Is Moderation One Big Myth?

We asked Michael Levy, PhD, outpatient director of substance use services at North Shore Medical Center in Massachusetts and author of Take Control of Your Drinking...And You May Not Need to Quit, to weigh in on this alternative to AA.

Q: Abstinence is still the number one way to treat alcoholism. Why do you consider moderation a viable option?

A: So many of us believe that not drinking is the only choice. That's how I was trained in school, too. But people with drinking problems fall on a wide continuum. Of course, some people will never be able to control their drinking—you hand them a thimbleful of beer, and they're off and running. But that's not the case for everyone. What often drives people away from treatment is that they know they'll be told they can never drink again; they just can't handle the thought. If you offer an approach that's less threatening, they may be more likely to give it a try.

Q: If moderate drinking isn't for everyone, how do you determine whether someone is a good candidate?

A: One of the first things I look for is whether the person has ever been so dependent on alcohol that they experience withdrawal symptoms when they stop. Those people have a harder time moderating successfully. Same for a drinker who's been hitting the bottle daily for decades—that habit is going to be harder to break. I've also found that those who succeed at moderate drinking tend to have a more stable life and a strong support network.

Q: How do you respond to those who say this is only delaying the inevitable, that people who think they can moderate are kidding themselves?

A: Studies have shown that people with drinking problems can learn to moderate under the right guidance. One study analyzed people who were in recovery for at least a year. Levels of recovery included not drinking; drinking within recommended guidelines, called low-risk drinking; and somewhat heavier drinking, which was more than the recommended guidelines but wasn't causing the participants any huge problems. Three years later, they found that about 50 percent of the drinkers in the last group were still in control—they hadn't tipped back into abusive drinking and weren't dependent on alcohol.

Q: What's your take on groups like Moderation Management?

A: They can absolutely be helpful, but they aren't for everyone. Much in the same way AA isn't for everyone. Though MM does offer some pretty sound drinking guidelines, I recommend that people also connect with a physician or an addiction specialist to determine the right course of action. It could be MM, it could be AA—the goal is to find the best personalized solution.


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