The Current - How to help a loved one drink less

Episode Date: January 6, 2025

Maureen Palmer’s partner Mike Pond has been an alcoholic for decades, but the couple say trying to quit completely never worked — and that focusing on abstinence could be doing more harm than good for some people who struggle with alcohol addiction. In their new book, You Don’t Have to Quit, they offer 20 strategies to help a loved one drink less, informed by Pond’s experience of being mostly sober.

Viking. Committed to exploring the world in comfort. Journey through the heart of Europe on a Viking longship with thoughtful service and cultural enrichment on board and on shore. Learn more at Viking.com. This is a CBC Podcast. Hello, I'm Matt Galloway and this is The Current Podcast. It's January, a lot of people will look at this as dry January, a time when they think about drinking less. There are words that have come to define the way we think about problem drinking. Abstinence is often the goal for those who drink too much.

A relapse signals a failure to meet that goal. Codependence is to be avoided at all costs or you'll be accused of enabling a loved one who continued drinking which could lead them to hit rock bottom. My next guests believe those words and the ideas behind them are doing some people more harm than good. Maureen Palmer is a journalist and author. Her new book is called You Don't Have to Quit and in it she offers 20 strategies backed up by science and research to help loved ones drink less. She has road tested these strategies herself and her relationship with her partner, Mike Pond.

Mike himself has struggled with alcohol abuse for five decades. He is also a therapist who specializes in treating addiction and they are both in our Victoria's studio this morning. Good morning to you both. Good morning, Matt. Good morning, Matt. Mike, I want to get to your story in just a moment, but Maureen, you talk about the title of this book and admit that it can come off as a provocation to some people. Tell me about that idea, you don't have to quit. I can see how some people would take it as a provocation, but I take it two ways. Number one

is you don't have to quit to be the entry point into a healthier relationship with alcohol. Ultimately, you may end up quitting. And the science says a lot of people who begin the journey to drink less ultimately end up abstinence or mostly abstinent, as Mike and I say. The other thing is I'm writing primarily for the loved ones of drinkers, heavy drinkers. And I'm saying you don't have to quit on the relationship as well. If we learn new skills as loved ones, traditionally we've been thought, well, we're

powerless. It's not true and science has proven that so and I've proven it in my own relationship. I want to come back to that idea of abstinence because, again, there are a lot of people who get really stuck on that. But Mike, describe your relationship with alcohol and if you don't mind, how it's impacted, how it's shaped part of your life. Mike Well, it depends on how far you want to go back, Matt. It's been a part of my life since since early adolescence, so I've always known I've had an alcohol problem, but you know in the more recent years my drinking got so so severe that I ended up losing my family, my home, my practice,

and homeless penniless on the downtown east side. And then from that experience, going through recovery houses and stay in the hospital and almost dying, eventually get sober or stop drinking. I'd been absent for just over a year and that's when I met Maureen on Plenty of Fish. Don't say that part. my mother hates that part. And disclosed to her pretty openly about what my experience had been. I didn't hear from her for a few days and then finally I got a call from her

and she says, I don't know if I want to date you but do you want to write a book? And it's quite an opening line. Yeah. And then within, you know, six months, I mean, she just couldn't resist me anymore, and, uh, and we developed a relationship. I got sober and I stayed abstinent for five and a half years. And just when we started filming the Nature Things documentary, I drank again. Timing was terrible.

Through filming and writing the books and other things that we were doing, I was still struggling with drinking. And so occasionally I would have an episode of drinking again. And through the relationship and the research that we were doing, we just came to this place that, you know, it's the loved ones that need help. It's the significant others that need to understand this problem. And they've been told that it's up to the drinker to solve the problem and there's nothing they can do and they need to detach with love, et cetera. Maureen, you're the significant other. I mean, how did Mike drinking again after five and a half

years of being sober, how did that change how you thought about sobriety? First of all, I was shocked, which, you know, anybody who's been in a long-term relationship with someone who drinks would say, why were you shocked? This is, relapse is not an uncommon thing. I was convinced we had to fix this problem, fix it right now so he would never drink again, but the reality was there was a lot of unresolved trauma. And, you know, Mike got to a place where now the drinking is once or twice a year, but there were a few years of real struggle where there was a bit more than once or twice a year. And I realized that how I interacted with Mike, because of the research we'd done, was really

pivotal on whether he would drink 10 times a year or two. Tell me about that. I mean, and the word, the word relapse is really important here, because as you write in the book, relapse can often be seen as a failure. And that you say is something that needs to be at the very least interrogated.

