If you are in Maryland or Virginia, and would like more information about how Addiction Recovery Medicine could help you, please fill out the form below for a free 5-minute phone consultation. 


5. The recommended solution for large organisations is to build teams completely outside their existing business
- which have NO people from existing businesses
- They are given he mandate to build a business model which completely disrupts our own existing business, leveraging these key trends
- to set up a multi-skilled team of 6-7 people which is under 35 years of age, NOT from the existing business or people who are the most willing to challenge status-quo
  - Housed independently with no corporate processes at all
- Working on lean startup principles (Design thinking/MVP/Agile)

If such a business turns out to be successful, do NOT bring it back into the Mother organisation.  Always keep it independent. In fact, make that the centre of gravity for building new businesses. (Unilever has implemented this globally and 5 of such initiatives/products have become the most profitable of all)

Framework for building Exponential Business Models

Each business needs to drop the vision, mission statement and have a simple Massive Transformational Purpose (MTP) that everyone in the team can understand and aspire to. For example Google has "To organise the world's information"

Businesses need at lease 4-5 of the following 10 things to create exponential growth.

*S-C-A-L-E  &  I-D-E-A-S*

S - Staff on Demand (Uber)(How many full-time employees vs Contractors) C - Community & Crowd involvement (Google Maps, Facebook, Quora etc) A - Algorithms (Uber - Matching drivers and passengers, Amazon - recommendations) L - Leverage existing Assets (AirBnB, Uber)(You must never own assets) E - Engagement (Contests, Gamification to driver user engagement)

I - Interfaces (Tech that allows external world to connect seamlessly and easily, example App Store) D - Dashboards (Real-time MIS on key metrics, knowing every key metric in real time) E - Experimentation - (Ability to constantly experiment, iterate and learn) A - Autonomy (How much autonomy to the lowest levels to decide) S - Social (How do you leverage social networks to listen, learn and engage).

 

Write down how many drinks you drink keep record of how much you drink, and Note where are you were drinking, and with whom. Write down any adverse experiences did you have as well.

If you can, switch to less concentrated beverages, and drink nonalcoholic beverages in between the alcoholic ones.

Make a schedule for what do you want to drink the next day. Also think about how fast you want to drink your drinks as well.
 

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https://www.ballardpsych.com/sinclair-method/

The Sinclair Method (TSM) is a treatment protocol for alcoholism developed by Dr. John David Sinclair.  He was inspired by the Russian physiologist Ivan Pavlov, who received a Nobel Prize for his research for Classical Conditioning in animal learning.

Dogs in Pavlov’s studies would receive a food treat shortly after the ringing of a bell.  Pavlov observed that eventually the dogs would associate the bell with food and begin salivating at the sound of the bell.  However, the degree of salivation would become less and less has he gave them smaller and smaller treats.  Pavlov referred to this process as “extinction,” which later laid the groundwork for Sinclair’s scientific approach to treating alcoholism.

Sinclair concluded that alcoholism is a learned behavior, after conducting laboratory experiments on the factors driving alcohol addiction and the effects of alcohol deprivation. A key discovery Sinclair made was that detoxification and deprivation do not stop the craving for alcohol, but actually increase subsequent alcohol consumption.

The Sinclair Method sought to challenge the idea that physiological dependence on alcohol led to alcoholism, and propounded the concepts of ‘learned behavior’ and ‘pharmacological extinction’. TSM involves the use of the prescription drug Naltrexone to reduce cravings for alcohol. It is somewhat controversial in that it calls for the use of naltrexone in combination with your normal drinking habits. You do not need to go through detox first or stop drinking.

Unlike other treatments that require you to abstain from alcohol, naltrexone must be used in combination with drinking to be effective. For this reason, if you are actively drinking, you are a better candidate for naltrexone treatment than someone who has been abstinent for over a week. It does not matter if you sometimes take naltrexone without drinking, but you cannot drink without taking naltrexone. Some individuals get a lot of reinforcement every time they drink, and over the course of their lives they have many opportunities to drink and get additional reinforcement. This manifests into a behavior that becomes too strong to resist, and they have a very difficult time controlling their drinking. The reinforcement occurs a neurological level.

