of great importance to choose your drink.

Some people have had considerable success by deciding that they will only drink the good stuff--no more cheap booze. For some people deciding to cut out the rot gut whiskey and only drink expensive Irish or Scotch whiskey leads them to savor each drink, drink more slowly, and reserve the drinking for special occasions since it is too pricey to drink every day.

Some people have success with a strategy which is almost the opposite of this--they decide to forgo their drink of choice and switch to a drink that they don't really like. Because they are drinking something which they don't like very much they find themselves drinking less per session and/or fewer days per week.

Alcohol content can be a major factor in how quickly people drink their drinks. Generally speaking, the lower the alcohol content of a beverage the more slowly the drink is ingested. Most people can toss back six shots of whiskey a lot more quickly than they can down six 12 oz beers,

Taste can also be an important factor. Generally the more tasteless a beverage is the more quickly a person will drink it. Many people report that they drink vodka more quickly than gin, and gin more quickly than whiskey, because of the respective flavors of the beverages.

The alcohol in some beverages is also absorbed more quickly than the alcohol in other beverages. The alcohol in carbonated beverages is absorbed more quickly than the alcohol in non-carbonated beverages. This means that a sparkling wine will give you a higher BAC than a non-sparkling wine with the same alcohol content even if you drink them both at the same rate. If you find that champagne makes you drunk, now you know the reason why.

However, if there is a great disparity in alcohol content then it may still be safer to go with the carbonated beverage than the non-carbonated. This is clearly the case with whiskey and beer--everyone gets drunk more quickly on straight whiskey even though it is not carbonated.

Artificial sweeteners also affect the rate of absorption of alcohol. Researchers in Australia found that the alcohol in drinks made with diet soda is absorbed into the bloodstream significantly more quickly than the alcohol in drinks made with regular soda.

So choose your drink wisely--not all alcoholic beverages are created equal.

2.3) Be Cautious of Drinking Games

Quantity: the sole purpose of drinking games is to make you drink more, not less

Safety: drinking too quickly can lead to blackouts or even alcohol poisoning and death

We are not saying that you must never engage in a drinking game--HAMS has no such absolute rules. If you choose to play a drinking game be careful and use your head. When you know that you have had enough stop. Or choose not to start if you don't want to--do your own thing and don't get peer pressured. More than one person has died of alcohol poisoning by trying to drink 21 shots on their 21st birthday. Take it slow and easy; you don't have to drink faster than you really want to and you don't ever have to play a drinking game if you don't want to. You always have the right to say "no".

2.4) Plan and schedule!

Quantity: restricting your drinking to scheduled drinking days can greatly reduce your total alcohol consumption

Safety: drinking on impulse without planning in advance can lead you to engage in every high risk behavior imaginable

It is amazing how much we can mess up our lives sometimes by just deciding to drink on impulse. Maybe we have a big final exam in calculus tomorrow and our buddy comes over and says "Let's get wasted" and we do it and blow the exam the next day and even wind up flunking out of school because of it. Getting into the habit of always planning and scheduling our drinking days and no longer drinking on impulse can be one of our most valuable harm reduction skills. It can save jobs, marriages, and even lives.That is why lots of Hamsters decide to cut out drinking on school nights or work nights or at least limit it to moderate levels on those nights. Planning and scheduling your boozing can help you to avoid having that big client walk out the door and go elsewhere because you reeked of booze from the night before.

3) Safer Drinking Strategies

3.1) Chart Your Behaviors!

Charting is one of the best tools we know of to accomplish behavioral change. HAMS has Risk Charts which you can use to chart and reduce your high risk behaviors. We recommend them strongly.

3.2) Travel in Pairs

It is always a good idea to have a good friend at your side when you participate in a drinking event. Friends can help keep each other safe when they are in bars or walking or taking public transport together home. If one falls asleep on the subway, the other is there to safeguard him/her. Pickpockets, muggers, and sexual predators all target the intoxicated. Merely being male does not safeguard one either. Having another person at your side is the best way to discourage these people from taking advantage of you.

