5.4. DREF: Drink Refusal and Social Pressure Skill Training
5.4a. Social Pressure and Drink Refusal
Social pressure plays a significant role in resumed drinking for many clients. There are two
distinct types of social pressure exerted by contact with other drinkers; indirect and direct social
pressure. Learning to cope with both types of social pressure can help prevent a client from returning to
drinking but it takes good decision making and practice to develop the skills to cope with both types of
It is important to remember that this module can be useful even if a client does not anticipate
direct social pressure to drink. A client may experience indirect social pressure when he/she feels
tempted to drink as a result of being around other people who are drinking. Situations in which other
people are drinking can create pressure or temptation for the client to drink, even if the client is not
offered a drink. For example, a client may go to a friend’s house for a party or to a family wedding
where most of the people in attendance are drinking. Although the client may not be offered a drink,
he/she may experience an increase in temptation or craving to drink simply as a result of watching his
friends or family members having a good time while drinking. Alternatively, a client may feel “left out”
of the party if he/she is not drinking along with other people, and be tempted to return to drinking in an
effort to feel more comfortable in a social situation. As a result of the client’s experience with drinking
in social situations, he/she may be more likely to feel the temptation to return to drinking in situations
where: (1) there is an expectation built into the situation that everyone will be drinking (e.g., at a
wedding), (2) the client is with people who have been drinking companions in the past, (3) the client is in
an environment that encourages drinking (e.g., at a bar), or (4) the client is in a situation in which he/she
lacks confidence in hihe/sher ability to cope without using alcohol (e.g., when socially anxious).
One way of coping with indirect social pressure is to avoid certain situations in which the client
knows he/she will be around other people who are drinking. This requires advance planning and good
decision-making about the types of situations that should be avoided. Since alcohol plays a role in many
social occasions the client is likely to find it difficult to avoid all situations in which other people are
drinking. In some cases the client may choose not to avoid situations in which other people are drinking
because the situations are significant events, such as an anniversary or holiday party. In these situations,
coping strategies may be necessary to avoid a return to drinking, such as: (1) leaving open the possibility
of escape from the situation if the temptation is too strong, (2) relying on sober support to cope with
temptation during the event, or (3) planning alternative activities during the event, like drinking soda, to
minimize the urge to drink.
A client may experience direct social pressure when he/she is offered an alcohol beverage or a
drinking opportunity, and as a result feel an increased temptation to return to drinking. The person who
offers the client a drink may or may not know that the client is trying to stop drinking, may make the offer
with varied levels of insistence, and may respond to a refusal with varied levels of assertiveness. For
example, a client may be faced one day with an innocent request from a waitress in a restaurant who asks
“What would you like to drink this evening?” or a coworker who asks “How about joining me for a few
beers after work?” However, the client may also be faced with a relative at a wedding who says, “Oh
come on, it’s a party. You’ve got to join us in the toast!” or an old drinking companion who responds to a
refusal by saying “I thought we were good friends, and now you’re saying you can’t drink with me?
You’ve tried to stop drinking lots of time and never made it, so do us both a favor and give up.”
In direct social pressure situations the client needs good drink refusal skills in order to avoid
returning to drinking. It may take practice for the client to develop good refusal skills, and to learn how
to cope with offers from different people and a variety of responses to a refusal. There are some general
guidelines that a client can learn for a skillful “drink refusal,” although the response may need to vary
with the person offering the client a drink, the intensity of the offer, the person’s response to the refusal,
and other aspects of the situation. For example, a friendly and casual offer from a waitress or coworker to
have a drink may require a different response from the client than persistent, aggressive offers from a
close friend or family member.
5.4b. Using Cognitive-Behavioral Therapy to Develop Drink Refusal Skills
Drink refusal is often much more difficult than the client anticipates it will be. Practicing various
refusal responses ahead of time can be quite valuable, especially if a client has difficulties with
assertiveness or responding effectively when he/she is feeling anxious. Practicing a refusal in the context
of treatment via behavioral role-play provides your client with an opportunity to receive feedback about
the effectiveness of his/her drink refusal response, to acquire some mastery over his/her refusal skills, and
to increase confidence in facing direct social pressure.
A client’s response to social pressure is likely to be influenced by his/her relationship with people
in the environment who are drinking or making him/her an offer to drink. Therefore, it is important to
examine a client’s ability to cope with social pressure in response to specific people. For example, it may
be more difficult for the client to make a decision to avoid family gatherings than the local bar, or it may
be more difficult for the client to refuse an offer to drink from a close friend who is insulted by the
client’s refusal than a casual acquaintance who is polite. For this reason it is useful to practice refusal
skills for a variety of personal relationship contexts.
