Just a glass ... or two

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Did she often drink alone? Check. Did she often have several drinks in quick succession? Check. Did she often use alcohol as an escape from her troubles? Check, check. By many standards. Mary was an alcoholic. By others--including her own--she was not. She didn't drink in the morning, didn't have physical cravings for alcohol, and her drinking never jeopardized her job in the food services department of an Ontario jail. She knew she needed help but couldn't imagine herself standing up at an Alcoholics Anonymous (AA) meeting, spilling out the story of her battle with the bottle. For a lot of reasons, it didn't feel right.

Unlike many problem drinkers, Mary didn't start drinking excessively until well into adulthood--at age 32, 15 years after she was raped by a friend of her father's. When she started drinking she already had three children and was married for the second time, to a man she describes as domineering and verbally abusive. "He wouldn't let me go out to the doughnut shop on my own," she recalls, "and his sexual tastes were...well, I won't get into that."

Looking back on her life, Mary sees a clear connection between her second marriage and her drinking. "I drank because of him," she says simply. At the time though she attributed her increasing dependence on white wine to shyness. After having one drink too many at social gatherings, Mary learned, as so many of us do, that alcohol melted away her reserve. She could join in conversations, say whatever came into her head, and people actually listened--even when she was babbling the sorts of inanities that only several urgently downed glasses of wine can produce. With alcohol, she had a way to feel powerful.

But when she learned that her husband was beating her children, Mary gathered the strength to leave. This solved some problems but created fresh ones--such as how to make ends meet, keep her kids off the streets and block out the deafening silence in her bedroom at night. She turned inward. Her social circle narrowed to a couple of talk show hosts and her cat. She kept drinking until she reached a plateau of five or six glasses of wine per day, several days a week.

Mary did a few sessions of therapy--not for her drinking but to get help dealing with the rest of her life. The therapist helped her see that her wine habit had helped cause her isolation and depression and suggested she try Drink-Wise, an alcohol treatment program that was news to Mary.

A Canadian-made program, Drink Wise has had success with women such as Mary, and boasts a higher success rate among women than among men. Directed toward those who drink too much--but not uncontrollably--DrinkWise gives problem drinkers the choice to either control their intake or abstain. It provides an alternative to the concept that alcoholism is a disease, suggesting instead that not all drinking problems are alike and that there's no one-size-fits-all solution. This philosophy apparently appeals to women, who make up 51 percent of DrinkWise clients, according to Rob Simpson, director of Homewood Behavioural Health in Guelph, Ont. (the company that developed the program and owner of its copyright). "Women are underrepresented in just about every other alcohol treatment program, but are overrepresented at DrinkWise." Why? Because more women than men fall into the category of mild-to-moderately dependent on alcohol, and those are just the types that can help themselves to moderation. Indeed, a recent Ontario study found that male drinkers are two and a half times more likely to have three or more indicators of alcohol dependence.

Formally established in 1991, DrinkWise has roots that go back to the early 1970s, when, Martha Sanchez-Craig who was originally trained as a psychologist, was studying hardcore alcohol abusers at Toronto's Addiction Research Foundation, now part of the Centre for Addiction and Mental Health. Teaching abstinence, she followed her subjects over the course of six-month intervals for a year and a half and found, to her great surprise, that about 10 percent had learned to moderate their drinking on their own. This finding threw cold water on the prevailing opinion that the only long-term cure for alcoholism was abstinence. Sanchez-Craig took particular interest in people such as Mary. The AA perspective that "You can't be a little bit alcoholic, just like you can't be a little bit pregnant" did not account for such people, she thought.

After many years of studying the problem, Sanchez-Craig and her colleagues accepted the conclusion that alcohol dependence exists on a continuum, from mild to severe. This has spawned alternatives to AA that, like Drink Wise, are geared toward people with more moderate drinking problems, such as Moderation management or Guided Self Change at the Centre for Addiction and Mental Health. These programs appeal to people who sense they may be able to control their drinking and who shy away from programs that require abstinence.

"Think about it," says Simpson of DrinkWise. "If you go for a checkup and find out that your blood pressure is a bit high, does your doctor book you for heart surgery the next day? Of course not. First, you try quitting smoking, eating less fat, exercising more. It's the same with drinking. If someone is drinking more than she'd like, it doesn't make sense to dangle lifetime abstinence in front of her eyes as the one and only solution. It turns many people off."

DrinkWise does not accept people who have a physical dependence on alcohol--people who have the shakes or other withdrawal symptoms when they've been without a drink for a while. It refers them to traditional abstinence-based treatment programs. Alan Ogborne, a senior scientist at the London, Ont., office of the Centre for Addiction and Mental Health, says, "For less seriously dependent drinkers, a controlled drinking approach may be more appropriate."

