How to find greater moderation?

May 7, 2007 1:13 PM

AlcoholFilter: Harm reduction advice?

I have what I consider a mild dependence on alcohol. Sometimes I drink because I enjoy it, other times I drink to reduce anxiety and ward off panic attacks. I'm fine with the former reason for drinking, but it's the latter that concerns me, given that when I drink to reduce anxiety I'm more likely to over do it which, of course, leads to increased anxiety the next day. While my drinking isn't getting in the way of any aspect of my life, I don't get into bar fights, and I don't drive when I'm drinking, etc., I really hate that feeling of dependence (not to mention Sunday morning hangovers).

FWIW, what I find especially difficult to deal with when I resist the urge to drink is that I don't know what to do with myself -- I want to veg-out and relax and unwind, but I can't, so I end up doing something like compulsively working on a programming project until I completely exhaust myself. Which is good for my programming projects, but doesn't exactly make for a pleasant evening.

So I'm looking for advice or recommendations on walking a path of greater moderation. Also, I know the whole harm reduction philosophy is pretty controversial, but I've had plenty of in-depth conversations with abstinence-only advocates (including a former significant other) and I don't feel more input, however well-meaning, from that side of the fence would be helpful.

Thanks!

posted by treepour to health (26 comments total)

Um, I don't know if this counts as "harm reduction" or not, but as it sounds like you have an issue with anxiety and panic attacks, have you considered speaking to someone about this, professionally? Seems like you would be a good candidate for anti-anxiety medication.

And before you or anyone else goes all anti-medication, realize that right now you're just self-medicating with ethanol, so it's not like you'd be getting any more chemically dependent. You'd just be using something more modern, hopefully more effective, and definitely less toxic.

Just be aware that it can take a few tries to find a med that works well for you, and don't get discouraged if the first couple tries don't work out well.
posted by Kadin2048 at 1:19 PM on May 7, 2007

I have the same exact issues. Not an alcoholic, but know what to do when I want to be drinking but shouldn't. Usually I end up reading or watching a movie and then taking a long shower and going to bed early. I try to return phone calls to family or friends that are overdue or work on projects around the house (cleaning out my closet, etc) that are also long over due. I find all these things to be pretty relaxing. Just find things that need to be done but are not stress-inducing.
Personally I suck at cooking, but it is time consuming, sometimes relaxing, productive, and you can have your friends over so as to not miss out on the social aspect of things.
posted by greta simone at 1:23 PM on May 7, 2007

Thanks, Kadin2048 -- good advice. I should have mentioned that I've recently gone on a very low dose of an SSRI (prozac) -- I'm planning to talk to my doc about increasing the dose, as it doesn't seem to be working. SSRI's have helped in the past; I just don't like being on them because of the side effects, so I was hoping I could manage with a very low dose.
posted by treepour at 1:23 PM on May 7, 2007

well I still think medication as a first line of action is pretty stupid. changes - as well as discipline - in your diet and lifestyle can have a tremendous effect on your behavior, especially your ability to deal with problematic patterns. if you smoke, eat fat food, or avoid fruits and vegetables, you should try to change that.

I sort of had a similar problem with fun time turning into work time. you'll eventually bottom out, i believe, but in the mean time i think it's time to teach your mind and body to separate fun and work. no more drinking and getting on the computer. learn to get on the computer sober, and aim to drink only in public situations. you may have a living situation where it's easy to get into the pattern you described - but i'm sure with a little sacrifice you'll get past the addiction.
posted by phaedon at 1:28 PM on May 7, 2007

Wow, 2 of the other three posts seem to want to treat a drug dependence with... a drug dependence. So you drink a bit.. so what? If you're only concerned about your (possible) addition to alcohol, go without for a few weeks to show you don't have a problem.

Alcohol is an age-old cure for what ails ya. I personally would never trade in my beer for prozac. Get a hobby; do something you find fun. Hell, maybe you could try brewing your own beer?
posted by triolus at 1:35 PM on May 7, 2007

pardon- but *don't* know what to do when I want to be drinking and shouldn't.
posted by greta simone at 1:35 PM on May 7, 2007

Wow, 2 of the other three posts seem to want to treat a drug dependence with... a drug dependence.

