I want to stop drinking. Appointment with doc tomorrow. What to expect?
April 7, 2016 9:57 AM   Subscribe

I'm a ciswoman, 50. I've been drinking a bottle and a half of wine every night for about 16 months. I have a really high tolerance now. I don't feel horrible in the mornings, but I can't say I feel very good. (When I did not drink I almost always had wonderful mornings.) In the afternoon before drink one I feel anxious and a little sweaty and crave it a bit. My sleep is terrible. I want to quit drinking, but I am scared of withdrawal. I made an appointment with my GP for tomorrow to tell her and to ask for medical supervision. I'm scared but now I am more scared of ruining my health and my mind. What should I ask her? What do I expect? Should I ask for some medication to help me with anxiety or sleep issues?

I don't know why I'm so scared to tell the doctor. I know her very well. I would rather not go to rehab, but I can see doing an outpatient program if that is what she thinks best.

Whatever else I am, I am very high-functioning. I just stop functioning much after about 5 p.m., which is wine o'clock for me. I am married with grown kids who are out of the house. I am a free-lancer, work from home a lot, and run our house. Lots of stress lately for various reasons.

For support I plan to check out either SMART Recovery or Women for Sobriety. AA is not appealing, unless I could find a women-only meeting. I am seeing a counselor and will let her in on developments, too.

After he gets home from work my husband also relies on wine o'clock. After I see the doc I will let him know what I need from him. I worry that it's the end of a long, kind of comfortable but unhealthy routine/rut for us. I want to get off the couch, though. I don't feel old, unless I'm hungover. I feel young, and I would like to feel a lot better. I know that I can after a while.

Without things devolving into chatfilter, who has been in my place? What info should I bring? Your best advice? The doc will probably do a physical soon. So far in the last couple of years my bloodwork has been actually great, though my IBS has flared something fierce, and I've developed some acid reflux--both of these things are exacerbated by alcohol for sure.  I don't want to wait for the day when the bloodwork shows liver problems. I want my life back!

Thanks for reading and for any advice.
posted by anonymous to Health & Fitness (22 answers total) 14 users marked this as a favorite
Unfortunately, addiction science isn't very well fleshed out in my experience and most doctors aren't very informed even on what is out there. There is medication that can help you quit drinking: Naltrexone. I would discuss that with your doctor. It reduces the craving and blocks the pleasure effect from drinking.

There are other medications that make you feel sick when you drink too.

I was descending into problem drinking for awhile. Just be ready to honestly discuss it with your doctor. They are there to help. I wouldn't be afraid to ask for that medication to try, and your doctor can evaluate if it is right for you. Admitting it to someone was the biggest step I took and helped so much. Good luck.
posted by OnTheLastCastle at 10:15 AM on April 7, 2016 [2 favorites]

Probably the simplest thing is to print out this question and take it with you.

Benzodiazepenes are often prescribed for alcohol withdrawal (not personal experience; that of a friend). They can help, but beware of dependency as benzo withdrawal can cause major long term problems and be actually physically dangerous. My friend went cold turkey because that was the only option for them; I've had other friends who have tapered down (not under medical supervision though) with varying degrees of success. It's very seductively easy to say "just one more today and one less tomorrow."

You'll need your husband 100% on board with you, which more or less means his wine o'clock will also need to diminish.

One thing you can do, if you don't go cold turkey, is to buy wine in smaller amounts. If you're going through 1.5 bottles by yourself per night, buy less than that. One bottle, e.g., for you and your husband to split over dinner. In general, limiting the amount of alcohol you have laying around will help reduce intake; the idea is to put multiple decision points between now and that next glass. It's super easy if that next glass is waiting in the kitchen. There are more opportunities to make a different decision if you have to put on pants, put on shoes, get in the car--or walk, go to the store, etc. At each point along that path you can choose something different.

One thing that helped my friend was avoiding social situations that revolved around alcohol for a while. (And also having us friends around them decline to drink when we were out for dinner, for example). Another thing that helped was substitution--tea consumption spiked dramatically in their household. Interesting mineral waters can be nice too.

Hobbies can help. A lot of drinking like yours (and mine) stems from boredom and general ennui. If you have other stuff to fill up that time, drinking becomes less of a necessity to pass that time.

