The holidays are one of the most challenging times for Melissa, a 49-year-old real estate agent and heavy drinker, whose ex-husband’s family had a troubling relationship with alcohol. “His family were all big drinkers,” she says recalling boozy Christmases, “With them, I’d be the first one to call it a night.”
Melissa (a pseudonym) is now a user of moderatedrinking.com, an evidence-based web application for people who are concerned about their alcohol use but do not want to quit. Many come to the site via Google searches; others have tried the free drinkerscheckup.com, an evidence-based screening and intervention method for alcohol problems that was created by the same research group and is similar to tests used by doctors.“The reason I signed up is that I feel like I’m borderline,” she says, “I feel like I have a good degree of control most of time, but there are sometimes when I don’t.”
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The app provides a way for people like Melissa, who may not be diagnosed with alcoholism, but are worried enough about their habit to self-moderate, to record their actual drinking and to set limits—both in terms of the maximum number they wish to consume per day and the limit for special occasions. The app is entirely based on self-report: research suggests that people can effectively monitor their drinking this way and that heavy drinkers tend to be honest about their consumption in private or in settings where they will not be penalized for telling the truth. While a smartphone version of the app isn’t available yet, it can be used on mobile phones through the web browser.
Users can turn to the app to determine their maximum blood alcohol levels by recording the number of drinks they consumed, the type and time between drinks, along with other measures like gender and weight. To help the drinker meet and maintain her goals, the software also dispenses feedback and tips such as how to identify triggers for heavy drinking and how to slow down the flow of beverages.
On a bad day, Melissa could polish off a bottle of wine on her own— but now she tends to stick to two or at most three drinks on the days she consumes alcohol. And she says, “I do not drink every day.”
After several months of using the site, she has been able to cut back on her drinking, although she still feels she has a way to go. Research on the app’s effectiveness, published in the Journal of Consulting and Clinical Psychology and Journal of Substance Abuse Treatment, showed an average decrease in drinking of about 50% within a year. Such DIY strategies are supported by an increasing number of physicians, and trials into their effectiveness are funded by the National Institutes on Alcoholism and Alcohol Abuse. In fact, as the Affordable Health Care Act goes into effect, primary care doctors are being urged to use the screening and brief intervention tactics on which these apps were based to determine which patients need help with drinking. Like Melissa, the vast majority of people with alcohol problems are not alcoholic and can benefit from simple advice on cutting back.
But for heavy drinkers who might want to take advantage of the app, the data suggests mastering moderation takes time. “No one learns how to do this immediately,” says Reid Hester, research associate professor at the University of New Mexico and director of research at Behavior Therapy Associates, which invented the app. It costs $59 for an annual subscription or around $5 a month, which is donated to the nonprofit Moderation Management support group.
Creating a new habit takes between three and six months, Hester says, “My recommendation clinically is [to try it for] 8 to 10 weeks. Some people, however know after 2 weeks that this is not going to work for them.” In that case, Hester recommends abstinence.
Women seem especially likely to benefit from computer-based approaches. Although 65% of AA members are men, moderatedrinking.com has the nearly the opposite ratio, with 68% female users.
“The shame and the guilt surrounding heavy drinking in women, especially in moms—leads women disproportionately to look for answers or solutions that are anonymous, confidential and can be done in the privacy of their own home, that’s our hunch,” says Hester, regarding the site’s popularity with women.
Another factor may be women’s discomfort with AA’s founding principles. Although the program works equally well for men and women who participate, feminists have long objected to its emphasis on “powerlessness” and “turning our will and our lives over to the care of God as we understood Him,” which are parts of AA’s first step and third step respectively.
Melissa says she once attended meetings of Al-Anon, the 12 step program for people whose loved ones have alcoholism. “That’s not who I am,” she says, “There’s this whole religious fervor even with Al-Anon and I don’t respond effectively that way.”
There’s also the fact that men and women drink for different reasons, and that directly influences which strategies are more appealing when it comes to stopping. “For women, I found that it’s about stress and depression and anxiety,” Gabrielle Glaser, who wrote a book on women and drinking called Her Best Kept Secret, told TIME last year. Melissa, who has an anxiety disorder, says that stress is her primary trigger for drinking.
Glaser also noted that “chockful schedules” drive women’s drinking — something that Hester thinks adds to the appeal of apps. “You don’t have to drive somewhere for a meeting and [you don’t have] childcare issues,” he says.
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For Melissa, the app has helped her to feel more confident about the heavy drinking associated with the upcoming holidays. Having the goals and tips in hand allows her to plan her imbibing in advance, which is one of the keys to moderation. “You need to figure out what you need to do ahead of time as well as at the party,” Hester says, noting that eating first and alternating between alcoholic and nonalcoholic drinks can help. “If you are comfortable with it, tell people there that you’re taking it easy that night,” he says, adding that you can always say that you are driving.
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He also suggests starting with a nonalcoholic drink that looks like an alcoholic one at holiday parties — that way you don’t feel like you stand out and you can appreciate that it’s possible to be social without turning to alcohol immediately.
And if you do overdrink, it’s critical not to beat yourself up. “Everyone makes mistakes while trying to learn new habits,” he says, “To the extent possible, learn from those mistakes rather than taking it as a sign of failure.”