The Sipping Point

Vogue.com Month 2011

http://www.moderation.org/press/Vogue2011MD-MMStory.pdf

The SIPPING
POINT
Loving the effects of
alcohol a little too much,
Rebecca Johnson looks to
limit—but not eliminate—
her nightly glasses of wine.

My name is Rebecca J. I am not an alcoholic. What I am is a
wine drinker. White, preferably, but as my wine-snob husband
likes to say, “As long as it’s fermented. . . . ” He’s actually wrong
about that. I don’t really like hard liquor, because I don’t like to get
drunk. What I like is wine’s long, slow slide to pleasantly buzzed.
I like how it muffles the critical voice in my head, the one that rears
its head at the cocktail hour, when all the petty irritations and insults
of the day have come to rest like the sooty sediment in an ancient bottle
of Cabernet Sauvignon.

And so it truly astonishes me that I was stupid
enough to let my drinking get out of control. Reformed alcoholics (and
remember, I am not one!) carry around a story about their drinking that
is inevitably bookended by disaster. I knew I hit bottom, they say, when
I ran over the family dog or woke up in bed with a guy who had a swastika
tattooed on his neck. I don’t have any stories like that. I knew I had to cut
down for much more prosaic reasons—I couldn’t sleep, I got tired of feeling
vaguely lousy the next day, and, most important, I had the nagging sense that
alcohol, once a boon companion I could take or leave, had settled in for a longtime
stay. It was a rare evening I did not have at least two glasses of wine. On a good
night, the level of wine would stay above the label. On a bad night, it would go
below the bottom (occasioning two Tylenol the next morning).

At first, I tried to
quit on my own. I didn’t bother trying to abstain at social events—there’s no way
I could get through a party without a drink—but as a parent of two small children,
I spend most of my nights at home anyway. I managed to grit my teeth through my
usual drinking cues—making dinner, eating dinner, the PBS NewsHour on the sofa
next to my husband—but when it came time to go to sleep, I would lie awake for hours,
hoping in vain for oblivion. The pattern was inexorable. The wine helped me get to sleep.
But then it woke me up at three in the morning, when I would find myself watching HGTV
while eating Oreos to calm the sugar crash of the alcohol leaving my system. OK, that
happened only one night, but the memory is seared into my neocortex.

I decided to address the sleeping instead of the drinking.
(Looking back, I am astonished I thought this made sense,
but I did.) When I naively told my primary-care physician the
truth—I was trying to cut down on my drinking but was having
trouble sleeping and wanted to get some sleeping pills—he
looked at me as if horns had grown out of my head.

“How much are you drinking?” he asked.

“One or two glasses of wine a night,” I said, fudging ever
so slightly.

He frowned. “Have you considered other ways of relaxing?”

This wasn’t going the way I planned. I thought he would
congratulate me for being proactive about my health, write
me a prescription, and send me on my way.

“You mean like hot baths with scented candles?” I answered
sarcastically. He sighed and wrote the prescription
for fourteen pills. No refills. But the look of disapproval
on his face had hit a nerve.

The pills were great for getting me to sleep, but
they did nothing to help me cut down to the one
drink a day recommended for women by the National
Institute on Alcohol Abuse and Alcoholism (NIAAA).
There is some debate about what level of alcohol is
considered healthy—New Zealand and Ireland set
the limit at two drinks a day for women—but most
health researchers agree that consuming more than
seven drinks a week leads to an increased risk of
stroke, cancer, and heart disease. Indeed, for all the
much-ballyhooed benefits of moderate drinking, the
reality is that the detrimental effects of alcohol
on the heart outweigh the positives on a populationwide
basis by a factor of 2.5 to 1 (according to the World Health Organization).

To get to a healthier level, I booked an appointment at
Hazelden, the world-famous addiction-treatment center. My
initial consultation in their New York City office in Chelsea
was with an earnest young man sporting a ponytail and
suit. It lasted an hour and a half and consisted of his asking
dozens of questions, all of which seemed designed to pull me
toward the overwhelming conclusion that I was a pathetic
loser whose life was out of control. The only problem was, I
answered no to most of the queries. Had I ever been in trouble
with the law because of my drinking? Had I ever lost a job?
Was my spouse or my family concerned about my drinking?
No, no, no. At one point, he asked me to hold up my hand,
presumably to see if it was shaking. It wasn’t.

