REGAINING CONTROL – Helping problem drinkers moderate without quitting
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A successful Redondo Beach businesswoman in her 40s, the single mother of a teenage son, had been using alcohol to cope with emotional issues, and had come to identify drinking as a problem “on and off” in her life.
Then she got a DUI.
“It was my wakeup call,” she said. “I realized I had an unhealthy relationship with alcohol.”
She wasted no time getting to Alcoholics Anonymous. At AA meetings she found people she liked and admired, but she wasn’t like them in a key way: while she had become a problem drinker, she had not developed alcoholism, an addictive state that is typically addressed with total abstinence.
“I went to multiple AA meetings to address whether I am an alcoholic. I really appreciated AA, it is a great service for people who are alcoholic. But I did not fit the profile at all,” she said.
“In the middle of a meeting I realized, I’m not an alcoholic,” she said. “And I realized why I was so uncomfortable there.”
She came across the book Sober for Good by Anne M. Fletcher, which mentioned another organization, Moderation Management.
“Not everybody has to stop drinking,” she said. “AA is not the only option.”
Then in late 2010 she found a weekly Moderation Management meeting led by Alicia MacGowan, a Hermosa Beach substance abuse counselor and clinical social worker. She began attending, and took up a program of mindful moderation, drink charting, and addressing her underlying issues that had triggered overindulging.
Now she is living a happier, freer life and is still drinking, but not over-drinking.
“Alcohol and I have a completely different relationship now. Moderation Management offered a healthy place to go and speak about what had gone on in the past, it showed me how to navigate and manage my alcohol, and it gave me like-minded people to be with,” she said.
“I realized it wasn’t about alcohol, it was about my relationship with myself,” she said. “Once I improved my relationship with myself, my relationship with alcohol changed dramatically, and for me, easily.”
Controversial approach
Moderation Management groups across the country meet in the shadow of Alcoholics Anonymous, a vastly larger organization that for decades has been respected among treatment professionals for its effectiveness.
Therapist and substance abuse counselor Alicia McGowan. Photo
MacGowan, founder and clinical director of Recovery Now Inc. on Pacific Coast Highway, deals with a wide range of people’s addictions and problem behaviors, treating individuals with cognitive and behavioral therapy, and leading a Moderation Management meeting. She said people with alcohol problems that have progressed to actual alcoholism do not qualify for Moderation Management – they have lost for good the ability to control their drinking and must seek abstinence through AA or other means.
And, she said, the moderation approach, for those who are not as far gone, is a controversial one. Many of her abstinence-oriented colleagues complain to her that Moderation Management will “get alcoholics drunk” by luring them to try one more time to drink with control, although they will be doomed to failure.
MacGowan said her individual clients participate in a screening process that results in some being told that they must seek abstinence rather than moderation. And drinkers in moderation groups can see whether they fit there or in an abstinence program such as AA.
“Since we started I have had one person attend group who was alcoholic, and was able to recognize the significance of his dependence when he heard others share their experiences,” she said.
“He later phoned me to express thanks for that experience, as he felt he was able to put to rest the idea of moderating and said ‘I am now a willing participant of AA as opposed to fighting the concepts of the program,’” MacGowan said.
The Moderation Management website states that about 30 percent of its members go on to AA or other abstinence-based programs.
The MM group MacGowan leads started in January with a handful of regular attendees, and has been steadily growing.
Michael Ballue, executive director of the National Council on Alcoholism and Drug Dependence of the South Bay, said the treatment community has come to embrace “harm reduction” methods similar to MM for drug and alcohol use, but not without some controversy.
Exchanging clean hypodermic needles for dirty ones, giving out condoms to young people, and telling people to drink lots of water if they insist on taking ecstasy – all have been met with resistance from people who believe that those messages undermine calls for abstinence.
Ballue said successes and failures can be found among moderation managers and AA members.
“Both state clearly who they are trying to serve…It’s not a one-size-fits-all world,” he said.
Ballue said a wholesale rejection of harm reduction strategies such as MM would “disregard a lot of progress that can be made.”
But he also expressed concern that alcoholics can be lured into drinking binges by fooling themselves that they fit within Moderation Management’s guidelines, and can continue to drink.
Many treatment professionals likely will not see Moderation Management groups as successful unless some comprehensive data is kept on their effectiveness, Ballue said. That’s not likely to occur anytime soon, because MM is an informally run organization.
AA, on the other hand, is long established, and since the 1930s its approach has received positive attention from treatment professionals, news accounts, and even the seminal psychologist Carl Jung.
In courtrooms across the U.S., judges send people convicted of DUI to AA meetings, with “court cards” that must be signed at the meetings. MacGowan said judges also accept court cards signed at Moderation Management meetings.
Counting drinks
MM guidelines defining a moderate drinker include usually drinking for no longer than an hour or two on a particular occasion, usually not drinking faster than one drink each half-hour, and usually staying within a.055 percent blood-alcohol level.