Even people who follow DrinkWise can choose abstinence as their goal, although most opt for moderation. This flexible program lets clients choose whether they want group, individual or even telephone sessions. In practice though, groups form only rarely because most people prefer the anonymity of one-on-one treatment. This is especially true for women who, according to Helen Robinson, the DrinkWise counselor and social worker who treated Mary, are more likely than men to be closet drinkers. "Women tend to drink in secret and hide a drinking problem longer, which is why some women are nervous about joining AA."

AA's philosophy that people have no power over their drinking also turns off some women, says Simpson. "From what I know about women today, they're interested in gaining power, not in giving it up. DrinkWise takes the position that problem drinkers have the power but are not exercising it very well." (See sidebar, "Not a drop to drink," right.)

DrinkWise seems to work. A year after finishing the program, 85 percent of clients report "freedom from alcohol-related problems." Research found that between 60 and 70 percent were drinking within moderation guidelines--no more than 12 drinks a week. Why do women report success rates of 18 percentage points more than men? Women tend to seek help for what Sanchez-Craig calls "internal reasons," such as concerns about emotional health or self-esteem, whereas men tend to be motivated by "external reasons," such as pressure from a spouse or boss. The internal motivators seem to push harder: women dutifully do their DrinkWise homework assignments and respond more thoughtfully to the feedback they receive.

Mary turned out to be the ideal DrinkWise client. She took copious notes, did all the exercises and never missed a day recording in her drinking diary what she drank. What helped her the most though was the individual attention she got from her counselor. "For the first time in my life, I was able to focus on myself, to see myself as an important person," she recalls. The diary was also an eye-opener for her. "It helped me understand what triggered my drinking and reminded me why I wanted to cut back."

Of course, not all women are good candidates for controlled drinking programs. A case in point is Anita, a Vancouver-based proofreader who has been attending AA meetings three or four times a week for the past six years and thinks AA saved her life. Although she never drank in the morning and never lost a job because of booze, she is certain that moderation programs wouldn't work for her because "I have never been able to have just one drink. If I don't have one now, after six years of sobriety, I can control it and can even keep booze around the house without being tempted. If I have one, all my self-control goes kaput."

People like Anita are often told that they have a disease they can't control. According to Dr. Nady El-Guebaly, director of the Calgary Regional Health Authority's Addiction Centre, instead of thinking drinkers lack willpower or suffer a moral weakness, new research suggests drinkers actually experience changes in their brain chemistry that makes them lose control when it comes to alcohol.

On the other hand, the disease theory can be a selffulfilling prophecy, says Audrey Kishline, founder of Moderation Management, a nine-step self-help program informed by Sanchez-Craig's original research, that is a small but growing alternative to AA-based programs in the United States. "Some problem drinkers can control their drinking but are told they can't," she explains. "If they buy into that belief, they may feel that 'all is lost' after one drink and end up going on a binge."

Theories aside, many alcohol-treatment professionals would agree that moderation can help someone such as Mary. It's not so clear-cut for more dependent people--people such as Linda, a tough-talking 45-year-old who spent years belting down 26 ounces of scotch every day, with hits of cocaine for good measure. Her story contains all the elements of an alcoholic-in-the-making: alcohol abusers sprouting all over her family tree and an alcoholic second husband who eventually killed himself.

During a counseling session at Montreal General Hospital, Linda was told that she had to stop drinking, period. She said no. (Actually, what she said is not printable in this magazine.) She also rejected 12-step programs and "all their codependent drivel," so Alcoholics Anonymous was out. Finally, in the fall of last year, she learned about an addiction counselor who wanted to start a moderation-based program, and she jumped at the opportunity.

By moderation standards, Linda is doing only passably well. She drinks just about every day but tries to stay away from hard liquor. She doesn't feel secure unless there's some alcohol in her home and occasionally has a drink in the morning. Now, for the first time in her life, she's dating a man who drinks moderately and doesn't do drugs.

For Mary, DrinkWise was the right approach. Over the five years since she took the course, she sticks to an average of six to eight drinks a week and has never stepped beyond the recommended moderation limit of 12 a week. "My self-esteem is also a bit better now, and that's partly due to DrinkWise," she says, her voice rising and falling with its usual hesitant lilt. And her kids appreciate her cutting down on the booze.

She still talks occasionally with Helen Robinson, who says, "I saw a dramatic change in Mary over time. She went from being depressed and isolated to feeling hopeful about life. By the end of my follow up with her, she was able to enjoy her social circle without overdrinking." What impressed Robinson: how Mary learned to drink for pleasure only--not out of habit or to cope. "I'm quite confident that drinking is no longer a problem for her."

