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.