You're scared because, as you say, you're in a comfortable rut and leaving that is frightening.

You're going to be fine. You're making a decision that will benefit your long term health at the cost of losing short term pleasure and that is hard hard hard to do. I'm sure your doctor has heard this before, and won't bat an eyelash. If your doctor is hell-bent on "you must AA/whatever," ask for a referral to another doctor who will work with you and your circumstances to find the solution that is right for you, not a one-size-fits-all.

Therapy can also help, with a therapist who specializes in dependency. In fact you're kind of an ideal candidate for therapy because you're walking in with a super specific goal in mind. They can work with you to help build the toolbox necessary to reach that goal, and then maintain once you've achieved and the therapeutic relationship comes to an end.

Also, and this is super important, one of the few things AA gets right is "one day at a time." Sometimes progress is two steps forward and one step back, and that's okay. Beating yourself up for 'failure' is an amazing way to ensure the failure continues. If you decide on a specific course of action and slip one day, accept it, and the next day don't slip. Perfection isn't something humans do, so don't force yourself to a ridiculous standard.

One of the things I learned in therapy was a (possibly different?) rubric for SMART when setting goals: Specific, Measurable, Attainable, Reasonable, and Time-Limited. So:

Specific: "I want to cut down on my drinking"
Measurable: "I want to cut my drinking to x per day/week/year/never"
Attainable: Is this attainable for you? All signs point to yes.
Reasonable: Is cutting down to 0 starting tomorrow reasonable for you? Is tapering more reasonable?
Time-limited: "I want to cut my drinking to x per [time period] by y date, by hitting these milestones at these times."

Also don't forget to reward yourself for milestones achieved. Go from 1.5 bottle today to 0.75 bottle by next week? Give yourself a reasonable reward for that--the movie you've wanted to see for a while, a karate class, a new book, whatever pleases you.

Figuring out your triggers for drinking can help too. If wine o'clock is the moment you get home from work, what about not going home immediately after work? Go to the library, maybe, grab a book and chill out for half an hour before heading home. That way you've got your daily decompression out of the way, now you can go home and do something else--engage in a hobby immediately, have a shower, make food, whatever. Something to occupy you that doesn't have you on the sofa with a glass.

Anyway, lots of rambling. I hope something in there will help. I'd wish you good luck, but from what you've written I don't think you need it.
posted by feckless fecal fear mongering at 10:25 AM on April 7, 2016 [27 favorites]

Huge congratulations for taking this first step, you might not feel like you deserve it yet, but you do. It's awesome that you're making this move to feel better and improve your health.

I just wanted to throw in that there's increasing evidence that total abstinence forever is not always necessary for recovering alcoholics. I say this because it can be seen as such a huge, dramatic, scary step, so it might help to tell yourself "I am not about to never drink again. I am going to cut down and, if I need to, stop for a while, but once my cravings are under control, I may choose to have a drink in the future if I want to" (rather than need).

Sending you good vibes for tomorrow - it'll be hard but worth it.
posted by greenish at 10:33 AM on April 7, 2016 [4 favorites]

You may find working with a therapist who has experience with substance abuse treatment would be helpful in terms of framing the process, setting goals, providing support, etc. Motivational Interviewing or Harm Reduction are some additional approaches to abstinence. You may want to try a couple before deciding the approach that feels best to you.
posted by goggie at 10:34 AM on April 7, 2016 [2 favorites]

I may choose to have a drink in the future if I want to" (rather than need)

I often think about the episode of M*A*S*H in which they all challenge Hawkeye to give up drinking. At the very end, he sidles up to the bar and says (paraphrased). "Oh look at this gorgeous martini, I really need this." Raises glass. Pauses. Puts it down. "I'll come back when I want it."
posted by feckless fecal fear mongering at 10:38 AM on April 7, 2016 [6 favorites]

I'm like you and enjoy wine after work. If you choose a path other than abstinence: something that helps me not drink a ton is to buy better wine, so I feel more inclined to sip and savor it bit by bit (rather than taking gulps and finishing a glass quickly). Part of my habit is that I enjoy having a drink nearby--not necessarily to be drinking it, but for some reason the presence of a glass of wine lends a je-ne-sais-quoi to whatever sedentary activity I'm doing in the evening (reading, writing, knitting, watching a movie, etc.). So I'll pour a glass and just set it on my desk while I do my thing, and take a sip here and there, and a couple of hours will pass and then it's time for bed.