Only if you go out of your way to write it that way. They want to replace self-medication with prescribed medication. Given the poster's concerns, that's not a bad idea.
posted by mendel at 1:38 PM on May 7, 2007

Wow, 2 of the other three posts seem to want to treat a drug dependence with... a drug dependence.

By 2 out of three, I assume you mean one out of three.
posted by phaedon at 1:39 PM on May 7, 2007

Make Sunday morning plans. Automatic nagging obligation not to get wasted the night before.
posted by hermitosis at 1:55 PM on May 7, 2007

By 2 out of three, I assume you mean one out of three.

Er, yes. Sorry. Didn't see that one of them was the OP.

Only if you go out of your way to write it that way.

I didn't go out of my way. Not one bit. I am terribly concerned that we're all facing a 'wonder cure of the future' in pill form, with all other things that once made people happy ruled out for 'health'.

Do what you want, OP. If you'd rather have your drugs in the form of a pill rather than a liquid, go for it. I just have one question for you: What will you do when you feel the same way about the pills as you do about the alcohol?
posted by triolus at 1:57 PM on May 7, 2007

Talk therapy or cognitive behavioral therapy are both very helpful (speaking from personal experience) with anxiety and panic. What that therapist would tell you would sound like this:

A very low does of xanax or similar will do the job of turning the worry down without impairing you otherwise. I take .25 mil, which is half the smallest pill, and in 10 minutes I'm sane and chilled out again. Sometimes it makes me sleepy, but not usually. When I don't have any Vitamin X, and all the exercises and breathing routines have failed, a shot of liquor does approximate that xanax effect pretty well, just to make that sensory correlation clear to you.

You should absolutely be taking a multivitamin and a B vitamin supplement, which aids your body in stress management. I have always had more anxiety with hangover, and the B pill I take (several hundred percent of each B variety's RDA, but they're water soluble minerals so you don't OD in any way, your pee goes green instead) made all the difference. My xanax intake has dropped by half or better.

If you treat yourself very well, getting plenty of sleep, exercise and sunshine and not too much sugar, you can wrangle the anxiety into shape without fearing alcohol. You many not even need the SSRIs. I discovered I didn't. The side effects can be insidious.

This book is a DIY approach, if you're diligent.
posted by Ambrosia Voyeur at 2:15 PM on May 7, 2007

Alcohol is a habit forming drug. Most prescribed anxiolytics are not.
posted by dendrite at 2:22 PM on May 7, 2007

er...change "most" to "many"
posted by dendrite at 2:23 PM on May 7, 2007

Harm reduction isn't about trying to control the amount of substance an addict takes in, it's about giving the addict the knowledge necessary to make healthier decisions regarding behaviors associated with their addiction. I.e., vein site rotations, how to legally procure clean needles without a prescription, how to perform sex work in a way that reduces potential HIV transmission. Your desire to moderate your drinking is just that: a desire to moderate. It doesn't necessarily have anything to do with mitigating adverse health factors co-existing with and causally related to it.

I'm not trying to be a jerk by pointing out that your usage of the term harm reduction isn't consistent with its use in the public health realm. I think it's important to clarify; there's a big difference between a discussion about moderating usage and harm reduction strategies regarding addiction to a particular substance.
posted by The Straightener at 2:25 PM on May 7, 2007

Most alcoholics are self-medicating depression, or more commonly anxiety. Taking an SSRI is no more stupid than meditating or paying money to someone to talk to them about your life. Saying it's stupid, then minimizing the deleterious medical and social costs of an alcohol habit, marks one as a moron, I'm afraid.

Anxiety is very, very amenable to therapy, whether you use an SSRI or not. Alcohol won't work. It causes a very brief amelioration of anxiety followed by a rebound that is more aggressive, which the poster has correctly noticed. Equating an SSRI with a self-declared alcohol dependency has been done on these pages before with abhorrent results, so if that's your bias, please preface your post with your credentials or keep it off the green.
posted by docpops at 2:26 PM on May 7, 2007

If you're only concerned about your (possible) addition to alcohol, go without for a few weeks to show you don't have a problem.

Just FYI, this will show exactly one thing: that you can give up alcohol for a few weeks. Nothing else. In fact, it's something alcoholics commonly do to "demonstrate" to themselves that they are really OK and don't need help. I've been there.

