Reducing alcohol intake
Significantly reducing alcohol intake which had been used to self-medicate worry and physical pain: Gareth’s story.
Gareth was a 41 year old father of 3 young boys who worked as a manager in a large company. Gareth had been involved in a serious car accident when he was 35 years old which had left him with continual pain in his back, neck and knees. The pain made it difficult for him to deal with the demands of his job and he worried about how long he would be able to continue to provide for his family.
Because of his pain, Gareth could no longer do the activities he used to do to wind down, particularly gardening, and he missed this very much. The pain also meant that his sleep was broken and this in turn made him irritable and tired during the day. He had turned to drinking in the evenings to cope with the pain and worrying about the future.
Gareth’s drinking had begun to put a strain on his relationship with his wife. Gareth’s doctor told him that his drinking was causing steady weight gain, and that his weight was contributing to the pain in his knees. His doctor advised him to stop drinking and lose weight.
The work we did
Step 1: Knowing what to change
- Gareth had already decided to reduce the amount of junk food he ate before work for breakfast and at work at lunchtime
- Gareth identified the key issue he wanted help with changing as reducing his evening alcohol consumption
- This meant he would need to find new ways to deal with his worries about the future
- Gareth wanted help to improve his sleep pattern as he felt this was contributing to his feeling bad and drinking
Step 2: Reducing the amount Gareth drank in the evenings
Gareth’s usual pattern was to drink 2-3 cans of lager on Monday to Friday evening (12 in total per week), and then 6 pints of beer in the pub with friends on Saturday and to drink a bottle of wine on a Sunday. When we looked at what would be an achievable first step, Gareth said that he would like to cut down to having one can of lager on Sunday to Thursday evenings, to have a bottle of wine on a Friday evening and to leave his 6 pints of beer in the pub on Saturdays as it was. He decided to have his evening can of lager with his meal rather than afterwards.
This would mean that Friday evening would feel more like a celebration at the end of the working week and he would keep his social drinking on Saturdays. This initial change therefore meant that he would be drinking 7 cans a week less which he worked out would reduce his calorie intake by 1085 calories a week. Gareth found this a very motivating statistic.
Gareth was pleased to find that reducing to one can a night with his meal was not difficult to do and he then chose as a second step to have 2 cans of lager instead of a bottle of wine on a Friday evening. An immediate benefit was that Gareth no longer felt bloated and uncomfortable in the evenings.
Step 3: Dealing with worry without drinking
Gareth was worrying most of the time about how long he would be able to continue working given his chronic pain. In the evenings these worries had felt overwhelming and it was this awful feeling that drove much of his drinking. Gareth was aware that as he cut down on the lager, he would need to manage his worries differently.
I explained to Gareth the principles of “worry time” where you allocate a specific period of time in the day to focusing on your worries, distinguishing which are under your control and which are not. Combined with a structured Problem Solving approach to the worries this allows constructive resolution of soluble problems and recognition of which worries are insoluble. It suited Gareth to do this at 7.30pm after the children were in bed.
Gareth found it helped him a lot to see which of his worries were ones he had some control over and which were out of his control. He used Problem Solving to develop a plan to deal with each of the soluble problems and was able to start recognising and accepting which issues he had no control over and was relieved to see that he had to let these go.
Step 4: Improving his sleeping pattern
Because he had been anxious about how much he was sleeping, a few months before he came to see me, Gareth had bought a Fitbit and used this to monitor his sleep. The Fitbit showed that on average he was getting 6 hours a night but there was a lot of variability and some nights he had as little as three and a half hours, which made Gareth more anxious about his work performance the following day.
To change this pattern, we agreed that he would abandon the Fitbit for a month and see what happened to his sleep. I gave him a relaxation CD to listen to when he woke in the night, but he didn’t find this particularly suited him, so instead he just kept his eyes shut instead of waking to look at the clock. Gareth found that not focusing on what his Fitbit said about how long he had slept led to him worrying less about his sleep.
We also worked out an evening wind-down routine to help his sleep. This included having a shower and spending the first part of the evening doing more active relaxing activities such as walking the dog, and spending the later part of the evening relaxing in front of the TV with his wife.
Step 4: Further changes to his drinking pattern
Once Gareth was used to having just one can a night on weeknights, he decided to change from buying 550 ml cans of lager to bottles of 275 mls. He found that this was still refreshing and in fact found that having a bottle rather than a can of lager straight from the fridge felt more refreshing because of the feel of holding the cold glass of the bottle as he drank. He noticed that this was a more pleasurable feeling than drinking from a cold can. It is well-established that the pleasure we get from what we eat and drink is powerfully influenced by senses other than taste, in this case touch and temperature.
Gareth lost one stone two pounds over the course of 6 months.
The pain in one of his knees stopped altogether and this meant his sleep improved, so he had more energy and his mood improved.
In Gareth’s own words:
“My knee used to be really bad but since losing over a stone, I don’t feel any pain in that knee.
I used to drink to block everything out, for comfort and for pain control. But it got to the point where my wife threatened to leave me unless I cut down dramatically. My mindset has changed and I am happy with one bottle of lager in the week. I still have 3 or 4 pints in the pub on Saturdays and then a couple of glasses of wine when I get home.
I feel better in myself and less bloated in the evenings. I can wear shirts I haven’t worn for 3 years.”