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Willpower alone is often insufficient to overcome deeply ingrained patterns of excessive drinking.

Repeated heavy drinking can alter brain chemistry, making alcohol use increasingly automatic.

Alcohol's ability to relieve emotional distress can powerfully reinforce continued drinking.

Professional treatment and medication can help interrupt persistent, self-destructive drinking patterns.

“Why can’t I get my drinking under control? I know I’m drinking too much. I’ve promised myself countless times that I’ll cut back or stop altogether, but sooner or later I end up doing the same thing again.”

I’ve heard some version of this question thousands of times during my 50-plus years of clinical practice as an addiction psychologist. Many are high-functioning individuals capable of exercising considerable discipline and self-control in other areas of their lives. Yet when it comes to drinking, they repeatedly fail to follow through on their intentions.

Why does this happen? And why do some people find it so difficult to change their drinking habits without professional help and/or medication?

Wanting to Change Isn’t the Same as Being Able to Change

Consider someone who wakes up after a night of heavy drinking feeling miserable, embarrassed, and absolutely determined never to repeat the experience. Several days later, however, after a stressful workday or during a social gathering, having a few drinks once again seems innocuous. Yesterday’s determination is displaced by other motivations, some operating outside conscious awareness.

Consider the case of a successful businessman who sought my help several months ago after a series of alcohol-related incidents. Two years earlier, he had lost a highly coveted executive position after behaving inappropriately while intoxicated at a company function. Devastated by the experience, he stopped drinking and vowed never again to jeopardize his career. Regrettably, several months later, having secured another desirable position, he attended a business dinner followed by several hours of heavy drinking with co-workers at an........

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