Sober Curious: Does Moderation Management Work?
When less is more … moderation management
I promise I am not researching moderation management for myself. It’s been a while since the little guy in the red jumpsuit on my shoulder has whispered, “Who would it hurt if you had one glass of red wine with dinner?” In fact, he’s been too busy the past three months to bother me, convincing those who drink to quell their anxiety that “just one more” will make our troubled times disappear. In fact, during the pandemic, alcohol sales have jumped 55% over last year.
Sober Curious: Does Moderation Management Work?
I have always been curious about the concept of moderation management for drinking alcohol. My question is, If you need to ‘moderate’ your drinking, shouldn’t you quit drinking? In looking for answers to my probing question, I found the online self-help group Moderation Management (MM). MM is a “lay-led non-profit dedicated to reducing the harm caused by the abuse of alcohol”. Moderation management programs allow continued, but controlled drinking. And according to MM, approximately 30% of those who join their group go on to abstinence-based programs.
The National Institutes of Health (NIH) asked the same question as me …
Actually they asked, “Can Targeting Nondependent Problem Drinkers and Providing Internet-Based Services Expand Access to Assistance for Alcohol Problems?” And they concluded:
Tailoring services to nondependent drinkers and offering assistance over the internet are two valuable methods of broadening the base of treatment for alcohol problems. Although interventions like MM are unlikely to benefit all individuals who access them, they do attract problem drinkers who are otherwise unlikely to use existing alcohol-related services. NIH
I work for Sanford Addiction Treatment Centers, and our clients are often reacting to the negative consequences of their drug and alcohol use when they call us. Because of this, they are usually ready to pursue abstinence from their substance of choice. Maintenance programs require a lower level of commitment. And the motivation may come from family members, educators, employers, etc. But MM does open the door to taking action and starting the conversation about alcohol misuse.
Glass half full or half empty?
Rethinking Drinking
The NIH addresses the subject of alcohol use and misuse in their excellent website Rethinking Drinking – Alcohol and Your Health. The website provides tools to evaluate one’s drinking quantity, and whether or how to make changes in drinking habits. They also discuss weight management, overall health effects, and even what constitutes an alcoholic “drink” (a rude awakening).
When someone is exploring options to moderate or quit drinking, they’re already feeling the internal indicator that there is a problem. It might not be a white flag yet, but many of those who explore moderation management meet the criteria for Intensive Outpatient Programs (IOP). From my perspective, as long as you get on the ladder, you can move up or down to appropriate levels of care.
Alec Green, Sanford, Managing Director
Meeting People Where They Are
I have always been envious of those folks who can nurse a glass of wine over an evening and leave an inch of liquid in the bottom of the glass. “I’ve had enough,” they say. As someone who could never get “enough”, I failed at moderation for years, although I never had a plan. I quit for a month, or two weeks, or a night, and then that little red devil talked me into “just one”. Of course, one would swiftly escalate to many, and the whole vicious cycle would begin again.
But the treatment of alcohol addiction, misuse, and use is an individual process. Everyone is different, and each person’s goals are individualized. Moderation Management might work for those who have not become dependent upon alcohol. Or for those who want to keep track of their controlled alcohol intake. Or for someone who is in denial about the extent of their alcohol misuse, as a first step to treatment. And it’s pretty easy to figure out if you can moderate or not. As an old therapist of mine suggested, “Wait till 6 PM. Have one glass of wine.” Even eight years sober, that seems unreasonable to me …
As therapists, we meet our clients where they are. But whether our clients start treatment in Residential or Outpatient programs, they have begun to experience the negative effects of alcohol on many aspects of their lives. We have clients who want to test their newly developed coping skills to ‘moderate’ their drinking. Or someone who’s drug of choice is alcohol might suggest they try cannabis. And I’m okay with people challenging me – it opens the dialogue. Never drinking again is a daunting prospect. But once those pathways to an alcohol use disorder have been opened, moderation is not the answer, the default is abstinence.
Lynnel Brewster, RN, LPC, LLMFT, CCTP, Sanford, Clinical Director
