Beyond Dry January - How to Help Patients Reduce or Eliminate Alcohol Consumption

Do you feel like you’ve been hearing the term “Dry January” more and more over the last few years? That’s because you have! This initiative officially emerged in 2013 out of a non-profit organization called Alcohol Change UK as a way to address heavy drinking patterns that lead to harmful health outcomes. Since then, more and more people have been inspired globally to not only take a month off drinking but also to re-examine their relationship with alcohol throughout the year. The success of this public health campaign is reflected in a growing body of research that demonstrates the health benefits of Dry January. This article explores how to support your patients during Dry January and beyond by offering them sustainable strategies for reducing alcohol consumption.

[signup]

Understanding the Impact of Alcohol on Health 

Even if a patient’s alcohol use does not appear to be causing significant harm in their lives, the health effects of alcohol consumption can be significant and may contribute to the root cause of their health concerns. Alcohol has been found to contribute to over 200 diseases and conditions across many body systems. The severity of this impact is dependent on dose, as well as other factors, like gender, age, and recent food intake, yet there remains conflicting data as to whether there is a safe amount of alcohol consumption when it comes to potential effects on health. Some research indicates that light and moderate amounts may be protective while other studies suggest that the “healthy dose of alcohol is zero.”   

In practice, clinicians may see that alcohol use can contribute to common health concerns, like:

• decrease sleep quality
• increase blood pressure
• increase digestive symptoms like acid reflux and gastritis
• suppress the immune system 
• disrupt reproductive hormones
• worsen mental health conditions

With heavy and chronic drinking patterns, there is an increased risk of:

• liver disease
• pancreatitis
• hormonal imbalance
• malnutrition
• diabetes
• respiratory illness
• cardiovascular complications
• cognitive impairment
• dementia
• cancer 

Some individuals also run the risk of developing mild to severe Alcohol Use Disorder (AUD), which may require specialized care to address psychological and/or physical dependency on the substance.

Identifying Patients Who May Require Higher Levels of Care 

Recognizing the role that alcohol plays in your patient’s life is the first step to identifying problem drinking and knowing when a referral for additional care may be needed. Given the potential for harm, most public health organizations, such as the United States Preventive Services Task Force, recommend annual screening for alcohol use of all adults over the age of 18, including pregnant people. A simple, 3-question screening tool called the AUDIT-C (Alcohol Use Disorders Identification Test-Concise) can help identify patients who are at risk for AUD by asking about how much and how often they consume alcohol. Other common tools for routine screening are the complete 10-question AUDIT and the 4-question CAGE, which is an acronym for questions about Cutting down, Annoyance by criticism, Guilty feelings, and Eye-openers. 

Beyond these screening tools, there are several factors to consider when determining the risk of alcohol use. People taking medications that interact with alcohol or whose medical conditions are worsened by drinking carry a greater health risk at any amount of alcohol use. A family history of alcoholism, as well as having experienced adverse childhood events (ACES) can make an individual more susceptible to developing AUD. Depending on the severity of alcohol use, your patient may benefit from an inpatient, a partial hospitalization program (PHP), an intensive outpatient program (IOP), or an outpatient program (OP). The National Institute on Alcohol Abuse and Alcoholism provides comprehensive resources for patients and providers on their website, Rethinking Drinking.

Motivational Interviewing and Patient Engagement

Identifying that a patient would benefit from reducing or eliminating alcohol is only the first step. Having an integrative toolkit for supporting them through what can be a significant change in their life can make all the difference for your patient’s success in transforming their relationship with alcohol. Motivational interviewing (MI) is an effective technique for engaging patients in alcohol use discussions that recognizes their autonomy and their ambivalence to changing drinking habits. 

Many integrative health providers already practice what’s known as the spirit of MI (described by the acronym PACE) by: 

• creating a Partnership with their patients
• demonstrating Acceptance
• expressing Compassion
• Evoking their patients’ existing strengths

In this non-judgmental dialogue, the clinician can respect the reasons that the patient has for maintaining the status quo, such as using alcohol to cope with stress and for socializing (sustain talk), and can amplify the patient’s own motivation for changing this behavior (change talk). By working together and establishing a discrepancy between the patient’s goals for their health and their current drinking behavior, the clinician and patient can begin to develop a strategy to reduce or eliminate alcohol.

