Transcript: MindDive Episode 83
Title: Thinking Differently about Drinking
Guest: Dr. William R. Miller
Distribution Date: Monday, October 19, 2026
Dr. Bob Boland:
So we're delighted today to have psychologist Dr. William R. Miller. Dr. Miller has spent more than 50 years studying what makes people change their attitudes and behavior, with a particular focus on addiction and the psychology of change. In 1976, Dr. Miller and psychologist Ricardo F. Munoz co-authored How to Control Your Drinking, challenging the idea that people who struggle with drinking needed to rely solely on professional treatment. Fifty years later, they have returned to that work with their new book, Rethinking Drinking, a guide offering a fresh look at understanding relationships with alcohol. Along the way, Dr. Miller spent 30 years as a clinical psychologist at the University of New Mexico, where he retired as Emeritus Distinguished Professor of Psychology and Psychiatry. He's also a pioneer of motivational interviewing, an approach that helps people find their own motivation to change, which is what we talked about with him. By the way, this is a second time of having him as our guest. That's what we talked about last time. So, in this episode, Dr. Miller joins us to talk about rethinking drinking, what we've learned about alcohol consumption over the past 50 years, and what that means for making informed choices. So welcome back, Dr. Miller.
Dr. Kerry Horrell:
Yes, thank you for coming back.
Dr. Bob Boland:
Thanks so much.
Dr. William R. Miller:
Glad to be here.
Dr. Kerry Horrell:
I'm currently helping with a class for some PhD students on health behavior change. And it's like we're not solely reading your work on motivational interviewing, but it is a large part of it. So, I was kind of humble bragging that I get to talk with you yet again about your work.
Dr. William R. Miller:
Yeah. Okay.
Dr. Kerry Horrell:
Well, why don't we get going with what, as we kind of alluded to in the bio, talking about what prompted you and Dr. Munoz to write this book. I'm particularly interested in if there were changes you noticed societally as well that sort of made this book feel timely.
Dr. William R. Miller:
Yeah, as you said, our first book appeared in 1976. And it was time to just think about whether we wanted to do a new book. And as we looked at what's been happening with alcohol in our society, there have been so many changes. The most recent Gallup poll found that only 54% of people say they drink alcohol at all. That's the highest proportion of people not using alcohol in 90 years. When we began doing this work in ‘76, alcohol use was just so much more prevalent. You almost expected it was just a part of social occasions. Average alcohol consumption was much higher. And it peaked about 1980 and has been decreasing ever since. So, it's also at a very low rate and particularly among younger people-- they're just not using alcohol the way previous generations did.
Dr. Bob Boland:
Yeah, I was going ask about why you thought that was. And I imagine it is a generational thing. We certainly noticed it, I think.
Dr. William R. Miller:
Well, I think we're just much more conscious of the health effects of drinking. When you go to your doctor now, the doctor asks about smoking, yes, but also asks how much you're drinking. It's just recognized as a risk factor in health. And I think people are so much more aware of that now. And younger generations, you know, may be much more health conscious also and so just aware of anything that may be jeopardizing health. And that's a substantial change. The three-martini lunch was pretty normal back in the 70s.
Dr. Bob Boland
Hard to imagine.
Dr. Kerry Horrell:
No, no one wants to go with your therapist after three martinis.
Dr. William R. Miller:
Exactly. That's right. So what was expected and normal in drinking that long ago is just dramatically changed.
Dr. Bob Boland:
Oh well, yeah, so I mean your book is named something really important, you know. Not everyone who drinks needs to stop drinking. And you know, I think that's still kind of controversial in our field. And I don't know, do you think so? Or what's the prevailing sense about that now?
Dr. William R. Miller:
Well, in a way, what we think doesn't matter because people make their own choices anyhow.
Dr. Bob Boland:
That's a good point.
Dr. William R. Miller:
So we just honor people's choice and their right to make that choice. And this book really is about just making the right choice for you and it's expanded from where we started. When we first wrote this book in ’76, we were mostly working with people who clearly drank too much. I mean, they were, as I recall on average, having 40 standard drinks a week.
Dr. Kerry Horrell:
That’s a bit.
