Title: The Problem Drinking Continuum: Patterns of Use & Abuse
Author: Gayle Rosellini & Mark Worden
Publisher: Do It Now Foundation
Publication Date: March 2011
Catalog Number: 805

..The Problem Drinking Continuum: Patterns
of Use and Abuse

Inside this
pamphlet, you’ll find a chart that may help you see something
you’ve never seen before.

The chart —
we’ll call it “The Problem Drinking Continuum” — is
a simple way of depicting something that can seem awfully complicated:
the range of behaviors and potential problems linked to various
levels of involvement with alcohol.

We developed
it as a tool for use in our own work with problem drinkers —
both to evaluate the extent of their drinking and break down
the system of denial that keeps them stuck there.

And while the
continuum itself might seem self-explanatory, we’d like to offer
a few comments at the outset to reduce the risk of confusion.

Although many
may read the chart from left to right and see a linear progression
of symptoms, the continuum isn’t intended to imply that an inexorable
downhill slide accompanies all drinking patterns.

Neither does
it imply that any point on the continuum is an early, middle,
or late stage of the disease of alcoholism.

It’s only intended
as an itinerary of some of the places that drinkers visit —
and a road map back for those who’ve been away too long.

..Questions and Answers

What’s the
best way to use the continuum?

The Problem
Drinking Continuum is best used as a tool to evaluate drinking
problems and break down the denial of problem drinkers.

The continuum
lists various drinking behaviors, from abstinence to alcoholism,
and reads from left to right, linking increased levels of consumption
with life problems.

Still, it’s
not meant to be read as a progressive, irreversible accumulation
of symptoms slide. Nor does it imply that any point on the continuum
is an early, middle, or late stage of the disease of alcoholism.

When is the continuum best used in therapy?

It’s probably
most effective when used in the first or second counseling session.After
interviewing the client (and, if possible, the family), the counselor
should explain the continuum and its purpose. Use of a blackboard
(or the continuum itself) may be helpful.

The counselor
will likely emphasize behaviors or incidents that are most relevant
to the client, such as arrests, a family crisis, blackouts, mounting
debt, or other pressing problems.

As the client
and counselor focus on these issues, it becomes increasingly
difficult for the client to maintain that his or her drinking
is merely “social.” And, often for the first time,
the client is able to admit that drinking is causing serious
life problems.

In future sessions,
the therapist and client can refine this awareness and define
individual problems more precisely.

Still, we repeat:
the continuum is not meant to be viewed as a chart of progressive
symptoms of the disease of alcoholism.

Why do you keep emphasizing that particular point?

The prevailing
concept of alcoholism as a chronic, progressive disease has been
invaluable in removing the stigma of alcoholism and in helping
tens of thousands get the treatment they need.

However, it’s
also fostered the popular misconception that if a person has
a drinking problem, he or she is probably progressing into alcoholism,
or conversely, that drinking is basically harmless for people
who aren’t alcoholics.

evidence shows that the progressive disease model of alcoholism
simply does not apply to all problem drinkers.

The continuum
can be especially helpful in showing young people and other high-risk
groups that, although they may not be alcoholic (that is, physically
or emotionally dependent on alcohol), their drinking style may
contribute to significant life problems.

Our message
is simply this: You don’t have to be an alcoholic to have a drinking

By defining
alcoholism only as a progressive and chronic disease, treatment
programs and professionals may exclude large numbers of people
who may need some help to change their drinking behaviors in
order to resolve other life problems.

Examples: A
college student who’s having trouble in school because he parties
and drinks several nights a week; a couple whose marriage is
in trouble because of financial problems brought about by his
repeated D.U.I. arrests; a young woman who suffers from guilt
and anxiety when she wakes up in a strange bed after drinking
too much at a party.

These people
may not be alcoholic — that is, they may not have developed
tolerance and physical dependency on alcohol.

Still, they
may all have to change their drinking patterns in order to resolve
current problems and avoid similar difficulties in the future.


here for larger


Are there any other recommended applications for the continuum?

You may want
to apply principles or insights derived from the continuum to
real-world situations which promote careless use of alcohol and
opportunities for problem drinking.

Examples: the
overly-long, commercialized “happy hour” at bars and
restaurants; the new night spot opening on the interstate highway;
drinking contests as a part of an initiation into a club or fraternity;
the custom of getting drunk on New Year’s Eve. These are all
socially-acceptable invitations to overdrink.

But primarily,
we hope that counselors, educators, and other helping professionals
will use the continuum to illustrate how drinking problems begin
and evolve in order to help individual clients eliminate
problem drinking patterns in their own lives.

For other readers,
we hope you’ll take what you need (and can benefit by) from the
continuum, and get on with whatever changes you may need to make
in your life and your relationship with alcohol.

And if it’s
time for you to take that big first step, thanks for the honesty
it takes to admit that to yourself and the courage it takes to
step beyond the problem drinking continuum.

This is one in a series of publications
on drugs, behavior, and health by Do It Now Foundation.
Please call or write for a complete list of available titles,
or check us out online at




And if you want to get your personal point across to us, click here or on the button at bottom.
And if you’d like to contact us for any other reason,
you’ll find our mailing address, phone, and fax numbers there, too.