Well, I think so because if we view relapse as a failure, it's against the monolith of abstinence. But if we actually look at what the research tells us, which is that a substance use disorder is a chronic relapsing condition like diabetes or heart disease, we don't shame or judge people who have a diabetic problem for a few weeks. We give them all the evidence-based treatment they need and we set them back on the right track with no judgment. And with alcohol, we do the opposite.

And I did the opposite, I doubled down. Why did you drink again? Do you know how much this is damaging our relationship? Don't you ever think of me? What about your sons? You've just rebuilt all these relationships. You know, you're killing yourself. None of that is effective.

Mike, what does that mean? You say you're in a place of mostly sobriety. What does that actually mean? Well, it's usually maybe once, twice a year, and the episodes are usually like on the evening. What does an episode include? I might drink, you you know what we call a Mickey right a half a pint of hard liquor and that's it and you know and with my clients as

well is the AA way of viewing it is that if you have one drop that's it you know down you go right you can't stop. Well what we find is that you can. And so what happens is when you do drink is what can come into your thought processes is what's been termed abstinence violation effect. So I've been abstinent, I violated it and the effect is there I go, I'm a loser, I'm an alcoholic. The clock has reset back to zero. Yeah, and I got to start all over again and it's a fail and I might as well just keep drinking, everybody's going to be mad at me

and so that's the effect that can compel a person to just keep drinking and drinking. And so if you focus on positive change, what is the impact of that? Well, the consumption goes down. When I'm doing work with my clients, I'm saying, okay, what we're looking for is for your consumption to start going down. We're not going to look at the goal of being, you're going to be abstinent now, you're going to stop and you have to stop. I work with people and say, we're going to just have you monitor how much you're drinking

and maybe include your partner in that. And over a period of time, over a month, we're going to look on a daily basis how much had you actually drank. You drank less when you did drink, and the periods in between drinking got longer. People start to get a sense of success in that, right? You're starting to see that I'm making progress here. And my job, I think, is to reinforce the success. When Mike would go out and drink sometimes, sometimes he'd buy two or three Mikis or a whole bottle. When he would just buy one and the episode was over and I'd help him through the next day, and we would talk about pretty well everything but the drinking. Sometimes I'd actually end up saying, thank you so much for just buying the one Mickey. Like hearing something

positive about that person's effort, we who don't have an alcohol problem have no comprehension of the willpower and effort required to not drink the 363 other days. So the more I reward the positive change, the more positive change I get. This is the reward progress, ignore setbacks piece that you read about in the book. Yes. What is the science that backs that up?

I mean, you can imagine there are people who are listening who would think that that sounds good, but where's the evidence that shows beyond your own experience that that is something that can help people. So a couple of things, and this is mostly from the work of Dr. William Miller, who's a huge legend in the world of alcohol treatment and research, and he's the founder of Motivational Interviewing.

He did a giant outcome study of treatment in America. One year later, 22 or 25% of people were totally abstinent. So that's, in his mind, a complete remission. The other 75% had a dramatic reduction in drinking, 87% less drinking. He says in any other condition, the 25% total remission and the 87% reduction in drinking is a huge win. But only in the way we view abstinence do we consider that 75% that drank dramatically less a fail. He also did this major study of following people who wanted to moderate their drinking. And what he found was there was a subset of people who were

early in their dependence who were able to moderate their drinking, but he found the vast majority who chose moderation ended up being abstinent or mostly abstinent. Pete How have you seen, I mean, one of the things that you read about in the book is that we love to drink. As a society, we love to drink. How are those attitudes shaped and how does that influence the conversation we have around alcohol use, particularly now in the wake of the pandemic? I think number one, the alcohol industry shapes the conversation and rules how we think about alcohol. And all you have to do is look at anybody's Instagram feed who's an alcohol influencer.