Were I you, I'd head straight to the nearest AA meeting. You may not need it, but you'll meet a lot of really nice folks who've been where you are. Listen to them. You're not alone.
posted by MarshallPoe at 2:43 PM on May 7, 2007

Ambrosia Voyeur, based on your remark about vitamins, I just did some research on what foods contain vitamin B complexes and a little light went off -- my anxiety has been noticeably worse since I went veggie nearly a year ago, and veggies are apparently pretty poor at providing vitamin B. It may just be coincidental, but I'm grabbing a supplement today.

As for for dependency on psychiatric medications vs alcohol, I've had the debate running in my head for years. My experience with SSRI's, though, is that I can use them until I'm feeling better and stable, then wean off of them without too much difficulty -- so while I don't like being dependent on them, it's just a temporarily dependence.
posted by treepour at 2:46 PM on May 7, 2007

Set yourself a limit, and try hard to stick to it. If you can't stick to that limit, then you have a problem and should seek some kind of help.

What should the limit be? Wikipedia has a Recommended maximum intake of alcoholic beverages page covering several countries.

Daily/weekly maximum drinks

These countries recommend a weekly limit, but your intake on a particular day may be higher than one-seventh of the weekly amount.

• Australia: 6/day; 28/week (@10g = 60g/day, 280g/week) Recommends one or two alcohol-free days per week.[14]
  
• Canada: 2/day; 14/week (@13.6g = 27.2g/day, 190g/week)[2][15]
  
• Hong Kong: 3-4/day; 21/week (glass of wine or a pint of beer)
  
• New Zealand: 3/day; 21/week (@10g = 30g/day, 210g/week)[10]
  
• UK: 3-4/day; 21/week (@8g = 24-32g day, 168g/week)
  
• USA: 4/day; 14/week (@14g = 56g/day, 196g/week)[13]

Pick one you think you can achieve and stick to it.
posted by TheophileEscargot at 2:49 PM on May 7, 2007 [1 favorite]

Oh, and thanks for clarifying the term "harm reduction," The Straightener. I (obviously) wasn't aware of the distinction.
posted by treepour at 2:50 PM on May 7, 2007

I had similar issues with alcohol, so I kinda quit new year's day 2006. When I say I kinda quit, I drink a bottle of wine maybe once every two months. Which is a way lot better than the bottle a night I was going through.

However, at this point I discovered there really isn't anything on television worth watching. (who knew!?) So I took up reading more, and I started studying, and I followed a hella lot more links from metafilter.

So it seems to me seeing as you're handling the depression stuff and all, that this question is really about, omg, free time now that I quit drinking, wtf do I do with it? I agree - don't work. But start a bunch of lists (there's lists out there on the interwebs to inspire you) about things you'd like to do. Do them. You could concentrate on your classical literature education, or your physique, or your creative side. You could paint your house. Take up embroidery. Learn another language. Meditate. Get addicted to WoW.
posted by b33j at 2:52 PM on May 7, 2007 [1 favorite]

TheophileEscargot: maybe the OP can just move to Australia? LOL Aussies!
posted by Ambrosia Voyeur at 3:15 PM on May 7, 2007

Is the question what to do with your time when you choose not to drink? Or is the question, what to do when you have high anxiety and/or panic attacks and choose not to self-medicate with alcohol?

If it is the second case, then you want to learn some other techniques to bring the anxiety down so you can have fun just unwinding. (Which what you said you want to do but can't.)

Generally you want to address the physical symptoms (for example, learning to breathe from diaphram can make a big difference) and help with the cognitive aspects (what you are telling yourself that increases or lowers the anxiety as it is happening). So my advice is look for help learning to deal with the anxiety - from a therapist, a relaxation/meditation/yoga teacher or one of the many self-help books available. Medication during the learning phase can be helpful but you may find that once you have more skills, you can deal with anxiety and panic yourself.
posted by metahawk at 5:24 PM on May 7, 2007

Treepour, I indulge in alcohol in what feels to me like a pretty similar Fx, amount, and anxiety-pattern to what you're describing.