There are two primary mechanisms the brain uses for changing its own wiring on the basis of experience. One is the learning for reinforcement-providing and strengthening behaviors. There is also extinction for removing behaviors that no longer cause reinforcement. Sinclair was inspired by the Pavlov classic conditioning experiment where the Russian physiologist’s dogs learned to salivate at the sound of a bell when it was followed by food, and then had the behavior made ‘extinct’ when food reinforcement was stopped after the bell was rung.

The process by which naltrexone works with TSM is called pharmacological extinction. Naltrexone must be taken every single time you consume alcohol, approximately one hour before the alcohol is to be consumed. By having naltrexone active in your body at the time alcohol is consumed, endorphins normally released by drinking are blocked. Over time, drinking loses its appeal. Because the use of naltrexone blocks the enjoyment one feels from drinking alcohol, drinking is gradually reduced over a period of a few months. Some people who have used the Sinclair Method are able to enjoy a drink or two socially without drinking to excess. Others choose to abstain altogether, but arrive at abstinence without acute cravings.

Sinclair’s laboratory studies showed that the reinforcement from alcohol, in most cases, involved the opioid system. The system, which controls pain, reward and addictive behaviors, is also where morphine, heroin, and endorphin produce their effects. Medications such as naloxone, naltrexone and nalmefene block the effects of endorphin and other opiates. The Sinclair Method reasons that, if an individual drinks alcohol when one of these opioid antagonists is blocking endorphin reinforcement in the brain, the extinction mechanism would be activated, and produce a small but permanent reduction in alcohol drinking and craving. Over time, the desire to consume alcohol decreases and people either abstain most of the time or drink occasionally.

Naltrexone is not addictive, and it does not directly reduce craving for alcohol. The Sinclair Method has been confirmed in more than 90 clinical trials around the world, and observed to be successful in approximately 80 percent of alcoholics.
Principles
Naltrexone blocks the release of endorphins whenever alcohol is ingested.
The blocked reinforcement caused by naltrexone whenever alcohol is consumed gradually weakens and ultimately extinguishes the behavior of drinking.
The reduction in craving and drinking is progressive. Benefits can be seen as soon as 10 days after starting, but the effects are more than three times stronger after three to four months.
The benefits continue increasing indefinitely as long as you take naltrexone every single time you drink alcohol.
Naltrexone has no potential for addiction, does not make you feel high or low, and seldom produces side effects.
The Sinclair Method is often effective without any intensive counseling, although education and medical monitoring are required.
Naltrexone is a lifetime commitment.
People with a positive family history respond particularly well to naltrexone treatment.
Peer-Reviewed Articles
Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. (link)

The use of naltrexone in the treatment of alcohol dependence: pharmacological aspects. (link)
Popular Press
Psychology Today:  Drink Your Way Sober with Naltrexone
Sinclair Method Books

Sinclair Method Online Services

 

 

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 Why Isn’t the Sinclair Method Used More Often?
I am often asked why Naltrexone is not prescribed more often for Alcohol Use Disorders, given that it is:

FDA-Approved for Alcohol Dependence (since 1994)
Generally well-tolerated (upset stomach is the most common side effect)
Inexpensive (about $1.25/pill out of pocket).
 

One possibility is that Naltrexone is at odds with the clinical philosophy of many providers. This 2015 article published in Substance Abuse Treatment, Prevention, and Policy examines the use of naltexone in the context of a counselor’s views of a patient’s responsibility for his or her addiction. “Responsibility” was divided into two categories:

Responsibility for the onset of the addiction (i.e. the patient could have avoided the dependence).
Responsibility for the treatment of the addiction (i.e the patient is personally responsible for the recovery and creating solutions).
 

The researchers provided counselors a vignette describing a patient seeking treatment for Alcoholism. The authors were careful to exclude any information from the vignette that might bias the counselors views on the patient’s responsibility for the onset of the addiction, the patient’s responsibility for the subsequent treatment of the addiction, and the advantages/disadvantages of using naltrexone. Here is a sample of the vignette:

Paul enters addiction treatment due to inability to stop drinking. He is having troubles at work and home. He has to drink twice as much as he used to just to feel “normal.” After a thorough evaluation, he is diagnosed with Alcohol Use Disorder, Moderate. Paul’s clinician decides to treat him with Naltrexone, a drug that claims to reduce or eliminate the rewarding effects of alcohol. He also suggests a 12-step program. Another clinician at the clinic raises objections to the use of Naltrexone for Paul’s treatment.
 