3.3) Control Your Glass

Don't let strangers pour your drinks. There are a lot of creeps out there with date rape drugs in their pockets just waiting to slip them into your drink. Males are not immune from this either. Let the bartender pour your drink or pour it yourself.

3.4) Drink Only at Home

Some people choose to drink only at home and always abstain when they go out. Others may have a one drink limit when they go out and choose to get intoxicated only at home--or some variation on this theme. The advantage is that there is much less worry about transportation or other dangers which can befall an intoxicated person when out and about. Some people don't care to use this strategy because their purpose in drinking is to increase social conviviality. Different strokes for different folks.

3.5) Plan Your Transportation

It is a good idea to never drive to a drinking event. The most sensible thing is to leave your car keys at home. Walking or using public transportation is the most sensible thing. Try to avoid drinking on impulse when your only means of getting home is driving. If you plan to use public transportation it is a good idea to travel with a friend for added safety.

Drinking and driving is definitely one of the highest of high risk behaviors. The average cost of a DUI in the US is well over $10,000. According to the 2010 Illinois DUI Fact Book, the average cost of a DUI conviction in Illinois where no one is injured is $16,100. If an injury or death results this skyrockets into hundreds of thousands of dollars and prison time as well. Isn't springing for a taxi fare of 10 or 15 bucks one hell of a lot cheaper?

If you really cannot stop yourself from driving after you drink, you may be better off selling your car and buying a bus pass instead.

3.6) Sleep On Your Friend's Floor

Establish an understanding between yourself and your friends that you can sleep on each other's floors when you are too intoxicated to make it home for the night.

3.7) Always Carry Condoms

Gay or straight, male or female, it is a good idea to always carry condoms when you go drinking--and use them! You might feel that you are not the type for a one night stand--but alcohol has a way of loosening inhibitions--and soon one thing leads to another. Unplanned pregnancy or HIV are not worth the risk--carry condoms and use them!

3.8) Take Vitamins / Milk Thistle

Alcohol depletes vitamin B1, and a lack of vitamin B1 can cause brain damage! Alcohol induced brain damage could be eliminated entirely in the US if our government would add vitamin B1 to all alcoholic beverages--however our government has steadfastly refused to do so. So it is up to you to always take vitamin B1 to prevent alcohol induced brain damage. HAMS also encourages people who drink alcohol to take a multivitamin because alcohol tends to deplete other vitamins and minerals as well. Milk thistle appears to have a protective effect on the liver and drinkers may wish to choose to take milk thistle as well.

3.9) Lock up Your Car Keys

If you can't resist the urge to drive once you start drinking, you may want to lock your car keys in a safe to make them less accessible before you down your first drink. Or you may give them to a spouse or a friend or a roommate to hold while you are drinking. You might even buy a time lock safe to make sure that you cannot get at them. Some people even choose to install a breath-alcohol ignition lock on their car to insure that they will not drink and drive.

3.10) Turn off Cell Phones and Computers

If your problem is drunk dialing or drunk emailing--then you may want to turn off your computer or cell phone before taking the first drink. If you need a stronger deterrent, lock them in a closet or a safe. Even your subconscious will realize that it might be a bad idea to drunk dial then. Google Mail Goggles is another option to help prevent drunk emailing.

3.11) Be Careful Of Mixing Alcohol with Prescription or Non-Prescription Drugs and Medications

Aspirin nullifies the effect of the enzyme which breaks down alcohol--taking aspirin before you drink alcohol can lead to blackouts and it may also cause bleeding in the stomach. Mixing alcohol and Tylenol greatly increases the chance of liver damage. Mixing alcohol with Benadryl increases the sedating effect although it is not otherwise harmful. Alcohol mixed with valium can lead to death from respiratory suppression. Wellbutrin can increase the odds of withdrawal seizures and maybe blackouts, too. Etc. Our page on Alcohol and Drug Interactions lists many more.

