Rethinking

Drinking SM

Alcohol and Your Health

Rethinking Drinking is designed
for U.S. adults who drink alcohol. It
provides evidence-based information
about alcohol and health, along
with tips, tools, and resources for
those who want to cut down on or
quit drinking.
Table of Contents

Rethinking Drinking ������������������������������������������������������������������������������� 2

How Much Is Too Much? ��������������������������������������������������������������������� 3

What’s a “Standard Drink”? �������������������������������������������������������������������������������������� 3
How Many Drinks Are in Common Containers? ������������������������������������������������ 3
What Are the U.S. Guidelines for Drinking? ���������������������������������������������������������� 4
When Is Drinking in Moderation Still Too Much? ������������������������������������������������ 4
What Is Alcohol Misuse? �������������������������������������������������������������������������������������������� 4
What Are the Harms? �������������������������������������������������������������������������������������������������� 5
What Are the Symptoms of Alcohol Use Disorder? ������������������������������������������� 7

Thinking About a Change? ������������������������������������������������������������������ 9

It’s Up to You ������������������������������������������������������������������������������������������������������������������ 9
To Cut Down or To Quit �������������������������������������������������������������������������������������������� 10
Planning for Change ��������������������������������������������������������������������������������������������������� 11
Strategies for Cutting Down ������������������������������������������������������������������������������������� 11
Support for Quitting �������������������������������������������������������������������������������������������������� 13
Evidence-Based Treatment Approaches ������������������������������������������������������������ 13

Appendix ������������������������������������������������������������������������������������������������� 18
Writing a Change Plan ���������������������������������������������������������������������������������������������� 18
Drinking Tracker Cards ���������������������������������������������������������������������������������������������� 19
Resources ������������������������������������������������������������������������������������� Inside Back Cover

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Rethinking Drinking
Do you enjoy a drink now and then? Many of us do, often when socializing with
friends and family.

For anyone who drinks, Rethinking Drinking offers valuable, research-based

information. Letʼs take a look at your drinking patterns and how they may affect
your health. Rethinking Drinking can help you get started.

The first part of this booklet—“How Much Is Too Much?”—answers many

questions about alcohol use. The second part—“Thinking About a
Change?”—offers tips, tools, and resources for people who choose to cut down
or quit. Persistence pays off. Even for people with alcohol use disorder (AUD),
studies show that most do recover.

What is alcohol use disorder?

AUD is characterized by an impaired ability to stop or control alcohol
use despite adverse social, occupational, or health consequences.
It is a spectrum disorder and can be mild, moderate, or severe and
encompasses the conditions that some people refer to as “alcohol
abuse,” “alcohol dependence,” or the colloquial term “alcoholism.” AUD
can cause lasting changes in the brain that make people vulnerable to
return to use. The good news is that no matter how severe the problem
may seem, most people with AUD can benefit from treatment with
behavioral therapies, medications, or both.

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How Much Is Too Much?
What’s a “Standard Drink”?
In the United States, a “standard drink” (also known as an alcoholic drink
equivalent) is defined as any beverage containing 0.6 fluid ounces or 14 grams
of pure alcohol. Although the drinks pictured here are different sizes, each
contains approximately the same amount of alcohol and counts as one U.S.
standard drink or one alcoholic drink equivalent.

8–10 fl oz of
malt liquor or 3–4 fl oz of 2–3 fl oz of 1.5 fl oz shot of
flavored malt fortified wine cordial, 1.5 fl oz of
12 fl oz of 5 fl oz of brandy or distilled spirits
regular beer beverages such table wine (such as sherry liqueur, or (gin, rum,
as hard seltzer or port; aperitif cognac
(a single jigger) tequila, vodka,
(shown in a 3.5 oz shown) (2.5 oz shown) whiskey, etc.)
12 oz glass)

about 5% about 7% about 12% about 17% about 24% about 40% about 40%
alcohol alcohol alcohol alcohol alcohol alcohol alcohol
Each drink shown above represents one U.S. standard drink and has an equivalent amount (0.6 fluid ounces) of "pure" ethanol.
The percentage of pure alcohol, expressed here as alcohol by volume (alc/vol), varies within and
across beverage types. Although the standard drink amounts are helpful for following health guidelines,
they may not reflect customary serving sizes.