There's millions and millions of people who follow these influencers. The alcohol industry, this is from Dr. Miller's research, has a vested interest in the abstinence movement because early on they figured out if you could view those people over there, those poor unfortunates who can't hold their booze, those are the ones we have to hive off and tell them to never drink again. Those people need to be abstinence. The rest of us can enjoy our booze. Well then the problem isn't the product, the alcohol, it's the humans. And the rest of us think that way, still, without realizing that one-third of adult

Americans drink too much, but don't yet have a dependence, and will suffer over 200 health effects. As long as we let the alcohol industry run the show, that kind of thinking is going to be pervasive. Is that why you have an issue with that phrase, or the word enabler as well? Yeah. That takes the pressure off of the industry and puts it on the individual? And it's so unfair because I still think the treatment industry and the public health system when it comes to addiction is ridiculous because it's-

What do you mean? Well, in no other part of our healthcare system in Canada do we hive off a significant portion of treatment of a serious mental health condition to private industry. People with money can afford it. For the rest of people, there's a long wait. Who is left to navigate the system? Family members and loved ones with no resources who are shamed and called codependent and enablers for fighting for the lives of people

they love. Mike, in addition to your own personal experience, you have a therapy practice and you work with people who are struggling with alcohol use. How has the way that you approach them changed since you became mostly sober? It's changed dramatically, Matt, and for a lot of reasons. But the main one is a kind of model openness and honesty. When I first started doing this work, if there was an episode, right, when I did drink, I wouldn't talk about it, of course. Right? I wouldn't be open about it. And now, when I'm in the midst of starting to work with somebody, I will say, you know, well, I have slips too. I have episodes too of drinking. And there's something that happens then in the dynamic of the relationship, right? There's always a sense of relief. Oh, okay. Where before I wouldn't feel free to do that, right, for obvious reasons. Historically, we get shamed, right?

What do you get back from your clients when you're open and vulnerable like that? I get openness and vulnerability from them. And relief. And relief. That they don't feel like they are somehow unique or broken because you have gone through similar experiences yourself. Exactly, exactly. So it's great that they can still see a professional that has the education, the experience, et cetera, and the credentials and then hear that person be open. Now, I would take a lot of criticism

earlier from other professionals that there's this boundary thing that you need to be aware of and where you're kind of up higher you know higher on the pedestal than than the client. When you change that dynamic those individuals start to get a sense of hope I can do this and the secret is I need to be open. And empathetic. At the core if we can engage with empathy with our loved ones, that opens the door to them trusting us, seeing us as allies and wanting to work with us. What do you see, Mike, as the promise of pharmaceutical treatments for alcohol use disorder? I ask you this because in part, you went, what is it, like a decade ago or so,

you went down to the States to get a drug to help you that you couldn't get here in Canada. Yeah, it was the injectable form of naltrexone that's long-acting and the injection and the medication lasts for a month, right? I found it extremely helpful. I noticed the effects within hours. There was this kind of calming sense and kind of the intrusive thoughts and the urge to drink had really diminished. So when working with clients, I say here's a menu of options that we have and start to introduce them to the different medications like naltrexone and gabapentin and

some of the others. It's a part of the toolkit that we provide and there's lots of science behind it. Maureen, in that toolkit, abstinence still has extraordinary power and weight. And you can imagine there are people who are listening who perhaps have had their own experience themselves or with a loved one. And they've been told that abstinence, it's this entrenched kind of approach to dealing with alcohol use. What would you say to them if they question your questioning of abstinence? I think I would say to them that all of the evidence tells us that there are multiple pathways to having a much greater, healthier relationship with alcohol. And the more that we are open to those multiple pathways,

just like in cancer, we have chemo, we have radiation, we have surgery, we have immunotherapy, we will move more people to drink less. And many of those people, the research says, will end up abstinent. I guess the fear from some people would be that you're, in saying you don't have to quit, back to the title of the the book but also just what we've been talking about is that you open the door to somebody who has worked really hard to to be sober to say you know what well I don't

have to quit maybe I could just I could just have fun. So I think that there's a couple of answers to that. Number one I think we ignore the innate wisdom of most people who have had a drinking problem. Dr. William Miller's evidence again says that there are lots of people who claim to be totally abstinent who slip. They don't tell their AA meetings that, but they told Dr. Miller's research team that. So the evidence tells us the vast majority of those people, they had a drink or two or a night of drinking and then went on for long, sometimes years, without drinking again. The evidence does not say or support

if somebody says, oh, I can go out and have a party, that they're going to have a catastrophic fail. It's the opposite. This is the time of the year when a lot of people are thinking about their alcohol consumption and maybe wanting to start fresh with a new approach. Just finally, Maureen, what would you say to them? I would say there are so many options for you to consider.