I know a couple who wanted to knock out their wine o'clock, so they make a point of taking their dogs for a walk right after work. That little bit of time together + activity was enough of a disruption to the evening routine that it was easier to incorporate bigger changes. It's also (fwiw) done a lot for their looks.

All of that said, my partner doesn't drink at all, and we have added a lot of tea, lemonade, fancy sodas, and mineral water to our kitchen. A really, really good decaf coffee is also good at night for a sort-of-special feeling. The early days were challenging, so a really good dessert was often served. Sugar is a big part of whatever cravings there are, apparently.
posted by witchen at 10:43 AM on April 7, 2016 [1 favorite]

Oh something else that may help: put a jar in the kitchen. Every time you don't buy wine (or buy less), put the money you would have spent into that jar. Watch it fill up.
posted by feckless fecal fear mongering at 11:07 AM on April 7, 2016 [4 favorites]

Just FYI there are women's only AA meetings. You can google "AA meetings in (your town)" and check the listings.
posted by BlahLaLa at 11:12 AM on April 7, 2016 [5 favorites]

Alcohol contains a ton of sugar, so you'll crave sugary things as you withdraw from the alcohol. Drink orange juice with a dash of honey, to replenish the sugar and provide you with vitamins. If you're into veggie/green juices, drink those too, to give yourself as much of a nutritional boost as possible.

Also be prepare for tingling in your limbs, which scared me half to death when I was in the first few weeks of sobriety.

It's 17 years for me now without a drink. If I can do it, you can do it too. Good luck.
posted by essexjan at 11:29 AM on April 7, 2016 [10 favorites]

I decided this year to take three months off (February, May, September) from drinking anything. And to limit my drinking on other months to one drink a night only on weekends. So far so good and I'm considering whether I may gradually move to giving up alcohol entirely.

I have not hit high consumption levels but I don't think my body metabolizes alcohol as well any more. And I think alcohol is such a dangerous friend, particularly to manage stress. I notice that very little drinking has greatly improved my sleep.

The two things that have helped me most are my utterly supportive husband, a recovering alcoholic who hasn't had a drink in about 30 years, and a consistent home supply of ice cold lime seltzer. I do sparkling water when I'm out to dinner.
posted by bearwife at 11:59 AM on April 7, 2016

Hi, I'm a toxicologist/epidemiologist. I'm a fan of harm reduction. I'm also a person who struggles with my vices, including drinking and smoking. I say this because a lot of health professionals you'll meet tend to seem distant from their work with substance use/abuse, as are many of the researchers working in that space, and that can lead to uncomfortable interactions with them. When your doctor has never had a drink or a cigarette, and they're coaching you on cessation, it can feel more like an anthropological study of peoples' weird habits rather than an individual assessment that considers the internal perspectives of people like us. With that said, I'm also not reading comments provided by others--I want to put on my blinders and talk to you directly.

My first suggestion is that you exhaust, or at the very least consider, non-pharmaceutical measures before trying pharmaceutical ones. Having a pharma option is great, but these are not benign interventions. They have short and long term side effects that should be considered and for which you can prepare. One way to prepare for that is to know first what your personal, subjectivedifficulties are managing your drinking. Is it getting over the hump of the end of the day without starting to drink? Is it limiting the number of glasses you have when you start to drink? Is it easier for you to control your intake when you're alone, alone with your partner, alone in public, or in a social group setting? Is taking one day off from drinking manageable? If you can take one day off from drinking, is it easier or harder to avoid alcohol the following day? These are all the sorts of questions you can ask of yourself based on your own experiences.

I've found a great deal of help in some surprising places over the years. I got a pretty good handle on my drinking mostly through scrutiny of my diet. I went to a registered dietician almost on a whim a few years ago to help me get focus on portion control, meal planning, and weight management strategies. Not that I didn't know, but it was stunning to sit down with her and do the napkin calculations of just how much of my daily energy intake was exclusively from wine and beer and cocktails.