Members of Moderation Management do “a 30,” a month-long period of abstinence, examining how alcohol has been affecting their lives, writing down “life priorities,” and looking at what triggers their drinking.
They go on to make positive changes in their lifestyles, and continue meeting with each other for mutual support and to help newcomers.
The Redondo businesswoman did a 60 instead of a 30, and then had a couple glasses of wine “to take the power out of it.” Unlike the alcoholic experience of losing control, she was able to return to “regular drinking.”
MM encourages members to “strictly obey local laws regarding drinking and driving” and abstain from drinking alcohol at least three or four days a week.
Women who have more than three drinks on any day, and more than nine drinks per week, might be drinking at harmful levels, and men (whose bodies are usually larger) might be drinking at harmful levels if they have more than four drinks on any day, and more than 14 drinks per week, according to MM.
The moderation approach is discussed in detail in the book Responsible Drinking by Frederick Rotgers, Marc F. Kern and Rudy Hoeltzel.
Bad PR
The Moderation Management movement suffered a significant setback in March 2000 when newspapers reported that the MM founder, Audrey Kishline, killed two people while driving drunk on a highway in Washington State.
However, as Ballue pointed out, Kishline had informed MM that her attempts to moderate her drinking had failed, and she was pursuing abstinence at the time of the crash.
“It’s definitely something that’s tinged the organization,” MacGowan said. “But the reality is that the concept is still good, and that’s why it continued…People who start these movements do it because they have some issues. Unfortunately they do not always address those issues successfully for themselves.”
She said MM had attempted to distance itself from Kishline, who “was not good for the organization,” before the crash.
Ballue said some of the treatment professionals who are “vehemently opposed” to MM “quote the story of its founder, and conclude that it is setting up alcoholics to continue drinking.”
Beyond alcoholism
MacGowan became interested in treatment approaches for problem drinkers who are not alcoholics in 1998, when she took part as a researcher in a DUI study.
“There were 500 people in the study. What I found was that first-time DUI offenders had little to no alcohol dependence, but as the number of DUIs went up over their lifetime, and their blood-alcohol level was higher, the level of their alcohol dependence went up as well,” she said.
The first-time offenders “were early-stage drinkers making serious mistakes. I thought that if I could help these people get a hold of their drinking before it snowballed into alcoholism, then I could help prevent repeat DUI offenses,” she said.
The National Institute on Alcohol Abuse and Alcoholism states that there are four times as many problem drinkers as alcoholics in the U.S.
MacGowan said the AA “Big Book,” the basic text written by the organization’s founders, addresses the problem drinker who is not yet alcoholic. It describes “a certain kind of hard drinker” who “may have the habit badly enough to gradually impair him physically and mentally.”
“If a sufficiently strong reason – ill health, falling in love, change of environment, or the warning of a doctor – becomes operative, this man can stop or moderate, although he might find it difficult and troublesome and may even need medical attention,” the Big Book states.
The “real alcoholic,” on the other hand, is said to have a physical condition that causes him or her to lose control of the amount they will consume, once the first drink is taken, and/or a mental state that threatens a return to alcohol during periods of sobriety.
The Big Book suggests a test for the mental aspect of alcoholism in which the drinker tries “leaving liquor alone for one year,” and a test for the physical aspect that involves trying “some controlled drinking” to see if that is still possible.
AA encourages drinkers to seek spiritual help if they have “lost the power to choose” whether they will drink, and the Big Book outlines a spiritually based 12-step recovery program.
MacGowan says AA is among the “gold standard” of abstinence programs. In addition, she and her colleague James Morrow offer abstinence programs including psychotherapy, group therapy and “recovery coaching” in-person and by phone and email. As a coach, Morrow also goes “into the field” to help a client “learn how to socialize in a public establishment without a drink” and “identify triggers and provide supportive strategies to avoid consumption.”
Epilogue
Meanwhile, our Redondo businesswoman continues to happily moderate her drinking, keeping her consumption well below the MM guidelines.
She continues to practices the MM program and go to individualized therapy sessions. She continues to address the underlying causes of alcohol becoming a medication for her, and reminds herself not to drink as a response to feeling hungry, angry, lonely or tired (which go by the acronym HALT).
“Now when I do drink it’s regular drinking,” she said, a glass of wine with friends, that sort of thing.
“The flavor, the smell, I enjoy it, and that’s enough. Because I enjoy moderation and it’s something that is not a struggle, my overuse in the past had to do with something other than alcoholism,” she said.
“I have some issues ahead of me, but on a scale of one to 10 I have improved to a good seven right now,” she said.
“For so long, all we knew about was AA, and I was such an outsider. I honor those people, their courage, how they are navigating their lives, but I was not one of them,” she said.
“For me this is a gift, because it changed my life. What I’m gaining from this will last me the rest of my life.” ER