I did, however, answer yes on occasion. I do drink because
I am bored. I do drink alone (I’ve never understood why that
is worse than sitting in a bar). I have regretted how much I
drank—I was so hungover during the tour of my local Montessori
preschool that I had to leave in the middle (then again,
I knew the Montessori model wasn’t for me). I had hoped the
counselor and I might have a nuanced conversation about
alcohol as a cure for the existential ennui of the human condition.
At one point, I even trotted out Winston Churchill’s
famous line “I have taken more out of alcohol than alcohol
has taken out of me.” I was rewarded with a thin, pitying smile.
At the end of the conversation, he did admit that I probably
was not a candidate for Hazelden. Instead, he recommended
a four-week residential stay in a facility specializing in women
with addiction issues. My mouth fell open in surprise.

“Really?” I sputtered. Four weeks? “But why?” I pressed.

“Four weeks is what most insurance will pay for,” he
answered.

Got it.

A decade ago, it was considered heresy for anyone in
the alcohol-treatment business to entertain the idea
of helping heavy drinkers reduce rather than abstain.
It was a shortsighted policy when you think about it,
because people like me are a lot more common than
the stereotypical alcoholic who needs a shot of tequila
first thing in the morning. According to the NIAAA,
about 16 percent of the adult population meets the
criterion for “nondependent problem drinker” (we
can take it or leave it, but we’d rather take it), with
only 5 percent meeting the criterion for alcoholism
(they can’t leave it).
The problem, according to Reid Hester, Ph.D., research
director of Behavior Therapy Associates,
an Albuquerque, New Mexico–based think tank for alcohol
issues, “is that most alcohol-treatment providers usually see drinkers at the
severe end of the spectrum, and their perspective is affected by that.” He believes
alcoholism should be viewed like hypertension. “There’s a spectrum,” he says.
“Not everybody with a heart condition needs surgery. There are other options,
such as diet, exercise, or drugs.”

Over the past few years, a solid contingent of researchers
and clinicians has arisen to serve the previously ignored
middle of the spectrum. In New York City, the best example
of this new generation of treatment centers is probably the
Center for Motivation and Change (CMC), an elegant, spalike
space on lower Fifth Avenue. Unlike most treatment centers,
CMC does not insist on abstinence as a goal. Instead, the therapists will
work with whatever goal you have, even if it’s simply reducing from five daily
glasses of wine to four. “If we treated only people who are clear they want to
abstain,” says Carrie Wilkens, Ph.D., one of the cofounders, “we’d be doing
a huge disservice to all the people who could change a lot if they just spent a
little time focusing on their problem in a new way.” The “new way” advocated
by CMC focuses on changing your life as opposed to your drinking. If your
habit is sitting on the couch every night and drinking wine (ahem), you have
to get off the couch and do something else. The approach seems to be working.
Since opening its doors in 2003, the center has grown by 140 percent a year.

For the do-it-yourselfer who can’t quite bear the idea, time commitment,
or the expense of face-to-face therapy, Reid Hester developed moderatedrinking.
com, an interactive Web site funded by a grant from the NIAAA and designed
specifically for people like me, who don’t want to abstain altogether
but need help cutting down. Back in the early eighties, Hester analyzed more
than 600 studies to determine which alcohol-treatment protocols worked
best and found that many of the more popular models, including twelve-step
programs and the classic confrontational interventions, turned out to be not
nearly as effective as thought. It makes sense—I would definitely need a drink
if my family got together in a room and started yelling at me for my drinking.
Motivational and behavioral therapies, on the other hand, which are based on
the idea of modification through positive rewards, seemed to work surprisingly
well.

Given the stigma associated with alcoholism, it occurred to Hester that the
anonymity of the Internet was the perfect way to help problem drinkers. For
a yearly fee of $59, moderatedrinking. com guides users through steps based
on the principles of Behavioral Self-Control Training: You keep records, you
set goals, you pay attention. The results have been more than encouraging. In
a randomized clinical trial conducted last year to measure the site’s effectiveness,
Hester found that the group using the Web site managed to reduce their
average number of drinks per day from 5.35 to 3.28.

I decided to give it a try. The first step was getting an accurate assessment of
my alcohol consumption at another site Hester helped develop, called drinkerscheckup.
com. At more than fourteen drinks a week, I was in the top 2 percent
of the American female population. Usually, I’d be thrilled to be in the top
2 percent of anything, but not in this arena.