How Many Drinks Are in Common Containers?

The table below shows the approximate number of standard drinks (or alcoholic
drink equivalents) found in common containers.

regular beer malt liquor table wine 80-proof distilled spirits

(5% alc/vol) (7% alc/vol) (12% alc/vol) (40% alc/vol)
12 fl oz = 1 12 fl oz = 1½ 750 ml a shot (1.5 oz glass/50 ml bottle) = 1
16 fl oz = 11/3 16 fl oz = 2 (a regular wine bottle) = 5 a mixed drink or cocktail = 1 or more
22 fl oz = 2 22 fl oz = 2½ 200 ml (a “half pint”) = 4½
40 fl oz = 31/3 40 fl oz = 4½ 375 ml (a “pint” or “half bottle”) = 8½
750 ml (a “fifth”) = 17

The examples shown on this page serve as a starting point for comparison. For
different types of beer, wine, or malt liquor, the alcohol content can vary greatly.
Some differences are smaller than you might expect, however. Many light beers,
for example, have almost as much alcohol as regular beer—about 85% as much,
or 4.2% versus 5.0% alcohol by volume (alc/vol), on average.

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Although the U.S. standard drink (alcoholic drink equivalent) amounts are
helpful for following health guidelines, they may not reflect customary serving
sizes. In addition, while the alcohol concentrations listed are “typical,” there
is considerable variability in alcohol content within each type of beverage. To
find out how much alcohol is really in your drink, check out the drink size and
cocktail content calculators on the Rethinking Drinking website.

What Are the U�S� Guidelines for Drinking?

Developed by the U.S. Department of Agriculture and the U.S. Department of
Health and Human Services, the 2020–2025 Dietary Guidelines for Americans
provide recommendations on what the average American should eat and
drink to promote health and help prevent chronic disease. According to the
guidelines, adults of legal drinking age can choose not to drink or to drink in
moderation by limiting intake to two drinks or less in a day for men and one
drink or less in a day for women when alcohol is consumed. Drinking less is
better for health than drinking more. There are some adults who should not
drink alcohol, such as women who are pregnant. Adults who choose to drink,
and are not among the individuals listed below who should not drink, are
encouraged to limit daily intakes to align with the Dietary Guidelines. People
who do not drink should not start drinking for any reason.

When Is Drinking in Moderation Still Too Much?

According to the 2020–2025 Dietary Guidelines for Americans, certain
individuals should not consume alcohol. It’s safest to avoid alcohol altogether
if you are:

▶ Taking medications that interact with alcohol

▶ Managing a medical condition that can be made worse by drinking
▶ Under the age of 21, the minimum legal drinking age in the United States
▶ Recovering from AUD or unable to control the amount you drink
▶ Pregnant or might be pregnant

In addition, certain individuals, particularly older adults, who are planning to

drive a vehicle or operate machinery—or who are participating in activities that
require skill, coordination, and alertness—should avoid alcohol completely.

What Is Alcohol Misuse?

Alcohol misuse, which includes binge drinking and heavy drinking, increases
your risk of harmful consequences, including AUD. The more drinks on any day
and the more alcohol misuse over time, the greater the risk.

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The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge
drinking as a pattern of drinking alcohol that brings blood alcohol concentration
(BAC) to 0.08%—or 0.08 grams of alcohol per deciliter—or more. This typically
happens if a woman has four or more drinks, or a man has five or more drinks,
within about two hours.

NIAAA defines heavy drinking as follows:

▶ For women—four or more drinks on any day or eight or more per week
▶ For men—five or more drinks on any day or 15 or more per week

What Are the Harms?

There is a wide range of short- and long-term consequences associated
with alcohol misuse. For some individuals, any amount of drinking could be
potentially harmful.