Dr. William R. Miller:
Which now seems like quite a lot. Now people are asking: Do I want to drink at all? There have been several books about this of, you know, what are your motivations for drinking and is it important in your life? And so this book also addresses that. If you're thinking about: Do I want alcohol to be part of my life? Or why am I drinking? You know, do I want to do that at all? You don't have to have a problem with alcohol or be drinking too much; it's just a question of whether you want this to be part of your life. And so Rethinking Drinking does both things. We've got 50 years of research helping people to reduce their drinking if they're drinking too much, but now we're also helping people think about ‘Do I want to drink at all? When and why am I drinking?’
Dr. Kerry Horrell:
That does feel like such a necessary part of our conversation in the field, because my sense is that it's felt a bit binary. You don't have a problem with drinking, so you don't need to think about it at all. Like if it's not become the level of problematic, no need to even have a thought about it. Or if it's problematic, you need to choose abstinence. You need to be in AA or you need to be in some other program, and it needs to be out of your life if it's hit the threshold of problematic. And sort of, I think anything in between, whether that's inviting anyone to think about, well, what's your relationship with alcohol? And do you want to be intentional about that? And then also inviting people who maybe again are starting to have a problem and thinking, well, this is becoming a habit. Is there more nuance than just saying you need to be in AA or you need to be in a program similar and be abstinent? So my sense is that this is a necessary and really destigmatizing and kind approach to be like everybody could think about this, and we invite you to be thoughtful about this.
Dr. William R. Miller:
Well, that binary thinking that you're talking about actually emerged after prohibition.
We had a period of 14 years when alcohol was totally illegal. and up to that time, actually, public education about alcohol was “this is was a really dangerous drug. No one can use it safely.’ That was the belief at the time and ‘if you do drink, you're going end up in a very bad place.’ And then suddenly it was legal again, and everybody can have it. And so we've got a massive national case of cognitive dissonance. We know this is a dangerous drug, and it's okay. What do we do with that? Well, what we did with it was to conclude ‘Oh, it's only certain people who are at risk if they drink alcohol. If you're an alcoholic. And if you're an alcoholic, then you shouldn't use alcohol at all, but leave the rest of us alone. Otherwise, if you if you're not alcoholic, you can drink whatever you want.’ And it's fine. You drink with impunity. Well, we now know that's not true. That health risk is directly related to the amount that you consume. And in fact, the old belief that a moderate amount of drinking is good for you, helps your health, is now being seriously questioned.
Dr. Bob Boland:
Well, I'm glad you brought that up because I certainly like earlier in my career, thought those were the healthiest people. The sort of feeling was the people who had a moderate, you know, amount of alcohol who sort of had a quote, “healthy relationship with alcohol” were the healthiest. Whereas, you know, there were obviously people who drank too much, that was a problem, but we weren't quite sure about the people who drank nothing either. And well, how normal that was.
Dr. Kerry Horrell:
And I think I'm obviously a bit younger. I still have heard the myth that's like a glass of red wine a day is good for your heart.
Dr. William R. Miller:
Sure. Yeah. Right, right. Well that just doesn't seem to be true.
Dr. Bob Boland:
Unfortunately, It hasn't held up as much as we wanted to.
Dr. William R. Miller:
It is true, however, that people who are moderate drinkers tend to be healthier than people who are non-drinkers. However, there are all kinds of reasons why people don't drink.
Dr. Bob Boland:
I imagine that's a proxy, though, right?
Dr. William R. Miller:
Exactly. It is that, but also why do people not drink? Well, that includes people who have had serious problems with alcohol and decided to quit, people who are sick, people who are taking medications. There was one study looking at of 30 cardiovascular risk factors, non-drinkers were higher on 27 of them than moderate drinkers were. And it doesn't seem to be because of the alcohol.
Dr. Kerry Horrell:
That's a great example of correlation does not mean causation, because people who don't drink probably have a lot of good reasons for that.
Dr. William R. Miller:
Yes, yeah. But the alcohol industry was a big supporter of the belief that drinking is good for you. And of course, alcohol advertising looks like that. If you look at alcohol ads, people who drink are happier, healthier, richer and more successful sexually and all kinds of things.
