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Section 4
Excessive Alcohol Drinker

Question 4 | Test | Table of Contents

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In the last section, we discussed affirming progress through rewards, self agreements, and his progress partner.

In this section, we will discuss identifying triggers that can lead to overdrinking.  This section provides practical information and techniques for dealing with four common triggers .  The four triggers that can lead to excessive alcohol use that we will look at in this section are places, people, time, and feelings.  As you listen to this section, you might consider your client and evaluating the Cognitve Behavior Therapy techniques in this section to decide if they are applicable to your practice.

Four Triggers That Can Lead to Overdrinking

♦ #1  Places
First, let’s take a look at places that trigger excessive alcohol use.  For bars, restaurants, and other public places that may trigger excessive alcohol use, clients can take a friend who will discourage rather than encourage excessive alcohol use, such as a progress partner as described in the last section. 

If your client usually orders a specific meal at a favorite restaurant accompanied by several glasses of wine, for example, he or she could order something different.  By avoiding places that trigger drinking, clients can break a drinking pattern. 

But what about clients who drink at home? 

You may give clients who are triggered to drink by being at home advice regarding changes at home.  For example, the client can rearrange the furniture or sit in a different room or chair than his or her "drinking chair."  However, like you, some of my clients have had to commit to not keeping any alcoholic beverages in the house at all.  Where does your ‘controlled drinking client stand regarding home as a drinking trigger?

♦ #2  People
Second, clients who successfully moderate their alcohol intake often avoid people that may influence excessive alcohol use.  

For example, Barry, age 32, lived with his girlfriend Theresa.  Barry was struggling with trying to moderate his drinking, but Theresa refused to even cut down on how much she drank.  Barry was in a tough situation, but I reviewed some options with him. 

a. First, Barry tried moderating his drinking to see if Theresa’s intake also decreased.

b. Second, Barry asked for Theresa’s support.  At a later session, Barry stated, "I let her know that I was working with these tools of moderation and that I didn’t want to become an alcoholic.  I asked her for help, but she wasn’t willing to help!  I think she felt like I was pressuring her to control her drinking."  Barry had made it clear to Theresa that he was not asking her to control her drinking, but instead just wanted her to support him in his own moderation.  Barry was specific about what he wanted from Theresa, but she avoided helping him reach his goals. 

c. A third option for Barry was trying to spend time with Theresa engaged in activities other than drinking.  I stated to Barry, "Maintain the underlying message that you care about Theresa and want to be with her, but don’t want to spend your time together drinking because you become tempted to drink too much." 

In a later session, Barry stated, "Nothing works with this girl!!  There is no way I can be with her and control my drinking!!  It’s really unfair that I have to choose between our relationship and my health!"  I replied, "You might just take a break from each other or a while so you can take control of your drinking.  In the long run, the relationship might be over, but perhaps it will be strengthened and regained."  Barry stated, "That sounds good, but either way, I’m doing what I need to do for my own health and well-being."

♦ #3  Time
In addition to places and people, a third common trigger for excessive drinking is time. 

When does your client drink most frequently? 

A good CBT technique for identifying time as a trigger is self-monitoring.  If you recall, Greg from section 1 implemented self-monitoring of his drinking habits as his first step to moderation.  If your client has already completed a self monitoring sheets, then you might consider using that self monitoring sheet to identify high risk times when excessive drinking occurs. 

For example, Greg’s self monitoring sheets revealed that he drank between ten to thirteen whiskey sours between 8 p. m. and 11 p.m.  These numbers almost doubled during the weekends.  Clearly, for Greg, having free time in the evening led to excessive drinking. 

Do you have a client like Greg?  What could he or she do in the evening to avoid excessive drinking?

♦ #4  Feelings
In addition to places, people, and time, excessive drinking can be triggered by certain feelings.  Clearly, the type of feeling that might trigger overdrinking depends on the individual. 

Lucas, age 26, was triggered to drink mainly when he felt stressed.  Lucas stated, "I get so wound up sometimes  Drinking helps me clear my head and just relax!"  Anger, depression, anxiety, and conflict also made Lucas want to drink. 

What feelings lead your client to drink?  Would this be a good top for your next session?  Would your client benefit form listening to this section?

Regardless of the drinking triggers your client experiences, here are two general tips that he or she, like Lucas, might find useful. 

a. First, consider how your client can compete with drinking.  As you know, certain activities, like running, skiing, or dancing are incompatible with excessive drinking.  Lucas looked for similar activities that could help him drink less.

b. Second, discourage your client from using alcohol as a reward.  Lucas stated, "Sometimes, I’ll have a night where everything goes my way and I’ll have avoided drinking too much.  Then, later in the evening I’ll start thinking, ‘I’ve gone all night without feeling drunk!  Why not just drink until I get a good buzz!?’  That’s probably a bad idea, if I want to decrease my alcohol intake!  Right?"

Does your Lucas reward himself with alcohol?  Could managing drinking triggers help your client begin to successfully moderate and control his or her drinking?

In this section, we have discussed identifying triggers that lead to overdrinking.  This section provided practical information and CBT techniques for dealing with four common triggers.  The four triggers that can lead to excessive alcohol use that we will look at in this section are places, people, time, and feelings.

In the next section, we will discuss using alcohol to manage emotions.  Two methods your client can use to manage emotions in a more productive way than by excessive alcohol use are systematic desensitization and dealing with unpleasant memories.
Reviewed 2023

Peer-Reviewed Journal Article References:
Cox, W. M., Fadardi, J. S., Hosier, S. G., & Pothos, E. M. (2015). Differential effects and temporal course of attentional and motivational training on excessive drinking. Experimental and Clinical Psychopharmacology, 23(6), 445–454.

McCrady, B. S., Witkiewitz, K., Venner, K. L., & Fokas, K. (2020). Education and training in substance use disorders and addictions: The University of New Mexico integrated training model. Training and Education in Professional Psychology, 14(1), 60–69

Muyingo, L., Smith, M. M., Sherry, S. B., McEachern, E., Leonard, K. E., & Stewart, S. H. (2020). Relationships on the rocks: A meta-analysis of romantic partner effects on alcohol use. Psychology of Addictive Behaviors. Advance online publication.

Nixon, S. J., & Lewis, B. (2019). Cognitive training as a component of treatment of alcohol use disorder: A review. Neuropsychology, 33(6), 822–841.

Roberts, W., Miller, M. A., Weafer, J., & Fillmore, M. T. (2014). Heavy drinking and the role of inhibitory control of attention. Experimental and Clinical Psychopharmacology, 22(2), 133–140.

Taylor, M. J., Vlaev, I., Maltby, J., Brown, G. D. A., & Wood, A. M. (2015). Improving social norms interventions: Rank-framing increases excessive alcohol drinkers’ information-seeking. Health Psychology, 34(12), 1200–1203.

QUESTION 4
What are four triggers that can lead to excessive alcohol use for the controlled drinker? To select and enter your answer go to Test.

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