Behavioural Self-Control or Self-Management Training

The behavioural self-control training approach (also called controlled drinking) teaches people to reduce their alcohol consumption and is suitable for people at the less severe end of the dependence spectrum without major harms.  

Identifying and agreeing upon treatment goals is an important process for many patients (see also Chapter 4). For patients with no or low levels of alcohol dependence, and who are not experiencing significant or irreversible alcohol-related harms, a goal of moderation may be achievable. Consumption within current National Health and Medical Research Council (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking Alcohol (2020) (see Chapter 1) can be recommended either immediately or as a medium-term target. Recent evidence provides support that reduction by more modest amounts but at least two of the four World Health Organisation (WHO) risk levels is associated with improvements in clinically meaningful outcomes.  

Note: *Note that WHO Low risk drinking level differs from Australian equivalent due to inclusion of a broader range of adverse outcomes in the Australian analysis.

For patients with severe alcohol dependence, and/or those presenting with associated problems such as organ damage, cognitive impairment and co-existing mental health problems, the most realistic drinking goal is likely to be abstinence. For many such patients, achieving abstinence is associated with a risk of alcohol withdrawal syndrome. If so, this should be managed before longer-term abstinence or reduced drinking can be achieved (see Chapter 8). Limited evidence indicates that people with moderate to severe dependence can successfully moderate their alcohol use in the immediate term, and a period of abstinence (at least 3 to 6 months) is generally recommended before attempting controlled drinking programs. See Chapter 4 for treatment planning and how to work with patients who identify unrealistic treatment goals. 

Behavioural self-management includes: 

• Goal setting 
  • setting the number of drinks to be consumed per day or week 
  • setting the circumstances in which drinking will occur 
• Self-monitoring of daily drinking, including 
  • time, place, and people with whom they drink 
  • number of drinks consumed 
  • how they felt at the time 
• Controlling the rate of drinking 
  • timing each drink and spacing drinks 
  • alternating between alcohol-based and non-alcohol-based drinks 
  • eating during sessions 
• Identifying problematic drinking situations and triggers to drinking. 

Various self-help booklets and resources are available to help patients attempting controlled drinking programs (see Appendix 6).