Dr. Bob Boland:
Yeah, way more social.
Dr. Kerry Horrell:
Tanned on the beach, you know.
Dr. William R. Miller:
Oh, they're amazing. Yeah.
Dr. Kerry Horrell:
I will say I'm really glad that I feel, in my generation, we're seeing that if I'm out with my friends or I invite somebody over, and I offer them a glass of wine and they say, ‘Oh no, I don't drink,’ it does not feel like there's a vibe of ‘Oh, you must be an alcoholic.’ Because I feel like for a while that was the vibe that, if you don't drink, you have a serious problem with it.
Dr. Bob Boland:
You must have a problem.
Dr. Kerry Horrell:
And I feel like now it's just some people don't drink. And that's totally, and again, it's like, okay, cool. Can I get you a seltzer instead? Like it feels way less stigmatizing than I think it used to be, even a decade ago. I wonder if that's your sense.
Dr. William R. Miller:
Well, sure. I mean, not drinking is very normal now. It's half the population that basically doesn't drink. And so in the 70s, if you didn't drink, people wondered what's wrong with you. Or you know, you had to explain why you didn't drink. My co-author, Ricardo Munoz, is an abstainer by choice and has been for 50 years. And early on, people had to ask, ‘Well, why are you not? What's the matter with you? Why are you not drinking?’ That just doesn't happen much anymore. And restaurants now routinely have alcohol-free drinks. It is just as expensive.
Dr. Bob Boland:
I know, yeah. Mocktails are a big thing at all the area bars here. Yeah.
Dr. Kerry Horrell:
When I was pregnant, I was so glad almost everywhere I went they had they had lovely alcohol-free drinks to choose from.
Dr. William R. Miller:
Yeah. Yeah. Alcohol free different wines and beers ---they're very accessible now. Yeah.
Dr. Bob Boland:
Oh yeah, yeah. Big industry in beer. But you know let's talk about when it does become a problem.
Is there a particular threshold that you're looking at? I suppose this… I suspect you're going say no, but you know is it, I imagine, it's more complicated than that, but how, if a person doesn't really know if they have a problem yet with drinking, how do you help them understand that?
Dr. William R. Miller:
Well we actually built into the book something we call ‘the drinker's checkup’ which is how can you figure out whether you should be concerned. Now, one thing is total amount, because health risk is directly related to that. There's been a guideline around that women should have no more than one standard drink a day and men no more than two. It now looks like that's way too much even, but we've had those limits. At least don't go above this amount. The one that's obvious is when alcohol is harming you. When it's doing harm to you or the people around you. In between is risky drinking, where the amount that you drink overall, or the amount that you drink on a particular occasion, is enough to put you or the people around you at risk. Or just the situation -- in some situations any amount of alcohol is unsafe. If you're flying an airplane as a pilot, you're expected that your blood alcohol level is zero and that's what the passengers on the plane would like also, yeah.
Dr. Bob Boland:
And there's a long period of time where they can't have drank before regardless.
Dr. William R. Miller:
That's right and there are good reasons for that. Sure, if you're having surgery you want your surgeon to not have any alcohol on board. You know indeed the only safe level of alcohol when driving is zero. Yeah, we have these blood alcohol limits, but it's clear that even at those limits, people are impaired. So the limits are way too high. Other countries have lower ones. California, for young people, has a 0.01 limit. Basically, no alcohol at all . And really the best guideline-- the only safe guideline-- is no alcohol in your system at all if you're operating a motor vehicle. Just as we want for our surgeon or our airline pilot, there are situations in which any drinking is foolish, but we underestimate that risk consistently. And for a long time, particularly back in the 70s -80s, drinking and driving was pretty much accepted. Not drunk driving, so as long as I’m not drunk, then it's okay. But no. it's not okay. You're still impaired even at low levels.
Dr. Kerry Horrell:
And what I wonder are what are some of the things you might encourage people to think about on the emotional side of the coin where maybe their drinking has become a part of their emotionally coping life or how again maybe they're just drinking a couple times a week, but they're starting to feel like I'm doing this for reasons of emotional coping. I wonder what are some signs to look for on that side of the coin?