4) Strategies for Cutting Back on Alcohol

Some people want to cut back on their weekly totals without cutting back how much they consume per session. Some people want to cut back on how much they consume per session. Some people want to change both. Whatever your goal--you will be supported at HAMS.

4.1) Chart Your Drinks!

Charting is one of the most effective behavioral change strategies that we know of. Drinking charts are here.

4.2) Baby Stepping or Gradualism

Some people decide to add on abstinence day a week for the first month, two for the second month, three for the third, and so on until they reach their desired drinking plan. Some people decide to cut back on the amount they drink per session by eliminating one drink per session for the first week--two for the second week and so on. We call these approaches which involve changing a little bit at a time "baby stepping" or "gradualism". Some people find that this is the best way to achieve their drinking goal whether the goal is cutting back on alcohol or even quitting entirely.

4.3) Set Limits

Many people find that rather than having a vague goal of drinking less it works better to set specific limits for how much they plan to drink per session and per week. It is okay to be flexible enough to make allowance for special occasions and there is no reason to beat yourself up for not being perfect all the time. Just keep your limits in mind as goals to shoot for. You can use your drinking chart for writing down your goals each week if you wish.

4.4) Add Abstinence Days

Choosing to have a certain number of abstinence days each week is a good way to cut back on your alcohol consumption. Some people add them in gradually using the baby-stepping method. Others add them in all at once. Some people decide that no alcohol on work nights or school nights is a good rule. Find what works best for you.

4.5) Buy Only What You Plan To Drink - Don't Keep Booze in the House

Some people find that if they have booze in the house they will drink it so they choose not to keep booze in the house and buy only what they will drink on their drinking day or else drink only in bars. Other people are not bothered by having alcohol in the house and like to keep a well stocked home bar for when friends come over. We are all different.

4.6) Drink Only in Bars

Some people decide to cut out drinking at home entirely and drink only in bars or restaurants as a strategy for limiting their drinking. This works very well for some people. We strongly urge you to remember to plan your transportation safely when you drink when you are out.

4.7) Limit Cash

Some people choose to limit the amount which they drink in bars by only bringing a set amount of cash with them to the bar and leaving their debit and credit cards at home.

4.8) Alternate NA Drinks

Alternating non-alcoholic beers with real beers is a good way to slow your pace down and keep yourself from drinking too fast and too much. Some people alternate with water instead. You can also alternate wine with water or plain coke with rum and coke--etc etc etc. Use your imagination and experiment with what works the best for you personally.

4.9) Start Later / Delay

Some people choose to schedule their drinking time and start later in the day. For some people this works fine. Others may just find themselves drinking later into the night and consuming the same number of drinks. Use it if it works for you--trash it if it doesn't.

4.10) Stop Sooner

Some people schedule their drinking time and choose to stop at a certain time in the evening. It works for some but not for all--try it if it seems that it will work for you.

4.11) Use Your Toothbrush

Lots of people who like to drink wine report that it tastes really bad after they brush their teeth. So some people go and brush their teeth when they reach their drink limit in order to put a period to the night's wine drinking.

4.12) Decant

Some people decide to buy a liter of whiskey and split it up into five 200 ml bottles. That way if they decide that 200 ml is their limit, they will know that it is time to stop after one bottle. Measuring your nightly dose ahead of time helps many people to stay within their limit--whatever the size of the dose is.

4.13) Buy a Breathalyzer

Some people buy a personal breathalyzer and set a goal of not exceeding a certain BAC when they are drinking.

4.14) Beer on Weekdays

Some people find that it is helpful to avoid hard alcohol on weekdays and only drink beer instead.

4.15) Use a Sleep Aid Instead Of Alcohol for Sleep

Some people drink themselves to sleep every night because they have bad insomnia. However, alcohol has many negative side effects which make it a poor choice as a sleep aid. For some people the best way to abstain from alcohol is to get a sleep aid for their insomnia so that they do not have to drink to get to sleep. For more info visit our sleep page.