Fatalities and injuries. Alcohol-related deaths are increasing in the United

States. Alcohol is a factor in about 25% of suicides, about 40% of fatal burn
injuries, about 50% of fatal drownings and of homicides, and about 65% of fatal
falls. Around 31% of all motor vehicle traffic fatalities involve alcohol. The rate of
alcohol-related emergency department visits increased by nearly 50% from 2006
to 2014, and about one-third of injuries treated at trauma centers are alcohol
related. In addition, a significant number of sexual assaults involve alcohol use.

Why do women face higher risks for alcohol-related consequences?

A growing body of evidence indicates that women who drink are
at increased susceptibility to short- and long-term alcohol-related
consequences, including liver disease, cardiovascular disease,
neurotoxicity, and alcohol-related memory blackouts, compared to men.
One reason for this is that alcohol resides predominantly in body water,
and pound for pound, women have less water in their bodies than men.
This means that after a woman and a man of the same weight drink the
same amount of alcohol, the woman’s BAC will tend to be higher, putting
her at greater risk for harm.

Other biological differences may contribute as well. While alcohol

misuse by anyone presents a serious public health concern, women face
alcohol-related problems sooner and at lower drinking levels than men.
Women who drink are also at greater risk for developing breast cancer
than women who do not consume alcohol.

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Alcohol-related blackouts. Blackouts are gaps in a person’s memory for
events that occurred while they were intoxicated. These gaps happen when
a person drinks enough alcohol to temporarily block the transfer of memories
from short- to long-term storage—known as memory consolidation—in a brain
area called the hippocampus.

Health problems. Drinking is associated with a number of health problems

and can make certain chronic health problems worse. Half of liver disease
deaths in the United States are caused by alcohol, and alcohol-associated liver
disease is increasing, particularly among women and young people. Research
has shown an important association between alcohol consumption and breast
cancer—even one drink per day can increase a woman’s risk for breast cancer
by 5% to 15% compared to women who do not drink. Individuals who carry
certain gene variants associated with alcohol-related flushing (e.g., the ALDH2*2
variant) are at an elevated risk of unpleasant reactions and even esophageal
cancer from alcohol consumption. Research has also shown that alcohol
misuse increases the risk of liver disease, cardiovascular diseases, depression,
and stomach bleeding, as well as cancers of the oral cavity, esophagus, larynx,
pharynx, liver, colon, and rectum. Many people who have had bariatric surgery
feel the effects of alcohol more intensely and quickly, even after drinking lower
amounts of alcohol, than prior to surgery. These effects can lead to greater
impairment and other consequences of drinking, including misuse and a risk for
increased alcohol problems, which can manifest several years after surgery.

Why is being able to “hold your liquor” a concern?

For some people who drink, it takes quite a few drinks to ʿʿget a buzzʾʾ
or feel relaxed, and they may be less likely to show signs of intoxication
compared to others. This is sometimes called being able to ʿʿhold your
liquorʾʾ or ʿʿdrink someone under the table.ʾʾ Often these individuals are
unaware that their bodyʾs lower response to the intoxicating effects of
alcohol isnʾt protection from alcohol problems but instead is a reason
for caution.

These individuals tend to drink more, socialize with people who drink
a lot, and develop a tolerance to alcohol (i.e., it takes more and more
alcohol to feel or act intoxicated). As a result, they have an increased risk
for developing AUD. Someone who misuses alcohol, especially over the
long term, can experience permanent liver, heart, or brain damage. And
all people who drink, regardless of the amount, need to be aware that
critical decision-making abilities and driving-related skills are already
diminished long before a person shows physical signs of intoxication.

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People who misuse alcohol may also have difficulty managing conditions
such as diabetes, high blood pressure, pain, and sleep disorders. And people
who misuse alcohol are more likely to engage in unsafe sexual behavior,
putting themselves and others at risk for sexually transmitted infections and
unintentional pregnancies.

Birth defects. Prenatal alcohol exposure can result in brain damage and other
serious problems in babies. The effects are known as fetal alcohol spectrum
disorders, or FASD, and can result in lifelong physical, cognitive, and behavioral
problems. Because there is no known safe level of alcohol for a developing
baby, women who are pregnant or might be pregnant should not drink.

