Controlled drinking can’t work for an alcoholic. Really? Why? Don’t they just have to stop once they’ve had enough?

One of the more confounding aspects of all this is why some people who drink too much and behave terribly and cause problems within their families because of their drinking can learn to “re-drink,” get their drinking and lives back under control, and why others, who do all of the same things, can’t.

This fact is what causes so many alcoholics and family members, alike, to go along with, “This time, it’ll be different. I’m going to only drink on Friday nights and holidays, but that’s it!” (or some variation thereof). And, sometimes that promise lasts for a while. Sometimes the person even stops drinking all together — for years. But, then “it” starts, again… the glasses get larger and the sneaking creeps back in and pretty soon, it’s right back where it started.

Why controlled drinking can’t work for an alcoholic

The reason it works for some — and some can be very heavy drinkers — and not for others is the disease of addiction. Alcoholism is one of the diseases of addiction, which is a chronic relapsing brain disease. This means an alcoholic’s neural networks have been so corrupted – hijacked – by their addiction, the chemical and structural changes that have occurred in their brains makes it impossible for them to EVER drink ANY amount of alcohol, if they want to be able to stop their drinking behaviors long-term.

Watch these two videos [part of HBO.com/Addiction, a collaboration of HBO, NIAAA, NIDA & Robert Wood Johnson Foundation] to better understand (Note: when Dr. Volkow refers to “drugs,” that includes alcohol):

• The Hijacked Brain — found in the right column, top video.
• Brain Imaging (You can stop watching this one when Dr. Volkow starts her interview with a patient.)

How can a person (family member or the drinker) tell whether a person should stop trying for “controlled drinking” and get treatment for alcoholism?

One thought is to understand the five key Risk Factors for developing the disease. The more Risk Factors a person has, the more likely they are to develop the disease of alcoholism; one of the diseases of addiction. Risk Factors include:

• Early use – because of the critical brain development that occurs from ages 12–25, alcohol affects the developing brain DIFFERENTLY than it affects an adult brain. The developing brain is especially vulnerable to the chemical and structural changes caused by alcohol misuse. (See “Underage Drinking – How Teens Can Become Alcoholics Before Age 21” for more information.)
• Genetics – persons whose parent or sibling are alcoholics are 4-7 times more likely to become alcoholics themselves. It’s not that there’s an addiction gene, but a person’s genetic make-up may cause them to have fewer dopamine receptors or lower levels of the liver enzymes needed to metabolize alcohol. Just as we have genetic predispositions for height, eye color, skin color, or some cancers, so too can we have genetic predispositions to develop alcoholism.
• Social environment – people who live, work or go to school in an environment in which the heavy use of alcohol is common – such as growing up in a home where heavy drinking is seen as ‘normal’ or living in a school setting where it is viewed as an important way to bond with fellow students – are more likely to abuse alcohol themselves. That abuse of alcohol causes chemical and structural changes in the brain.
• Mental illness – just over one-half of persons diagnosed as alcoholics or alcohol abusers have also experienced a mental illness (e.g., depression, PTSD, ADHD, bipolar) at some time in their lives. With mental illness there are also chemical and structural changes in the brain. Persons with a mental illness may turn to alcohol to self-medicate and/or their alcohol misuse may make their mental illness worse.
• Childhood trauma – abuse (such as verbal, physical or mental abuse) or neglect of children, persistent conflict in the family (such as that surrounding a family member’s unacknowledged alcohol abuse or alcoholism), sexual abuse and other traumatic childhood experiences can shape a child’s brain chemistry — especially during the early development ages of birth to about 12 — and subsequent vulnerability to alcohol misuse.
• Alcohol Abuse – binge drinking, for example, is alcohol abuse, and it is the kind of drinking that causes drinking behaviors — which in turn causes problems. It is also the kind of drinking that can change the chemical and structural make up of the brain, which is a contributing factor to the developing the disease of alcoholism.

Bottom line…. if a person has tried repeatedly to control their drinking but keeps finding it does not work for one reason or another, it might help to determine how many Risk Factors they have.  If a person can “see” any, they may be able to better “see” the problem and thus more inclined to get help or talk to a professional. Equally as important is for the family member to do this exercise, as well. That way the family member can give up believing that this time the controlled drinking plan will work and instead, do what they need to do to help themselves.

One last suggestion…. a person (family OR drinker) can always go to NIAAA’s website, Rethinking Drinking, to do an anonymous assessment of their drinking patterns and find suggestions for further help.

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©2009 Lisa Frederiksen

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Lisa Frederiksen

Author | Speaker | Consultant | Founder at BreakingTheCycles.com

Lisa Frederiksen is the author of hundreds of articles and 12 books, including her latest, "10th Anniversary Edition If You Loved Me, You'd Stop! What you really need to know when your loved one drinks too much,” and "Loved One In Treatment? Now What!” She is a national keynote speaker with over 30 years speaking experience, consultant and founder of BreakingTheCycles.com. Lisa has spent the last 19+ years studying and simplifying breakthrough research on the brain, substance use and other mental health disorders, secondhand drinking, toxic stress, trauma/ACEs and related topics.

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