4.16) Ice

Some people add ice to beer or whiskey or white wine to help them slow down. In Socrates' time it was standard operating procedure to add water to wine to slow down the pace. If it was good enough for Socrates...

4.17) Use Blue Laws

Some states have blue laws which outlaw the sale of hard alcohol on Sundays. Some people choose to only buy alcohol and drink it on Saturday night to prevent themselves from continuing to drink on the Sunday morning.

4.18) Get the Right Amount

If you only buy what you will drink when you drink, it can be important to get the right amount. If 750 ml is too much and 375 ml is too little then maybe you want to buy one 375 ml bottle and one 200 ml bottle to make a total of 575 ml. While it is true that it is more expensive to buy your alcohol this way, in the long run it may actually be cheaper because of the grief that you save yourself from.

4.19) Get Medications

The next section goes into detail about medications to help you reduce your drinking.

5) Medications to Change Your Drinking

5.1 Naltrexone

Naltrexone is an opioid antagonist which is helpful in changing people's drinking habits because of alcohol's effects on the naturally occurring opioids in the brain. Dr David Sinclair has been doing research for the government of Finland on the use of naltrexone to treat alcohol problems for decades. The Sinclair Method of using naltrexone involves taking 50 mg of naltrexone one hour before drinking alcohol and not taking naltrexone at any other time. Research by the Finnish government shows that the Sinclair Method is 70 to 80 % successful in turning even the heaviest of drinkers into moderate drinkers or abstainers. The Sinclair Method works by extinguishing the conditioned response to alcohol--it takes about three or four months to complete.

Instead of using the highly successful Sinclair Method, most American addiction experts recommend that patients be told to take naltrexone daily and to abstain from alcohol. When prescribed in this manner, naltrexone is hardly more effective than a placebo. This method of using naltrexone appears to be far inferior to the Sinclair method in terms of positive results. For more information about naltrexone and the Sinclair Method please see Naltrexone and the Magic of Pharmacological Extinction.

5.2) Antabuse

Antabuse (generic name disulfiram) is the drug that makes you sick when you drink alcohol. Antabuse works by blocking the breakdown of a poisonous byproduct of alcohol metabolism called acetaldehyde. This leads to symptoms of nausea, vomiting, sweating, flushing, rapid heartbeat, and in extreme cases, death. Mixing alcohol and antabuse is nothing to fool around with. Medication compliance with antabuse is extremely low--so low in fact that several studies found that antabuse was no more effective than a placebo in helping people to achieve abstinence from alcohol (Hughs and Cook, 1997). A drug will not work if people hate it and refuse to take it because of its effects.

However, some people who are highly motivated to abstain have found antabuse an effective aid to abstinence. Others who have requested that their spouse administer the antabuse each morning have also found it effective. At least one HAMS member has found a way to use antabuse as an aid to harm reduction. She takes antabuse when she wishes to have alcohol-free days. When she decides that she wishes to have a drinking day she stops taking the antabuse four days in advance of the drinking day. This is because it takes about four days for antabuse to clear the system. Then she drinks and after she sobers back up goes back on the antabuse until she chooses to have another drinking day.

5.3 Topamax

Topamax is a drug which was created for the treatment of epilepsy, but which has also been found effective in helping people to reduce their consumption of alcohol or to abstain. The generic name for Topamax is topiramate.

A large scale randomized, placebo controlled, double blind study of Topamax for the treatment of heavy drinking was published in JAMA (The Journal of the American Medical Association) in 2007. 371 subjects took part in this study. Topamax was significantly better than a placebo in reducing the percentage of heavy drinking days (p = 0.002). Statistically significant improvements were also seen in the number of abstinence days, the number of drinks per day, and in liver enzyme tests.