AUD. Please see page 2 for a definition of AUD. Some signs of AUD are
continuing to drink even though it is causing trouble with your family or at
work, drinking more than you intended, having to drink more than before to
get a desired effect, being unable to stop drinking after repeated attempts, or
continuing to drink despite negative consequences. Signs of AUD may also
include drinking to alleviate negative emotions, such as feeling ʿʿlow,ʾʾ anxious,
uneasy, unhappy, unwell, dissatisfied with life, or other negative emotions that
were caused or worsened by alcohol misuse. Learn more about the symptoms of
AUD below and on the next page. Having any of these symptoms may be a cause
for concern. The more symptoms one has, the more urgent the need for change.

Beyond these physical and mental health risks, frequent alcohol misuse also is
linked with personal problems, such as losing one’s driver’s license or having
relationship troubles.

What Are the Symptoms of Alcohol Use Disorder?

Having even a couple of symptoms—which you might not see as trouble
signs—can signal a drinking problem. It helps to know the signs so you can
make a change early. Doctors diagnose AUD when a person has two or more of
the symptoms listed on the following page. AUD can be mild (the presence of
two to three symptoms), moderate (the presence of four to five symptoms), or
severe (the presence of six or more symptoms).

Note:
The questions listed on the next page are based
on symptoms of AUD in the American Psychiatric
Association’s Diagnostic and Statistical Manual
(DSM) of Mental Disorders, Fifth Edition, Text Revision.
The DSM is the most commonly used system in the
United States for diagnosing mental health disorders.

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See if you recognize any of these symptoms—or others, such as feeling
low, dysphoria, or malaise—in yourself. And don’t worry—even if you have a
symptom, you can take steps on your own or with help to reduce your risk of
AUD and other alcohol-related consequences.

In the past year, have you (check all that apply):

☐ Had times when you ended up drinking more, or longer, than you intended?
☐ More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
☐ Spent a lot of time drinking, being sick from drinking, or getting over
other aftereffects?
☐ Wanted a drink so badly you couldn’t think of anything else?
☐ Found that drinking—or being sick from drinking—often interfered with taking care
of your home or family? Or caused job troubles? Or school problems?
☐ Continued to drink even though it was causing trouble with your family or friends?
☐ Given up or cut back on activities that were important or interesting to you, or gave
you pleasure, in order to drink?
☐ More than once gotten into situations while or after drinking that increased your
chances of getting hurt (such as driving, swimming, using machinery, walking in
a dangerous area, or engaging in unsafe sexual behavior)?
☐ Continued to drink even though it was making you feel depressed or anxious
or adding to another health problem? Or after having had an alcohol-related
memory blackout?
☐ Had to drink much more than you once did to get the effect you want? Or found
that your usual number of drinks had much less effect than before?
☐ Found that when the effects of alcohol were wearing off, you had withdrawal
symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating,
a racing heart, dysphoria (feeling uneasy or unhappy), malaise (general sense of
being unwell), feeling low, or a seizure? Or sensed things that were not there?

If you don’t have any symptoms, then staying within the limits provided in the
2020–2025 Dietary Guidelines for Americans on page 4 could reduce your
chances of having problems in the future. If you do have any symptoms, then
alcohol may already be a cause for concern. The more symptoms you have, the
more urgent the need for change. A health care professional can look at the
number, pattern, and severity of symptoms to see whether AUD is present and
help you decide the best course of action.

Thinking about a change? The next section may help.

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Thinking About a Change?
It’s Up to You
It’s up to you as to whether and when to change your drinking. You don’t have
to wait until you develop AUD or other alcohol-related problems to evaluate
your relationship with alcohol. Even participating in events such as Dry January
and Sober October can offer the opportunity to take a break from alcohol to
understand how it is affecting your life. Other people may be able to help, but in
the end, it’s your decision. Weighing your pros and cons can help.

Pros: What are some reasons why you might want to change your drinking?

