canadian propecia online

Call Now To Set Up An Appointment: 214-471-8650

Not Everything in Moderation

A more modern and controversial viewpoint on substance abuse and addiction is moderation management. As a therapist and counselor, I have been asked about my viewpoint on this very topic. I hope this article can help to provide a well-rounded perspective on a controversial topic, and provide a forum to continue an open discussion on this issue.

Can a recovered addict moderate their usage of alcohol or drugs? There is not enough research to give a definitive “yes” or “no” regarding this, but it is a fact that some alcoholics who have been abstinent for many years have been able to drink in moderation. There are many unknowns, however. We don’t know how common occurs, or if it is more rare than common. Therefore, at this time, when people think about using alcohol after years of sobriety, my recommendation would almost always be that it is not worth the risk. I would ask the person “why?” Presumably part of being abstinent for this period of time is a realization that alcohol is not necessary for much at all in life, so why use now? This can help these individuals to determine if it is worth risking the hard work that earned them their sobriety.

One of the concerns that I have about moderation management is that it is not likely going to be under the supervision of an addiction professional. Typically the idea of trying moderation would come after a significant period of time of maintaining abstinence. For this reason, I am concerned that the individual may fall back into a period of denial should a significant problem arise. Even worse, this person would not be processing their thinking and problems with someone who can help them identify issues, if there are any.

At this time moderation is a treatment option when it is the only option. There are those who enter treatment to appease the courts, a judge, or an attorney. Many of these individuals are extremely defensive about the idea of abstinence from alcohol. Not all of them are addicted to it either. Some people who enter Outpatient Treatment for Alcohol have abused it for a period of time, but only because they did not recognize that their pattern of use was abusive. Many of these individuals are able to moderate their use of alcohol, without future problems, when educated about alcohol use, and what makes patterns maladaptive and why. Also, pushing the issue of lifelong abstinence will likely drive these people out of treatment or at least cut down on their level of commitment while in treatment, if they are not ready to consider abstaining. Therefore, teaching some moderation techniques can give them some strategies to use, which they may be open to listening to.

Moderation management is a relatively controversial concept in the treatment of substance abuse. Is it going to be the new wave of treatment strategies? Time will tell. Before this takes place, there needs to be more research to show its efficacy of use. Until that time, it should only be used with extreme caution and when there are no other alternatives.

Share
4 Comments
  1. Hi, You wrote:
    “One of the concerns that I have about moderation management is that it is not likely going to be under the supervision of an addiction professional. Typically the idea of trying moderation would come after a significant period of time of maintaining abstinence. For this reason, I am concerned that the individual may fall back into a period of denial should a significant problem arise.”

    I have several comments on this:
    1. 75% of people recover from heavy drinking and alcohol related problems without ever seeing a therapist or going to a self-help group. And most do so by moderating. There is a large body of literature on this under the term “natural recovery.”

    2. Most people who contacted us to participate in our randomized clinical trial of moderatedrinking.com were not previously abstinent and alcohol-dependent. Both our web app and MM were helpful in participants reducing their drinking and alcohol-related problems. And our program and MM is clear that the probability of successful moderation declines as one’s severity of alcohol-related problems increases.

    3. In my decades of clinical practice that included working with clients w/alcohol problems both to moderate and to abstain I encountered a small handful of abstinent people with histories of heavy drinking who were interested in resuming drinking with a goal of moderation. These clients did resume drinking with the intention of moderating but were not successful and, after a brief period of time, agreed that they should resume their abstinent lifestyle.

    • Reid,
      Thank you for your comment. It is good to get the perspective of another clinician on this. I do agree that many people do get better without having seen a therapist, and not everyone needs therapy to recover. In that particular paragraph, I was primarily talking about someone who had been abstinent for a period of time, but was now desiring to try to drink in moderation. I may have not been clear on that point.

      Thank you for your clinical studies on moderation management as well. I would say that my personal experience would also validate what you are saying about the success declining as one’s severity increases.

      Thank you for you insight and feedback.

  2. Hi, Michael. Thanks for dropping in to check out my website! I wanted to check yours out, too, and this article caught my eye.

    I, too, think that the jury is still out on whether “moderation” is a viable choice for those who have struggled with alcohol abuse / dependence. I worked in the field of substance abuse for years and also have many friends who have struggled with alcoholism. Although I believe it is possible, I don’t think I know of anyone – client or friend – who has successfully moved from alcohol dependence to moderation – although many have tried. And, a few would even claim to do so. My observations of those few is that they are “white knuckling” their way through moderation with a good dose of denial. And, it appears to me that they are already sliding down that slippery slope of denial.

    When I talk with clients about abstinence, I explain it this way. . . . I love green tea. But if the doctor told me that green tea was likely to rob me of my health, my sanity, my family, my work, my passion, . . . I would not hesitate to give it up – entirely. One clue to knowing you are possibly being dependent on something (like green tea or alcohol) is to absolutely refuse to give it up even when things you claim to value are possibly being threatened.

    One of my friends just celebrated her 21st sobriety date. It’s a huge accomplishment. And, I appreciate your willingness to take a hard line stand for your clients on something as important as this.

    I look forward to dropping back in to check out more of your blog in the future, Michael. Thanks for sharing what you know!

    • Thank you Tamara for your comment, and your perspective on this issue. I like the ideas that you present as well. Thanks again for your blog and thought perspective.

Leave a Reply

  1. Contact us today to learn about how I can help.

Contact Me

Vantage Point Counseling Services
3300 Oak Lawn Ave, Suite 415
Dallas, TX 75219
(214) 471-8650

Connect With Us

Visit Us On TwitterVisit Us On FacebookVisit Us On Google PlusVisit Us On LinkedinCheck Our Feed