From that basis, I started using a simple drink counter app to track my drinking. I learned all sorts of interesting and helpful things: I drink a lot when I'm alone, I rarely drink when my kids are around, drinking with a meal keeps me in the 1-2 drinks range, drinking hungover makes me drink almost double my usual quota, 6-7 hours of sleep the night before makes me drink less the following day, I drink more if I keep alcohol in the house instead of going out to grab a drink, I drink much less if I drink after aerobic exercise, etc.

I've often considered trying a non-AA outpatient program, and I thought getting a better idea of my problem spots would help me be a good self-advocate. It ended up being such an interesting self-analysis tool that I'm still at that stage, but moving in the direction I want to be moving. I'm losing weight, and exercising more, just by consuming less alcohol and instituting small personal interventional policies (the biggest so far being no drinking on days I don't jog or otherwise exercise). Seeing this progress gives me the impression that I'm changing my behavior slowly and by building replacement routines--something I know from my own (professional, not anecdotal) research is crucial for long term management of anything from diet to drinking to work stress.

So, a future outpatient program isn't off the table, but I'm enjoying watching myself ratchet down use just by putting in a real effort to learn more about my intake while reducing it.

Feel free to memail me if any of this sounds useful.
posted by late afternoon dreaming hotel at 12:10 PM on April 7, 2016 [22 favorites]

You may want to check out Secular Organizations for Sobriety. They offer similar AA type of meetings and support without the religiosity that some people aren't comfortable with.
posted by brookeb at 12:17 PM on April 7, 2016 [1 favorite]

Good for you for wanting to make a positive change in your life. That's a great thing just to think about and be aware of.

I don't have a lot to say except with regard to the physical withdrawal: alcohol converts in the body to sugar so in the beginning, in order to help with the physical cravings, you may want to replace that sugar. Of course refined sugar is not ideal for the body, so you may want to have fruit on hand. Keep a large bag of frozen fruit in your freezer, or in the fridge at work, for when you don't have fresh fruit. Frozen blueberries are an awesome snack. So is frozen mango or papaya, or whatever strikes your fancy.

Best of luck. Do check back and let us know how you're doing.
posted by vignettist at 1:50 PM on April 7, 2016

Just going to add my voice to the chorus as someone who's been in something like your place (I drank at home, too. Tho I drank for many years). A few points (most mentioned by others above)

- change your habits, for sure. Substitute the ritual of drinking with something else, especially if that first glass of wine signals "end of day, stress is over, aaaaand unwind". Make it something enjoyable tho. Don't try to be all wholesome and healthy at first (I actually started smoking after I stopped drinking. *cough* I don't recommend that necessarily, but it was still better than the alternative).
- I'd strongly recommend getting your husband on board. The first few months are gonna be unnecessarily hard otherwise.
- the beginning (first 1-2 years) was no fun for me, but I had been an alcoholic for most of my adult life. If you've only been drinking to excess for 16 months, you may find transition back to a life without alcohol easier. Still, I think you'll take some weeks even past physical withdrawal symptoms where your perception of the world will shift. It may be unpleasant (don't believe the AA types who claim clarity came instantly. Well, maybe it was true for them). But it will pass, and then life will be better without alcohol!
- speaking of AA. I did a 12-step programme, tho I am an atheist and did have some trouble with it. I didn't do meetings for very long after I got back, but I appreciated the community of like-minded people it provided. Everyone's so different, yet so similar.

The things that have helped me are so cliché I almost don't want to mention them: therapy (2.5 years!!), then healthy eating, exercise & mindfulness. In other words: Figuring out what I hated about my life and why I drank (in therapy) and replacing it with something healthier (exercise and good nutrition).

Good luck!!!
posted by ClarissaWAM at 1:57 PM on April 7, 2016 [1 favorite]

Just a few other points I would make. I deal with alcoholics daily at my job and treating alcohol withdrawal (emergency department). Of course, usually when I see people it's because they've run into problems trying to quit, but just be aware that I've seen a number of people who have been drinking regularly for so long they really don't know how it's going to be when they are in withdrawal. If it's not going well, you can go into the ED - don't wait until you have a seizure at home. Some people actually need benzos to get through withdrawal safely, alcohol withdrawal itself can be life threatening (but is easily treatable!). Not all docs address it the same way, but I've been willing to give folks limited scripts to use to try to quit at home, if it seems like that's what it will take for them to feel confident enough to commit to quitting. If your doc seems uncomfortable with managing this you can ask for a referral to an addiction specialist who will know more about the tools (because there are a number of tools pharmacologic and not).