☐ To improve my health ☐ To avoid more serious problems

☐ To improve my relationships ☐ To meet my own personal standards
☐ To avoid hangovers ☐
☐ To do better at work or in school ☐
☐ To save money ☐
☐ To lose weight or get fit ☐

Cons: What are some possible barriers or reasons you might not want to
change your drinking?

☐ I’d need another way to unwind. ☐ Change can be hard.

☐ It helps me feel more at ease socially. ☐
☐ I wouldn’t fit in with some of ☐
my friends.

Compare your pros and cons. Put extra check marks by the most important
one(s). Is there a difference between where you are and where you want to be?

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Ready ... or not?

Are you ready to change your drinking? If so, choose whether to cut down or
quit, and make a change plan. Don’t be surprised if you continue to have mixed
feelings. You may need to remake your decision several times before becoming
comfortable with it.

If youʾre not yet ready, consider these suggestions in the meantime:

▶ Keep track of how often and how ▶ Deal with other priorities that may
much you’re drinking. be in the way.
▶ Notice how drinking affects you. ▶ Ask for support from your doctor,
▶ Make or remake a list of pros and a friend, or someone else you trust.
cons about changing. ▶ Review this booklet from time to
time to refresh your memory about
these tips.

To Cut Down or To Quit …

If you’re considering changing your drinking, you’ll need to decide whether to
cut down or quit. It’s a good idea to discuss different options with a health care
professional, a friend, or someone else you trust. Please note, when someone
who has been drinking heavily for a prolonged period of time suddenly stops
drinking, the body can go into a painful or even potentially life-threatening
process of withdrawal. Symptoms can include nausea, rapid heart rate, seizures,
or other problems. Seek medical help to plan a safe recovery. Doctors can
prescribe medications to address these symptoms and make the process safer
and less distressing. Quitting is strongly advised if you:

▶ Have tried cutting down but cannot stay within the limits you set
▶ Have had AUD or now have any symptoms (see pages 7–8)
▶ Have a physical or mental health condition that is caused or being
worsened by drinking
▶ Are taking a medication that interacts
with alcohol Don’t wait for a crisis
or to “hit bottom.”
▶ Are or might be pregnant
When someone is
If none of the conditions above apply to drinking too much,
you, then talk with your doctor to determine making a change
whether you should cut down or quit based earlier is likely to
on factors such as: be more successful
▶ A family history of alcohol problems and less destructive
▶ Your age
to individuals and
their families.

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▶ A history of drinking-related injuries
▶ Symptoms such as a sleep, pain, or anxiety disorder and sexual dysfunction

If you choose to cut down, see the 2020–2025 Dietary Guidelines for Americans
on page 4 and seek advice from a health care professional if needed.

Planning for Change

Even when you have committed to change, you still may have mixed feelings
at times. Making a written “change plan” will help you to solidify your goals,
why you want to reach them, and how you plan to do it. A sample form is
provided on page 18, or you can fill out an online form on the Rethinking
Drinking website.

Strategies for Cutting Down

Small changes can make a big difference in reducing your chances of having
alcohol-related problems. If one approach doesn’t work, try something else.
Below are some specific strategies to try. Check off perhaps two or three to
try in the next week or two, then add others as needed. If you haven’t made
progress in cutting down after two to three months, consider quitting drinking
altogether, seeking professional help, or both.

Reminder strategies
Change can be hard, so it helps to have concrete reminders of why and
how you’ve decided to do it. Some standard options include carrying a
change plan in your wallet or posting sticky notes at home. If you have a
computer, smartphone, or other mobile device, consider these ideas:
▶ Fill out a change plan online at the Rethinking Drinking website, email
it to your personal (non-work) account, store it in a private online folder,
and review it weekly.
▶ Store your goals, reasons, or strategies as notes in your smartphone or
other mobile device so you can retrieve them when an urge hits.
▶ Set up automated phone, smart device, or electronic calendar alerts
that deliver reminders at a time of your choosing, such as a few hours
before you usually go out.
▶ Create passwords that are motivating phrases in code, such as
1Day@aTime or 1stThings1st! The act of typing in your password each
time you log in reinforces the motivational message.

