The Enlighten Blog

Do I Have to Quit Drinking Before I Start Therapy?

You can come in drinking. Why I don’t lead with quitting, and what the first conversation actually covers.

No.

That’s the whole answer, and I’m putting it at the top because I think it’s the thing keeping some people from calling.

The worry goes something like this: if I bring this up, the first thing out of her mouth will be that I have to stop. And I’m not ready to promise that to a stranger. So the call doesn’t happen, and the drinking carries on being the thing nobody knows about.

You can come in drinking. People do, most weeks.

Why I don’t lead with quitting

I’m a licensed mental health therapist and a licensed addiction counselor, which means I didn’t learn about drinking as a separate subject from everything else. I learned it as something people do for a reason.

The drinking is usually doing a job. It’s getting you to sleep. It’s putting a lid on something at nine at night that you’ve been holding all day. It’s the twenty minutes where your shoulders come down. Sometimes it’s the only thing that reliably works, which is exactly why it’s hard to put down.

If I take the job away before anything else can do it, I’ve made your evenings worse and called it treatment. That tends to last about a week.

So I’d rather start with what it’s handling. When something else can hold that, the drinking usually gets easier to move — not always, and not on a schedule, but a lot more often than the other way around.

What we’d actually talk about first

Not units. Not a pledge.

More like: when does it start, most nights. What’s happening in the hour before. What it does for you that nothing else is doing. What you’re like the next morning and whether you’ve started planning around it.

That last one is usually where people hear themselves say something they hadn’t said out loud.

Anger and drinking travel together more often than not, in both directions — the drinking loosens the anger, and the anger gives the drinking a job to do. If both are in the picture, that isn’t two problems you’d have to go to two places with. It’s usually the same knot.

You’re not promising anything by calling

Making a phone call isn’t a commitment to a plan. It isn’t a commitment to stopping, or to a label, or to anyone else finding out.

You can say I don’t know if this is a problem and mean it, and we can start there. Not knowing is a perfectly good place to begin. Plenty of people find out it isn’t the problem they thought it was, and a few find out it’s a bigger one — but either way you’d rather know than keep wondering at eleven at night.

One thing I will be straight with you about

There’s a point where stopping on your own stops being a willpower question and becomes a medical one.

If you’ve been drinking heavily and daily for a long stretch, suddenly stopping can be genuinely dangerous — shaking, sweats, confusion, and at the serious end, seizures. That’s not a reason to keep drinking. It’s a reason not to white-knuckle it alone on a Sunday because you decided Monday is the day.

If that sounds like you, talk to a doctor about how to come off it safely before you cut down. That’s the one piece of this where the order genuinely matters, and it’s a short conversation, not a referral into a whole system.

If you’re nowhere near calling anyone

That’s a real position and it’s where most people sit for a while.

You could tell one person. A friend who won’t make a project of it. Naming it to someone who likes you does more than most people expect, and it doesn’t commit you to anything after it.

You could also just start noticing — what time it starts, what happened that day, what it took the edge off. Not to build a case against yourself. Information is easier to work with than a verdict.