I've been prescribed a very low dose of xanax for several years, and if you don't know xanax is an extraordinarily addictive substance with incredibly short-term effects. Medically, physicians have explained to me that the effects of xanax and alcohol w/r/t short term decrease in anxiety followed by worse rebounds are very similar. There are other, way safer, longer-term and less dangerous anti-anxiety drugs - xanax is so bad that you can't even use other really-addictive benzo's like valium to taper off. I've also been prescribed something called Topamax, which is on-label for epilepsy and bipolar disorder but off-label for alcoholism treatment. I'm not in any way saying you need this pill (and in fact, I detested it) but some doctors and some people might suggest it. It's got anti-mania and mood stabilizing effects, and overall in some clinical studies has been shown to reduce the craving for alcohol.

But I am not a doctor, and you did not ask about the prescription drugs available to treat a "condition" you seem to mostly feel acceptance of. I don't think that all use of alcohol is automatically "self-medication" that needs "treatment" with (in my personal experience) more dangerous, or addictive, or unpleasant or side-effect-ridden cocktails of newly discovered substances.

I hate that sometimes my life is either I'm out partying and drinking, or watching TV like a vegetable. I get depressed when I don't fulfill my responsibilities if I've been partying too much, so I try to be really careful to do my share of housework and cleaning and cooking and other things I find incredibly, mind-numbingly boring. I have dogs, and adore them, so with the nice weather I like to try to kill two birds with one stone and exercise by running with the larger dog. I feel like this is the healthiest thing I can do, offsetting both the anxiety/depression and hopefully some negative health effects from moderate drinking. I read a lot, I have to say, and voraciously - I would probably drink way, way more if it did not impair my ability to read sometimes 200 pages a day of medical history stuff (loving Oshinksy's historical analysis of Polio right now), Jane Austen-y stuff and whatever else. I like to do things sometimes that while they may include drinking, or perhaps simply facilitate friends drinking while they are with me, minimize my alcohol intake but are fun too - guitar hero, bowling, endless wii tennis tournaments, whatever. I also, yep as others have pointed out, spend a lot of time reading MeFi posts I might otherwise not check out because they're outside my purview of normal interests, and I've learned a lot and I think broadened my mind a bit - I love, love to learn stuff and take in facts (hence reading, Mefi, re-reading the same issue of a science magazine until I FINALLY understand something), etc.

I'm wondering loosely how old you are - I feel like 2-3 years ago I always felt way more pressure with Mr. Bunnycup to always be DOING something - which meant being out partying. Now maybe I pressure myself less and it's okay to do different things too. And it took some time to develop other interests.

I'm sorry if I've made any offensive assumptions or whatnot - I am definitely not coming from the sphere you'll see of people who think you are an addict if you ever touch the stuff. I understand WHY some people feel that way. But I hate all the crap I get from some total-abstainers. Others, of course, are perfectly courteous. Soooo, I'm not judging anyone.
posted by bunnycup at 5:46 PM on May 7, 2007

Whoa, I hadn't considered the prospect of taking xanax daily. That isn't the only way to use it. I go through 1 ml/month, thanks to the alternate approaches learned in therapy.
posted by Ambrosia Voyeur at 6:28 PM on May 7, 2007

Huh. Just looked at my Vitamin X (hee!) prescription and it's .5mil, and I need it at least once per day. The problems that bunnycup describes are true. (really weird dreams if I miss more than 36 hours) My doctor was leery of prescribing it because of its habit forming properties. My perspective was that I would at least remember to take it.

But I'll tell you what, I sure feel human these days. I've battled anxiety and depression most of my life, and the X has done me some good.

And I'll be looking at getting some vitamins too.
posted by lysdexic at 9:00 PM on May 7, 2007

Many thanks, all. This has really been helpful and has given me much to mull over. Just FWIW, to clarify, I am working on my anxiety issues via deep breathing, some cognitive behavioral work (though I need to be more dedicated about), a bit of therapy, and possibly the prozac.

One thing this thread has helped make me aware of it is that the question of what to do with my free time when I'm not drinking is actually a more significant one than I realized. Too much unstructured time is one of my major anxiety triggers -- so it occurs to me that I may sometimes drink not so much to ward off anxiety per se, but rather because I don't want to be confronted with that question of what to do with my time.

Thanks again!
posted by treepour at 10:19 PM on May 7, 2007