Sobering Up: The Women exploring the alternatives to AA

In 2008, I went through a stressful cross-country move with my three children as my husband started a new job. At night, I found myself sipping an uncharacteristic third glass of wine to cope with the sorrow of leaving my home of many years. I cut back on my drinking before it became a problem, but my experience made me realise how much alcohol had become intertwined with being a woman today.

I saw it in my new neighbourhood—women who held high-pressure jobs, then downed a bottle of wine at dinner. I met mums who poured Baileys into travel mugs to swig after driving their kids to school. I saw it on TV shows: women hoisting oversized glasses of vino. On Facebook, I found groups such as “Mums Who Drink and Swear” and “Mums Who Need Wine”. I was so struck by the major—but unspoken—role played by alcohol that I spent three years researching the topic and wrote a book, Her Best-Kept Secret.

My observations were borne out by 2011 figures from the Centres for Disease Control that showed binge drinking—consuming four or more drinks on an occasion—was common among women in the US: one in eight women regularly binge-drinks. And as their alcohol intake has increased, so have the negative effects. More women now are getting picked up for drunk driving, and more university-aged women wind up in A&E because they’re dangerously intoxicated.

Epidemiologists say that for many women excessive drinking begins in university, as they match their behaviour to men’s, and continues as they get older. Women today have the means to drink—and the stress that can push them to overdo it. Alcohol may seem like a handy antidote to work deadlines, children’s demands and the challenges of ageing parents. Add to this the fact that twice as many women as men are diagnosed with anxiety disorders, which they often medicate with alcohol, and it’s a combustible mix.

The intoxicating effects of alcohol are higher for women because female bodies contain more fat (which can’t absorb alcohol, causing it to enter the bloodstream) and less water (which dilutes alcohol). Women also produce less of the enzyme dehydrogenase, which helps process alcohol. That means women get drunk faster.

In a study in the early 1980s, one in ten women said yes to the question, “Are you concerned about your drinking?” By 2002, it was one in five. In the past decade, record numbers of middle-aged women have sought treatment for alcohol abuse. Others have gone to recovery groups. For many of them, that’s been Alcoholics Anonymous (AA).

Globally, AA membership is more than 2.1 million people in around 170 countries. But its model has been the same since the 1930s, when it was founded by two men based on their experience with problem drinking. Alcoholism, in AA’s literature, is defined as “a progressive illness that can never be cured”, and the organisation’s goal for its members is “recovery”, which means total lifelong abstinence and adherence to the 12 steps as laid out in its Big Book. In the first of AA’s 12 steps, members must admit their powerlessness over alcohol; in the next step, they must state their belief that help rests in a “power greater than ourselves”.

AA has helped countless people, providing them with structure and community. Some women, though, have sought out newer groups that don’t consider alcohol abuse an incurable illness but rather an unhealthy behaviour that can be changed. Like AA, the groups are free and offer meetings run by peers, but they differ in key ways: people can participate online, the techniques that the groups use are based on behavioural psychology and neuroscience, and they emphasise personal responsibility.

Many women find AA’s attitudes too rigid. Telling them that they have no power over alcohol, for instance, doesn’t go down easily. Women recover more quickly from alcohol abuse when they’re able to take control of their situation, not relinquish it, says psychiatrist Mark Willenbring, a former director of treatment research at the National Institutes on Alcohol Abuse and Alcoholism. “Assertiveness training and empowerment are healing to them,” he says.

Here are some stories of women who rejected the AA orthodoxy for a better solution to their problems.

She began drinking more in 2001 after having her first child. “If I had a bad day, alcohol was my reward after my son was in bed on Fridays or Saturdays,” she says. By the summer of 2002, that reward was a six-pack of beer followed by wine. While she tried scaling back on her own, she says, “drinking less turned out to be hard to do”.

Donna, now 51, got as far as reading AA’s 12 steps, but she was stopped by its demands. She didn’t think alcohol made her life unmanageable, she didn’t feel helpless and she didn’t want to adhere to a lifetime of abstinence. “If you told me I could never drink again, that would be the only thing I thought about,” she says.

Donna read an article about Moderation Management (MM), a secular group founded in 1993 that, like AA, offers a programme that starts with an alcohol-free period. But unlike AA, MM limits the ban to a month and doesn’t require that its members submit to a higher power. Instead, it focuses on self-monitoring so that people can live better lives (which can include moderate amounts of alcohol). Its steps consist of simple exercises such as “write down your life priorities” and “take a look at how much, how often and under what circumstances you drink”.

