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Patient Information

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Form for Identifying Reasons to Cut Down On or Stop Alcohol Use

Overview

If changing your alcohol use is a goal, then knowing what you'll gain by cutting back on or not drinking can help keep you motivated. Take a moment to fill out the form. Be honest. You may find that you have good reasons to cut back or quit-whatever your goal is. Put a check next to the statements that you agree with:

My health

  • _____I'd like to be at a healthy weight. Alcohol is adding too many empty calories to my diet.
  • _____I'd like to get a better night's sleep. Drinking is affecting the quality of my sleep.
  • _____I'd like to feel good in the morning instead of feeling sick to my stomach, shaky, or anxious.
  • _____I am planning to get pregnant, or I am pregnant.
  • _____I take medicines that interact with alcohol.
  • _____I want to better manage a health problem that is made worse by drinking. For example, I have liver problems, heart failure, high blood pressure, or a mental health condition.
  • _____I want to be healthy in the future and avoid problems like some cancers or issues with my liver, stomach, or nervous system.

My relationships

  • _____I'd like to not be a worry to my family and friends.
  • _____I'd like to not get into arguments and regret any of the things I said or did.
  • _____I'd like to avoid sexual problems. Alcohol is impacting my sex life.

My performance at work or school

  • _____I'd like to improve how well I can think and learn.
  • _____I'd like to improve my concentration, be on time, and not call in sick.

My other benefits

Add any other benefits, such as saving money or being a good role model to your children, or whatever comes to your mind:





If you checked any of the above statements, you've just created a list of reasons to cut back or stop drinking. Nice work!

Take a closer look at some of the benefits. Are any of them stronger or more meaningful to you than the reasons why you like to drink? Keep your list with you as you change your alcohol use and for several weeks or months after. Review it whenever you are struggling to remember why you took the step in the first place.

Credits

Current as of: April 30, 2024

Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Current as of: April 30, 2024

Author: Ignite Healthwise, LLC Staff

Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.