Life rarely follows a smooth upward curve, and Mary is no exception. Now 52, her children all grown and out of the house, she lives alone with her two dogs and works 12-hour shifts in the same job she's held for more than two decades. All in the same year, she moved to a new apartment, got into debt and learned of her mother's serious illness. She talks about having had memory lapses when she was a problem drinker, nameless fears at night. In a life that often plays a humdrum tune, an occasional glass of wine is one of the small pleasures she allows herself. "She's clearly able to control her drinking over a long period of time," says Robinson, "so why deny her that pleasure?"

Getting with the program

So far, just about 1,300 people have gone through DrinkWise's research and treatment programs, compared with the millions who have sat through AA meetings. About a half-dozen DrinkWise programs exist across Canada--such as Winnipeg's Addictions Foundation of Manitoba and New Brunswick's Campbellton Regional Addiction Services--but geography matters little since clients can sometimes do long distance telephone counseling.

The cost of the for-profit program creates a potential stumbling block--close to $500-although some employee assistance programs cover the fee. Counselor Helen Robinson says, "In the initial assessment, we encourage clients to tabulate the cost of their drinking. They're often shocked. The program cost can seem low in comparison."

DrinkWise's philosophy maintains that people can unlearn the habit of excessive drinking. Clients participate in four sessions (five if in a group format) over a period of about 10 weeks, with follow-ups after three and nine months. During the sessions, the counselors helps the client set specific drinking goals, such as" ceremonial drinking only" or "10 drinks a week." Counselor and client also discuss moderation strategies in great detail: keeping track, pacing, measuring, planning ahead and replacing, among others.

Yet what goes on between sessions accomplishes just as much. Clients keep journals, one to log alcohol consumption and one to record coping strategies. They're also given homework assignments to complete on the consequences of drinking they want to avoid or how to plan ahead for a tempting occasion. Through these exercises, "Problem drinkers become more aware of their automatic behaviours, which paves the way for change," says Robinson.

Although clients discuss moods and feelings, Robinson stresses that it's not therapy. "If you want to talk hours about an unhappy marriage, this is not the place."

For more information about the DrinkWise program, call 519/824-3417 or 1/800/445-1798. G.B.

Not a drop to drink

Women for Sobriety (WFS) offers an alternative to unisex treatment programs. Requiring members to abstain, this self-help organization claims female drinkers can take charge of their lives and their drinking problems.

Launched more than 20 years ago by U.S. sociologist jean Kirkpatrick, who herself had a drinking problem, WFS quickly blossomed into an international organization. According to Marion State, who works at the Toronto Hospital with people who have multiple disorders, women who misuse alcohol often tend to have a very low opinion of themselves. "Kirkpatrick felt that AA was geared to how men thought and that women needed a program that put more emphasis on the positive."

At WFS meetings, participants introduce themselves with the statement "My name is X, and I'm a capable, competent, caring and compassionate woman." With the help of a certified moderator, they recite and discuss 13 affirmations--for example, "negative thoughts destroy only myself"--and each person finds at least one positive event in her life to share with the group.

Most important, WFS encourages women to leave the past behind, says Paula Douglass, who moderates a group in Toronto. Many WFS participants were turned off by the horror stories at AA. "People trot out their tales of woe, week after week. At WFS, we say that the past is the past and let's get on with the present."

Currently, WFS has more than a dozen chapters in Canada. Groups meet weekly, and participants must have at least 24 hours of sobriety behind them at each meeting. It costs nothing to participate. To find out more, call the WFS head office in Quakertown, Pa., at 215/536-8026 or www.mediapulse.com/wfs. G.B.

Booze lessons

DrinkWise teaches five main strategies. Here's a sample:

Monitor yourself

[Symbol Not Transcribed] Record your drinking for three months--nothing what made you drink and how you felt before you had the urge to drink. (DrinkWise clients who monitor themselves are generally more successful.)

Pace yourself

[Symbol Not Transcribed] Measure each drink.

[Symbol Not Transcribed] Dilute drinks--try ice in Wine.

[Symbol Not Transcribed] Sip; don't gulp.

[Symbol Not Transcribed] Have just one drink an hour.

[Symbol Not Transcribed] Alternate alcoholic with nonalcoholic beverages.

[Symbol Not Transcribed] Prepare for tempting situations. Decide in advance whether to drink or abstain.

[Symbol Not Transcribed] Develop a way to count your drinks.

[Symbol Not Transcribed] Identify ways to pace yourself.

She-tox

The addiction community is finally recognizing that women respond to treatment differently than men. Now, severely addicted alcohol or drug abusers can find help at treatment centres designed specifically for women.