How we collectively adapt to these changes and new stressors remains to be seen. For many of us, alcohol may be a part of our coping strategy.

Most Americans who drink usually do so safely. SAMHSA’s 2018 data show that of 179 million of us who consumed alcohol that year, 112 million did not engage in “binge drinking” (four drinks or more on one occasion for women, or five for men). Before sheltering in place, many of us would simply enjoy a drink to wind down at the end of the day, a couple of drinks at a party, wine with dinner, a nightcap before bed, drinking while watching the game, or a few rounds of shots at happy hour. At the same time, we know that problematic substance use does not impact all sections of society equally, and that incidence and outcomes are worse for people with socioeconomic stressors.

While adjusting to the changes of the past weeks, have you noticed yourself drinking more than usual? You are not the only one. Alcohol sales are soaring, virtual happy hours are a new norm and alcohol delivery apps are a thing. Potential harms range all the way from mild hangovers to impacted relationships or severe health challenges.

Whether you are actively concerned about your drinking habits over the past few weeks or just want to be a more mindful drinker during these challenging times, we want to share some tips for safer drinking that you might find useful. (For more information, check out the book How to Change Your Drinking or the HAMS website. We also have a book of member stories titled Better Is Better.)

Identify how your drinking has changed.

Try to remember what your average pre-coronavirus drinking pattern was. How many days a week did you drink, and how did you decide which nights to drink? How many drinks per occasion? Compare this to your drinking over the past few weeks. Are you drinking more often? More drinks per occasion? If your pattern has changed, ask yourself which factors (emotional, situational, social, etc.) have contributed to this. 

Set clear drinking goals.

You can use the chart below to define “moderation,” or you can set a completely different goal of your own, remembering that “better is better.” Whatever goal you set, make it as realistic as possible: within your budget; not so far from your previous level of drinking as to cause withdrawal; and possible for you to maintain while in close contact with family (who we may be at home with for a long time!), or under the stress of being an essential worker on the front lines of fighting the pandemic.  

This chart from the HAMS website describes drinking and risk levels:

Chart your drinks.

Once you’ve set your drinking goal, chart your drinks, including the time of day when you consume them. Sample charts can be found in Chapter 13: Charting and Measuring, of How to Change Your Drinking.  

Start later in the day.

The later you start, the less time you’ll have to drink before bed. If you find you are likely to want to continue to drink once you’ve had one, the later you start, the easier it will be to stick to your goal.

Build in abstinence days (if this is safe for you).

If you’ve been in the habit of drinking daily—but are not a very heavy drinker at risk of withdrawal—building in abstinence days will help break the body’s craving for alcohol at a certain time. It will also build your confidence that you can go without alcohol if you need to or choose to. Alternating abstinence days with drinking days may be a good way to start.

Take advantage of the change in routine.

Many of us have daily or weekly events that signal us to drink. Coming home from work in the evening calls for a glass of wine. Watching a game calls for a round of beers. The weekend means a bender. But many if not all of these cues will be removed during this pandemic. Take advantage of this to change your own drinking routine. 

Talk back to “If X, then I have to drink” thinking. 

Even during ordinary times, many of us see certain events as reasons why we must drink. Arguments with a partner. Problems at work or lack of work. Sudden changes in our life circumstances. This time will be full of events that seem to require drinking. Who wouldn’t want to numb out the reality we’re facing? To practice safer drinking, we have to talk back to those thoughts.

Break the “if, then” loop by saying: “I always have a choice.” Repeat it over and over again, like a mantra. Speak to yourself in the affirmative—about what you can do—in an empowering voice. There are many things that we can’t control during this pandemic: Whether and how we drink is different.  

If you slip, don’t beat yourself up. Just get back on track!

In HAMS, you don’t “lose” your time because you slip, whether in terms of days of abstinence, moderation or safer drinking. No one should expect perfection. The key is to learn from the slip—what do I do next time X, Y or Z happens?—and get back on track. It might be helpful to try to forget that the slip even happened. Focusing on the negative only reinforces the belief that you are powerless over alcohol: a prophecy that is usually self-fulfilling.  

Get support!

HAMS is an entirely internet-based, worldwide support group for anyone trying to change their drinking. Through our Facebook groups—including HAMS for Women, Alcohol-Free HAMS, and others as well as the main HAMS group—we provide 24-hour support. Whether you are in crisis or just need others to talk with, HAMS is available. Since we have members in every continent, you can find support at any hour of the day or night. 

Communicating with friends and family on the internet can be an excellent source of support as well, but there’s something different about talking with others who share the same issues. We are a non-judgmental organization that supports all goals—whether it’s moderation, abstinence or safer drinking. And we’re always here.  

