By Diana Umene, M.D., internal medicine, The Portland Clinic

Maybe it started with the pandemic. Or maybe it was the re-entry into socializing, or the demanding holiday season, or a stressful life change. Whatever the cause, before you knew it, your alcohol use had crept up on you.

If you’re ready to cut back, we can help. Willpower alone may not be enough, and rehab may be more than you need (although it’s an important option for some). For most people, effective change can begin right in your doctor’s office.

As medical providers, we understand that the issues around alcohol use, just like diabetes and weight management, are health issues, and we’re trained to help. Your primary care provider can help you to:

• Explore why your drinking has increased
• Assess your level of alcohol use
• Identify your motivation for cutting back
• Set safe and realistic goals
• Create a practical, structured, and highly individualized plan for cutting back

Explore: Why has your drinking increased?

As with any other health problem, understanding the cause is the first step toward successful care. Your health care provider can help you explore and uncover what led to your increase in drinking. Did the pandemic cause anxiety? Did a job loss lead to depression? When we focus on the causes, rather than just the problem, success is more likely.

Assess: Are you a moderate or heavy drinker?

It’s hard to assess your own drinking, when you might not even be sure what the difference is between moderate vs. heavy drinking. That’s why health care providers use objective screening tools and questionnaires, such as SBIRT (Screening, Brief Intervention, and Referral to Treatment for substance use) and AUDIT (Alcohol Use Disorders Identification Test) to accurately assess alcohol use, risks, and appropriate levels of support.

Identify: What is your motivation to cut back?

I always ask my patients, why are you trying to decrease your alcohol intake? Do you want to be healthier? To feel better, physically and emotionally? To improve your relationships? What is motivating you? When temptation arises — and it will — going back to what motivates you will help you stay on track.

Decide: How much do you want to cut back?

Your health care providers don’t set your goals for you. We’re here to ask questions that will help you clarify your own goals. Using a counseling technique called motivational interviewing, for example, I might ask: What do you feel you can achieve in the next month? If you say you’d like to cut back from 14 drinks per week to 12, then I might probe further: Why not 11? Why not 13? “Put simply,” says psychologist Stephen Rollnick, one of the developers of the technique, “this involves coming alongside the person and helping them to say why and how they might change for themselves.”

In addition to helping you set realistic goals, we also want to make sure your goals are safe for you. Quitting cold turkey, for example, is often discouraged because it can be dangerous, depending on how much a person drinks.

Plan: What strategies will be most helpful for you?

Once you’ve set a goal, your provider can help you create a plan of action and build a toolbox of practical strategies, resources and supports that can help you achieve it. The more specific your plan is, the better — winging it leaves a lot of room for error.

While the best strategies for you will be highly individualized to your lifestyle, here are some examples that other people have found helpful:

• Follow-up: Before you leave your provider’s office, schedule a one-month follow-up visit to talk about your progress and update your goals.
• Social support: Ask for support from the people you live with and drink with. Share your goals with them and make sure they’re supporting you rather than trying to pull you back into your old habits.
• Trigger reduction: If weekend social drinking is your routine, consider cutting back on these occasions or suggest other activities.
• Social strategies: When you will be drinking socially, go in with a plan. For example: I will limit myself to no more than two drinks. I won’t drink on an empty stomach. I’ll have a glass of water between drinks. I’ll sip slowly. I’ll have a go-to non-alcoholic option at the ready.
• Scheduled skip-days. If you usually drink on work nights, for example, try skipping Tuesdays and Thursdays.
• Tracking and keeping it real. Logging your daily drinks in a journal or calendar can help you stay on track. And make sure you’re clear about what size one drink is: about 1.5 ounces (one shot) of hard alcohol, 5 ounces of wine or 12 ounces of beer.
• Stress management. If you drink to decompress, find a new way to unwind. Start walking after work. Join a yoga group. Shoot hoops with friends. Take up woodworking, painting or knitting. Volunteer to walk dogs at a shelter. Soak in a hot bath.
• Medication. Because alcohol can rewire the brain, sometimes it takes more than willpower and counseling to cut back. Fortunately, your health care team can offer another tool: medication. Today, we have several medications that can help people reduce alcohol use. Many of my patients are benefiting from them.

The door is open

Working on your alcohol use doesn’t have to be a solitary effort. I really encourage you to partner with your provider, because there are so many ways we can help. I, for one, am passionate about it.

Helping people gain control over alcohol or other substances is by far the most gratifying part of my job. It takes time, it takes a lot of rallying, and there are often underlying factors involved — it can be complex. But once people achieve control, it’s amazing how it can change their whole life.