The authors complied a list of common objections to using Naltrexone, based on published literature. The counselors were provided six options and asked to rate their degree of agreement on a Likert scale. My objections to the these objections are in italics.

Compliance. Counselors are often worried that patients will simply not take the Naltrexone as prescribed.There is some validity to this concern, as the rates of compliance for naltrexone range from 40% to 90%, depending on the study. While the worst-case-scenario of 40% compliance with Naltrexone may seem low, it is in line with a compliance rate in general medicine of around 50%. Given this data, if one objects to the use of Naltrexone on the basis of compliance, one must object the use of medications in general. There is nothing usual or specific about the rates of compliance with Naltrexone.
Side Effects. Counselors are often worried that Naltrexone will cause unpleasant or unsafe side effects.Again, this is true for all medications. The most common side effects of Naltrexone are gastrointestinal (nausea, diarrhea, and vomiting). This occurs in about 10% of users. Of course, some users may be allergic to Naltrexone or develop other side effects, including liver damage. However, this is why the use of prescription medications are monitored by a provider. If one objects to the use of Naltrexone on the basis of potential side effects, one must object to the use of medications in general.
Risk of Combining Opioids. Naltrexone blocks opioid receptors, which means that prescription opiates (morphine, oxycodone, vicodin, percocet, etc.) and heroin will not have an effect on the user.The concern here is that a patient using Naltrexone cannot take opiate pain medications. This is true. They will have to stop taking Naltrexone prior to dental surgery, for example.
Symptoms vs. Cause. Counselors are sometimes concerned that although Naltrexone is effective, it does not treat the “underlying” or “root” cause of the drinking.The was the strongest concern of the counselors, with 58% agreeing or strongly agreeing that the medication would not improve the “underlying” causes of the drinking. What we know about alcoholism is that there is unquestionably a strong genetic component, with a 50% risk of alcoholism based on your biological family. Even if you believe that the issue is psychological or psychodynamic, can we make a prediction that patients will benefit from therapy more if their brains are not being saturated with alcohol on a daily basis? The desire to create a Narrative is not often observed when discussing other ailments. For example: What’s the “root cause” of lactose intolerance?
Willpower. Counselors are sometimes worried that using Naltrexone will undermine a patient’s resolve, impulse control, and willpower to stop drinking.This is the opposite of what usually happens. Naltrexone improves control over alcohol and instills hope in the alcoholic that they will be able to successfully manage the addiction.
Motivation. Counselors are concerned that Naltrexone will decrease a patient’s motivation to participate in 12-step groups or other interventions to help him or herself.In my experience, patients are highly motivated to engage in treatments that work. When they observe the benefits of taking naltrexone, they are motivated to continue taking it. Typically, the reduction in alcohol use results in improved sleep, increased energy, increased engagement in hobbies, improved relationships, and better overall health. These positive changes are highly motivating, and increase the likelihood of a patient participating in additional self-care. Consider the withholding a blood pressure medication because the provider was concerned that the patient’s motivation for regular exercise and eating a low-sodium diet could be reduced. A provider might reasonably do this, depending on the severity of the hypertension, but the rationale for withholding should be explained to the patient.
The authors collected data regarding characteristics of the 117 counselors in the study, including their gender, age, level of education, whether they accepted insurance as payment, and if the counselors were in recovery from addiction themselves.

Results indicated that

Counselors who assigned greater personal responsibility for the onset of addiction were less likely to support the use of medications for four of the six reasons above.
Assignment of personal responsibility for the recovery from addiction was less predictive of views of using naltrexone.
Counselors who saw a higher percentage of patient’s paying out of pocket were less likely to support the use of medications.
The researchers do not speculate on the origins of these views. However, they do conclude with a question appealing to cynics, wondering if it is “possible that these organizations that deliberately do not accept insurance have chosen to adopt a highly responsibility-focused view of addiction that rejects both medical insurance and medication.”

The clinical orientation of your provider is critical. As this study demonstrates, you may not be offered a particular evidenced-based treatment if your provider has a philosophical objection to it. Your provider may not reveal this aversion voluntarily, so be sure to investigate. Good questions include:

What is your explaination for my drinking problem?
What causes my loss of control?
Are there treatment options other than AA?
Will medications help me? Why or why not?

