Reducing Alcohol Consumption Takes More Than Just Willpower

by Paxten Wahlund

May 2025

Perhaps of interest to Walsh County residents is a fact from a 2025 North Dakota Health Department report: The state ranks highest in the country in number of bars per person. That might link to easy access to the regular use of alcohol.

In some situations, alcohol use is a way to unwind and to celebrate special occasions. Sometimes it's used to handle stress, sadness, or anger. For some, alcohol use is even a way to tame down feelings of guilt or shame. Whatever the reason for using alcohol, doctors also know that for many people, too much alcohol can cause liver, heart, and other physical problems.

When alcohol consumption causes liver, heart, and physical problems – or interferes with job duties or personal relationships – healthcare providers refer to this amount of alcohol use as alcohol use disorder (AUD). How does alcohol misuse happen? Science shows that in addition to hitting the cells of the liver and heart, AUD involves powerful changes in brain chemistry that make it hard for the brain to resist the positive feelings that alcohol creates. Additionally, these brain changes are so strong that just having the desire to stop drinking doesn't always work. For people wanting to cut back or who want to just quit alcohol altogether – or who've tried, were unsuccessful, but want to try again – doctors and AUD treatment experts make several suggestions: medications and counseling.

When it comes to the options of medications and counseling for AUD, experts also suggest thinking of AUD like diabetes. For a diabetic, willpower alone can't lower blood sugar. The medication insulin is needed. The same is often the case for someone with AUD. Willpower alone is usually not enough. Medications are sometimes needed. Also, diabetics will consult with a dietitian or nutritionist because these healthcare providers have advice on how to influence blood sugar by eating right. Similarly, professional advice from AUD counselors helps influence alcohol consumption.

One medication that is available for AUD is naltrexone. Taken as a pill every day or given monthly by injection, it can help dull the good feeling some people feel when they drink alcohol. Other medications that work on other areas of brain chemistry are also available.

Medications alone might be a good approach for some, but AUD experts suggest that medications work best when partnered with an AUD counselor's advice – very much like diabetics pairing their insulin use with getting advice about their diets. Although AUD counseling might seem an awkward step for some people, others find it helpful because talking with a counselor helps uncover links to why someone consumes too much alcohol. Counselors will also offer stress management strategies that can help avoid leaning on alcohol.

No matter the option chosen, for those who've made the decision to lower alcohol consumption, AUD experts advise that checking in with a healthcare provider is important because stopping regular heavy alcohol use can trigger serious and even life-threatening withdrawal symptoms.

To wrap up, for any North Dakotan – or for any North Dakotan who's a concerned friend or family member: If AUD might be present, don't hesitate to reach out to a healthcare provider to discuss medication, counseling, or a combination of both. There are ways to support individuals on a journey to AUD recovery.

About the Author

Paxten Wahlund is a third-year medical student at the University of North Dakota School of Medicine & Health Sciences. As a participant in patient care experiences offered in Park River, Wahlund also chose to participate in the Targeted Rural Health Education program, or TRHE. The program focuses on teaching student doctors the importance of rural newspapers as a way to share health information with their rural community. The information is not for diagnosis or treatment and should not be used in place of previous medical advice provided by a licensed practitioner.