How to Break Out of a Binge

Are you stuck in a vicious cycle you can't escape? Here's how to wean yourself away from the bottle before your last call.

Nicolas Cage picks his poison in the 1995 classic "Leaving Las Vegas."

It should come as no surprise that swallowing a shit-load of booze in a single evening can wreak havoc on both your life and your health. Many alcoholics who drink regularly build up a certain physical tolerance that allows them to function on a day-to-day basis. But weekend warriors and binge drinkers are much more at risk for serious trouble. These are the people responsible for most of America's DUI arrests and bar brawls, not to mention those full-on blackouts that neatly erase memories of everything (and everyone) you'd never consider doing sober. And when they drown in their own vomit or pass out from alcohol poisoning, it’s not a big stretch to assume that a long line of shot glasses or wine bottles were emptied along the way.

But if you only binge on weekends, you’re much better off than the run-of-the-mill cocktail-hour alkie, right? It’s true that daily drinkers suffer more liver damage than bingers and that most people who binge are not technically alcoholic—that is, physically addicted to booze. Also: Who’s to say how much alcohol constitutes a “problem”? “Every time I drank, I drank to the point of blacking out, and when I woke up the next day, I could never remember how I got home,” says Roger Winthrop, a professional New Yorker in his 50s. “But I only drank on Friday nights, and I could count the number of binges I went on each year on two hands—which is how I rationalized my behavior.” That’s 40-odd sober weeks a year!

College students are notorious binge drinkers—indeed, getting trashed once or twice a week with their peers is practically a rite of passage at many American high school and universities. According to recent research, afull quarter of the teenagers and young adults in the US admit to being binge drinkers, and they’re starting younger every year—at a time when their adolescent brains are extra vulnerable to damage of the sort that can affect memory and learning. A recent CDC survey on America’s drinking habits found that two out of three high school students, and one out of three adults, admit to regularly bingeing on alcohol. Almost 90% of the booze imbibed by high school students, and more than half downed by their elders, is consumed during a binge, according to the survey. About 70% of binge drinking episodes involve adults 26 or older. The most common demographic is white males ages 18 to 34 with median incomes above $75,000. What’s with America’s overindulgence?

Most addiction experts we consulted agree that there are a few basic responses you should consider if you think your drinking is getting out of hand. Different people exhibit different levels of tolerance, of course. But most physicians officially defined binge drinkers as women who down more than four drinks in two hours, or men who swallow more than five. You may also have a problem if your pattern of drinking regularly boosts your blood alcohol concentration to a level above 0.08%. Robert Huebner, PhD, acting director of the Division of Treatment and Recovery Research at the fed’s National Institute on Alcohol Abuse and Alcoholism (NIAAA), recommends starting with an online tool like the NIAAA’s own “Rethinking Drinking.” “There’s a fun drink calculator in there that people can play with,” he says. “And where they can learn techniques like ‘pacing and spacing. If people simply sipped a glass of water after every alcoholic drink they consumed, it would make a huge difference in how they felt the next day. Or it could be as simple as having something to eat before you go to a party.”

Others insist the counting and learning should take place in a supervised setting instead. “You’d be surprised how much people can spin things to put themselves in one category or another,” says Joseph Lee, MD, medical director at the Hazelden Center for Youth and Families. “I think the individualization of care needs to be done with professional help. I’ve heard all sorts of things: gulp down water between drinks, drink Coke or alternate your alcohol use with caffeine—but none of these solutions are research-based at all.” He says that your best bet is talking with an addiction professional—and your worst is consulting other drinkers: “If you have a bunch of bar buddies, it’s probably not a good idea to ask them if you have a problem.”

Often, both Huebner and Lee say, the most useful advice will come from your primary doctor (the NIAAA’s “Clinicians Guide” provides lots of tips about how to discuss alcohol use with physicians). Shrinks can also be very helpful. Recalls Winthrop, “My therapist said very simply, ‘You have reached the point where you are putting your life in danger with your drinking’—this was after I woke up from a binge with broken ribs. Those words, coming from her, chilled me to the bone.”