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Confusion over how to describe the action of alcohol on the human system has evolved in parallel with the evolving understanding of neuroscience and medicine.  The term alcoholism first appeared in the mid 1800’s, and replaced less scientific terms such as “sot” and “drunkard”. As various disciplines considered the condition, there were various opinions about how “alcoholism” should be defined.  In 1992 a joint committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine was charged to provide a medical definition, an effort which culminated with a JAMA Special Communication defining alcoholism.

 

The American Psychiatric Association developed the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was first published in 1952.  Instead of using the word “alcoholism”, the DSM defined the term “alcohol dependence”.  In the initial and subsequent versions of the DSM, the term alcohol dependence was not directly compared or contrasted with the term alcoholism and therefore it remains unclear whether these concepts are interchangeable or inconsistent with each other.  

In recognition that alcohol related problems exist in less severe forms, the term “alcohol abuse” was codified in the DSM-III as a category for diagnosing those who did not met the criteria for alcohol dependence, but who continue to drink despite alcohol-related problems, or who drink in dangerous situations.  The term “alcohol abuse” remains in popular use, typically as a description of a binge drinking pattern, but it is no longer used as a formal diagnostic category following the 2013 release of DSM-V.  Both terms, “alcohol abuse” and “alcoholism” continue to be used by physicians and the medical literature, but with the publication of the most recent DSM version, DSM-V, they have no specific diagnostic meaning

 

What your writers note here (https://www.verywellmind.com/diagnosis-alcohol-use-disorder-67880) is accurate: 

 

“There really is no official diagnosis of alcoholism. The condition that has long been termed alcoholism is technically called "severe alcohol use disorder," according to the May 2013 publication of the 5th edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM–5) by the American Psychiatric Association. With the DSM-5, if a person exhibits two or more symptoms from a list of 11 criteria, they are diagnosed as having an alcohol use disorder, with classifications of mild, moderate, and severe.”

 

DEFINITIONS

 

The DSM-V originated the term "alcohol use disorder, (AUD)", which it defined as:

 

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or more of 11 listed symptoms occurring at any time in the same 12-month period. AUD is further defined as mild, moderate, or severe based on the presence, respectively, of 2-3, 4-5, or 6+ of these symptoms.

 

The term “alcoholism” has both medical and popular usage and has been defined in various ways.  

 

 

Webster’s dictionary provides this definition of alcoholism:

 

“1: continued excessive or compulsive use of alcoholic drinks.

 

2a: a chronic, a progressive, potentially fatal disorder marked by excessive and usually compulsive drinking of alcohol leading to psychological and physical dependence or addiction.

 

Webster’s dictionary goes on to clarify that alcoholism is generally thought of as a serious disorder:

 

Alcoholism is typically characterized by the inability to control alcoholic drinking, impairment of the ability to work and socialize, tendency to drink alone and engage in violent behavior, neglect of physical appearance and proper nutrition, alcohol-related illness (such as hepatitis or cirrhosis of the liver), and moderate to severe withdrawal symptoms (such as irritability, anxiety, tremors, insomnia, and confusion) upon detoxification.

 

The definition of alcoholism noted above as a JAMA Special Communication was published in 1992 as follows:

 

“Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.”*

 

The DSM has no definition or diagnostic criteria for alcoholism; the term is outside of any formal medical diagnostic scheme.

 

DISCUSSION

 

The term “alcoholism” is a narrow yet imprecise term and does not fit the condition of those with early symptoms; it does not generally include people who occasionally abuse alcohol or binge drink or those who exhibit minimal alcohol problems. AUD encompasses a broader spectrum of behaviors and conditions than does alcoholism and can be applied to all these situations.  Generally speaking, when someone has alcoholism, they will meet diagnostic criteria for an alcohol use disorder; however, if someone has alcohol use disorder, they may or may not have alcoholism.

