Thank you to all of you who replied to my post. From those of you who have been there, it sounds like the consensus is that long term changes require support from others. I know that no one here cares about my grades or how many hours I work, but I posted them simply to illustrate the nature of my problem as a psychological dependence, rather than a physical dependence. I could quit today and with no worries about withdrawal, if I had a compelling enough reason to do so. That is, I know my habits are seriously unhealthy, but at this point, I haven't done anything where the damages I have caused surpass the level of embarrassment, so the choices are all mine. That is a good thing, and in part d/t the fact that I have been extremely lucky. However, I am in the position of knowing that I have a problem, and also knowing that right now not changing my habits is far more comfortable than changing them. I see the long term picture, but it's just too easy to tell myself that I will start doing better tomorrow.
I know that the addiction literature addresses the issue as a disease, rather than a matter of willpower. I'm not convinced I have a disease. Perhaps I'm just an idiot who makes a lot of poor choices. Either way, willpower still has a role in overcoming psychological dependence. This may sound arbitrary, and obviously I'm not yet completely educated about recovery, but I suspect that the nature of support necessary to overcome psychological dependence is somewhat different from that necessary to overcome physical dependence. As I see it, what I need is accountability. Frankly, I have a hard time seeing myself as a cause. The best decisions I have made in my life have been motivated by what I believe I owe to the people I care about.
The bottom line is that I doubt I'll make the necessary changes until I have an honest conversation with someone I care about, and ask them to follow up with me.
Maybe it is not the ultimate solution, but probably a necessary step. There are three people I have considered, as people I could trust. One is a good college friend (prior degree, not nursing school), and former roommate - she's seen some of my more embarrassing inebriated moments, so the confession would certainly not be shocking. The second is a classmate, who I was partnered with during one of my clinicals, who has been open in discussing with me and other students, her own attempts to reduce the amount she drinks (Couldn't help but wonder if it wasn't fate/God that placed us together in the same setting, where we both were struggling with the same issue). The third is one of my clinical instructors. She is an outstanding, seasoned critical nurse and one of the most incredible people I have ever met. After all that she's seen, she still has the patience to respond thoughtfully to all of the petty, trivial day-to-day concerns of students, and not be judgmental (not that all student concerns are petty or trivial - I'm just saying that she responds thoughtfully to the ones that are, as well as to the things that are really important). She has been understanding and supportive, in the past, in allowing me to discuss my own vulnerabilities.
Let me know if you think any of these people are an appropriate resource. Is it appropriate to ask my friends, colleagues, instructors to check in with me? Would it be academic/professional suicide to discuss unhealthy patterns of alcohol use at school? In the professional setting, there are policies and systems for mandatory communication that I don't entirely understand. If I admit to someone in a position of authority that this is an issue I struggle with, will that require some type of documentation, reporting or some process of mandatory observation?