Dr. William R. Miller:
Well, that's something else we built into this edition: ‘what are the reasons for drinking?’ The most common reason for drinking is enjoyment. I just enjoy the taste of a glass of wine. That's true for me. I enjoy a good glass of wine, not the enjoyment of being drunk , that's a different matter. But it's just a pleasant thing to do. Or relational factors-- other people around me drink, I drink to be with them. I drink to be just a part of that, drinking in order to socialize, in order to feel comfortable, which some people do. I’ll have a few drinks, then I can dance better. Then I feel more comfortable talking to people and so on.
Dr. Bob Boland:
Now you're getting into ‘you sing better’…oh yeah absolutely….
Dr. William R. Miller:
Or at least you remember that you sang better. Hopefully no one recorded it. But the drinking to socialize then enters into the category of drinking for relief…to feel more comfortable. To feel less depressed. To forget about things that you don't want to think about. And another step up the level is drinking to be drunk that what you're looking for is to be intoxicated and find that pleasant state of events. And then at the very top of the scale, drinking because it's necessary that, if you don't drink, you're uncomfortable. You're perhaps having alcohol withdrawal and drinking in order to stave that off, so if it's uncomfortable not to drink, that's the top of the reasons. So that the further up that reason scale you go, yeah, the more people tend to be drinking and the higher the risk that they're going to run into problems with alcohol. So why you drink is a definite issue too and if it's drinking so that you can enjoy, or so that you don't have to think about things, or so that you don't feel certain things, then you're really getting into risk. And of course, drinking in order to be drunk or drinking because you're uncomfortable not drinking, those are the highest risk categories.
Dr. Bob Boland:
Which is an interesting way of thinking of it. I have to say, early in my training questions about why you drank were more or less discouraged. It was kind of like: Well people don't know why they do what they do. What we really just want to know is the amount.
Dr. Kerry Horrell
Let's not poke that nest…
Dr. Bob Boland:
Yeah exactly. Like no one knows why they do anything and so it's just a matter of, you know, let's just get the amounts that they drink, and the patterns, and that will tell us what we need to know. Which seems like a pretty blunt way of thinking about it now.
Dr. William R. Miller:
Yeah. Now we know it matters and, sure, we probably should talk about tolerance. People with high tolerance may say alcohol doesn't affect me as much as other people. I can drink other people under the table.
Dr. Bob Boland:
Sure, I can still drive…
Dr. William R. Miller:
Yeah, exactly right and what they're saying is they don't feel the effects of intoxication. Now in fact the alcohol is still present. It's still doing the damage that it would do to anybody else, but the person doesn't have any sense that it's there. I treated people for whom the first indication that they drank too much was they stumbled when they got off the barstool. I mean that's their first clue and that's a pretty high blood alcohol level. So, tolerance for alcohol is partly hereditary and partly a matter of practice, practice, practice. The more you drink, the higher your tolerance is for alcohol and the less you feel it and the less it's obvious in your social behavior. So, you can look reasonably sober to other people, but you're not. That's the point-- and alcohol is present in the body and doing its cellular damage even though the person is not feeling it. So, the analogy I use is it's like having a house without a smoke alarm. There's no warning sign there. You can drink and not feel it and that's bad news actually.
Dr. Kerry Horrell:
Yeah, that's a great analogy…
Dr. William R. Miller:
You're much more likely to develop alcohol problems if you have a high tolerance to alcohol, so it's not a safety factor, it's a danger factor. It's a primary risk factor.
Dr. Kerry Horrell:
When I was in college I studied abroad in Dublin, Ireland and, without hoping to be too stereotypical of the Irish people who I adore and love, the culture there is to drink and to drink a lot. I was 20 at the time, so I had not been drinking when I was before this. Anyways, we drank a lot that semester. I remember I came home from that semester, and I turned 21 and I would go have some drinks with my friends and I noticed I don't feel anything with a few drinks. That was one of the first times I might think my parents talked about it. They're like, ‘I think when you were in Ireland you developed a tolerance and that is a bad sign. We should chill out.’ I was like good point… a good lesson for all college students to remember if there are huge cultural differences.