 

Today when a physician employs a diagnosis of alcoholism, this diagnosis may be considered vague and lacking precision when compared to the term AUD. The term “alcoholism” is an older and somewhat nebulous description of someone who typically suffers from what might be severe or moderate alcohol abuse disorder. Compared to the term “alcoholism”, AUD is a more clinical, dispassionate, and specific scientific term.  The use of the three AUD categories, (i.e., mild, moderate, and severe), make for a more precise diagnosis. Also, the category of mild AUD incorporates those with early disease, and therefore has the potential to encourage early identification and treatment of what can be a progressive condition.

 

The term “alcoholism” is commonly understood to mean someone with a severe problem with alcohol and often has negative connotations; someone with mild AUD may object to receiving this diagnosis. AUD is a “politically correct” term which removes the sense of moral judgment that can accompany the older terms, “alcoholism” and “alcohol abuse”.  People labeled with these older, more pejorative terms may avoid seeking help because of the guilt and shame associated with a diagnosis of “alcoholism”.  In contrast, people given a diagnosis of AUD may be relieved that they have a “disorder” which can be treated.

 

An example from my private practice: Not all my patients consider themselves to have alcoholism, but all accept that they have AUD. All my patients understand that they have a disorder that can be treated with medications, but some might be reluctant to get treatment reserved for people with “alcoholism”.

 

Today, for all the above reasons, physicians are increasingly encouraged to use the term AUD instead of “Alcoholism”.

 

Alcohol and addiction drug recovery, rehab information, and helplines:

http://www.recovery.org/  

Ten Rules for Recovery

 

  1. Surround yourself with positive people for good advice, encouragement, counseling, and support

  2. If you are currently drinking alcohol, drink only with meals - never drink on an empty stomach; Enjoy your meals with others and don’t eat on the run

  3. Eat high omega-3 foods like seafood at least once a day; (fish raised in tanks like tilapia and cat fish don’t count).  Fish oil can help too.

  4. Enjoy food with oil from olive, coconut, and canola but avoid oil from soy, peanut, safflower, and corn; Avoid products from animals fed these commodities - they are high in omega-6 fat 

  5. Enjoy high fiber foods like vegetables, fruits, whole grains, and oats.  These and other pre-biotic foods like milk should completely replace processed foods.  Organic foods and vitamin supplements, although expensive, may be beneficial.  Avoiding food additives and gluten may also help.

  6. Drink coffee but avoid beverages which contain corn sweetener; Some scientists believe that classic soft drinks sweetened with sugar are safer than those with high fructose corn syrup

  7. Eat pro-biotic foods like yogurt, kefir, sauerkraut, brine cured olives, soft aged cheese and sour cream.

  8. Exercise outdoors to get plenty of sunlight exposure and vitamin D.

  9. Work with your physician to see if medication could help you reduce excessive alcohol drinking.

  10. Find your purpose: “An unexamined life is not worth living” – Socrates

Caution:

Heavy drinkers who reduce their alcohol use too quickly may experience seizures and delirium tremens, a medical emergency requiring hospitalization - call 911

My Perspective on Alcohol Recovery

 

Alcohol use disorder, (AUD), known as alcoholism when its effect is obvious, is a complicated problem, without a universally effective solution.  However, there are some principles which apply to everyone, as I learned through 20 years of research at the National Institutes on Alcohol and Alcohol Abuse at the National Institutes of Health (NIH).  Humans are designed a certain way and the closer we follow that pattern, the better we can overcome the power of addiction. That’s why I’m convinced that the most effective treatment will recognize the importance of psychological, social, dietary, spiritual, medical, and lifestyle aspects of recovery.

 

As a physician, I look for the latest scientific knowledge about how to treat alcohol use disorder and will adapt this knowledge to each individual’s situation.  My approach will often include non-addictive medications, counseling, social support, as well as the proper diet to help your body recover from the damaging effects of excessive alcohol consumption.

My research and that of others shows that alcoholism may be driven by an inflammatory process in the brain, a neuroinflammatory state which is made worse by lifestyle choices. Drinking too much alcohol promotes

neuroinflammation, and eating the wrong foods will make this process worse.  I’m passionate about the particular kind of fats and sweets that we eat, and the importance of outdoor exercise for our health.  And of course, we can’t be healthy unless our heart and mind is at peace; the latest neuroscience explains why this is so. Surrounding ourselves with good people is critical; Many people find that knowing someone cares about their well-being will help them recover for the long run.  Skilled counselors can help reduce the subconscious stress which promotes drinking, and peer groups can give you the support and encouragement needed to stay sober. We can help you find the connections  you need and suggest help for your family and loved ones.