Thoughts as well as behavior are involved here. How a client thinks about his/her decision to
either avoid a social situation involving drinking or to refuse a drink in order to stay abstinent can
influence how successfully he/she copes with social pressure. Some common concerns that clients have
that other people will see them as “weak” or a “goody goody” for deciding that they will no
that they are “boring” or will be rejected if they do not drink,
that it will be impossible for them to make new friends or maintain old friendships if they are not
that it is not “right” to refuse a drink when everyone else is sharing an occasion involving
that they do not want to give up a relationship with a heavy drinker simply because they (the
client) have stopped drinking, and/or
that they are imposing on or offending other people if they are assertive about not drinking.
It is also important to explore how the client thinks about sobriety itself. A common perception early in
sobriety is that “I can’t drink” or “I am not allowed to drink.” It is as if some external authority were
imposing rules and limits on them, and this can set the stage for a kind of “cognitive claustrophobia”
against which the client ultimately rebels. This makes it easier to cave in to indirect or direct social
pressure to drink.
5.4c. Assessing Social Pressure
Begin this module by explaining the two types of social pressure (direct and indirect) that can
increase the temptation to drink. Indirect social pressure is related to observing other people drinking,
even if no one is directly encouraging you to drink or offering you a drink. Direct social pressure is when
other people directly offer you a drink, encourage you to drink, or give you a hard time for not drinking.
Determine what types of social pressure the client believes could increase his/her temptation to
resume drinking. Explore both indirect and direct social pressure situations. Throughout this module, use
the worksheet “Identifying Social Pressure Situations and Coping Responses” (Form cc) to record
specific risk situations (and then possible coping responses). For some clients, only one type (direct or
indirect) of social pressure may seem important. It is not necessary in every case to prepare for both
direct and indirect social pressure coping if your client sees no need for one or the other. (We recommend
printing this worksheet on carbonless 2-page forms, so that you can give a copy to your client and also
retain one for your file. Photocopying the completed form is another option.)
First help your client generate a list of potential indirect social pressure situations that he/she
may face in the future. These are situations in which the client will feel tempted to return to drinking as a
result of being around other people who are drinking or intoxicated. Examples of situations that may
involve indirect social pressure include weddings, anniversaries, or holiday parties, hanging out with
friends who drink, working with people who drink on the job, family members who show up at the
client’s house intoxicated, or going to a drinking establishment with coworkers. To generate this list, ask
your client to think about situations from the past in which he/she has felt tempted to drink primarily as a
result of just being around other people who were drinking. Also, ask the client to think about new
situations in which he might encounter other drinkers and would be likely to feel a temptation to drink
(e.g., an airline flight on which free alcohol is served). Record these situations in the left-hand column of
Next ask your client to think about specific people who might offer a drink or pressure him/her to
drink, and the situations in which this might occur. Remember that the focus here is not only on the
actual offer of a drink, but also more generally on direct invitations, encouragement, cajoling, shaming,
and other forms of direct social pressure. Again ask for experiences from the past and also anticipate
situations in the future when this might occur. Examples of people who might offer the client a drink
would include friends, neighbors, relatives, coworkers, an employer, and a former drinking companion.
Some of the people who may offer the client a drink may have already been mentioned in indirect social
pressure situations described above. Examples of situations in which this might be more likely to occur
include those in which alcohol is served (e.g. in a bar or restaurant that serves liquor), drinking is
encouraged (e.g. at a party where alcohol is served), or other people with drinking problems are present.
Again, record these on the worksheet in the left-hand column.
Reference: Form cc
You may also have your client complete the optional “Checklist of Social Pressure Situations”
(Form dd) to suggest potentially problematic situations, and learn your client’s perception of how much
of a problem each is likely to be. This can provide a basis for further discussion.
5.4d. Developing Skills for Coping with Social Pressure to Drink
As you make the transition from assessment to focus on coping skills, emphasize how helpful it
can be to have thought through and practiced how to cope with the situations just discussed. Being
prepared can make the difference between not drinking and drinking. Of course there will always be
situations for which you have not prepared specifically, but the more you can prepare, the better. Also,
when you have rehearsed a variety of different coping strategies, you are better prepared for the
unexpected. Therefore, the purpose of the next section is to develop a number of different skills for
coping with social pressure. (Remember to practice and not just talk about coping strategies.)