What isn’t helpful is “binary” thinking of the sort that qualifies drinking as either alcoholic or not, because it stops people from exploring the vast range of boozing habits and patterns in between. While in any give year, about 30% of the population can be said to have a problem with booze, only 4% of those people exhibit severe dependence, according to the NIAAA. The lifetime prevalence of dependence, however, is 13%.

Our generally appalled attitudes about alcoholism often prevent people from recognizing that they have a problem. “The stigma is certainly a barrier,” says Hazelden’s Lee. “In some Midwestern states, up to 10% of the population above the age of 12 qualify as alcohol abusing or dependent. That’s a big chunk of people. They’re not the only ones who have problems with binge drinking—and it doesn’t mean they have an addiction—but they definitely shouldn’t be their own judge.”

OK, so once you’ve found someone to help evaluate your excessive drinking, what do you do? If the usual tricks prove insufficient (counting cocktails, rearranging your social life, listing the pros and cons of drinking), you probably are suffering from some kind of dependency—and/or another condition requiring medical help, such as depression. Treatment options for alcohol abuse range from abstinence-based therapies like Alcoholics Anonymous and harm-reduction approaches like Moderation Management to cognitive behavioral therapy (CBT) and even prescription meds. Three of these are FDA-approved for reducing alcohol cravings: naltrexone (Vivitrol), acamprosate calcium (Campral) and disulfiram (Antabuse).

While it has proven to be an effective deterrent for some people, Antabuse, a drug that has been around for decades, is notorious for its harrowing side-effects. If you dare to down a few drinks after taking the pills, the alcohol almost immediately induces the symptoms of your worst-ever hangover—vomiting, tremors and dizziness that while rarely lethal, are often dangerous enough to send you to a hospital. Other medications such as Naltrexone and Campral,which usually cause few adverse side-effects, are often prescribed together because they work on different aspects of a patient's drinking problem. Campral cushions the blow of detoxing, notably lessening the physical and emotional distress many people experience after withdrawal. Naltrexone dulls both the “high” of the effects of alcohol, while aimultaneously quelling cravings after you stop drinking. When the drug first debuted, patients were required to take Naltrexone every day to achieve maximum results, but many patients could not keep up with the schedule. As a result, the drug is now also available as a monthly injectable called Vivitrol that you can’t “forget” to swallow every morning. While some insist that both of these drugs work wonders, others claim their benefits are modest, at best. To know for sure, you should probably try them out for yourself. Others credit everything from massage to lemon oil and hypnosis for allowing them to cut down or quit.

For those few souls who choose to break out of a binge while they're still engaged in one, most doctors insist that you do so only under medical supervision. Which means if you’re going to try to quit cold turkey, you may need to get your ass to your local ER (unless you happen to have a bed in a rehab ready and waiting for your arrival). No matter where you choose to detox, withdrawal from drugs and alcohol can take anywhere from three to nine days, and can present a plethora of serious health risks. Check out "From Blackout to Breakout: A Detox 411” for helpful tips on how to manage a safe and successful detox.

“There is no set certain solution or timetable for this problem,” says Lee. Many binge drinkers are well on their way to full-blown alcohol addiction, he says, but the whole abominable cycle can be stopped in its tracks for even for the heaviest drinkers if they receive the proper treatment.

Ultimately, the most essential tool in breaking out of a binge-drinking routine is your desire (or desperation) to do so. Roger Winthrop stopped his binging episodes after he was treated for depression. With help from therapy and anti-depressant drugs he suddenly found himself disgusted with his self-destructive behavior. “I now associate the taste of alcohol with hangovers and a physically gross feeling,” he says. “That has become as visceral as the craving. I don’t know if there’s a concept for that—maybe you could call it an anti-craving—it almost feels like my entire experience as a binge drinker also acted like aversion therapy. But the whole process took so long and cost me so much. And it almost cost me my life."

Sally Chew was an editor at Time Inc.’s Health.com as well as at Vibe, Out and POZ magazines. She also authored a true crime book and was a wire-service reporter overseas.