Photo by Joe Hepburn on Unsplash

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For many, this is an inconvenience. But for extremely heavy drinkers, suddenly ceasing to consume alcohol can lead to dangerous and even fatal withdrawal symptoms. 

Shouldn’t “Alcoholics” Just Tough It Out? 

As we watch this global pandemic claim more lives every day, people who use drugs will be among its victims—due to their higher risk of infection, but also due to disruptions in their drug supplies.

There has been a growing acknowledgment that illicit drug supply chains are already changing. This impacts drug quality and cost for people on the ground, increasing their risk of involuntary withdrawal and overdose. Fortunately, a number of excellent harm reduction resources have been developed by prominent and respected organizations to help drug users to prepare for this change.

But let’s not forget that alcohol is more widely consumed in the United States than any illicit drug. Over of half of Americans over the age of 12 had at least one alcoholic beverage in the past month. Although the majority of drinkers consume moderate amounts of alcohol, roughly one in 10 qualifies as a heavy drinker who might be at risk for withdrawal if cut off from a steady supply.

But where are the harm reduction tips for heavy or dependent drinkers? We hope this piece can offer some guidance.

Who Is At Risk of Withdrawal? 

Not every heavy drinker is at risk for withdrawal, and levels of severity may differ based on gender, number of drinks typically consumed, and how long you’ve been drinking at this level. The following graphics illustrate our estimated 50-50 risk levels of major, mid-level or minor withdrawal according to those three variables:

Graphics taken from the book How to Change Your Drinking, by Kenneth Anderson, via HAMS.

People at risk for serious withdrawal symptoms typically include those who have gotten intoxicated every night for a month or more, those who drink small amounts of alcohol continuously throughout the day for a month or more, or anyone with a history of withdrawal symptoms.

You are in withdrawal if you are visibly shaking, sweating profusely, having a high or irregular heartbeat, or experiencing high blood pressure after you stop drinking. 

For more information, check out this helpful graphic by the Pennsylvania Department of Drug and Alcohol Programs:

Hospitals Focused on the Infected, Not the Intoxicated

We recommend in-hospital detoxification for people in danger of withdrawal. But hospital resources at this time are likely to be focused on caring for the infected, not the intoxicated.

Even if detox beds are available, going into the hospital exposes non-infected drinkers, whose immune systems are already weak, to the danger of becoming coronavirus patients themselves. We also know that the majority (95 percent) of people with alcohol use disorders do not seek treatment.

While detoxification in hospitals commonly involves being given medications called benzodiazepines (Xanax, Valium, Librium, etc.), most of us may not have access to a prescription and it may be especially difficult to get one now.

Fortunately, there is a way to detoxify from alcohol without entering the overburdened healthcare system or requiring prescription meds. It’s called tapering, and it can save the lives of people whose liquor supply has been cut off and who may not seek or receive professional help.

How Do You Taper? 

Tapering uses gradually lowered levels of alcohol to wean the body off of it over an extended period of time.

Fortunately, even though liquor stores are closed in the state of Pennsylvania, beer is still available in grocery and convenience stores, so you should make sure to stock up before you implement this plan. Based on our experience, it is actually best to taper with beer, since attempting to taper with wine or liquor can easily lead to getting drunk again.

Tapering, if that’s your goal, should be done with the aim of avoiding withdrawal, not getting intoxicated. So drinkers should consume only as much beer as is absolutely necessary to hold off shaking and sweating.

If you have been drinking more than 20 standard drinks a day throughout the day, we recommend that you start with one beer per hour, beginning when you wake up in the morning, for a total of 16 beers the first day. (However, if you notice yourself experiencing any signs of withdrawal during this time, then you may want to have a few extra beers on hand.)

On the second day, try drinking one beer every hour and a half, for a total of 10 beers in the day, if you can. Then continue to taper down by reducing the amounts by two beers per day until you are down to zero.

If you have been drinking less than 20 standard drinks per day, you can try to reduce your total number of drinks a day by two standard drinks per day. For instance, if you’ve been drinking a total of 12 drinks a day, you might want to try to drink a total of 10 beers on the first day of the taper, eight the second, and so on.

You should bear your other health circumstances in mind when deciding on the speed of your taper. A younger, healthier person may prefer a relatively fast taper; an older person with other health conditions may well need to take it slowly. More detailed information about tapering can be found here.

You Are Not Alone

For people who drink very heavily, going cold turkey can be life-threatening. Tapering provides a safer way to eliminate the physical need for alcohol, even while sheltering in place. 

Remember that “social distancing” should not mean that you are isolating from social contact, and you can take advantage of online support to help you meet your goals. HAMS (Harm Reduction, Abstinence and Moderation Support), which we operate, is a non-faith-based, worldwide internet support group that supports all drinking goals, from abstinence to moderation to safer drinking.

Photo by Marco Chilese on Unsplash

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