Dr. William R. Miller:
I talked about my research where the average drinking of the people that we were treating was 40 drinks a week. I presented that research in Scandinavia and they said: Where did you find people who drink so much? Oh, my word,’ and I presented the same thing in Ireland and they said: ‘Well what's the problem?’
Dr. Kerry Horrell:
Exactly. Well, you know another question we were thinking about is that, and this happens I think both in our field as clinicians but also just culturally, which is the idea that if it seems like somebody has developed or they're developing some problem with drinking, and they don't want to stop or they're not interested in full abstinence, then they just must be in denial. And I wonder if you know if we're thinking about that side of the coin or this kind of side of the spectrum of people who maybe have developed a habit that's not healthy and that they want to look different. Is abstinence the only choice and, if that's not what they see, are they in denial?
Dr. William R. Miller:
Well, that's partly why we wrote this book in the first place in 1976 and the research I was doing early on was to work with people who wanted to moderate their drinking. The people who came to our clinics clearly were drinking too much and they didn't want to quit drinking. They wanted to moderate their drinking and we said: ‘Okay, let's give it a try.’ And we developed a method for helping people to moderate their drinking. What we found interestingly over time was that more people who came to our clinic wound up quitting drinking than drinking moderately. I thought that would happen because they would try to moderate their drinking and fail and therefore conclude logically, they have to not drink. I don't remember a single case where that was what we saw.
Dr. Bob Boland:
So that's not the case.
Dr. William R. Miller:
Instead, they'd moderated their drinking. They mean on average cutting it in half, and what folks who were going to abstain said to us at that point was: ‘This is really hard. I'm hanging on and it's like walking tightrope and it's just difficult for me to drink a little. And what's the point in drinking so little? I'm working really hard here for nothing, you know, I might as well quit.’ And they did. So, people who had that experience of it being difficult to moderate, and they wanted more, the logical choice for them was to abstain and that's what many of them did. Others did maintain moderation over long spans of time, and that that was fine too. And others did not succeed either in moderating or quitting, so we had the usual mix of outcomes. But some people who have been drinking too much do drink moderately over time. And we even learned that we could predict who would be able to moderate their drinking with our program. And it was the more severe the alcohol problem was to begin with, the more likely it was they're going to wind up quitting. And the less serious the dependence and problem, the more likely it was that they would be able to moderate their drinking if they chose to do so. In a way, that fit into the idea at the time that if you're an alcoholic, you can't moderate your drinking. We found something like that the more developed the alcohol problem and dependence was, the less likely it was that people would wind up moderating. But part of that was it just didn't make sense to them to drink so little.
Dr. Kerry Horrell:
If I wasn't drunk, what am I doing?
Dr. William R. Miller:
Yes, and if that was their experience, then they said, ‘We might as well quit’ and they did.
Dr. Kerry Horrell:
I've had a good handful of patients…more than that…a significant amount of patients who describe: ‘If I have one (drink), I'll have 10 and then, once I'm on that train, I just don't feel like I have that capacity. Once my inhibitions are even a bit lowered or I've given in that I'm going drink, it's gone.’ Whereas again, I do feel like I've had patients who, they've developed at times a relationship to alcohol because they're going through a stressor or they're recovering from a trauma, and they've started to use alcohol. And as they've recovered from the stressor or the trauma, they have been able to reintroduce alcohol in their life like having a glass of wine at a dinner party and it not feel like ‘Oh now I have to drink a lot.’ So, I do feel like there's people who can manage in different ways. There's not a one-size-fits-all.
Dr. William R. Miller:
What doesn't work well, if someone says ‘I want to moderate my drinking’ is to say ‘You can't do that. You have to abstain.’ Because then you're putting up a barrier and they naturally respond to that defensively. Now in the 1970s we believed that people who had an alcohol problem or were alcoholic or drug addicted had this strange personality where they overused denial and they're terribly defensive and so forth. It turns out that was because of the way we were treating them. The treatment at the time was very authoritarian. It was not unusual to say to a patient with alcohol problems, ‘Sit down. Shut up. I'm going to tell you what's wrong with you and what you have to do because you can't see reality.’ Well, guess what, human beings don't respond well to that way of being talked to and they naturally become defensive. And the question was why are all these patients so defensive? It must be something about their personality. It was a reaction to the way in which we were talking to them.
