Drinking

Help! I Need to Quit Drinking!

Drinking: What’s the Big Deal?

Alcohol is a mind-altering substance. It's a legal one, and for many it's a safe one, but it can lead to dependence and addiction like so many other things can. It's one that in the vast majority of the United States is normalized through advertisements, bars, and media of all forms. It's something that many people don't view as harmful, but if misused or overused it can lead severe consequences.

Unfortunately, alcohol can also be dangerous and difficult to quit on your own. The easiest way to determine whether it would be safe to cut back or stop entirely on your own is to talk to your doctor in an open and honest way. You should be assured that everything you tell your doctor is confidential, and there should be no judgment within the exam room about whatever you tell them.

If, for whatever reason, you don't feel comfortable talking to your doctor or don't have a doctor, there are other options as well.

Monument is an online evidence-based subscription service that can connect you remotely with physicians and therapists that are specially trained in alcohol harm reduction, regardless of whether your goal is to completely quit or to simply use moderation with future drinking. They can prescribe medications (discussed below) and also help with counseling to work together with the medication.

This Prediction Tool can give an indication of whether any withdrawal you might go through would be safe without being admitted to a facility. A score of 4 or more suggests that it would likely not be safe to stop drinking without expert guidance.

What Can my Doctor Do to Help?

Your doctor can do several things to help in your journey.

1. They can act as a cheerleader! They can point you in the right direction for resources, commend you for the hard work that you're doing, and celebrate successes with you.

2. They can refer you to treatment programs. Every area has different resources, but more and more there are telemedicine options for counseling, therapy, or psychological help.

3. They can help by prescribing medications. In the hospital (and in the clinic with specially trained physicians) there are medications to treat withdrawals and acute symptoms. These get complicated and can be very precise, and change on a patient-by-patient basis. Past the acute phase though, there are several medications which can help you to curb cravings and safely assist you to stay at the level of drinking that's right for you.

• Naltrexone - Not to be confused with Naloxone, this medication can be a daily pill or a monthly injection (though this injection can be expensive, depending on your insurance). This is a medication which cuts back on the cravings that you have which turn the feelings of "I really need a drink" into "I might like a drink, maybe" or the urges that turn one drink into five. It can also decrease some of the neurological rewards from alcohol. This is very safe, but for people with severe liver disease may need to be monitored a bit more closely.

  • • This can sometimes cause GI upset, headache, sleepiness, or difficulty sleeping. If you start to experience any of these, contact your physician and they can discuss how best to manage them.

• Acamprosate - Brand name, "Campral" this medication is unfortunately a higher pill burden, requiring two pills be taken three times daily (for a total of six pills per day). This medication is just as effective as naloxone however is not used as often due to the more difficult scheduling; the main advantage is that while Naltrexone is metabolized and cleared by the liver, acamprosate is metabolized and cleared by the kidneys. This means that for people who have liver disease or damage, acamprosate will be safe for them to use.

• Disulfiram - Brand name, "Antabuse" this medication is unfortunately one of the best known because it has been widely marketed for the longest period of time. This medicine stops an enzyme in your liver that helps to metabolize alcohol, which means that while this medicine is in your system if you try to drink you become very nauseated and often throw up. This aversion can be helpful for some, but many find it too burdensome and aggressive a treatment. Many treatment facilities use this medication since they can help to administer it to you directly, but can also be used at home if you have a partner in your attempt to cut down who can keep you accountable to taking it regularly.

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Talk to people in your life who drink!

Nobody wants to go through challenges alone, and it can help to have the support of those you love while quitting or cutting down drinking. Even more important, if they drink too then your chances of successfully dropping your alcohol intake will be made that much more difficult. Remember: if you’re spending time with people while they drink, you're making things that much more challenging for yourself. Instead, invite them on YOUR challenge and quit or cut back together, so you can maintain accountability as a team.

Good luck, and remember that you’re not alone - everyone at your doctor’s office is on your side!

Some people have had great success with Holly Whitaker’s book, Quit Like a Woman (useful for all genders!), and with her organization Tempest.