For roughly 60 years, Alcoholics Anonymous and similar programs have dominated therapeutic thinking, treating alcoholism not as a behavior but as a disease – insisting on abstinence. But a growing number of moderation programs across the country are challenging that model. Moderationadvocates distinguish between ““chronic drinkers,’’ who are ““severely dependent on alcohol,’’ and who have long histories of substance abuse, and ““problem drinkers,’’ whose bouts with alcohol have lasted five years or less and do not sufffer physical withdrawal when they abstain. Proponents of moderation contend that problem drinkers can still maintain careers and families – and they can learn to manage their drinking without eliminating it entirely. Moderation supporters acknowledge that their approach isn’t for everyone. But they also cite studies, including one by the American Society of Addictive Medicine, indicating that problem drinkers outnumber hard-core alcoholics four to one.
Most moderation programs have codes of conduct much like AA’s 12 steps – but without spiritual references. Drink/Link, a seven-year-old program in Northern California, teaches people not to drink more than one drink an hour. MM suggests abstinence for three or four days a week. Practically all of the programs insist that problem drinkers begin with alcohol-free periods of 30 to 90 days. At the University of Washington in Seattle, researchers are preaching ““harm reduction.’’ Using a mock bar and nonalcoholic beer, students are taught that some of drinking’s effects, like slurred speech, can be psychosomatic – you expect to feel drunk, and you do. So, students are told, they don’t need to drink that much to have a good time.
Some problem drinkers, especially those who fail at cutting back, use moderation as a road to abstinence. Albuquerque, N.M., psychologist Reid Hester says this slower process of kicking the habit is called ““warm turkey.’’ Success rates for moderation programs are hard to determine. Research in Canada showed that after a year about 50 percent of those using moderation were drinking within its guidelines, but critics ask whether these programs will be effective over the long haul. Many participants say they now live normal lives without being stigmatized. ““The monkey fell off my back when I realized that I wasn’t an alcoholic, that I wasn’t out of control,’’ says Audrey Kishline, who founded Moderation Management and wrote a new book, ““Moderate Drinking: The New Option for Problem Drinkers.’’ Kishline says that many European countries widely use moderation. In the United States evidence mounts that one treatment model may not fit all. A 1994 publication of the National Institute on Alcohol Abuse and Alcoholism says that ““moderate drinking may be an acceptable goal’’ for some drinkers with a ““relatively mild’’ problem.
The stakes are high in this emotional clash of philosophies: there are some 15 million alcoholics and problem drinkers in the United States. To Kevin, a recovering alcoholic from Chicago, all the moderation talk is a ““kind of rationalization to keep drunks drinking. If I could drink like that, I wouldn’t have the problem.’’ Many who treat alcoholics are equally skeptical of what they see as a dangerous delusion. Paul Wood, president of the National Council on Alcoholism and Drug Dependence, worries that alcoholics might get wind of the moderation message and tumble off the wagon. ““Every alcoholic’s great dream,’’ he says, ““is to be a moderate drinker again.’’ For most experts, AA’s ““one day at a time’’ still beats moderation’s one drink at a time.