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☐ Keep track.
Keep track of how much you drink. Find a way that works for you, such as
using a small card in your wallet (see pages 19–20 for samples), check marks
on a kitchen calendar, notes in a smartphone or other mobile device, or
notes on paper. Making a note of each drink before you drink it may help you
slow down when needed.

☐ Count and measure.

Know the standard drink sizes so you can count your drinks accurately (see
page 3). Measure drinks at home. Away from home, it can be hard to keep
track, especially with mixed drinks, and at times, you may be getting more
alcohol than you think. With wine, you may need to ask the host or server
not to “top off” a partially filled glass. Drink size and cocktail calculators are
available on the Rethinking Drinking website.

☐ Set goals.
Decide how many days a week you want to drink and how many drinks
you’ll have on those days. It’s a good idea to have some days when you
don’t drink.

☐ Find alternatives.
If drinking has occupied a lot of your time, then fill free time by developing
new, healthy activities, hobbies, and friendships, or by renewing ones you’ve
missed. If you have counted on alcohol to make you more comfortable in
social situations, manage moods, or cope with problems, then seek other
healthy ways to deal with those areas of your life.

☐ Avoid triggers.
What triggers your urge to drink? If certain people or places make you drink
even when you don’t want to, try to avoid them. If certain activities, times
of day, or feelings trigger the urge, plan something else to do instead of
drinking. If drinking at home is a problem, keep little or no alcohol there.

☐ Plan to handle urges.

When you cannot avoid a trigger and an urge hits, consider these options:
Remind yourself of your reasons for changing (it can help to carry them in
writing or store them in an electronic message you can access easily, such
as on a smartphone or other mobile device). Or talk things through with
someone you trust. Or get involved in a healthy, distracting activity, such
as physical exercise or a hobby that doesn’t involve drinking. Or, instead of
fighting the feeling, accept it and ride it out without giving in, knowing that it
will soon crest like a wave and pass.

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☐ Know your “no.”
You’re likely to be offered a drink at times when you don’t want one. Have
a polite, convincing “No, thanks” ready. The faster you can say no to these
offers, the less likely you are to give in. If you hesitate, it allows you time to
think of excuses to go along.

To help you manage urges to drink and build drink refusal skills, see the tools
available on the Rethinking Drinking website.

Support for Quitting

If you think you might have AUD and decide to stop drinking completely, don’t
go it alone.

Evidence-Based Treatment Approaches

Evidence-based treatment approaches (medications, behavioral therapy,
and mutual-support groups) are available to help people stop drinking. One
size doesn’t fit all, however. It’s a good idea to do some research to find peer,
social, and professional support options that appeal to you because you are
more likely to stick with them. You may find that a treatment strategy that
combines evidence-based approaches can be effective for you. For guidance,
visit the NIAAA Alcohol Treatment Navigator® (see page 15) and review current
choices in the booklet Treatment for Alcohol Problems: Finding and Getting
Help. (See also the Resources section on the inside back cover.) Chances are
excellent that you’ll pull together an approach that works for you.

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Peer Support (Mutual-Support Groups)
Consider seeking help from your faith leader or joining Alcoholics Anonymous®
(AA) or another mutual-support group. People in recovery who attend groups
regularly do better than those who do not. Mutual-support groups can vary
widely, so search around for one that’s comfortable. You’ll get more out of it if
you become actively involved by having a sponsor and reaching out to other
members for assistance.

There are many options for mutual-support groups, with AA being the most
common. (See the Resources section on the inside back cover.) Meetings
occur either in person or online and involve participants sharing their personal
histories with drinking and recovery, encouraging progress along “12 steps,”
many of which, but not all, have a strong spiritual component. Because group
dynamics can vary from meeting to meeting, people often visit several meetings
before they find one where they feel comfortable.