And if the first place you could look was the new Canadian guidance on alcohol and health, it actually even instructs doctors to consider a harm reduction approach with their patients. And we need to support our loved ones who want to try to drink less. Mike? For me, it was always about the shame, right, and the secrecy. That is, in my mind, the number one problem. And once we can kind of allow people to be more open and honest about what their drinking is and have that communicated in a very open and effective way. And not feel stigmatized or shamed if, I was going to say if you slip, but if you have

another drink. Yeah. Yeah. It just opens the door up, so to speak, right? Because let me tell you, I lived a life of secrecy and shame and hiding and strategizing and manipulating and doing whatever I could to have my drink yet not get caught, right? Yeah.

Thank you both for this. I mean, the fact that you have this long intertwined relationship that is based around a lot of things, but that you've been long intertwined relationship that is based around a lot of things, but that you've been willing to talk about this openly, I think is really quite powerful, and the book is the latest example of that. Maureen, thank you so much.

Thanks for the opportunity, Matt. And Mike, thank you. Yeah, thank you, Matt. Maureen Palmer is a journalist and author. Her new book is titled, You Don't Have to Quit, 20 Science-Backed Strategies to Help Your Loved One Drink Less. She had help writing that book

with her partner, psychotherapist Mike Pond, who has alcohol use disorder. This message comes from Viking, committed to exploring the world in comfort. Journey through the heart of Europe on a Viking longship with thoughtful service, destination-focused dining, and cultural enrichment on board and on shore. With a variety of voyages and sailing dates to choose from, now is the time to explore Europe's waterways. Learn more at Viking.com. Essential reading for everyone, Health for All is the instant number one national bestseller

by Jane Philpott, former federal minister of health and Ontario lead on primary care. With over six million Canadians lacking basic health care, Philpott offers a prescription for a healthier society focusing on hope, belonging and purpose. Available in hardcover and audiobook, narrated by Jane Philpott. Dr. Evan Wood is an addiction medicine specialist at the University of British Columbia in Vancouver. He is the co-author of Canada's first clinical guidelines for treating high-risk drinking and alcohol use disorder.

Those guidelines were published last year. He's in Vancouver. Dr. Wood, good morning to you. Good morning. What do you make of that idea of the message, you don't have to quit? Wow, it's just such a complex issue, this one. I think it's intentionally provocative

and I really like what Maureen said and that this is meant to be an entry point. Mike and Maureen would be the first to acknowledge this isn't a one size fits all illness, you know, coming from their perspective of the frustration of a sort of abstinence oriented model that as Mike says, does create a sense of shame and can push people away from care, you know, that's hugely, hugely problematic. At the same

time, you know, for others, you know, abstinence is really important and has saved their lives. And so it's really complex, you know, there's, I was thinking, listening to the conversation, there's genetic underpinnings of addiction that some people will have these culprit genes and other people will not. And the strategies for family members, I think is a really important part of the conversation. It's not something that I'm objecting to in any way, shape or form, but I do wanna ensure

that, you know, there is that sense of balance. There's many pathways to getting better for people that are struggling with alcohol problems. to in any way, shape, or form, but I do want to ensure that, you know, there is that sense of balance. There's many pathways to getting better for people that are struggling with alcohol problems. We don't talk a lot about harm reduction when it comes to alcohol use. We talk a lot about it currently when it comes to, for example, the overdose crisis. Why do you think harm reduction hasn't been more commonly used when treating alcohol use disorder? Yeah, there's probably historical, sort outdated models where, blessings to them,

but the sort of founders of addiction medicine, many of them were individuals who were in recovery themselves, who had got better through 12-step models and really were emphasizing an abstinence-only approach. Again, that has a critically important role and so I don't want to diminish that. But then I think there is just the research showing that we need to be pragmatic, we need to be realistic for some people and acknowledge that cutting down on their alcohol use and really it can be a moving target. For others, you know, somebody who drives a truck, a semi-trailer, those types of things may be totally unrealistic. Again, just such a complex issue.