You may have found my website because you have heard of the Sinclair method. This method is a way to help actively drinking people through the use of naltrexone.  Naltrexone, an FDA approved prescription medication, is taken an hour before drinking alcohol.  Naltrexone can also be taken every day in other situations.

 

The two other FDA approved medications for alcohol abuse include acamprosate, which can reduce craving, or disulfiram which can give an extra incentive to avoid alcohol by making someone very sick if they do drink. Other medications have been proven in clinical trials to help people with Alcohol Use Disorder, but are not recognized by the FDA for that purpose. Such medicines include topiramate, ondansetron, prazosin and omega-3 fatty acids. Some medications will require blood tests to make sure that the medicine is safe for you.

Alcohol Use Disorder is a chronic, relapsing disease, meaning it doesn’t ever completely go away.  People try to drink normally when their problems fade into the past all too often they find themselves in trouble again.  Therefore, if a medication is found which does work in your case, many people take it indefinitely, and stay involved with others who will encourage their recovery.

Alcohol is one of the most dangerous drugs from which to withdraw. In some cases, a heavy drinker who stops drinking suddenly will experience confusion and other withdrawal symptoms including shaking, shivering, seating, seizures, and hallucinations, a potentially fatal condition known as delirium tremens.  This is a true medical emergency; Therefore heavy drinkers, particularly those at risk for  a seizure, are typically advised to detox from alcohol in a hospital setting.  The telemedicine service we offer through addictionrecoverymedicine.org is not designed to help alcoholics in withdrawal, but can help after withdrawal is over.

If you are in Maryland or Virginia, and would like more information about how Addiction Recovery Medicine, please fill out the form below for a free 5-minute phone consultation. 

Keeping a record of drinking is extremely important for the medical treatment of alcohol use disorder.  To make this easier, the C Three Foundation has a free drinking log excel spreadsheet that you can download here: http://www.cthreefoundation.org/tsm-drink-log.html

 

Also, there are a number of smartphone apps that you can use to keep track of how much you drink.  You may be able to use  one of the smartphone apps noted below.  (Note: Using web resources such as this apps may create a risk to your privacy; they are provided by private vendors.  

I'm a paragraph. Click here to add your own text and edit me. It's easy.

Handling urges to drink

Plan ahead to stay in control

As you change your drinking, it's normal and common to have urges or a craving for alcohol. The words "urge" and "craving" refer to a broad range of thoughts, physical sensations, or emotions that tempt you to drink, even though you have at least some desire not to. You may feel an uncomfortable pull in two directions or sense a loss of control.

Fortunately, urges to drink are short-lived, predictable, and controllable. This short module offers a recognize-avoid-cope approach commonly used in cognitive behavioral therapy, which helps people to change unhelpful thinking patterns and reactions. It also provides worksheets to help you uncover the nature of your urges to drink and to make a plan for handling them.

With time, and by practicing new responses, you'll find that your urges to drink will lose strength, and you'll gain confidence in your ability to deal with urges that may still arise at times. If you are having a very difficult time with urges, or do not make progress with the strategies in this module after a few weeks, then consult a doctor or therapist for support. In addition, some new, non-habit forming medications can reduce the desire to drink or lessen the rewarding effect of drinking so it is easier to stop.

Recognize two types of "triggers"

An urge to drink can be set off by external triggers in the environment and internal ones within yourself.

  • External triggers are people, places, things, or times of day that offer drinking opportunities or remind you of drinking. These "high-risk situations" are more obvious, predictable, and avoidable than internal triggers.

  • Internal triggers can be puzzling because the urge to drink just seems to "pop up." But if you pause to think about it when it happens, you'll find that the urge may have been set off by a fleeting thought, a positive emotion such as excitement, a negative emotion such as frustration, or a physical sensation such as a headache, tension, or nervousness.

Consider tracking and analyzing your urges to drink for a couple of weeks. This will help you become more aware of when and how you experience urges, what triggers them, and ways to avoid or control them. A sample tracking form is provided below.