Back at moderatedrinking.com, the site directed me to make a list of good
things I expected from changing my drinking, and not-so-good things. In
our interview, Hester had said that simply writing things down can be powerful.
But sometimes writing things down can also flatten them out. When I saw
the reasons I like to drink laid out in black-and-white—to relieve stress, to be
less bored, to feel less irritated by things, to satisfy an urge—I felt humbled by
their banality. Not to mention a certain circularity. I drank to deal with my irritability,
but perhaps it was the drinking that caused the irritation?

The only way to answer my chicken/egg questions about drinking was to
follow the site’s advice and stop drinking altogether for 30 days. It is not necessary
to “take a 30,” as it is called, but it’s an effective way to break a pattern.
Moreover, when (and if) you return to drinking, you’ll feel the effects of alcohol
more intensely at lower levels. I decided to take the challenge. Eventually.
After all, it was summer. Who wants to give up white wine or cold beer when
the days are balmy and endless? I was like Saint Augustine in The Confessions:
Make me pure, Lord, but not just yet. Every time I looked at the calendar, I
found another reason to put the experiment off. A family vacation without
alcohol? Unthinkable. A visit from the in-laws? No way. But finally, fall rolled
around, the kids were back in school, and I felt my excuses begin to dry up
(so to speak).

I wish I could tell you giving up alcohol was easy. It was not. The first week, I
was such a horrendous bitch, it’s amazing that I am still married. I can remember
one night in particular. We were at our house in the country. It was late afternoon,
my kids were quietly absorbed with LEGO, my husband was chopping
ginger for one of his Asian dinners. I was sitting on the stool at the kitchen
island, watching him work, the Sunday New York Times spread in front of me.
From the outside, the tableau looked perfect. How many happy evenings had
I passed in just this manner? Only there was one crucial element missing. Wine.

Instead of being content, I felt as if flaming centipedes were crawling up
and down my veins. As my husband chopped, all I wanted to do was grab
the knife and run through the house screaming like crazy Grace Poole in
Jane Eyre. Addiction experts advise people trying to quit to think of their
urge as a wave. In the moment that it crests, you feel powerless before its immensity,
but if you hold your breath and face it head on, you will come out the
other side. In the meantime, I had to get the hell out of that house and the wine
cellar in the basement where my husband keeps a few dozen cases of wine,
including a 2004 Pomerol that tastes, when you drink it, like liquid steak.

“I think I’ll go hit some balls,” I announced.

“Good idea,” he answered.

The courts were empty when I arrived. Most women my age were home
with their families, not battling some invisible demon on their backs in the
dying light of an autumn day. I rolled out the ball caddy and began to hit the
ball over and over as hard as I could. The thwack of the ball against the
backboard disturbed a flock of black crows settled on a ridge overhead. As I
stopped to watch them take flight, their aggrieved caws filling the air, I felt something
in me loosen and take flight as well. The wave had passed. When it got
too dark to see the ball, I headed home.

After that, the next few weeks were not so terrible. I weathered two dinner
parties and a few restaurant dinners without drinking a drop. At the end of
one party, an older woman friend, one of those tough dames who broke the
gender barriers of New York tabloid newspapers back in the seventies, said,
“You know, Johnson, you’re OK sober.” I think she was as surprised as I was.

As the end of my 30 days approached, I began to get nervous. I may
have been able to quit easily enough, but I was looking forward to drinking again.
All those positives I was supposed to experience— sleeping better, feeling good
in the morning, having more energy— were nice, but they didn’t cancel out the
desire for a glass of wine at the end of the day. As Carrie Wilkens, from the
CMC, had warned me, “Thirty days is enough to break a pattern but not a habit.”
Hester’s Web site had some standard tips on moderation—pacing, drinking
on a full stomach, keeping track of my so-called triggers. But the best thing I
did was buy the AlcoHawk, an inexpensive Breathalyzer of the sort that police
use to measure blood-alcohol levels of people suspected of driving under the
influence. The gadget, which requires you to blow into it for ten seconds, then
gives you a digital readout, was the perfect nonjudgmental companion I could
turn to when the urge for another drink set in. When I described it to a friend
who is in AA, she laughed. “You found the perfect sponsor,” she said.

These days, I aim for one drink a night but occasionally end up at two.
Ironically, the majority of people who come to the CMC seeking moderation
end up choosing abstinence after all. I can see why. I found it a lot easier to
say no than maybe. When the urge for a second drink hits me (and Lord knows
it does), I force myself to pause and consult “my sponsor.” Knowing I am
hovering around the .08 mark, the legal limit in America, usually persuades me
to stop, light a scented candle, and take that hot bath after all.