Another Way Is Possible. How to Move Towards ‘Drinking Healthier’

Feeling stressed as you consider attending holiday parties? Knot in your stomach as you wonder how this year’s family dinner will go — either because you’re worried about drinking too much, or because you’re worried a loved one will?

We spoke with broadcaster and filmmaker Maureen Palmer, a Vancouver Island resident of Spirit Bay, B.C., and the author of the recently published You Don’t Have to Quit: 20 Science-Backed Strategies to Help Your Loved One Drink Less, about navigating these tricky situations. Palmer also worked with her partner Mike Pond to co-author a 2016 book exploring adjacent themes called Wasted: An Alcoholic Therapist’s Fight for Recovery in a Flawed Treatment System.

In Wasted, Palmer and Pond sought evidence-based treatment approaches for Pond’s struggle with alcohol addiction. In You Don’t Have to Quit, Palmer follows up with non-judgmental tips, tricks and tools for people looking to support loved ones who struggle with drinking — and take care of themselves, too.

You Don’t Have to Quit is both practical and deeply compassionate, sharing frameworks and mindset shifts with the goal of seeking positive change and breaking intergenerational cycles. The Tyee spoke with Palmer about some of these shifts, and how to make them. This interview has been edited for length and clarity.

The Tyee: The holidays can be both a stressful and a boozy time. What are your top tips for people with alcohol use disorder who are navigating sobriety goals through this season?

Maureen Palmer: Some of my tips are for the individual themselves, and some are more for the friends and family around those people.

I think the key thing, all around, is managing expectations for people who have alcohol use disorder or are problematic drinkers.

There tend to be pretty good reasons why people drink. There’s an upside for them. But most of us who observe them don’t see the upside. We only see the downside, right? Quite often people drink, in a lot of cases, because of past trauma. The holidays are a particularly challenging and triggering time in a lot of families, right?

If newly embarking on sobriety — and this would take a lot of courage — I would say to the people in my life, “It would be great if for just this one dinner, nobody would drink. What do you guys think of that idea? How do you feel about having a non-alcoholic Prosecco at the meal? Or some mocktails? Or what about, if you guys really need to drink, you drink before or after the dinner?

“I really want to be there and enjoy the family celebration. And I want to be healthy, and I know that the healthier I am, the less chance I’m going to screw up your celebration. I don’t want to morph into the kind of behaviour that ‘destroys Christmas dinner’ — the belligerence, the over-loquaciousness, the belittling, the abuse of other people in the family.”

That would be Job 1, I would say, if you’re newly sober.

If you’re managing to reduce intake and on a program of cutting back, I would talk to my family members about what I’m doing, and I’d say, “Here’s what I’ve done in the last month or two months, and here’s my expectation of myself for the next couple of weeks, and here’s how I could see you helping me meet that expectation.”

And I think if all of us who are around that person, if we’re not all walking on eggshells, waiting for the slip, ready to pounce — “Why did you drink so much last night? What were you thinking?” — all of that stuff reinforces something called the abstinence violation effect, which is where the more somebody who drinks feels badly about the incident — the more we pass judgment, the more we make snide comments — the more likely they are to drink some more.

If we could be, at best, neutral about the drinking, or maybe even a little bit better — saying things like “Thank you so much for not drinking so much. I’ve noticed, in the last couple of weeks, for the last couple of months, I have seen these marked changes. Here’s what I see. Tell me what your approach has been, and how can I support it?” — then that will support our loved one.

Positive response for positive change.

In your book, you discuss the issues with our North American all-or-nothing mindset when it comes to alcohol: basically, that someone who drinks problematically should do a 12-step program and stop drinking forever, and that’s the only path forward. What’s wrong with this approach?

This is what Dr. William Miller told me, and he’s one of the world’s greatest addiction researchers and the founder of motivational interviewing [a conversational method designed to help strengthen a person’s motivation and commitment].

Miller said, back in the 1930s and 1940s, when Alcoholics Anonymous was just gaining traction, the alcohol industry loved its approach to total abstinence, because that approach makes it clear that there is this group of bad drinkers over there, and those people, we need to hive those people off and tell them they are destroying their lives and the lives of everybody else around them, and they can never drink again.

But everybody else over here, we’re fine to keep on drinking, to enjoy our cocktails.

The alcohol industry loved that because the problem was not the product, it was the individual person. That has been deeply embedded in our culture.

I think we blame the individual for a problem completely created and supported by the alcohol industry. And its ability to undermine public policy when it comes to helping us resist alcohol.

We now know there’s over 200 health conditions associated with alcohol. That’s why Canada’s new guidance on alcohol and health is that zero is the only amount of drinking that is safe. The alcohol industry doesn’t want you to talk about that.

The reality is one in three adult Americans drinks too much.