Avoid high-risk situations

In many cases, your best strategy will be to avoid taking the chance that you'll have an urge, then slip and drink. At home, keep little or no alcohol. Socially, avoid activities involving drinking. If you feel guilty about turning down an invitation, remind yourself that you are not necessarily talking about "forever." When the urges subside or become more manageable, you may decide to ease gradually into some situations you now choose to avoid. In the meantime, you can stay connected with friends by suggesting alternate activities that don't involve drinking. (Also, see the module on building drink refusal skills.)

Cope with triggers you can't avoid

It's not possible to avoid all high-risk situations or to block internal triggers, so you'll need a range of strategies to handle urges to drink. Here are some options:

  • Remind yourself of your reasons for making a change. Carry your top reasons on a wallet card or in an electronic message that you can access easily, such as a mobile phone notepad entry or a saved email. (Visit the pros and cons page to list and sort your reasons.)

  • Talk it through with someone you trust. Have a trusted friend on standby for a phone call, or bring one along to high-risk situations.

  • Distract yourself with a healthy, alternative activity. For different situations, come up with engaging short, mid-range, and longer options, like texting or calling someone, watching short online videos, lifting weights to music, showering, meditating, taking a walk, or doing a hobby.

  • Challenge the thought that drives the urge. Stop it, analyze the error in it, and replace it. Example: "It couldn't hurt to have one little drink. WAIT a minute—what am I thinking? One could hurt, as I've seen 'just one' lead to lots more. I am sticking with my choice not to drink."

  • Ride it out without giving in. Instead of fighting an urge, accept it as normal and temporary. As you ride it out, keep in mind that it will soon crest like an ocean wave and pass.

  • Leave high-risk situations quickly and gracefully. It helps to plan your escape in advance.

Building your drink refusal skills

Plan ahead to stay in control

Even if you are committed to changing your drinking, "social pressure" to drink from friends or others can make it hard to cut back or quit. This short module offers a recognize-avoid-cope approach commonly used in cognitive-behavioral therapy, which helps people to change unhelpful thinking patterns and reactions. It also provides links to worksheets to help you get started with your own plan to resist pressure to drink.

Recognize two types of pressure

The first step is to become aware of the two different types of social pressure to drink alcohol—direct and indirect.

  • Direct social pressure is when someone offers you a drink or an opportunity to drink.

  • Indirect social pressure is when you feel tempted to drink just by being around others who are drinking—even if no one offers you a drink.

Take a moment to think about situations where you feel direct or indirect pressure to drink or to drink too much. You can use the formbelow to write them down. Then, for each situation, choose some resistance strategies from below,or come up with your own. When you're done, you can print the form or email it to yourself.

Avoid pressure when possible

For some situations, your best strategy may be avoiding them altogether. If you feel guilty about avoiding an event or turning down an invitation, remind yourself that you are not necessarily talking about "forever." When you have confidence in your resistance skills, you may decide to ease gradually into situations you now choose to avoid. In the meantime, you can stay connected with friends by suggesting alternate activities that don't involve drinking.

Cope with situations you can't avoid

Know your "no"

When you know alcohol will be served, it's important to have some resistance strategies lined up in advance. If you expect to be offered a drink, you'll need to be ready to deliver a convincing "no thanks." Your goal is to be clear and firm, yet friendly and respectful. Avoid long explanations and vague excuses, as they tend to prolong the discussion and provide more of an opportunity to give in. Here are some other points to keep in mind:

  • Don't hesitate, as that will give you the chance to think of reasons to go along

  • Look directly at the person and make eye contact

  • Keep your response short, clear, and simple

The person offering you a drink may not know you are trying to cut down or stop, and his or her level of insistence may vary. It's a good idea to plan a series of responses in case the person persists, from a simple refusal to a more assertive reply. Consider a sequence like this:

  • No, thank you.

  • No, thanks, I don't want to.

  • You know, I'm (cutting back/not drinking) now (to get healthier/to take care of myself/because my doctor said to). I'd really appreciate it if you'd help me out.

You can also try the "broken record" strategy. Each time the person makes a statement, you can simply repeat the same short, clear response. You might want to acknowledge some part of the person's points ("I hear you...") and then go back to your broken-record reply ("...but no thanks"). And if words fail, you can walk away.

