En español | Many people — including many addiction experts — believe that the only way to handle a drinking problem is to quit altogether. Indeed, abstinence-based programs such as Alcoholics Anonymous (AA) have helped countless people manage their addiction and live healthier lives. And for some drinkers, including those with a more serious dependency, abstinence is still advised.
But for many others whose drinking is less problematic, moderation can be a more appealing, effective option for establishing a healthier relationship with alcohol, says George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health (NIH) in Bethesda, Maryland. In fact, he adds, “That's how everyone should approach alcohol if they partake. There is a cohort that doesn't want to drink at all and that's to be respected, but everyone else should limit their drinking.”
Limiting alcohol consumption is important at every age, but especially for older people. “As we age, the enzymes in our stomach and liver that help metabolize alcohol are less active,” says Austin Lin, M.D., a psychiatrist with McGovern Medical School at UTHealth Houston, who notes that this metabolic slowdown can increase a person's blood alcohol concentration (BAC) by 20 to 50 percent.
If you'd like to cut back on your drinking but aren't sure how, here are some steps to get you started.
1. Be honest
Many doctors don't ask about alcohol use. If they do, patients may be tempted to lie about how much they drink. “Folks are great at hiding their use, and that's detrimental to themselves because they're not able to get the help they need,” says Lin. A first step is admitting how much alcohol you're actually consuming.
2. Track your intake
The NIAAA recommends a maximum of four drinks on any given day for men and three for women, and a total of no more than 14 drinks per week for men and seven for women. Exceeding those limits is considered “heavy” or “at-risk” drinking — but, as noted above, older people may want to limit their drinking further. (See “Are You Drinking Too Much?")
To keep yourself within that range, it's important to know how much you're drinking at any given time. “Counting is really effective,” says John Mendelson, M.D., clinical professor of medicine at the University of California, San Francisco, and founder/chief medical officer at Ria Health. Keep a number in your mind representing how many drinks you will have. ("I'm not going to have more than two glasses of wine tonight.")
A spouse or friend can help you stick to it. If you're alone, Koob recommends making a check mark on a piece of paper each time you have a drink. “We're all forgetful when we get older,” he says.
3. Slow down
If you're accustomed to opening a beer at 5 o'clock every night, try waiting until 7. If you usually order a drink immediately upon arrival at a party, order a seltzer first. When you get a drink, nurse it, then go back to seltzer.
4. Eat something
“Drinking on an empty stomach is not a good idea,” says Koob. If you eat while you drink, alcohol gets into the food and slows the absorption — meaning you won't feel the effects as quickly, and will have an easier time keeping your drinking under control.
5. Get a Breathalyzer
They are not just for police officers! You can buy a professional-grade Breathalyzer online (you can find them for $30 and up) and use it to gauge your own BAC. Some of the devices can be paired with smartphones. “Anyone can use one,” says Mendelson. “They're great.” He asks his patients to measure their BAC twice a day and document it. Seeing indisputable evidence of how much you're drinking can help you cut back.
6. Use your time differently
Because drinking is sometimes a response to boredom, Koob recommends joining a group that interests you. Look into classes offered by a community center or whatever religious organization you belong to. Take a walk or go for a swim. “You don't have to learn rock climbing at 65,” he says. But finding something else to occupy your time can help you drink less.
7. Consider medication
Mendelson is a fan of prescribing drugs to help patients decrease their drinking. “There are a number of medicines that are quite effective,” he says. They include naltrexone, which helps ward off cravings and reduce the pleasurable effects of drinking. It's an option you can discuss with your doctor.
8. Address anxiety and depression
"One reason people drink heavily is because they have other psychological problems, like depression and anxiety,” says Mendelson. Treating those problems can in turn help with alcohol moderation. The Anxiety and Depression Association of America has an online screening tool that can help you determine whether you may be depressed or anxious. Take the quiz, then share the results with your health care provider.
9. Gauge how you feel
“If you cut back and you feel better, that's telling you something,” says Koob. If your head is clearer, you get more work done and you're sleeping better when you drink less, that's a sign that what you're doing is beneficial and motivation to continue on that path. “Listen to your body,” he says.
10. Seek support
Enlisting a spouse or friend to cut back with you, or just to offer encouragement, can help. So can the resources at NIAAA, including Rethinking Drinking, a website that helps you assess and change your drinking habits, and Alcohol Treatment Navigator, an online tool that helps you find treatment programs by zip code. Moderation Management offers online support as well.
Mendelson emphasizes that moderation often doesn't work by itself. In some cases, he says, “You really need to add to that with medication and counseling support.” If you have trouble cutting back on your drinking, speak to a health care professional.
The good news: Drinking problems can be successfully treated at any age. “We have people as old as 80 in our program,” says Mendelson. “We see similar results in those patients as in younger patients.”
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