Is everything we know about treating drinking harm wrong?

The more I learn about treating drinking harm, the less I think I know. In health care, the debates about what is the best way to solve drinking harm rage on. Is not drinking at all better than moderation? Do people have to reach rock bottom before they get better? Does medication have a role in treatment?


Which treatment?

There’s a wide range of services for treating drinking harm most of which are underfunded and under pressure. There’s AA, private and public residential services, community services, psychotherapy, counselling, housing first, etc.

Each of these services for treating drinking harm have their own approach and can offer anything from 12 steps treatments, medications, cognitive behavioural therapy, motivational interviewing, peer support groups, psychotherapy, occupational therapies, exercise therapies, anger management to neurofeedback and EMDR.

We wrote about choosing a service here.


Which service for treating drinking harm work best?

So which treatment for drinking harm work best? The answer to this is we don’t know for sure. We know some treatments work for some people but not for others. I get really frustrated by the lack of regular up to date reporting on success rates. Services make claims about treatment success rates, but we don’t even have one standard definition of what success is. Is it about not drinking at all?  Is it about  drinking less? Is it someone being happy and fulfilled in their life?


There is no look back to see what works

At this stage, I’m sure everyone knows about the cervical cancer screening scandal. We wrote it about here. But if this type of scandal happened in alcohol treatments nobody would know. Because there is no routine clinical audit in alcohol treatments. Unlike mainstream medical treatments where there is a culture of looking back on what treatments worked and which did not , alcohol treatment services don’t do this. You see if the treatment does not work, the tendency is to blame the person with the problem- not the treatment. People who fail are told.

”You did not work the system hard enough”


Pat Bracken throws some light

So when I first came across the writing of Pat Bracken, some years ago, it was a light bulb moment for me. It was really helpful in making sense of why some treatments work for some people and not for others.

Pat writes that what is most important is looking at the values, meanings and relationships in our lives. We should prioritise

  1. Understanding the power and relationships in our lives
  2. Understanding what is the meaning and context of our lives
  3. Understanding what are our values and our priorities.

In these areas, we are the experts. We are the most knowledgeable and well informed in our own lives.

Pat argues that the role of therapy, treatment models, research are all secondary or subservient to these three issues.


You are the expert

In Pat’s approach, the role of the health care professional changes from being an expert “fixing” the person drinking too much. Instead the health care professional becomes a trusted ally helping the person drinking too much to make sense of their lives. The person drinking too much is the expert in fixing their own life.


Sounds crazy?

Maybe this sounds crazy. And, yes there are many crazy approaches to treating alcohol harm. (The scientologists are even setting up in Ireland, but sin scéal eile) But Pat is most definitely not crazy. He worked as a HSE consultant psychiatrist in West Cork for many years and introduced many new and novel approaches there which are gradually being adopted nationwide.


Try it out

So why not try it out?  Ask yourself these questions

  1. Do you understand who has power in your life? E.g. you, your partner, your boss, your parents, siblings, friends
  2. Do you understand the relationships in your life e.g. are they supportive, critical, nurturing, toxic etc.?
  3. What is the meaning and context of your life e.g. Do you know what your purpose in life is? If yes are you happy with that purpose
  4. What are your values and priorities e.g. Do you know what your values are. Are you living a life consistent with these? What are your priorities? Do you feel you are making progress on your priorities?


These questions can help

Asking yourself these questions could be the first step in getting your drinking under control. In a future post, I’ll talk about a real story, where someone I loved nearly died, as a direct result of the meaning they placed on something that happened in their life.


If you found this post useful you might enjoy these as well

Can an alcohol counsellor help you?

Rehab when is it useful?



Photo by NeONBRAND on Unsplash

This post was written by Carol

As some who gets hangovers lasting a week, Carol never drank too much - Once she got to a sensible age! However as a patient with an auto immune illness, since she was a teenager she has to drink very little. So she really understands how Irish society makes this very difficult. Carol is responsible for all aspects of Lifewise operations that Valerie and Angela do not cover.

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