Definitely you must have support. If not AA, please do something. It's one thing I've heard time and again from alcoholics who have successfully quit - that the support is what got them through. There is a reason why the sponsorship model is used, it really works. I applaud you for recognizing this is a problem. So many people are in denial even as the medical problems set in. Best of luck, I know you can do this!
posted by treehorn+bunny at 2:45 PM on April 7, 2016 [4 favorites]

I suspect available resources will depend on the health care system you're in and I guess your insurance (I know AA is the most ubiquitous in the States), and your doctor's familiarity with guiding people through this.

But there's a *lot* of good evidence behind motivational interviewing. 2nd looking for that in opportunities for therapy you come across. Oversimplifying, but it is basically having a bunch of structured conversations around helping you find something you like better than drinking, and building up your own intrinsic rationale for doing it.

Also, know that problem drinking in later life isn't unusual among women, especially women with high-stress careers. Look for ways to reduce stress - including eliminating stressors, if possible - and work on developing alternative coping methods.

(Anecdotally, I know a few people who used fitness to do a 180 from different kinds of addiction. Lots of runners and cyclists. Lots of runners.)
posted by cotton dress sock at 3:00 PM on April 7, 2016 [2 favorites]

There is a lot of good advice upthread. I will just add that a lot of people have a relationship with alcohol that is in some ways more immediate and more predictable than their relationships with other people. Thus, breaking up with alcohol makes some people grieve in ways similar to breaking up with a lover or an intimate friend. Don't be surprised if you find yourself experiencing feelings of longing, regret, anger, or remorse.

But, yeah, be honest with your doctor, keep looking for help if you don't get what you need from her, get as much exercise as you can, and try drinking tea, juice, water... anything other than alcohol. Feel free to memail me.
posted by Multicellular Exothermic at 5:28 PM on April 7, 2016 [2 favorites]

Please tell your doctor everything. It takes some guts to do so but it was one of the best things I did when I quit. Several doctors that I see were very supportive and helpful. Next, try some AA meetings. If you are in an urban area there will be lots to choose from. Different AA meetings can be very different. keep trying to find one you like. I am an atheist and dislike religion but have found AA meetings that I enjoy and have made many friends there. There's nothing like being around people who have been where you have been. Finally, check out the subreddit /r/stopdrinking. Good luck.
posted by charlesminus at 6:31 PM on April 7, 2016

This article--The Irrationality of Alcoholics Anonymous--was fascinating to me, particularly their support for naltrexone/The Sinclair Method.
posted by needs more cowbell at 7:23 PM on April 7, 2016 [2 favorites]

You might find it useful to read The Biology Of Desire, which is by a neuroscientist about how addictive substances affect our brains. He's compassionate and includes real-world examples of people addicted to different things and how/why they stopped. Addiction works quite differently than how it's presented in pop culture and the media, and not all doctors are up to date with the evidence. So it might be a helpful alternative in case you get a lot of moralising advice.
posted by harriet vane at 11:11 PM on April 7, 2016 [2 favorites]

I often drank about the same as you until very recently (and sometimes still do) and I find the thing that slows me down (and can give me nights of just a single glass) is sticking rigidly to 'drink one, water one' - sip a full glass of water after you have a glass of wine. If I also delay wine o' clock by an hour, avoid chugging wine while I'm cooking, and then sip mindfully with the meal, I find I get some very low consumption nights under my belt and then I'm feeling I can tackle this long term.
posted by colie at 4:23 AM on April 8, 2016 [1 favorite]

You might not want to start on medication while you're still drinking heavily, but your doctor will know best. Be honest, and make sure you tell your doctor accurately how much you drink, and what drugs (even vitamins or supplements) that you take regularly. This could affect what you're told or prescribed.

You'll probably find that your quality of sleep will improve when you cut back on alcohol. What I've heard is that it lowers your body temperature since it's a depressant, and causes you to wake more times in the night, though you won't remember waking up.
posted by serenity_now at 10:30 AM on April 8, 2016

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