We’re talking about millions of people who do not yet have a dependence. Those people aren’t going to be open to the message that they need to be abstinent. What they might be more open to is “I think maybe I should think about healthier drinking.” What could that look like? What could that feel like?

If we could move a massive number of people into drinking healthier, what an enormous win we could possibly have with the sheer volume of alcohol use disorders we might be able to head off at the pass.

The problem is that the message of AA and all of the mythology that’s built up around abstinence — like you have to hit rock bottom before you’ll quit — is the opposite of early intervention.

Everybody’s enjoying the person who drinks too much, but we’re all obviously seeing they’re drinking too much, but nobody wants to intervene, because we all like the party.

So nobody says anything as that person does literally barrel towards rock bottom.

If we shifted our collective mindset into “We are going to treat alcohol use disorder like every other major health-care issue that exists in the public realm, with a broad evidence-based tool kit, as early as possible and as often as possible,” I think we have a win.

Let’s say someone wants to go to their parents’ home for the holidays, but they’re feeling worried or anxious about a parent’s drinking and what might follow. In your book, you talk about how trying to control the behaviour of someone with alcohol use disorder — confronting them about drinking, ferreting out their bottles and disposing of them — doesn’t really work, and leads to more conflict. What would you recommend instead, for someone who feels affected by a parent’s drinking?

The No. 1 thing is to be rigorously honest with yourself. What are you capable of?

If some of the parent’s behaviour in the past has been so harmful, you need to protect yourself. I think you need to go in there and say, “Mom or Dad, I’m wondering, what is a realistic conversation for us to have about drinking, at least on Christmas Day? What do you think you are capable of? Would you consider moderating? And what would that look like?” And maybe you have an agreement that after three drinks, you will leave the table, or be allowed to go home with anybody getting on your case.

It's negotiation that’s at the core of motivational interviewing — making people feel heard and understood, and building an empathetic relationship.

We are not going to have any agency with our family members if they don’t trust us, if all they’ve ever heard from us is criticism and, you know, screaming fights because we’re justifiably afraid of where their behaviour might take them and us, there is no relationship of trust.

I think that there are a lot of behaviours in families where alcohol has been there for generations, where we all learn to amp up the drama.

Can you say to yourself, “Why would I do that, and what would it take for me to not do that this time?”

Do you recommend a different approach for people whose partners become abusive when they drink?

I have zero tolerance for anybody treating me badly because they feel badly. You don’t get to treat me badly — or worse, you don’t get to treat the children badly.

I think that our No. 1 job as parents, even though we may love our heavy-drinking spouse, is to minimize the intergenerational damage caused by alcohol use.

We can minimize that in two ways: zero tolerance for any abusive behaviour on the part of the drinking parent, but also zero tolerance for shaming the drinking parent in front of the children, because the kids still love that person even when they’re drinking, even when they’re abusive.

It’s our job to model the behaviour we seek. If you just say, “This is not working for me today, and I’m going to go elsewhere with the kids,” I think that’s just fine.

The people who are drinking, you can come back at them the next day with the recriminations or the blame or the fault-finding. Or you can come back and try to engage from a place of, what are the seven steps of positive communication, which is a strategy of CRAFT, community reinforcement and family training.

Or you can begin a healing conversation.

In the book, addressing partners of people with alcohol use disorder, you recommend that they shift their mindset from victim to ally. Why is that important, and how do you start to do it?

It’s a really hard thing to do, especially if you grew up in a home with a parent who had alcohol use disorder. I think the best place to begin is by building empathy and by looking at some of the strategies in CRAFT.

It’s a program that teaches you how to build a connection with people who drink. Not losing that human connection is vital, because everybody cuts them off.

There are steps in there that were really hard for me to follow at first, but then I actually saw with my own two eyes how effective they could be.

Like saying, “How can I help?”

Like admitting — and this is the hardest one for me — partial responsibility. In mine and Mike’s case, the day after he drank after 5 1/2 years of sobriety — I should never have had that bottle of wine in the fridge.

When we filmed a documentary for The Nature of Things, I saw Michael undergo an alcohol cue test at the Medical University of South Carolina, where they showed him alcohol drinks and non-alcohol drinks, and his brain lit up like a Christmas tree at the pictures of the alcohol drinks, even though he said he felt zero craving.

Really, we’re beginning to just understand how the human brain works in relation to alcohol. I can’t have alcohol in the house if I’m going to be supportive of Mike. So I said, “That was a really bad idea of me to have alcohol in the house.”

And I’ve said things like — back in August was the last drinking bout — “I realized that you just went through something tremendously difficult with a family member, and I knew that that was going to be difficult for you. I could have helped you more. We could have done more hikes. Or we’re not going to have people over for three or four nights. You need quiet.

“What can we do to maximize your ability to not drink, and then if you do end up drinking, what can we do to minimize the damage?”