The biggest drawback to Topamax are side effects which can include confusion, psychomotor slowing, difficulty with concentration/attention, difficulty with memory, speech or language problems, particularly word-finding difficulties, depression or mood problems, and somnolence or fatigue. These side effects have led some people to discontinue Topamax treatment. About 15% of the subjects in the JAMA study reported cognitive side effects.

5.4 Campral

Campral (generic name acamprosate) is an anti-craving medication. Researchers believe that Campral may reduce cravings by interacting with the GABA or the glutamate system in the brain. The evidence suggests that Campral increases the success rate of people who are highly motivated to abstain from alcohol. Campral does not appear to be effective for people with little motivation. There is no evidence that Campral is helpful in helping people to moderate their drinking.

6) Dietary Supplements to Change Your Drinking

6.1) Glutamine

Glutamine has been found to reduce alcohol consumption in rats by 35% (Rogers et al, 1955). A number of people have also reported that glutamine has helped them to reduce their drinking. Glutamine is available as an over the counter dietary supplement. In a preliminary study with human subjects, Rogers et al (1957) administered 1,000 mg of glutamine to subjects who had reported alcohol problems. Subjects were instructed to take 400 mg of glutamine with breakfast, 400 with lunch, and 200 with dinner. Subjects in this study reported much improvement after taking the glutamine; however, the sample was not large enough to allow for statistical analysis.

6.2) Kudzu

Kudzu root has been found to significantly reduce alcohol consumption in both rat studies and human clinical trials (Benlhabib et al, 2004, Lukas et al 2005). The dosage of kudzu root for humans is two 500 mg capsules of kudzu root extract taken three times daily--a total of 3,000 mg per day. Kudzu root is not to be confused with kudzu flower which is not effective in reducing drinking.

7) Other Tools

7.1) How to Taper Off Alcohol

Why Taper?

Some people can just quit drinking alcohol cold turkey without having significant withdrawal symptoms. Other people, however, may suffer significant withdrawal symptoms when they suddenly stop drinking. Alcohol withdrawal is potentially fatal, so if you find yourself starting to experience significant alcohol withdrawal symptoms when you stop drinking then it is important to gradually detoxify from alcohol rather than quitting all at once “cold turkey”. You can gradually detoxify from alcohol by tapering off. You can taper off either by using alcohol itself or by using medications.

Who Is Likely To Have Significant Alcohol Withdrawal Symptoms?

  • People who have stayed drunk several days in a row
  • People who have gotten drunk every night for a month or more
  • People who have drank small amounts throughout the day for a month or more
  • People with a history of alcohol withdrawal symptoms

What Are Withdrawal Symptoms?

Doctors classify withdrawal symptoms into three categories: mild, moderate, and severe.

  • Mild or minor alcohol withdrawal usually occurs within 24 hours of the last drink and is characterized by tremulousness (shakes), insomnia, anxiety, panic, twitching, sweating, raised blood pressure and pulse, and stomach upset.
  • Moderate or intermediate alcohol withdrawal usually occurs 24-36 hours after the cessation of alcohol intake. Its manifestations include intense anxiety, tremors, insomnia, seizures, hallucinations, high blood pressure, racing pulse.
  • Severe or major alcohol withdrawal aka Delirium Tremens (D.T.s). This usually occurs more than 48 hours after a cessation or decrease in alcohol consumption. It is characterized by disorientation, agitation, hallucinations, tremulousness, racing heart, rapid breathing, fever, irregular heartbeat, blood pressure spikes, and intense sweating. When untreated about one person in five will die of D.T.s. Some people refer to shakes as D.T.s but this is inaccurate.

Even mild or moderate withdrawal can be dangerous for people with high blood pressure or bad hearts. Because withdrawal raises blood pressure there can be a danger of heart attack or stroke. The longer and harder a person has drunk alcohol--the more severe the withdrawal will be.

Can People Successfully Use Alcohol To Taper Off?

