Today I attended a half day training on alcohol use: “Identification and Brief Advice: How to deliver a brief intervention for alcohol users”. Overall, I found it to be very informative, to the point, and highly useful. Sometimes it can be hard to know where the line is between having a drinking problem or not, and how bad that drinking problem may be. And although most of the information delivered today could be quite easily found on the internet, today’s short training put all the essential elements together to form a comprehensive system for assessing healthy and unhealthy levels of alcohol use.
Awareness was the central point today, that if we become more aware of what one unit of alcohol is, and how many units in our favourite drinks, then we are able to know ‘how much is too much’ as well as have an understanding of what alcohol does to our body, mind and our social life; depending on how much, what, and how often. With this awareness we can not only modify our own drinking patterns (hopefully for the better), but also help others change their own drinking habits, to prevent future problems and illnesses related to excessive alcohol use.
We looked at various tools that are used to assess if somebody has an alcohol problem, and how we can use a variety of interventions to approach the alcohol user in a non-threatening and non-shaming way. During which, the trainer consistently referred to alcohol users not recognising that they have a problem, or accepting perhaps that they need to change etc. In Transactional Analysis we call this discounting, a way of not recognising something significant, such as a problem, self, other, seriousness, solvability etc. One piece of Transactional Analysis theory; The Discount Matrix (Mellor and Schiff, 1975) really stands out here, where both the professional and the alcohol user can gain an understanding of which area the discount is being made in (and how), and therefore to work through the various discounts one-by-one, helping the alcohol user to ‘solve the problem’. Here are some examples of discounts:
“What drinking problem?”
“Everybody likes a drink”
“I’ve done it so long it’s part of who I am”
“I can stop if I wanted to”
“I only drink at weekends”
“My Father is 84 years old, it never harmed him”
“I’m too old to change”
Discounting can be done at four different levels:
- The existence of a problem
- The significance of a problem
- The change possibilities
- The ability to change the problem
And at each of these levels, there are three different types of discounts:
This means that there are many ways to discount the self, others, our environment, a situation, a problem, the severity, the effects etc, so the Discount Matrix could help us assess how serious the alcohol problem is, and provide us with guidance for effective interventions, so we are not attempting to resolve the person’s ability to solve the problem, before resolving a discount of the existence of the problem. I am interested to see how this could fit into/with the assessment tools shared today, and if it is indeed useful as a quick assessment tool.
Although this training was aiming at awareness, knowledge, and understanding of alcohol, there were a couple of areas that I thought would be useful to include; underlying causes, and the role of psychotherapeutic services (as opposed to specialised alcohol agencies). With regards to causes, my concern is that alcohol is the main focus, as unhealthy alcohol use is often a symptom, a ‘state changer’, and a person’s good intention to be okay in the world; by focussing on the content (alcohol) the process (avoidance of…) can be missed or overlooked. Consequently interventions can be ineffective and no actual long lasting change is achieved by the alcohol user. Psychotherapy can offer an alcohol user a safe and holding environment to explore any underlying issues resulting in their alcohol abuse, without working directly with the issue of problem drinking. This way of working is non-shaming and non-blaming as their behaviour around alcohol is not the main focus, and experiencing a therapeutic relationship where they are accepted and acknowledged promotes self-confidence, self-esteem, self-worth, and self-value.
Back to the title of this blog post, how much is too much? Do you know how many units you have over the period of a week? Does your alcohol consumption have a pattern? Do you know how many units of alcohol are in a medium glass of wine? or even do you know if your home glassware holds 125ml, 175ml or 250ml of wine? Do you know how many units are in a pint of beer depending on its alcohol content?
Over the course of the next week or so, I will be adding an alcohol awareness page to our website, giving out all the information you will need to assess your own alcohol consumption, know how many units are in various popular drinks, what alcohol can do to your body in the short and long term, and tips for reducing your alcohol intake. I will post in the comments box below to let you know of any updates.
We welcome your comments, questions, stories and ideas.
A brief overview of the Discount Matrix
Claude Steiner – Games Alcoholics Play
Ken Mellor and Eric Schiff – original article on Discounting and The Discount Matrix
Mellor, K. Schiff, E: “Discounting”, Transactional Analysis Journal, V.5, No.3, July, 1975, p 295-302
Schiff, J.L. et al. (1975) The Cathexis Reader: Transactional Analysis Treatment of Psychosis. New York: Harper & Row.