Explain that in general there are two ways of coping with social pressure:
1. Avoid situations in which social pressure is likely to occur, and
2. When you cannot or choose not to avoid such situations, have specific coping strategies ready
before you enter the situation. It is wise to include an escape plan for leaving the situation if
temptation feels too high.
The first of these involves conscious decision making. It is a strategy that is used earlier in the course of
recovery, by people who successfully abstain. Which situations involving drinking can be avoided? Ask
your client to identify which situations on the worksheet he/she thinks it would be best to avoid altogether
in order to reduce the temptation to drink. On the worksheet, write “avoid” as one coping response in the
right-hand column for each situation the client plans to avoid. Anticipate and explore thoughts, feelings ,
and problems that could occur in relation to avoiding these situations. Look for specific thoughts or
feelings that could interfere with the appropriate use of avoidance as a coping strategy for these situations.
Are there negative consequences that could be anticipated as a result of avoidance? For example, does
the client feel guilty about avoiding friends or family or worry about how it will appear to other people if
he/she avoids a situation? Does the client feel he/she is weak for needing to avoid a situation in which
there will be a temptation to drink?
Of course, people cannot avoid all situations in which other people are drinking, or where they
will experience direct pressure to drink. Even if the client’s intent has been to avoid certain situations,
they may still be exposed to them by accident or choice. This raises the issue of what other coping
responses the client will have and use to avoid drinking. Emphasize the need to develop several possible
strategies for situations that he/she can or will not be able to avoid. (It is both acceptable and a good idea
to record two or more possible strategies in the right-hand column for risk situations.)
Consistent with the motivational style described in Phase 1, your primary approach for
developing coping strategies should be one of asking more than telling. There in nothing wrong with
giving your client good ideas for possible coping strategies, and direct rehearsal is part of this module, but
always first ask your client to suggest ways in which he or she could cope with the social pressure
situations. This includes exploring successful drink refusals in the past. Clients usually have very good
Reference: Form dd
ideas about what would work for them, often better and more appropriate than the ideas a therapist might
prescribe for them. There’s nothing wrong with suggesting strategies, but it is important for the client to
“own” and accept the strategies you develop together. To avoid “yes .. but” scenarios (a variation of the
denial-confrontation trap described in 2.4), it is a good idea when making suggestions to present a range
of different ideas and ask your client to tell you which of them might work best. If you have serious
concerns about a coping method your client is proposing for a particular situation, use the approach
described in pull-out module, “Raising Concerns” (4.2).
For situations in which the client believes he/she could be tempted to return to drinking as a result
of direct or indirect social pressure, ask your client what strategies might help him/her to avoid drinking.
How could he/she cope in these situations? Some general ideas are:
Bring along a sober friend.
Plan an escape if the temptation gets too great.
Ask others to help him/her not drink by refraining from pressuring or drinking in his/her
Practice effective “I don’t drink” responses.
Remember not only to draw on your client’s expertise, but also to use plenty of reflective listening and
positive reinforcement. Here’s an example of a discussion of social pressure and how to cope with it.
The situation involves both indirect and direct social pressure, but the initial focus of the discussion is on
how it will feel to be around other people drinking.
THERAPIST: Now that we’ve talked about the two types of social pressure that can lead to
temptation, and some of the general strategies that you might use to decrease the risk of drinking
in these situations, I’d like to get a better idea of how you are affected by social pressure. I think
you mentioned that you feel particularly tempted to drink when you are around other people who
are drinking. Is that right?
THERAPIST: Tell me more about that - describe some of the situations in which you might find
yourself around other people who are drinking.
CLIENT: I’ve been drinking for a long time. There are a lot of them.
THERAPIST: Yes, I’m sure there are, so lets start with a situation that you are likely to be in
sometime soon – for example, do you have any current plans to socialize with family or friends
CLIENT: Actually I’m supposed to go to a friend’s house for a barbecue next Saturday. It’s a
yearly event. I know there will be plenty of drinking at the party. It’s kind of a heavy drinking
THERAPIST: Good example! Do you have some concerns about going to the party?
CLIENT: Definitely! I’ve never been to one of these parties without drinking. You know how it
is— it’s hot and everyone’s drinking beer. The party starts in the afternoon and by dinnertime
everyone is feeling pretty happy.
Documents you may be interested
Documents you may be interested