Many approaches to working with people whose alcohol use is excessive are based on the 12 step model of Alcoholics Anonymous. This works on the belief that an alcoholic has no power over their use of alcohol, and needs the help of a higher power to regain control of their lives. I think for some people this is true, and for them the AA approach works well.
Many drinkers, however, do not see themselves as alcoholics, and for them a different approach is more useful. It is better to ask "In what way is your use of alcohol a problem?" It becomes a problem when it costs the drinker more than they pay for it: for example their health, job, house, driving licence, friends and relationships.
The drinker then has to make a decision as to whether to change their drinking habits, or risk losing something. This is a difficult choice, as drink can be seen as a friend and helper, giving a social scene, a way of relaxing and a way of dulling emotional pain. So distancing from alcohol can feel like a loss, which needs to be recognised and grieved.
Alcohol is also physically addictive, and many drinkers don't like to face the prospect of detoxing, with its range of withdrawal symptoms. Although these last for a week or less they are distressing if not controlled medically.
Drinking takes time, and drinkers need to find other activities to fill that drinking time. Developing a menu of alternatives that the drinker can try out is useful.
And up to now we have not looked at the choice of abstinence or controlled drinking. In the AA model there is only abstinence; in the problem focussed approach controlled drinking is an option until the drinker realises they cannot manage it. Some drinkers can and do control their drinking, although it is the more difficult choice in practice, requiring a clear and precise plan for control.
We also need to look at the drinker's family and social setting. These are often chosen and arranged by the drinker to enable them to carry on drinking as usual. If changes can be made in social habits and if family members can be encouraged to stop supporting the drinking behaviour (e.g. buying alcohol, excusing absence from work, hiding the drinking from others) then the drinker will find it more difficult to continue in the same way.
Drinking behaviour can be changed if people are given support, and a belief that it is possible. It requires a willingness by the drinker to try different ways of changing, to learn lessons from lapses, and to keep up a level of self-esteem by doing something to improve the lives of both themselves and those around them.
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