From an alcoholic to a moderate user - can it be done?
“It’s either me or the liquor. Choose. He put up a good fight." With this comment from Jussi, who underwent treatment at Contral Clinics, begins an article published by Yle on 18.9.2016. Jussi exchanged a bottle of whiskey for one sauna beer – can a person with alcohol problems survive to become a moderate consumer? The article focuses on Jussi's story from alcoholism to moderate consumption and different perspectives on the topic. The original article can be read here.
Jussi's story towards moderate consumption
Jussi's story begins in a very familiar way for thousands of Finns: alcohol consumption gets out of hand with a major life change, and eventually those close to him demand a change. In the 80s, Jussi was hit by a drunk driver's car and had to take several years of sick leave, during which time alcohol consumption began to increase. His loved ones took notice of this yet his drinking continued for several decades.
Finally, in 2015, Jussi's son told him the tragic words at the beginning of the story and demanded that he choose between liquor and family. Jussi did not blame his son, but knew himself that the time for change had come. However, giving up alcohol altogether was not an option.
Before Jussi decided to switch to moderate consumption, he had heard a story about a friend who had decided to sober up. His friend went to get treatment in Myllyhoito, which requires a complete refusal from alcohol. However, he fell back into alcohol. This is a frequent occurence. Being completely alcohol-free is challenging, especially without medical treatment.
Kaarlo Simojoki, Chief Physician of the A-Clinic Foundation, says that when sobriety fails, shame is often enormous.
The same was true of Jussi's friend, who sadly passed away a year after sobriety treatment. When Jussi decided to make a life change, he still remembered his friend's fate and didn't want to go down the same path.
The alternatives were treatments from Contral Clinics and naltrexone medication. Six months of treatment changed his drinking habits from 13 doses per week to moderate use. Nowadays, days can go by when he doesn't feel like drinking at all. He’ll be able to enjoy one glass, but the following ones no longer taste as good.
The change in alcohol consumption habits has been directly visible in Jussi's life. The relationship with his son has improved significantly and they’re even taking trips together. At the same time, his health has taken off, and Jussi no longer suffers from too many alcohol-related ailments.
To many, this story certainly sounds like a heroic story. It is an exemplary story of how excessive alcohol consumption can lead to normal everyday life. Still, Jussi wants to remain anonymous and hides the matter. Many people do not see the transition to moderate consumption as the right option, which complicates the matter.
Simojoki's comment quoted in the article sums it up well:
"It takes credit away from the thousands of people who have made small changes in their lives. They used to drink a bottle of wine a day, now they only drink a bottle of beer. But society nevertheless deems them as worthless. No praises. All or nothing is required. It's absurd."
Moderate consumption as a solution to alcoholism
Moderate consumption is usually seen as recommended alcohol consumption. This is, for example, one beer a day. If you drink more one night, you shouldn't drink more than five beers.
There are as many as half a million people in Finland who far exceed their moderate consumption, but many of them do not count themselves as alcoholics. They manage their everyday activities reasonably well, from going to work to taking care of themselves. Still, you consume more alcohol than a can of beer a week or an entire bottle of wine in the evening. They are rapidly moving towards health problems, but they are not quite there yet and therefore intervention is seen as unnecessary.
A major problem is that we are often offered the only option to give up alcohol altogether.
As in the case of Jussi and his late friend, this is a massive step that many prefer to ignore and continue to drink or end up giving up. Giving up has been made a great shame in our society, even though it is rarely the fault of the drinker himself. Alcoholism is a chronic disease and, for example, genes can be predisposed to it.
In the article, Yle also quoted Hannu Alho, a physician and professor of substance abuse medicine who worked at Contral Clinics. "But even if you have that condition, it's manageable if you follow treatment guidelines." Like many other chronic diseases, alcoholism can be kept under control with your own lifestyle and medical treatment, even if it can never be completely cured.
Moderate use as an alternative to total abstinence has been talked about for a long time, but it hasn't really been seen in treatments. And especially moderate use through medication is a truly new phenomenon, both in Finland and around the world.
Esti Laaksonen, who defended her doctoral dissertation on the effectiveness of alcoholism treatments in an article, commented on this problem by saying that there is no point arguing about quitting and moderate use, because both are useful and difficult at the same time.
So how can moderate consumption work?
Yle's article tells a little about the treatment Jussi received at Contral Clinics. A half-year treatment, which includes 10 appointments with a doctor and psychologist. Between visits, the rules would be absolute, but still permissible. Whenever you drink alcohol or feel like drinking, you should take medicine first. The purpose of the drug is to prevent the feeling of pleasure that arises from drinking alcohol.
According to Esti Laaksonen, medication as part of the treatment of alcoholism improves the effectiveness of treatment by about 15–25% of those who have tried them. In the past, total absolutism may have been the only and best option, but other treatments are constantly improving.
Drug treatments have been found to help, but they are still avoided. At the time of writing the Yle article, only 2% of those struggling with alcoholism receive medication, but on the other hand, this is not a big surprise, since 80% of alcoholics do not undergo treatment either. New doctors do recommend medical treatment and moderate use, but many doctors of the older generation have been caught with alcoholism, concluding it as an incurable disease. That is understandable, but no longer entirely true.
We as a society should also change our perspective on alcoholism. Full sobriety is no longer the only option, but there are more and more people like Jussi. Those who move from overuse to moderation should be rewarded instead of condemned. The Yle article quoted Hannu Alho well:
"For me as a doctor, it is enough for a person to be able to control their alcohol consumption to a level that does not pose a health risk."