Saying No to Drugs and Alcohol

Someone offers a drink, or a drug, and the room waits. That moment is ordinary, and it is also where a lot of plans fall apart. NIAAA's drink-refusal module says social pressure can make it hard to cut back or quit even when you already decided to change. The module is a recognize-avoid-cope activity used in cognitive behavioral therapy. It can sit beside counseling. NIAAA says it is not a substitute for professional help.

If you might be in withdrawal from alcohol or a benzodiazepine, or someone will not wake, call 911. For a mental health crisis, call or text 988. A sentence you rehearsed does not treat a seizure.

Two kinds of pressure

NIAAA splits social pressure into two kinds. Direct pressure is when someone offers you a drink or a chance to drink. Indirect pressure is when you feel tempted just by being around other people who are drinking, even if nobody offers you anything. A toast is not the same problem as a quiet pull from watching everyone else. Write down which one actually happens to you. The plan follows the type.

SAMHSA's family-therapy protocol, TIP 39, makes a related point from the research it summarizes. Positive support for recovery is related to long-term abstinence. Conflict, and social pressure to use, is related to a higher risk of returning to use. Those are associations across studies. They are not a prediction for one friend group. Who stays in your life is the longer question on the friendships guide. The moment in front of you is the offer.

Leave when you can

For some events, NIAAA says the best strategy is not to go. If you feel guilty about skipping, it says you are not necessarily talking about forever. When your refusal skills are stronger, you may ease back into places you now avoid. Until then, you can stay in touch by suggesting something that does not involve drinking.

The Matrix client's handbook, a SAMHSA treatment manual for people with stimulant use disorders, is blunter about drugs and alcohol together. Staying abstinent, it says, has little to do with how strong you are. People who maintain abstinence do it by being smart. They keep far away from situations in which they might use. If you are where drugs might appear, the example is a club or a party, or you are with friends who are drinking and using, your chances of using are much greater than if you were not there. The handbook's instruction is not to count on being strong.

It even quotes the thought people use to talk themselves into the test: "I have been doing well, and I think it is time to test myself." Another version is "I can have a drink and not use. I never had a problem with alcohol anyway." The handbook treats those lines as the mistake. Smart people stay abstinent by avoiding triggers. Why a cue can still hit after you meant to stop is on the triggers guide.

The same handbook defines triggers as people, places, objects, feelings, and times that cause cravings. One of its examples is a Friday night built from cashing a paycheck, friends, and stimulants. The triggers on that list include Friday night, after work, money, friends who use, and a bar or club. The brain links the trigger to use, and one trigger can start the sequence even after you decided to stop. The handbook's order is simple. Name the triggers. Prevent exposure when you can, and the example is not handling a large amount of cash. Cope in a different way than before, and the example is scheduling exercise and a mutual-help meeting on the night you used to go out. Intentions have to become a change in what you do.

NIDA's principles say behavioral therapies may include building skills to resist drug use. Its treatment page says cognitive behavioral therapy can strengthen resolve when you meet cues such as people, places, things, and moods tied to past use. That wider set of skills is on the relapse-prevention guide. The therapy itself, which a counselor delivers, is on the CBT guide.

A short no, then a way out

When alcohol will be served and you cannot skip it, NIAAA says to have the refusal ready. The goal is clear and firm, and also friendly and respectful. Long explanations and vague excuses tend to stretch the talk and give you more chances to give in. Do not hesitate. Hesitation is time to think of reasons to go along. Look at the person. Keep the response short, clear, and simple.

The person offering may not know you are cutting down or stopping, and they may not stop at the first no. NIAAA suggests planning a series, from a simple refusal to a firmer one. The examples it prints are: "No, thank you." Then, "No, thanks, I don't want to." Then a longer line you fill in yourself: you are cutting back or not drinking now, for a reason that is yours, and you would appreciate help rather than another offer. You can also use what it calls a broken record. Each time they push, you repeat the same short answer. You can acknowledge a piece of what they said ("I hear you") and then return to the no. If words fail, you can walk away.

Those lines are about alcohol. They come from a drinking module adapted from a clinical research manual for therapists. They are not a SAMHSA script for methamphetamine, opioids, or cannabis. For those, the Matrix point still applies: do not stand next to the drug to prove a point. A counselor can help you practice the words that fit the drug you actually use.

NIAAA adds a few other moves. If you are quitting, keep a drink without alcohol in your hand. If you are cutting back rather than stopping, keep track of every drink so you stay inside the limit you set. Ask other people for support. Plan an exit if the pull gets too strong. You can ask others not to pressure you, or not to drink in front of you, and NIAAA notes that this request can be hard. If you have already refused an offer and it worked, remember what you did and reuse it.

Practice before the night. Imagine the person and the place. Write what they will say and what you will say. Say it out loud. NIAAA suggests a role-play with someone who will apply realistic pressure and tell you honestly whether the no landed. Skills grow with repetition. The first attempts often feel clumsy. Clumsy still counts.

The decision is yours

NIAAA says the way you think about the decision matters. "I am not allowed to drink," as if someone else made the rule, can breed resentment and make it easier to give in. The module tells you to challenge that thought: you are in charge, you know how you want your life to be, and you decided to change. Worry about how other people will see you gets the same answer. It is your life. The decision should be respected.

That is the opposite of a sermon. It is also not a reason to skip care. If the offers are constant, if you cannot leave, or if a return to use has already happened, the next step is a clinician, not a better comeback. Search FindTreatment.gov. Call or text (800) 653-9376 if you want help sorting a program. SMART Recovery is a separate mutual-help program, described on the SMART Recovery overview.

Additional Resources

Sources cited on this page:

• NIAAA Rethinking Drinking: Building Your Drink Refusal Skills
• SAMHSA Matrix Intensive Outpatient Treatment: Client's Handbook (SMA15-4154)
• NIDA: Principles of Drug Addiction Treatment, third edition (revised January 2018)
• NIDA: Treatment
• NIAAA: Alcohol Use Disorder: From Risk to Diagnosis to Recovery
• FDA: Boxed warning on benzodiazepines
• SAMHSA TIP 39, Chapter 4: Integrated family counseling (NCBI Bookshelf)
• 988 Suicide & Crisis Lifeline
• SAMHSA FindTreatment.gov

Common Questions