Dr. Bob Boland:
Yeah. I mean to me the saddest part, too. is that at a lot of treatment centers, if you lapsed during the treatment and came and admitted that you had a drink the night before, they would discharge you from the program because you failed or failed some contract …something like that.
Dr. William R. Miller:
We don't do that with diabetes or cancer. We figure out what needs to be changed in the treatment plan and adjust it. But we did have that shaming business and just the very idea of relapse is adding shameful baggage to what's just behavior and very normal. I mean it's very normal for us as human beings to kind of go back to what we were trying before that used to work and try it again. And it still doesn't work. You know that's not unusual at all, but we put lots of moralistic baggage around it and that, of course, creates
Dr. Kerry Horrell:
I was going say, and I think that's still very much lingering ,you know, as someone who works quite a bit with young adults, I think in talking about alcohol use, a lot of times they don't even want to get into it at all because they're like ‘you're just going tell me that there's no other option but stopping drinking and I don't know that I'm going want that.’ And it's like there's already an expectation that as they're coming into mental health treatment, they need to just be on board a hundred percent with any sort of abstinence. And again, I'm not suggesting that like that's never the case. I've worked with plenty of people who we'd be really concerned about them leaving treatment and drinking. That would feel very concerning to us based on their history and where they're at in their own recovery. But again, I think that approach of saying ‘We're here to talk with you and think with you and to hear about your values and your preferences and to try to help make a plan,’ I think that frees people up. I think something I really appreciate about your book is that it is not stigmatizing, it's not judgmental. It's saying ‘Hey, let's think about this. Let's open up a conversation within yourself to be around what do you want and where are you noticing that this is not what you want, and how then how is there support to help you get to that place that you want?’ Because again, I do I think when people feel like, if I talk about this at all I'm just going be judged. And I'm just going to have to fall in line, then people aren't going to want to talk about it or explore what does this mean for me? Why do I reach for this in those moments?
Dr. William R. Miller:
So yeah, well, that that's what our book is for…we just offer it as an option. One of the surprises in our research was that early on we had a control group in our treatment program. Some people saw a counselor right away and were being treated but we had a control group who were given this book and sent home to work on their own. And we said we'll see you in two months and see how you're doing. What we found in four different randomized trials was that people going home with the book had just the same rate of success in changing their drinking as those seeing a counselor. Now we had some counselors whose success rates were higher than that. And we had some counselors for whom the patient would have been better off going home with a good book actually. Bun on average, people could be as successful working on their own with the book as working with counselors in general. So that just was replicated over and over again. So, we have good data that. This book can help people to make changes in their drinking on their own. You can send them home with it.
Dr. Kerry Horrell:
What a cool thing. I imagine though, I could be wrong about this, that there's not that many books I can say like ‘our book is evidence based’ like ‘utilizing our resources evidence-based, that's pretty cool.
Dr. William R. Miller:
Yeah no, that's true.
Dr. Bob Boland:
Yeah, I mean as we're getting near the end, I just did want to hear a little bit more about some of the other techniques that you use during therapy and treatment and what you found helpful for people who are struggling with this.