Script and practice your "no"

Many people are surprised at how hard it can be to say no the first few times. You can build confidence by scripting and practicing your lines. First imagine the situation and the person who's offering the drink. Then write both what the person will say and how you'll respond, whether it's a broken record strategy (mentioned above) or your own unique approach. Rehearse it aloud to get comfortable with your phrasing and delivery. Also, consider asking a supportive person to role-play with you, someone who would offer realistic pressure to drink and honest feedback about your responses. Whether you practice through made-up or real-world experiences, you'll learn as you go. Keep at it, and your skills will grow over time.

Try other strategies

In addition to being prepared with your "no thanks," consider these strategies:

  • Have non-alcoholic drinks always in hand if you're quitting, or as "drink spacers" between drinks if you're cutting back

  • Keep track of every drink if you're cutting back so you stay within your limits

  • Ask for support from others to cope with temptation

  • Plan an escape if the temptation gets too great

  • Ask others to refrain from pressuring you or drinking in your presence (this can be hard)

If you have successfully refused drink offers before, then recall what worked and build on it.

Remember, it's your choice

How you think about any decision to change can affect your success. Many people who decide to cut back or quit drinking think, "I am not allowed to drink," as if an external authority were imposing rules on them. Thoughts like this can breed resentment and make it easier to give in. It's important to challenge this kind of thinking by telling yourself that you are in charge, that you know how you want your life to be, and that you have decided to make a change.

Similarly, you may worry about how others will react or view you if you make a change. Again, challenge these thoughts by remembering that it's your life and your choice, and that your decision should be respected

Recovering from a drinking episode when your goal is to quit

Nine practical tips

  1. Get right back on track. Stop drinking—the sooner the better.

  2. Remember, each day is a new day to start over. Although it can be unsettling to slip, you don't have to continue drinking. You are responsible for your choices.

  3. Understand that setbacks are common when people undertake a major change. It's your progress in the long run that counts.

  4. Don't run yourself down. It doesn't help. Don't let feelings of discouragement, anger, or guilt stop you from asking for help and getting back on track.

  5. Get some help. Contact your counselor or a sober and supportive friend right away to talk about what happened, or go to an AA or other mutual-help meeting.

  6. Think it through. With a little distance, work on your own or with support to better understand why the episode happened at that particular time and place.

  7. Learn from what happened. Decide what you need to do so that it won't happen again, and write it down. Use the experience to strengthen your commitment.

  8. Avoid triggers to drink. Get rid of any alcohol at home. If possible, avoid revisiting the situation in which you drank.

  9. Find alternatives. Keep busy with things that are not associated with drinking.

For additional support, see the modules on drink refusal skills and handling urges to drink.

iet wisdom from science and tradition
Since diet remains the chief weight-loss factor, the obvious question arises.

How should we eat to shed pounds, and/or keep them off?

The evidence supports these "food rules" from author/journalist Michael Pollan:

  • Eat food. Not too much. Mostly plants.

  • Don't eat anything that won't eventually rot.

  • Don't buy food where you buy your gasoline.

  • Don't eat anything your great grandmother wouldn't recognize as food.

  • Don’t eat anything with more than five ingredients, or ingredients you can't pronounce.

  • Stay out of the middle of the supermarket (packaged products); shop on the perimeter (fresh produce, seafood, meats, etc.).

  • It's not just what you eat but how — do it slowly, and stop when you’re just starting to feel full.

We’d like to add some more evidence-based recommendations:

And, yes, get moving, whether it’s gardening, dancing, swimming or cycling.

On top of its overall health benefits, excercise provides strong support for your weight loss efforts.

CONTENT IS INFORMATION ONLY AND NOT ADVICE -- In offering information on this site, ALcohol Recovery Medicine is not forming or attempting to form a doctor-patient relationship with anyone, or to diagnose or treat anyone. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or for any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for seeking any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication or changing its dose, or if you have or suspect you might have a health problem. You should not stop taking any medication without first consulting your physician.  If you are in crisis, the National Suicide Prevention Lifeline offers a free, 24-hour hotline at 1 (800) 273-8255. If your issue is an emergency, call 911 or go to your nearest emergency room.  We do not offer nor do we attempt to offer nor are we equipped to offer crisis counseling or emergency services. Please see Terms & Conditions. and our Privacy Policy.                                           

             

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