Role of Diet and Nutrition in Alcohol Reduction

Since alcohol affects the digestive tract through direct exposure to the stomach and intestinal lining, understanding the impact of alcohol on nutrient status and digestive health is important for healing. Chronic alcohol use can reduce the healthy digestive function of the stomach, intestinal lining, liver, and pancreas, as well as the gut microbiome, which leads to improper digestion and absorption of nutrients. 

Considering that their nutritional status may already be compromised, nutrition for alcohol reduction focuses on making sure these patients are eating enough nutrient-dense foods throughout the day. Low blood sugar, also known as hypoglycemia, can stimulate the stress response, which is a known trigger for alcohol cravings.   

Common nutrient deficiencies seen in chronic alcohol use include:

• Thiamine (B1), is especially crucial because alcohol blocks its absorption and it is recommended for all patients with AUD.
• Folate (B9) and vitamin B12, which additionally can contribute to anemia.
• Vitamin C (along with B1, B9, and B12) is important in glutathione production, which is a primary liver antioxidant. 

If you suspect that a patient’s digestion has been impaired due to alcohol use, you may consider dietary support for reducing alcohol. A Functional Medicine approach to healing the digestive tract may be an important part of the overall treatment plan.  

Incorporating Behavioral and Lifestyle Changes

As with most chronic health conditions, it’s important to incorporate lifestyle changes for alcohol moderation, such as adopting stress reduction techniques, finding healthy social activities, and engaging in regular physical activity. Many people use alcohol to cope with their stress since it can have an immediate relaxation effect. Ironically, alcohol itself is a stressor and raises serum cortisol and can disturb hypothalamic-pituitary-adrenocortical (HPA) axis function. Part of supporting your patients to reduce or eliminate alcohol consumption includes helping them develop alternative ways to cope with stress. This could include mental health interventions such as Cognitive Behavioral Therapy (CBT), which helps identify thoughts that can contribute to the stress response, and Dialectical Behavioral Therapy Skills Training (DBT-ST), which teaches emotional regulation, distress tolerance, and mindfulness.  

Many people struggle with finding healthy social activities that don’t involve drinking, so it’s important to encourage and support your patients to get out of their comfort zone. The National Institutes of Health publishes a resource called the Social Wellness Toolkit that can be a great way to start a conversation with your patients on strengthening their social connections. 

Physical activity, whether done with others or individually, can also play a role in helping patients reduce drinking. In a recent meta-analysis, regular exercise has been shown to reduce alcohol consumption, though it is not clear the optimal type, duration, and frequency. 

Addressing Potential Challenges and Relapse

Making any change can be difficult and a relapse to prior behavior is an expected part of the process. Maintaining a non-judgmental, supportive environment for your patients helps in managing challenges in reducing alcohol. It’s important to develop strategies to navigate situations that are likely to arise, such as periods of stress and social settings that involve alcohol, especially for patients with social anxiety, as this can be an additional risk factor for drinking. 

Many of the lifestyle techniques described above, such as CBT and mindfulness, not only help patients reduce or eliminate alcohol but also can prevent relapse to unsustainable patterns of drinking. Stand-alone mindfulness training (Mindfulness-Based Stress Reduction) has been shown to reduce the frequency and severity of relapse. Don’t underestimate that supporting your patients through the foundational lifestyle changes that address nutrition, physical activity, stress management, and sleep are all part of a strategy for long-term success. 

[signup]

How to Help Patients Reduce Alcohol Consumption: Final Thoughts

Initiatives like Dry January do a great job of bringing awareness to the personal health impact of drinking, yet there is no one-size-fits-all approach to finding long-term success in alcohol reduction. As a trusted integrative health provider, you are poised to provide a non-judgemental and supportive space that allows your patients to explore their relationship with alcohol. Through compassion and education, you can help them determine whether their current consumption patterns are aligned with their health and life goals. With your support, your patients’ curiosity about Dry January could lead to a sustainable change that has a huge impact on their health.