Why it is dangerous not to include support for moderation in recovery

Stock photo of a bar from Wikimedia Commons.

When Demi Lovato announced that she was “California Sober” recently, we heard an outcry from people in the recovery support community who champion total abstinence.

“It’s dangerous. If problem drinkers believe they can moderate, they will delay the inevitable choice of total abstinence or drink themselves to death.”

“To tell someone like Demi that she can moderate, is almost criminal.”

“Next drink, next drunk.”

These beliefs permeate our society which has been immersed in the philosophy of the 12-step programs that abstinence is the only answer for those of us who worry about our drinking.

Most people are unaware that support for reducing drinking is available, or that a growing number of therapists support this approach, or that the NIH’s (National Institute of Health) National Institute of Alcohol Abuse and Alcoholism (NIAAA) has their own “Rethinking Drinking” site which offers tips and worksheets for those who are concerned about their drinking and wish to cut back.

In fact, last fall the NIAAA presented their draft definition of recovery at a roundtable discussion of researchers and experts in the recovery field:

Recovery from AUD (Alcohol Use Disorder)

“Recovery is a process through which an individual pursues both remission from AUD and cessation from heavy drinking. An individual may be considered “recovered” if both remission from AUD and cessation from heavy drinking are achieved and maintained over time.  For those experiencing alcohol-related functional impairment and other adverse consequences, recovery is often marked by the fulfillment of basic needs, enhancements in social support and spirituality, and improvements in physical and mental health, quality of life, and other dimensions of well-being.3 Continued improvement in these domains may, in turn, promote sustained recovery.”

Note that the NIAAA considers cessation from heavy drinking — not total abstinence — as a qualification of recovery. All of the other markers mentioned e.g., “fulfillment of basic needs, enhancements in social support, and improvements in physical and mental health” are also markers of successful moderation.

Is abstinence-focused recovery the safer, more reliable option though?

From a podcast interview with Katie Witkiewitz, PH.D., Regents’ Professor of Psychology at the University of New Mexico in Albuquerque, New Mexico, Scientist of the Center on Alcoholism, Substance Abuse, & Addictions, and Director of the Addictive Behaviors and Quantitative Research Lab. Per Dr. Witkiewitz, the numbers quoted below are from various sources and may not be exact.

Nearly 80% of people with AUD never seek treatment. 

Large survey data suggests that the focus on abstinence as the expected outcome of treatment is an obstacle to people seeking treatment. 

Medication to reduce drinking is often not prescribed because prescribers believe that abstinence is the only solution.

Of the approximately 20% of people with AUD who seek treatment, only around 35% will succeed at abstinence which means in the vicinity of 7% people suffering from AUD are currently being helped by abstinence-focused recovery. 

The majority of government funding goes to abstinence-based programs.

On the other hand, Dr. Witkiewitz also says:

People who reduce their drinking have great outcomes and achieve the markers mentioned above in the NIAAA’s definition of recovery. 

If we open up treatment to support harm reduction or reduced drinking, approximately 40% of people with AUD will be helped.

But is moderation possible?

While MM does not track success rates of our members, our sponsors, Cutback Coach, Step Away, and Checkup and Choices, who offer programs and apps that aid and support reduced drinking, all report reductions in alcohol usage and heavy drinking of 50-60% for people who use their apps or programs. Many of our members use these apps or programs to track their progress.

Meeting people where they are and letting them choose their first successful step.

This is where Moderation Management (MM) comes in. We are here for those other 80% of people who are afraid, reluctant or steadfastly opposed to reaching out for help because they don’t want to be told they have to abstain forever or that they are powerless or that they have to turn things over to a Higher Power. 

In fact, we don’t tell them they have to do anything. We give them a safe and supportive environment in which to determine and take the first step at which they feel they can succeed and then we encourage them to build on that success. There are no Day 1’s at MM!

We view “recovery” as a cycle of change. Sometimes the change comes quick, sometimes it takes a while. Sometimes we make steady progress. Sometimes we take a step backward, however, the cycle does not end when that happens. We don’t go back to the beginning. We can’t unlearn what we have learned about ourselves and we can’t un-grow the ways in which we’ve grown.

A good number of our members do end up choosing abstinence, but most of them say they would never have been able to make that choice without losing their fear of long-term abstinence through MM. Abstinent days and longer periods are encouraged but, again, not required.

Like AA, MM is a peer support community, which means we are not professionals who can advise others on what is best for them. Instead, we share our experiences and learn from each other through those shared experiences. Our community support is free and anyone is welcome. We are not an exclusive community and we encourage our members to explore other avenues of support and to, again, share with us what they learn.

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