For most people, the answer to that issue is simply, you cut back on your drinking or you quit—you just do it. Like smokers who quit smoking, most drinkers arrive at a solution to their problem on their own. They either happily have a drink or two with friends occasionally, or they say, "No thanks." They set a limit that works for them.

Interestingly, people who quit smoking don't consider themselves smokers for the rest of their lives. They may take each day as it comes, but they don't usually go to groups or consider themselves to be continually at risk for relapse. The 12-step program would say that people who quit on their own never had a problem in the first place, and when it comes to alcohol, that they are "dry drunks" if they control their drinking on their own and never hit rock bottom or attended AA. Alcoholics Anonymous helps many, many people. Yet not all who attend their program are successful at stopping alcohol use-- and not all of these who drop out or are unsuccessful have "character defects" as AA asserts.

On the other hand, many alcohol users come to a point where they believe their drinking is a problem for them, and yet they find it nearly impossible to quit on their own. Perhaps they are a successful business person, or a high-achiever in all areas of life, and value self-control. They worry that their drinking is out of control and want to bring it back in line to better fit their values. Or they are a serious athlete and value their health. Or they see that their relationships are suffering because of alcohol use. But they find it harder than they expected to quit or cut back, and they won't attend AA. Why? Reasons I often hear are: They don't agree with the "higher power" concept required in AA—they are of a religion other than Christian, or they don't consider spirituality to be important to their life at this time. And/or they don't want the community to see them at an AA meeting. (It's not really anonymous—no one wears masks.) And, they do not feel "powerless" and will not go along with having to state that they are. What, as a counselor, can be done to help such a person if we can't just ship them off to treatment at a 12-step program?

Cognitive-behavioral therapy is beneficial, as is behavioral therapy, and Motivational Interviewing. Education in life skills can also help someone regain control of a behavior that has become too all-encompassing in their life. Drinking is a habit—not a disease. It can certainly become a serious, life-threatening habit requiring detox before therapy, but still it is a behavior, not a brain disorder. Habits can be changed, and replaced. Therapy can help the client find, acknowledge, and use the same strengths and resources they have and use in other areas of life to overcome their addiction. The situations that trigger their behaviors can be examined, analyzed and understood. Options can be identified. People can learn to examine their own self-talk and replace it with more rational and useful thoughts. A common reason people drink is in order to relax—many clients have never learned how to feel comfortable in social situations, and rely on alcohol to take the edge off their nerves. Then they come to believe they NEED the alcohol in order to function the way they want to in a group or other social situation. The solution is to learn how to relax, how to communicate better, how to be assertive and calm in these social situations. When these skills are in place, the compulsion to use a social lubricant lessens. Therapy is a great place to learn and practice new skills.

When alcohol use threatens relationships, it's time to re-evaluate how much those relationships mean to the person in question. Clients often say, "My spouse thinks I drink too much." The drinking is then a problem to the relationship, if not to the drinker. So what is to be done? If the client values the relationship, they will explore the issue with their partner, come to an understanding of how the partner feels and why, and either drink less or quit or continue to drink the same. Motivational Interviewing can help them see the pros and cons of drinking. Perhaps the pros outweigh the cons for them—it's certainly an option, and the client is the only one who can make that decision.

Harm reduction is the theory that any degree of movement in the desired direction can be helpful. Clean needles are better than dirty, if a person is going to use heroin. Three beers are better than six if a person wants to drink less. Perhaps with less use, the benefits will become more obvious with time and the client will be motivated to cut back even more. Drinking less can be proposed as an experiment: "Try it for a week and see what happens for you." It's always very interesting to hear about the feelings that come up for people as they try this. It's all grist for the therapy mill, and always leads to greater insight and awareness for the client. If three beers a night works better for them, progress has been made.