Dr. Washton's structured four-step approach to alcohol treatment for executives and professionals.
One size does not fit all when it comes to changing your drinking. That conviction has guided my clinical work for over five decades, and it is the foundation of everything we do here. Our Four-Step approach grows out of decades of scientific research showing that relatively brief, moderation-focused treatment can be remarkably effective for people with mild to moderate alcohol problems. It is also the backbone of The Drink Smartly Program.
The basic premise is straightforward: most drinking problems are learned behaviors, and learned behaviors can be changed. Using cognitive-behavioral techniques combined with practical, no-nonsense guidance, we help clients take control of their drinking in a way that fits their values, lifestyle, and goals.
What makes our approach truly different is that we address both the behavioral and the psychological dimensions of problem drinking. Heavy drinking is a habitual behavior tied to specific situations and triggers — and learning to find your off switch is a key part of changing those patterns. But drinking is also frequently a form of emotional self-medication. Many of the people I work with drink excessively in response to anxiety, stress, or emotional upset, using alcohol as a coping tool to escape or forget. Since alcohol never fixes emotional problems but almost always makes them worse, learning better ways to manage negative moods is an essential part of treatment. As psychologists and psychotherapists, we are equipped to address not just the drinking itself, but the underlying issues that feed it.
The Four Steps
Once you have completed the initial consultation and we have determined together that moderation is an appropriate and realistic goal for you, the Four-Step program begins.
Step One: Commitment and Planning
Make the commitment to change and develop a detailed plan that includes specific drinking limits. For many — but not all — clients, this means starting with a period of abstinence of at least two to four weeks. Some people taper down rather than stop completely, but temporary abstinence has unique benefits:
- It breaks your habitual drinking pattern
- It establishes an alcohol-free baseline
- It allows you to experience daily life without any alcohol
- It helps pinpoint your drinking triggers
- It prepares you to begin moderate drinking with a clear head
I often describe this as sobriety sampling — trying abstinence as an experiment, not a life sentence. Many clients find it far less daunting when framed that way.
Step Two: Drinking Control Skills
Learn and practice a toolbox of drinking control skills designed to help you succeed at moderating your drinking. This includes keeping an accurate log of your alcohol consumption, but it goes well beyond record-keeping. You learn how to avoid or safely manage situations most likely to trigger overdrinking for you — certain places, certain people, certain feelings like anger, boredom, or anxiety. It also means finding more rewarding activities and healthy pursuits that do not involve alcohol.
Step Three: Managing Setbacks
Learn how to deal with slips, should they occur. I think of a setback as a bump in the road, not proof that moderation has failed. The goal here is to prevent any incident of drinking beyond your new limits from leading you to get discouraged, give up, and return to a regular pattern of harmful drinking.
Few people who attempt to break a well-practiced behavior succeed without a hitch on the first try. Slips are not required to succeed at moderation, and some people do get it right the first time. But since mistakes sometimes happen, it is important to be prepared. When a slip does occur, the most important thing is to turn it into a positive learning experience rather than treat it as evidence that you simply do not have what it takes. Progress, not perfection.
Step Four: Addressing Underlying Issues
Address other issues in your life that may have contributed to the development of your drinking problem or been part of the negative fallout from it. These issues may include:
- Problems managing anxiety, depression, or other negative feeling states
- Communication problems and relationship conflicts
- Self-criticism, guilt, and lack of self-acceptance
- Difficulties with anger management and assertiveness
- Job or career crises
Whatever these co-occurring issues might be, as professionally trained psychotherapists, we are in a position to help you deal with whatever emotional and psychological issues are intertwined with your tendency to drink too much. Happy, emotionally well-adjusted people rarely develop drinking problems. The function and meaning of alcohol in the person’s life always matters.
Other Helpful Tools
Medication
Some clients find it easier to moderate or abstain with the help of medication. Our complete guide to medications for alcohol problems covers these options in detail. Several medications — including naltrexone (Revia), acamprosate (Campral), and topiramate (Topamax) — can reduce the likelihood of heavy drinking or make it easier to maintain abstinence by offsetting changes in the brain caused by alcohol. None of these medications are mood-altering, addictive, or make you sick when you drink. And they tend to be more effective when combined with therapy or counseling — such as group therapy — than when taken alone. Medication is a tool, not a cure.
Self-Help Programs for Problem Drinkers
I routinely encourage clients to supplement their treatment with participation in Moderation Management (MM), accessible at www.moderation.org. MM is a free self-help program for people concerned about their drinking, designed to assist those with mild to moderate alcohol problems achieve either moderation or abstinence. It is currently the only self-help program that supports moderate drinking goals. MM provides information about alcohol, moderate drinking guidelines, drink monitoring exercises, goal-setting techniques, and self-management strategies. There are only about two dozen MM meetings nationwide, but internet forums and chatrooms are available.
Other clinical-science-based self-help options include SMART Recovery, which uses cognitive-behavioral techniques similar to those in our program. Both are worth exploring.
How to Get Started
If you are concerned about your drinking and want professional help in deciding what to do, I invite you to schedule a confidential consultation. Just fill out the Contact Us form on this page or call our office in Manhattan at (212) 944-8444 or in Princeton, NJ at (609) 497-0433. There is no obligation, no pressure — just a thoughtful conversation about what might work best for you.