Dr. William R. Miller:
Yeah, well early on to set goals and one of the things that sometimes people do on their own is just try to set a clear limit for themselves. And how do you do that? Well, we have several ways of doing that. Maybe it’s just the overall amount…where do you want to limit your drinking in terms of the total amount you're going to be drinking. But then also per occasion. So, we teach people how to figure out what their blood alcohol level is going to be with certain amounts of drinking. And if you have tolerance, you just don't have a sense of that. But you can do it by the book. You can literally say: ‘ if I have two drinks in this period of time, this is what my blood alcohol is likely to be, and I want to keep it under that level.’ So, helping people set clear goals for themselves was a first step. Keeping track. We had people record their drinks and the rule was: before you start your drinking, write down what it is, how much it is, what time it is, so just like when you're trying to lose weight, you may track the calories and so forth. So, tracking the amount of alcohol you drink. And we always said in the first week to people keeping those records: ‘Now you don't have to change your drinking this week, just keep good records.’ But on average drinking dropped one third in the first week of keeping records. And people told us why. ‘I got out the card and then I thought: Well do I really want another drink? I already had a couple.’ You know, there's a reactive effect of doing that. We taught people just to slow down their alcohol consumption, to make a drink last longer and figure out if you want to limit your consumption to say, two drinks in an hour or three drinks in two hours, how long does a drink have to last? And then don't start a second drink until that amount of time has passed. Have a non-alcohol drink in between-- just slowing down. And it turns out that if you can slow down the first couple of drinks, it has a big impact because people tend to drink faster at the beginning. They're thirsty or they're looking to get the effect. So, you want to slow down the process that's there.
Dr. William R. Miller:
We had people begin looking for ‘what are my risk situations? When do I tend to drink too much? Is it with certain people? Is it when I'm feeling certain ways?’ And as you begin to figure out what are the triggers, you can learn to be extra careful in those situations. And then, maybe just as important, there's a whole section of this book on alternatives to drinking. So, if you drink to cope, if you drink to feel better, if you drink to get to sleep, whatever it is, there are ways to do that without relying on a drug to do it for you. And so, learning those skills. What is it you're hoping to accomplish by drinking? What do you want the drug to do for you? Alcohol is not a very good medication in most cases, like for sleeping and so on.
Dr. Bob Boland:
Definitely not for sleeping.
Dr. Kerry Horrell:
Definitely not for sleeping. Let's say that, friend, when listening.
Dr. William R. Miller:
Yeah, yeah, although it'll help you get to sleep, perhaps.
Dr. Bob Boland:
Yeah, yeah. People sometimes perceive it as being good for sleep, but it's quite terrible.
Dr. William R. Miller:
So, learning some skills for having the experience you want to have, feeling the way you want to feel, without having to rely on the drug, without being dependent on it. So those are kind of the hallmarks of the self-control program that, whether it was being done by a therapist or whether it was a person working on their own with the book, we on average, had people cutting their drinking in half.
Dr. Bob Boland:
Amazing.
Dr. Kerry Horrell:
That's incredible.
Dr. Kerry Horrell:
Yeah. I wonder as kind of a last question, last thought for our audience, you know, what words of wisdom would you offer therapists as they're trying to approach this conversation with their patients and they're they really want to be non-judgmental. They don't want to overly pathologize, but they do want to talk about a person's drinking. Yeah. What words of wisdom do you have?
Dr. William R. Miller:
Well, you know, most therapists know not to be judgmental. They know how to listen to people, they just forget to do that when an issue like this pops up. And they may have other beliefs about the way you have to talk to a person about drinking that are probably wrong. What we have found is listening to people, being compassionate with people, noticing what's good about people, affirming their strengths and so forth, all those things that you would normally do if you're treating someone who's depressed or who is anxious, for example, are the same kinds of things in a therapeutic relationship that help people to make changes in their drug and alcohol use as well. So it's not something mysteriously different, actually. It’s using what you already know about being a good therapist and just remembering to do that when you're talking about alcohol. When you raise the issue, being curious and listening well.
Dr. Bob Boland:
Yeah, that's great advice.
Dr. Kerry Horrell:
Well, thank you so much for joining us again, Dr. Miller, and also for your work on this book. Again, it's it seems like, and as someone who's read it, it is it is an incredible resource for our field and for again, I think bridging this gap sometimes between the sensation of like ‘you don't need to talk about drinking at all or you need to stop.’ And so thank you for your work and for joining us.
Dr. William R. Miller:
Thank you for yeah, thanks for inviting me.
Dr. Kerry Horrell:
Yeah, and as a reminder, you can find Dr. Miller and Dr. Munoz's book called Rethinking Drinking. it is out now, I believe and, again, you've been listening to Dr. William Miller on the Mind Dive podcast. I'm your host, Dr. Kerry Horrell
Dr. Bob Boland:
And Dr. Bob Boland
Dr. Kerry Horrell:
And thanks for diving in.