An unqualified YES. People have been using alcohol to taper off from alcohol since the dawn of history. Withdrawal medications are a recent invention. The idea that tapering cannot be done is a myth created by the alcohol treatment industry.

How do I know if I need to taper off?

If, when you stop drinking, your hands are visibly shaky, you begin to sweat a lot, you have a rapid or irregular pulse, or your blood pressure is very high then it is advisable to taper off alcohol and not quit cold turkey. You can taper off by using alcohol or by getting prescription meds from your doctor. A pulse of over 100 beats per minute is a definite danger sign.

How Do I Use Alcohol To Taper Off?

Beer is the best form of alcohol to use when tapering off. If you attempt to taper off using wine or hard liquor you might just wind up getting drunk again because these have higher alcohol content than beer. Try to limit yourself to drinking no more alcohol than necessary when you start tapering. Drink just enough to keep the sweats and shakes at bay. Gradually reduce the consumption of beer as you continue to taper. If the withdrawal is not too extreme you should be tapered off in a day or so. Some people may, however take longer--three days or even a week. If you start to feel withdrawal symptoms it is a sign that your taper is not done yet.

It is also very important when tapering off to fight dehydration and to replenish lost vitamins. If you go through a medical detox the people they may rehydrate you with an IV and may also give you vitamin shots. If you are doing a self detox be sure to drink lots and lots of fluids and to take vitamin pills. We recommend Gatorade because it has balanced electrolytes. If you choose to drink water make sure that you get enough salt for electrolyte balance so that you avoid water intoxication.

How Much Alcohol Should I Drink When Tapering Off?

The average person takes around an hour and a half to metabolize a single standard drink--for example one 12 oz beer. People who have a very high tolerance to alcohol can metabolize up to two standard drinks (28 g of alcohol) per hour. People who have a very low tolerance to alcohol might require two or three hours to metabolize a standard drink. Males metabolize alcohol faster than females. The more you weigh the higher your tolerance. Heavy drinkers who have increased tolerance also metabolize alcohol more rapidly than average. On the other hand people who have liver damage and reverse tolerance metabolize alcohol more slowly than others.

Our general rule of thumb is for people to taper off by drinking one beer per hour. However, you may have to adjust this number up if your tolerance is very high, or you may have to adjust this number down to one beer per two or three hours if your tolerance is low. If you start with one beer an hour we recommend that you gradually cut this down to half a beer an hour over the course of the taper.

How Do I Taper Off With Other Meds?

If you tell your doctor that you are having a problem with alcohol withdrawal s/he will help you taper off with a benzodiazepine such as Valium or Librium. In some states such as Minnesota the doctor is required by law to commit anyone suffering from alcohol withdrawal to an inpatient detox facility for at least 72 hours. In other states the patient may be allowed to attend an outpatient detox program or the patient may be given a prescription for a benzodiazepine for use for self detox. Typical detox regimens using these medications are as follows:

  • Diazepam (Valium); 10 mg 3 or 4 times in first 24 hours, then 3 or 4 times daily as needed.
  • Chlordiazepoxide (Librium); 50 mg every 6 hours for four doses, then 25 mg every 6 hours for eight doses.

If you do go to a doctor for alcohol withdrawal you may have a diagnosis of alcoholism on your medical records for the rest of your life. This can make it difficult to get medical insurance and sometimes even employment. If you want to avoid this you may choose to do the self-detox using beer as described above.

Does an Instance Of Alcohol Withdrawal Mean That I Can Never Safely Drink Again?

Not necessarily. Every individual must decide for him/herself whether their best option is to pursue a goal of alcohol abstinence, moderate drinking, or harm reduction. If you choose to drink again the best way to avoid another instance of withdrawal is to avoid drinking two days in a row. If you can’t do this, then at least try to get in three abstinence days during the week. Try to avoid drinking day and night. The more abstinence time you have each week the lower the chance of having another instance of withdrawal. If it is just too damn much work to pursue a goal of harm reduction or moderation with too little payoff, then you may just decide that quitting is simplest. HAMS is wholeheartedly opposed to programs which try to use fear to motivate permanent abstinence from alcohol. We see these programs as usually backfiring and leading people to ever worse binges and ever worse withdrawals. We have found that people are most successful at quitting when they choose that goal for themselves.

