Helping Clients Navigate their Relationship with Alcohol: Should the Path be Mindful Drinking or Abstinence Altogether?

By: Stephanie lama

January 2023

Admitting the Problem

Admitting to having problematic drinking patterns is scary for some. It is easy to become defensive and justify a habit that has been normalized and encouraged in modern society. Some of our clients come seeking advice regarding this very dilemma, though not fully wanting to admit that the one thing that they enjoy doing may actually be harming them.

As a clinician, how do we help them navigate this without sugarcoating, acquiescing, or wrongly labeling them with having an addiction? Do we recommend a mindfulness approach to drinking or complete abstinence?

Checking Ourselves First

Primarily, it is important to check our own relationship with alcohol, and the opinions and biases we may hold. How do we feel about the topic? Does it make us uncomfortable? Can we hold the space to talk about this with others or do we first need to reevaluate our own experiences with drinking?

The Role of Society and Stigma

Drinking, unlike drug addiction, is tolerated differently in our society. It is more widely accepted and less frowned upon, as is evidenced by the multiple (and enticing) ads and promotions all throughout the public sphere. This of course creates a more oppressive system for those addicted to other substances.

Understanding the Client’s Relationship with Alcohol

First and foremost, it is important to get a sense of what path the client feels they need to take with their drinking, and what specific goals they have around it. When a client comes to us either directly seeking advice on their drinking habits or casually mentioning it in conversation, there are a few things to pay attention to.

Justifying or Minimizing

Is our client downplaying how much they drink? Are they making more justifications than not? Are they trying to seek approval or permission from the therapist?

Role of Alcohol

What is the role that alcohol plays in their lives? What purpose does it serve? Is the drinking aimed to numb the pain, ease anxiety, relieve stress? Is alcohol consumed only in social settings? What patterns are noticed around alcohol consumption? Does it happen around a certain time or after a potentially triggering situation/feeling? Are there cultural norms around it or social traditions? How often does the person mention alcohol in sessions?

After Effects

What happens after an episode of drinking? Do clients feel bad about themselves, guilty, or regretful? Do they feel energized or happy recalling the moments they spent? Are they embarrassed or ashamed?

Consequences

Does alcohol have negative ramifications in their life? Has their mental or physical health suffered because of it? Have they encountered problems with the law? Have relationships suffered or jobs been affected?

Gathering more information on these areas can give the clinician an idea as to how problematic one’s drinking habits may be.

Where Do We Go From Here?

Now the question is, where to go from here? Choosing a path that works for the client may not be the same as choosing the path that is best for the client. This can be tricky, as they may not be ready; from a “stages of change” perspective, they are pre-contemplative. This brings up the question for therapists, “what is our role?”

It has been my experience in various SUD treatment facilities, that the role of therapist has become tainted by state laws, agency requirements and red tape. In private practice, that is not the case. So how do we take a balanced approach where we ultimately guide the client to a decision that best fits their needs, while also reducing the risk of harm?

The most important thing to remember is that ultimately, we have to meet the client where they are at.

Mindful Drinking or Abstinence?

Mindful drinking is the path of least resistance, and from a harm reduction perspective, better than no intervention at all. However, mindful drinking can lead to enabling if there is a loss of control to the point where the intention of being mindful leads to blackout city. As a therapist, our role is to walk the client through these steps in a genuine manner.

If the path of abstinence is chosen, then it is important to come up with a joint plan that the client agrees with and had full involvement in creating. If the path is mindful drinking, discussing what that looks like, including helpful strategies, will be key.

Most importantly, acknowledging progress, normalizing setbacks, and avoiding stigmatizing or oppressive language is what will keep the therapeutic relationship intact, which as we all know, is the most important component in the process of healing or change.

Recovery Is Not One-Size-Fits-All

It is important to note that everyone’s process is different and there is no linear approach tied to alcohol moderation, abstinence, or recovery.

As Demi Lovato states in her docuseries, Simply Complicated:

“I’ve learned that it doesn’t work for me to say that I’m never going to do this again…I know I’m done with the stuff that’s going to kill me, right?…Telling myself that I can never have a drink or smoke marijuana, I feel like that’s setting myself up for failure because I am such a black-and-white thinker. I had it drilled into my head for so many years that one drink was equivalent to a crack pipe.…I also don’t want people to hear that and think that they can go out and try having a drink or smoking a joint, you know? Because it isn’t for everybody…Recovery isn’t a one-size-fits-all solution. You shouldn’t be forced to get sober if you’re not ready. You shouldn’t get sober for other people. You have to do it for yourself.”