Professional Support
Recent advances in treatment of AUD have provided more choices for patients
and health care professionals. In addition to the summary below, you can
visit the NIAAA Alcohol Treatment Navigator® to learn more and search for

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 Feeling depressed or anxious?
It’s common for people with alcohol
problems to feel depressed or anxious. Mild
symptoms may go away if you cut down
or stop drinking. See a doctor or mental
health professional if symptoms persist or
get worse. If you’re having suicidal thoughts,
call your health care provider or go to the
nearest emergency room right away. You can
call or text the 988 Suicide & Crisis Lifeline
or chat at [Link]. Effective treatment
is available to help you through this difficult
time. Information about depression, anxiety,
and other mental health topics is available
from the National Institute of Mental Health.

evidence-based treatment options near you (see the Resources section on

the inside back cover). Evidence-based AUD treatment settings come in many
forms and include:

▶ Outpatient—regular office, virtual, or telehealth visits for counseling,

medication support, or both
▶ Intensive outpatient or partial hospitalization—coordinated outpatient care for
complex needs
▶ Residential—low- or high-intensity programs in 24-hour treatment settings
▶ Intensive inpatient—medically directed 24-hour services, and may
manage withdrawal

Medications to treat AUD. The U.S. Food and Drug Administration has
approved three medications for treating AUD: naltrexone, acamprosate,
and disulfiram.

NIAAA Alcohol Treatment Navigator®

This is a one-stop resource for learning about
treatment, how to recognize high-quality
treatment providers, and how to search several
national directories of treatment programs and
specialists. [Link]

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Naltrexone and acamprosate can help a person quit drinking by offsetting
changes in the brain caused by AUD. Disulfiram works by causing unpleasant
reactions when a person drinks while taking this medication. None of these
medications is addictive. They can be combined with mutual-support groups or
behavioral treatments. See the Resources section on the inside back cover for
more information.

Behavioral treatments. Research has shown that behavioral treatments,

including cognitive-behavioral therapy, motivational enhancement, marital and
family counseling, or a combination of approaches, can be very effective in
treating AUD.

Getting help in itself appears to be more important than the particular

approach used, as long as it offers empathy, avoids heavy-handed
confrontation, strengthens motivation, and provides concrete ways to change
drinking behavior. Visit the NIAAA Alcohol Treatment Navigator® for information
about finding a treatment provider, or see the Resources section on the
inside back cover of this booklet for a list of organizations to help you find a
psychiatrist, psychologist, social worker, or other treatment professional.

16 [Link]
Social Support (Friends and Family)
One potential challenge when people stop drinking is rebuilding a life without
alcohol. It may be important to:

▶ Educate family and friends

▶ Develop new interests and social groups
▶ Find rewarding ways to spend your time that don’t involve alcohol
▶ Ask for help from others

When asking for support from friends or significant others, be specific. This
could include:

▶ Not offering you alcohol

▶ Not using alcohol around you
▶ Giving words of support and withholding criticism
▶ Not asking you to take on new demands right now
▶ Going to a group like Al-Anon

Don’t give up.

Changing unhealthy behaviors such as smoking, overeating, or
drinking too much can take a lot of effort, and you may not succeed
with the first try. Setbacks are common, but you learn more each
time. Each try brings you closer to your goal. Whatever course you
choose, give it a fair trial.

If one approach doesn’t work, try something else. If a setback

happens, get back on track as quickly as possible. In the long run,
your chances for success are good. Research shows that most
people who drink heavily, even those with AUD, can cut back
significantly or quit.

For tools to help you make and maintain a change, visit the
Rethinking Drinking website.

[Link] 17
Appendix
Writing a Change Plan
Even when you have committed to making a change, you may still have mixed
feelings at times. Making a written “change plan” will help you to solidify your
goals, why you want to reach them, and how you plan to do it. A sample form is
provided below.

Change plan:
☐ I want to drink no more than drink(s) on any day and no more
Goal than drink(s) per week. (See page 4 for the 2020–2025 Dietary
(select one) Guidelines for Americans.)
☐ I want to stop drinking.

I will start on this date:

Timing


My most important reasons for making these changes are:

Reasons


I will use these strategies (see pages 11–13):

Strategies


The people who can help me are (list names and how they can help):
People


Signs of I will know my plan is working if:

success 

Possible Some things that might interfere and how I’ll handle them:
roadblocks 

18 [Link]
Drinking Tracker Cards
If you want to cut back on your drinking, start by keeping track of every drink.
Below are two different forms you can cut out or photocopy and keep with you.
(These are also available on the Rethinking Drinking website.) Either form can
help make you aware of patterns, a key step in planning for a change. Try one
form or try both to see which is more helpful.

