805.jpg bar Title: The Problem Drinking Continuum: Patterns of Use & Abuse
Author: Gayle Rosellini & Mark Worden
Publisher: Do It Now Foundation
Date: March 2011
Catalog Number: 805

..The Problem Drinking Continuum: Patterns of Use and Abuse

Inside this pamphlet, you'll find a chart that may help you see something you've never seen before.

The chart -- we'll call it "The Problem Drinking Continuum" -- is a simple way of depicting something that can seem awfully complicated: the range of behaviors and potential problems linked to various levels of involvement with alcohol.

We developed it as a tool for use in our own work with problem drinkers -- both to evaluate the extent of their drinking and break down the system of denial that keeps them stuck there.

And while the continuum itself might seem self-explanatory, we'd like to offer a few comments at the outset to reduce the risk of confusion.

Although many may read the chart from left to right and see a linear progression of symptoms, the continuum isn't intended to imply that an inexorable downhill slide accompanies all drinking patterns.

Neither does it imply that any point on the continuum is an early, middle, or late stage of the disease of alcoholism.

It's only intended as an itinerary of some of the places that drinkers visit -- and a road map back for those who've been away too long.

..Questions and Answers

What's the best way to use the continuum?

The Problem Drinking Continuum is best used as a tool to evaluate drinking problems and break down the denial of problem drinkers.

The continuum lists various drinking behaviors, from abstinence to alcoholism, and reads from left to right, linking increased levels of consumption with life problems.

Still, it's not meant to be read as a progressive, irreversible accumulation of symptoms slide. Nor does it imply that any point on the continuum is an early, middle, or late stage of the disease of alcoholism.

When is the continuum best used in therapy?

It's probably most effective when used in the first or second counseling session.After interviewing the client (and, if possible, the family), the counselor should explain the continuum and its purpose. Use of a blackboard (or the continuum itself) may be helpful.

The counselor will likely emphasize behaviors or incidents that are most relevant to the client, such as arrests, a family crisis, blackouts, mounting debt, or other pressing problems.

As the client and counselor focus on these issues, it becomes increasingly difficult for the client to maintain that his or her drinking is merely "social." And, often for the first time, the client is able to admit that drinking is causing serious life problems.

In future sessions, the therapist and client can refine this awareness and define individual problems more precisely.

Still, we repeat: the continuum is not meant to be viewed as a chart of progressive symptoms of the disease of alcoholism.

Why do you keep emphasizing that particular point?

The prevailing concept of alcoholism as a chronic, progressive disease has been invaluable in removing the stigma of alcoholism and in helping tens of thousands get the treatment they need.

However, it's also fostered the popular misconception that if a person has a drinking problem, he or she is probably progressing into alcoholism, or conversely, that drinking is basically harmless for people who aren't alcoholics.

Increasing evidence shows that the progressive disease model of alcoholism simply does not apply to all problem drinkers.

The continuum can be especially helpful in showing young people and other high-risk groups that, although they may not be alcoholic (that is, physically or emotionally dependent on alcohol), their drinking style may contribute to significant life problems.

Our message is simply this: You don't have to be an alcoholic to have a drinking problem.

By defining alcoholism only as a progressive and chronic disease, treatment programs and professionals may exclude large numbers of people who may need some help to change their drinking behaviors in order to resolve other life problems.

Examples: A college student who's having trouble in school because he parties and drinks several nights a week; a couple whose marriage is in trouble because of financial problems brought about by his repeated D.U.I. arrests; a young woman who suffers from guilt and anxiety when she wakes up in a strange bed after drinking too much at a party.

These people may not be alcoholic -- that is, they may not have developed tolerance and physical dependency on alcohol.

Still, they may all have to change their drinking patterns in order to resolve current problems and avoid similar difficulties in the future.


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Are there any other recommended applications for the continuum?

You may want to apply principles or insights derived from the continuum to real-world situations which promote careless use of alcohol and opportunities for problem drinking.

Examples: the overly-long, commercialized "happy hour" at bars and restaurants; the new night spot opening on the interstate highway; drinking contests as a part of an initiation into a club or fraternity; the custom of getting drunk on New Year's Eve. These are all socially-acceptable invitations to overdrink.

But primarily, we hope that counselors, educators, and other helping professionals will use the continuum to illustrate how drinking problems begin and evolve in order to help individual clients eliminate problem drinking patterns in their own lives.

For other readers, we hope you'll take what you need (and can benefit by) from the continuum, and get on with whatever changes you may need to make in your life and your relationship with alcohol.

And if it's time for you to take that big first step, thanks for the honesty it takes to admit that to yourself and the courage it takes to step beyond the problem drinking continuum.

This is one in a series of publications on drugs, behavior, and health by Do It Now Foundation.
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