“MM taught me to pay attention to how each drink tasted and how I felt after it,” says the mother of two. Since 2008, she alternates one month of abstention with two months of moderate drinking (which MM defines for women as up to three drinks a day and no more than nine a week). “It works for me,” she says. “Drinking has become a treat again.”

“I like to drink,” says Jane, 54, who asked that her last name be withheld to protect her privacy. “I like the buzz.”

Losing her job in 2008 led the businesswoman to seek comfort in alcohol. “I didn’t realise how much my identity was wrapped up in work. When I didn’t have it, I was lost,” she says. She liked to have a glass or two of wine at night to unwind, but over 18 months she switched from wine to vodka, polishing off up to a pint in a sitting.

Her turning point came when, she says, “I felt terrible all the time.” She was familiar with AA, but its religious bent and insistence on powerlessness left her cold. “I saw my drinking as a choice,” she says. She went online to research alternatives and discovered HAMS (Harm Reduction, Abstinence and Moderation Support), founded in 2007. The programme’s orientation is more pragmatic and encouraging than MM’s. HAMS “recognises recreational intoxication as a reality and seeks to reduce the harm associated with it”,
according to its website, and it “doesn’t force people to change in ways that they don’t choose themselves”. Members name an objective—safer drinking, reduced drinking or quitting—and craft a plan to get there.

Participating via chat rooms, Jane abstained from alcohol for the required 30-day period. It was a challenge, she says. “I had to learn to enjoy being in my own skin again.” She read books, cooked and played her guitar.

After she reintroduced alcohol into her life, she followed the HAMS suggestions and took notes when she drank. When she reviewed the notes the next day, she saw that she felt good after the first and second drinks but worse after the third and fourth. And although alcohol brought pleasure, Jane realised it kept her from activities that truly made her happy: the guitar and reading. “I still have the odd night when I go over my two-drink limit,” she says, “but it’s rare. I like having access to my brain.”

Fifteen years ago, Ashley Phillips, 59, a women’s health educator and life coach, hit a low. She was juggling two jobs, she and her husband had decided to divorce, and she was worried about being a single parent. “I used wine as my anxiety reducer,” she says, imbibing more than a bottle a night. Ashley spent a month in rehab. She attended AA for two years as part of her out-patient treatment, but she was unsettled by its insistence that she submit her will to God.

She looked for other options and read about SMART Recovery (Self-Management And Recovery Training), which was created in 1994 by mental-health professionals as a science-based recovery group that “teaches increasing self-reliance”. SMART has four strategies: building and maintaining motivation; coping with urges; managing thoughts, feelings and behaviours; and living a balanced life. It urges people to use logic to examine their drinking. When an online facilitator gave her a cost-benefit analysis contrasting her drinking with her ideals, Ashley realised that her consumption didn’t make sense: “Seeing it in black-and-white, I could make healthy choices,” she says. “Now I can deal with stress and frustration without drinking.”

There are many other AA alternatives. Rational Recovery helps alcohol abusers recognise their “addictive voice”; SOS (Secular Organisations for Sobriety) is a network of autonomous, science-based recovery groups.

Some women are seeking pharmaceutical help. Naltrexone blocks the release of endorphins, which create the “high” of drinking. (Naltrexone isn’t the same as disulfiram, or Antabuse, which makes people vomit when they consume alcohol, but isn’t as effective because people stop taking it when they want to drink.) Researchers theorise that when alcohol no longer produces feelings of well-being, as with those who take naltrexone, she “unlearns” the habit of drinking. Since  using it under a doctor’s supervision in 2009, actress Claudia Christian, 48, reports she’s never had more than two drinks in a night.

Still, the vast majority of problem drinkers—male or female—never get assistance. Of course, women who’ve achieved success with AA or other 12-step approaches should continue. But those for whom it doesn’t work shouldn’t blame themselves for failing. When it comes to treating alcohol abuse, society needs to acknowledge what so many studies have found: one size couldn’t possibly fit all. “We have many tools now to help,” says Scott Stern, a New York psychotherapist who works with clients who have drinking problems. “It’s tragic more women don’t know [about them].”