Problematic Drinking and the Harm Reduction Debate

Problematic Drinking and the Harm Reduction Debate

There’s a great deal of debate when it comes to answering the question, “Can a person with a drinking problem reduce how much they drink so it’s no longer a problem?”

I was prompted to write this post after listening to Paul Staley’s perspective on KQED Radio’s April 3, 2015, “With a Perspective” program.  Participates on the program are selected to give a one-minute perspective on a topic of their choice. Paul Staley titled his, “Becoming a Moderate Drinker.” You’ll see why after you listen to it – it’s just one minute long (click on the title).

For the Person Who is Not an Alcoholic – Harm Reduction (Moderating One’s Drinking) Can Work

Lisa Frederiksen explains harm reduction when it comes to problematic drinking.

As this screen shot of a page on the NIAAA website, “Rethinking Drinking,” shows: 1/3 of American adults don’t drink any alcohol; 1/3 of America Adults always drink within low-risk limits; and 1/3 have a problem (the 9% and 19%) figures.

To answer that opening question,”Can a person with a drinking problem reduce how much they drink so it’s no longer a problem?”

The short answer is, “Yes – IF the person is not an alcoholic – meaning that person does not have the chronic, often relapsing brain disease of addiction.”

[Paul’s Perspective explained how he was able to moderate his drinking. He’s also very clear, his approach might not work for everyone.]

If, however, a person is an alcoholic – does have the brain disease of addiction – there is absolutely NO AMOUNT OF ALCOHOL they can consume without triggering their disease (meaning the behaviors they exhibit as a result of their dependence on alcohol).

Surprising to many in this debate is the fact that one-third of American adults don’t drink any alcohol and one-third always stays within “low-risk” limits, which are described in the image below:


NIAAA Defines "Low-risk," aka "Moderate," aka "Normal," drinking in this image.

NIAAA Defines “Low-risk,” aka “Moderate,” aka “Normal,” drinking in this image.

As you can see in the “What’s your pattern?” image above, which comes from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), that leaves only about one-third of American adults who misuse alcohol – meaning, they have a problem with how much they drink.

Now here’s the little understood piece of this last figure.

2/3 of the people who misuse alcohol are not alcoholics (the 19% figure). Yet the behaviors they exhibit can be just as awful as the people who are, which is why people tend to fight to the end to protect their drinking patterns so as not to call themselves an alcoholic, and in so doing, find themselves feeling the way Paul described in the opening of his Perspective.

These are the people for whom moderation, aka harm reduction, aka learning to change one’s drinking pattern to fall within low risk limits, can work. [Note: I got to this image by selecting, “Is your drinking pattern risky?,” and then purposefully inserting high daily and high weekly figures. You can do check your own drinking pattern by clicking here.]

For More Information

This ten minute video of mine, “Alcoholism is a Disease and It’s Not Alcohol Abuse,” shares more on this subject, as does NIAAA’s website, Rethinking Drinking. You will find so much other great information on the NIAAA site, including tips for cutting down, the definition of a standard drink and drink calculators to help you determine how much alcohol is in your favorite cocktail or alcoholic beverage container. This post also has some helpful links and information, “Why Can’t an Alcoholic Have One Drink?

The bottom line is it’s possible for a person to learn to moderate their drinking, but only if they don’t have the brain disease of addiction (alcoholism).

Lisa Frederiksen

Lisa Frederiksen

Author | Speaker | Consultant | Founder at
Lisa is the author of hundreds of articles and 11 books, including "If You Loved Me, You'd Stop!," "Addiction Recovery: What Helps, What Doesn't," and "Secondhand Drinking: the Phenomenon That Affects Millions." She is a national keynote speaker with over 25 years speaking experience, consultant, and founder of She has spent more than 14 years studying 21st century brain research in order to write, speak, and consult on substance use disorders prevention, intervention and treatment; mental disorders; addiction (aka substance use disorders) as a brain disease; adolescent addiction treatment vs adult addiction treatment; effective treatment for co-occurring disorders (having both a substance use and mental disorder); secondhand drinking | drugging; help for the family; and related subjects. In 2015, she founded SHD Prevention, providing training and consulting to companies, public agencies, unions, nonprofits and other entities to address the workplace impacts of employee secondhand drinking and alcohol misuse.

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