What Is 'Moderation Management'?
“Everything in moderation” – a bit of wisdom as old as the Ancient Greeks. Their version, inscribed on the temple at Delphi, was, “Nothing in excess.” Good advice. But for those struggling with alcohol or drugs, “excess” may be closer than it appears.
Moderation management is an idea advanced by some therapists and counselors that separates addiction from problem use, with the idea that these two categories need different types of treatment. Primarily, problem use doesn’t need complete abstinence, while addiction does.
Moderation Management in Practice
Moderation Management (MM), the organization, uses a step procedure but differs dramatically from AA and other step programs in that all steps are to be completed within the first 30 days—and maintaining long-term abstinence is not the goal. For the first month, participants are told to stop drinking completely, and the ability to do so helps separate the problem drinkers from the true addicts. The thinking is that addiction is a behavior that cannot be willfully controlled or stopped, so those who can’t follow the steps without drinking may have an addiction and, while they are free to remain in the program, may want to seek outside help.
Members are also free to pursue complete abstinence if they wish.
The “Steps of Change”
1. Start keeping a diary of your drinking to help learn how your problems with drinking occur.
2. Look at the limits of drinking for moderate drinkers, and some of the practices and attitudes that go with moderate drinking, to get a clear picture of the moderation objective.
3. With that clear picture of what moderation looks like, consider whether moderation or abstinence seems the better objective for you. Also score your problem severity with a self-test, and consider other factors, to see whether moderation would be workable for you.
4. Make an extensive list of the problems drinking has caused you, and the benefits you expect from moderation, to strengthen your resolve.
5. Start on a period of abstinence of 30 days or more, to experience the positives of non-drinking. During this period away from alcohol you can work through some steps to help you achieve moderation:
- a. Learn skills for avoiding drinking on occasions when you choose not to drink.
- b. Learn skills to control drinking on occasions when you do drink.
- c. Identify the key triggers that lead you to over-drink, and develop means to neutralize those triggers.
- d. Develop your own personal rules that will keep your drinking moderate.
- e. Identify and start new spare-time activities that will displace drinking in your life.
6. At the end of your period of abstinence, you can start drinking again cautiously, being mindful of your limits and personal rules for drinking. Maintain a high degree of attention to your drinking during this period, including keeping a diary.
7. If and when you have slips, do a post-mortem to see what went wrong, and change your personal drinking guidelines if necessary.
Along with these basic steps, support groups are available as well as many other materials. More can be found at the MM website.
What the Experts Say
Perhaps surprisingly, treatment professionals are not dead set against moderation in their patients. A recent survey (November 2012) showed that about half of treatment professionals would approve of some alcohol use in some of their patients. This is twice as many as answered the same way in a survey done 20 years previously.
The benefits of moderation over complete abstinence come primarily from patient acceptance. It is estimated that up to 90% of problem drinkers do not seek help and this is at least partially because they do not wish to stop drinking completely, they only want to cut down and manage the behavior. For this segment of the drinking community, programs that require complete abstinence ask too much. Some worry they won’t be able to stay alcohol-free, others fear they may actually be an alcoholic and don’t want the stigma of a formal identification. Others try an abstinence program and quickly drop out.
Allowing management, as opposed to abstinence, shifts the dynamic away from “all drinking is harmful” and closer to that of other social problems, like overeating or spending too much time on any activity.
The primary criticism of MM is that those who are least able to make clear decisions are determining the course of the treatment. Alcoholics Anonymous and others are very familiar with the kind of denial that alcoholics are capable of.
They point out that all alcoholics want to drink and want to find a way to both drink and not have the dire consequences. According to AA, for the alcoholic, this simply isn’t possible. In AA, there is no category of “problem drinker.” Either someone is an alcoholic or they are not. In fact, one critical step in AA is admitting to being an alcoholic, with all that the label entails. Problems with alcohol are indicative of alcoholism and nothing else.
To meet this criticism, MM offers tools to help self diagnose. They are also not against having a professional involved. MM also recognizes that their methods will not fit everyone and that some should pursue abstinence instead of moderation.