What Causes Alcohol Withdrawal?

Alcohol withdrawal is caused by neurotransmitter rebound. The main neurotransmitter system involved in alcohol withdrawal is the GABA (gamma-aminobutyric acid) system. Simply put, GABA receptors cause a person to feel calm, relaxed or sleepy. Alcohol enhances the functioning of these GABA receptors. This is why when people drink alcohol they will feel calm, relaxed, or sleepy. However, when the GABA receptors are exposed to alcohol over a long period of time they struggle to overcome the effect of the alcohol and to return to normal functioning. This is one reason why drinking alcohol has less and less of a payoff when consumed constantly over a long period of time. One is not nearly so relaxed by alcohol the third day into a bender as one was on the first day. After being exposed to alcohol over a long period of time the GABA receptors stop responding as efficiently to the presence of GABA. When the alcohol is suddenly no longer there, these GABA receptors now respond only very weakly to the presence of GABA. The result is anxiety, panic, and insomnia.

Another thing which happens when the function of the GABA receptor is enhanced by alcohol is that the brain tries to overcome this calming effect by producing more adrenaline and other similar neurotransmitters. When the alcohol is completely taken away then this adrenaline and its cousins are left to run rampant in the brain. This leads to raised blood pressure, raised pulse rate, rapid breathing, fever, hallucinations, seizures and D.T.s.

Alcohol also inhibits the glutamate receptor--which is the cause of staggering, slurring, and general interference with muscular coordination. Glutamate receptor rebound also appears to contribute to the withdrawal symptoms described above.

What Is "Kindling"?

Some people who have repeatedly gone through cold turkey withdrawal without tapering off become more and more likely to have bad withdrawals form even small amounts of alcohol. This phenomenon is referred to as “kindling”. People who have undergone kindling can suffer withdrawal seizures from drinking as little as a six pack of beer. Some decades ago some detox facilities forced clients to undergo cold turkey withdrawal to "teach them a lesson". Not only did this fail to stop people from drinking, it resulted in many people suffering from kindling. Fortunately this barbaric practice has been discontinued. The way to avoid kindling is to taper off.

7.2 The Geographical Cure

When you are struggling with an alcohol problem it only makes it more difficult to struggle with additional obstacles at the same time. Some geographical areas of the US are right wing, some are left wing, some have high unemployment, some have low unemployment, some discriminate a lot against certain minority groups, others do not, etc., etc. Sometimes moving to a more suitable geographical area can spell the difference between success and failure at achieving your drinking goal. So if you feel the need for the geographical cure, go for it!

7.3 Journaling

Many people find that writing about the thoughts and feelings associated with the events in their lives is therapeutic--much as it can be therapeutic to tell them to a counselor. Journaling is most helpful if one writes in detail about feelings and cognitions related to life events, as one would discuss topics in therapy.

Journaling not only allows people to clarify their thoughts and feelings and gain insights into themselves, journaling can also work as a problems solving tool by letting people hash things out on paper until they come up with a solution. Journaling also allows people to process traumatic events by fully exploring and releasing the emotions surrounding them.

Research shows that if you journal then it is important to focus on both cognitions and emotions (Ullrich and Lutgendorf, 2002). Focusing solely on negative emotions can backfire and leave you feeling worse than before. So use the journaling to help you gain insight and understanding and journal about both the positive and the negative to get the best effect from this tool.

7.4 AA Deprogramming

First off we want to say that it is a fact many people who have alcohol problems find that AA is helpful to them personally. If you are one of them then we congratulate you. You may stop reading this section right now because we have no desire to convert you.