The four-week tracker card is a simple calendar form. If you mark down each
drink before you have it, this can help you slow down if needed. The drinking
analyzer card can help you examine the causes and consequences of your
drinking patterns.

Four-week tracker
Goal: No more than drinks on any day and per week.

Week starting Su M T W Th F Sa Total

   /  

   /  

   /  

/  

Drinking analyzer

Situation (people, place) Type of Consequence

Date Amount
or trigger (incident, feelings) drink(s) (what happened?)

/ /
/ /
/ /
/ /
/ /
/ /
/ /

[Link] 19
Drinking Tracker Cards (continued)
These are the same cards as on the previous page. If you cut one out of this booklet, you will have the
drinking analyzer on one side and the four-week tracker on the other side.

Drinking analyzer

Situation (people, place) Type of Consequence

Date Amount
or trigger (incident, feelings) drink(s) (what happened?)

/ /
/ /
/ /
/ /
/ /
/ /
/ /

Four-week tracker
Goal: No more than drinks on any day and per week.

Week starting Su M T W Th F Sa Total

   /  

   /  

   /  

/  

20 [Link]
Resources

Comprehensive Resources
NIAAA Alcohol Treatment Navigator®. This is a one-stop resource for learning about treatment, how
to recognize high-quality treatment providers, and how to search several national directories of
treatment programs and specialists. Visit [Link] to learn more.
Treatment for Alcohol Problems: Finding and Getting Help. Search for and download this booklet at
[Link] or call 888–MY–NIAAA (888–696–4222) to request a print copy.

Professional Help
Your primary care or mental health provider. Primary care and mental health providers can
provide treatment for AUD.
Specialists in alcohol-related treatment. Contact your primary care provider, health insurance plan,
local health department, or employee assistance program for information about specialty treatment.
Other resources include:
SMART Recovery®
Professional Associations of Medical and [Link]
Nonmedical Addiction Specialists 440–951–5357
American Academy of Addiction Psychiatry Women for Sobriety
[Link] [Link]
401–524–3076 215–536–8026
American Psychological Association
[Link] Groups for Family and Friends
[Link]/about/apa/organizations/associations Adult Children of Alcoholics® & Dysfunctional
800-374-2721 Families World Service Organization
American Society of Addiction Medicine [Link]
[Link] 310–534–1815
301–656–3920 Al-Anon Family Groups
National Association of Social Workers [Link]
[Link] 888–425–2666
SMART Recovery Family & Friends
Treatment Facilities [Link]/family
NIAAA Alcohol Treatment Navigator® 440-951-5357
[Link]
Information Resources
Substance Abuse Treatment Facility Locator
[Link] National Institute on Alcohol Abuse
and Alcoholism
Mutual-Support Groups [Link]
301–443–3860
Alcoholics Anonymous® (AA)
[Link]/meeting-guide-app (for iOS and National Institute on Drug Abuse
Android smartphones) [Link]
212–870–3400 301–443–1124

LifeRing National Institute of Mental Health

[Link] [Link]
800–811–4142 866–615–6464

Moderation ManagementTM Substance Abuse and Mental Health Services

[Link] Administration’s National Helpline
info@[Link] [Link]/find-help/national-helpline
800–662–HELP (800–662–4357)
Secular AA
[Link]/meetings

For additional resources, visit [Link].

“Sometimes we do things out of habit and we don’t
really stop to think about it. This made me think
about my choices.”
“I thought the strategies for cutting down were
really good. It gives you tools to help yourself.”
These are comments from individuals who drink
alcohol and who reviewed Rethinking Drinking in
focus testing. We welcome your comments as well.
Send an email to niaaaweb-r@[Link]
or call 301–443–3860.
For an online version of this booklet with
interactive features and additional resources, visit
[Link].

NIH Publication No. 23-AA-3770

Updated April 2024