As I mentioned, you are the co-author of the first clinical guidelines for treating high-risk drinking and alcohol use disorder. Until last year, these guidelines didn't exist. And when they came out, you said, in the absence of effective care, people are being routinely prescribed potentially harmful medications that can,

unknown to most prescribers, actually increase alcohol use in some patients. What are you talking about there? Yeah, well, Maureen really made the point that it's crazy that we have the burden of illness with substance use, including alcohol in Canada, and we don't have a functioning system of care. And so people will be struggling and looking for support. They might go to walk-in clinics or their family doctor or frankly, and I say this as a specialist physician, go to a specialist

physician who is prescribing medications, usually antidepressants, but also medications that get used off label. Schizophrenia medications routinely get prescribed to people with alcohol use disorder. And actually, the double-blind placebo-controlled trials that tested those medications often found that people craved alcohol more or drank more alcohol. I think it's just a fascinating evidence-based medicine story and probably has a role of pharmaceutical industry influence, and that those trials were sort of buried in the archives of, you know, medical libraries and not discussed amongst prescribers and not evident in guidelines. And if you went into your average family doctor's office and hopefully this is changing and said I'm trying

to cut down on drinking, my mood is really low, the prescription pad will, you know, immediately come out in so many instances to prescribe the medication that can increase drinking and will do nothing to improve depression symptoms. And if you go back and see that family doctor in a week and say, you know, things aren't really better, what are they gonna do? They're probably gonna increase the dose of the medication that may actually be worsening the situation.

So it's a huge problem in Canada. We do not have a functioning system of care for substance use disorder, particularly alcohol, but all substance use disorders It's um, it's really shameful I mean Mike talked about how he traveled to the States to get Pharmaceutical treatment that that that he says has helped in some ways that wasn't available here. What does that tell you? Well, it's no surprise to me because I work for the publicly funded large regional health authority in British Columbia

That is actually in the city's renovated animal shelter and we have people desperately looking for treatment who are routinely discharged from there to homeless shelters because there's no where for them to go. Even that description that it's in the form, I mean the way that you described it sounds as though it's been pushed off to the side somewhere. It's an orphan discipline that has been sort of the unwanted stepchild within mental health. I'm an internal medicine specialist. I know what specialized health care environments look like. I've had family members who've had cancer. I've worked in those environments and if you're

struggling with a substance use disorder, you know, you might end up at the emergency room and unlike everybody else that's there for a medical condition, Canada, you're much, much less likely to be admitted. And, um, you know, there's very, very few resources for people out there to prevent them going to the emergency department in the first place. It's just a national shame in my view. What is that about? Is that this idea that you do it to yourself and that there's less sympathy perhaps, and because less sympathy, less fewer resources are put into that. What else is going on? Yeah, well, first of all, we all pay for it.

So we should be clear about that, but there's structural issues certainly. And one of them is stigma, but another is a lack of training for healthcare providers in this area, so they don't know what to do. And I've alluded to the consequences of that. There's historically been a lack of therapeutic guidelines.

I'll give as an example, we've legalized cannabis in Canada, which I was an advocate for because I don't think criminalizing the use of drugs is helpful, but we don't have a therapeutic guideline for the treatment of cannabis use disorder when people struggle to cut down or reduce their use of cannabis, the same for stimulant. There's structural reasons for why we're in this mess,

and there's a clear path to get out of it if policymakers are listening. How do you train that next generation of addiction specialists to deal with everything we've been talking about and make them equipped to truly treat people? I think that the majority of care can be provided within primary care, but there has to be an investment

in training for individuals who are providing care, whether that's nurses, doctors, social workers, primary care physicians and specialists in evidence-based substance use disorder prevention, treatment and care. Because we do a lot of things that place people at risk of substance use disorder in this country as well in terms of unsafe prescribing of pain medication or the easy availability of alcohol that's great for consumers, but does increase the prevalence of alcohol use disorder in our society. So there's many levers to pull at

to have a healthier society and we're not reaching for them in the way we should be. Evan Wood, we'll leave it there. It's good to talk to you. Thank you very much. Thank you so much. Dr. Evan Wood is an addiction medicine specialist and clinical scientist at UBC.

As you've been listening to this, what has been going through your mind? Have you or perhaps loved ones struggled with alcohol abuse? This is the time of the year, as I said, when a lot of people are rethinking the relationship with alcohol. US Surgeon General just said that there should be

warning labels on alcohol bottles to talk to people about the health effects of drinking. And as you're listening to that conversation in that context, what are you thinking about? What sort of approach have you tried? What's worked? What hasn't worked? You can email us. The email address is thecurrent at cbc.ca.