However, it is also a fact that many people with alcohol problems are not helped by AA. Many people have reported being damaged by their involvement with AA. Some people report that attending AA meetings make them crave alcohol. Some people report that their drinking increased greatly in quantity or turned extremely dangerous after they began attending AA. Still others report that attending AA meetings makes them depressed or suicidal. If you suffer from any of these problems it may well be in your best interest to leave AA immediately. If a patient is allergic to penicillin, the answer is not to give the patient more penicillin. Likewise, if a person is allergic to AA, the answer is not more AA.

Because AA uses a number of elementary brainwashing techniques, many people find that the damage which they have suffered as a result of attending AA continues to persist long after they have left AA. The primary brainwashing techniques which AA uses involve undermining your self efficacy by forcing you to admit that you are powerless (step one) and insane (step two). People are led to believe that alcohol is more powerful than they are--but that AA itself is a "Higher Power" which can rescue them. This leads to a total dependence on AA and a hysterical fear of anything which is not AA.

However, researchers such as Dr. Albert Bandura tell us that the most powerful force for positive self change is self-efficacy. AA destroys self-efficacy and replaces it with an unhealthy dependency on AA. This is why AA members are always on the verge of relapse even after 20 years of sobriety. As AA says, "Always recovering, never recovered." This destruction of self-efficacy is also why relapse in AA is so common. Dr. James Prochaska tells us that people who change their behaviors on their own will often forget about their bad habits in a year and have no desire to return to them because they no longer think about them. People who go to AA dwell on drinking at every meeting and never get it out of their heads--they are always on the verge of relapse.

AA also keeps members mentally off balance through the use of cognitive dissonance. AA forces members to hold two contradictory beliefs at the same time. The way to recover from AA brainwashing is to realize that you are powerful and sane. AA has no power over you unless you give it power over you. AA is insane--not you.

If you have a gut feeling that AA is wrong for you then it almost certainly is. Do not allow yourself to be forced into AA against your will by anyone--not even a doctor or a psychologist or a judge or an employer or a friend or a family member. Do not allow anyone to put the notion into your head that you are diseased or powerless of that you will die without AA. The majority of people who quit drinking do so on their own--regardless of how much they drink.

The research shows that AA is one of the least effective treatments for alcohol problems out there--nowhere near as effective as more traditional forms of psychotherapy (see our page on AA Efficacy for a discussion of this). It is nothing short of criminal that medical doctors refer people with alcohol problems to something which is ineffective in general and harmful to many instead of referring them to something which could actually help them. And the same is true for courts or employers who force AA on people. Fortunately many states have recognized that forced AA participation is unconstitutional because it violates the right to freedom of religion.

If you have been harmed by participation in a 12 step program you may find the following books helpful for use in AA deprogramming:

Several of these books are available for free on Ken Ragge's web site: http://www.morerevealed.com

A lot of people are AA members and believe that AA has cured them of their disease. A lot of people are Christian Scientists and believe that prayer cures cancer and surgery does not. Believing something does not make it so. Research suggests that AA tends to be helpful only for people with a dependent personality type who need a paternalistic and authoritarian figure to control them (Poldrugo and Forti, 1988). AA can be a disaster for free thinkers. Sometimes getting AA out of your head is essential for successfully accomplishing your drinking goal--whether that goal is safer drinking, reduced drinking--or even quitting.

As we have said many times--all elements, tools and strategies of HAMS are optional and not all will work for everyone--you must choose what is right for you. AA works for some people and we wish them well and have no argument with them. However, some people have been significantly psychologically harmed by AA and have increased their drinking or have become depressed or suicidal as a result. If you are one of these people you may need AA deprogramming.

7.5 Acupuncture

8 Add Your Own

HAMS is not all knowing or all powerful. Feel free to add any tools that you think up for yourself to your list of alcohol harm reduction tools. You may come up with something great that no one else has even thought of yet!! Think before you drink. There's more than one way to skin a cantaloupe!


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