We should be aware that a person who sees their drinking problem as "a moderate dependency" may be under-reporting thier use and consequences. Under treating Alcoholism can be a fatal choice for many.

I've found it very useful to start with the goal of moderation with college students, coupled with small group sessions using goal setting, values clarification, etc. to examine their drinking. Many are able to cut back considerably; others decide on their own that total abstinence is the only route for them. If I tell them to stop drinking, the only thing that they stop doing is coming to see me!

"Under-treating Alcoholism can be a fatal choice for many." What are you implying here, Bill, re the role of the counselor?

Moderation is key to preventing and reducing most problems caused by excessive drinking. Unfortunately, abstinence only and/or zero tolerance attitudes and policies regarding alcohol have made it more difficult to promote moderation and responsible drinking.

This report reminds me of the criticisms of the Sobells' work in the 70s. Yes, a number of patients in their moderation training group died from drinking. But a similar number died in the abstinence group. Recovery is not fundamentally about "treatment." "Under-treatment" is an irrelevant concept. Clients accomplish what is important enough to them. Professionals may be able to assist clients in identifying deeper values and living in closer alignment with them. Most clients who change make that re-alignment on their own.

This is great for people that are coming in on their own and want to stop drinking initially. What do you do with people who are under court order for treatment and are mandaded to stay clean?

Do we really need all those dollars spent on research when the ol' hoaky "cult" of AA suggested all along that if a person is not convinced they're addicted -go try some controlled drinking. If they can- lift your hat. If they can't- moderation (harm reduction) is probably a dangerous way to go. As far as Sobell's work- yea, whats a few lives to prove a moot point?

Part of the discussion should include the distinction between alcohol use / abuse / addiction -- especially the disease concept of addiction and what that actually means. It's these fine lines that allow people to kid themselves about how much is too much (e.g., their definition of moderation) and loved ones to go along with it -- all to avoid the label, "alcoholic," which we now know, thanks to brain imaging technologies, is a person with a chronic, relapsing brain disease -- the disease of addiction (an addiction to alcohol).

Why do we even consider moderation as important? If a patient/client has to come in for TREATMENT for abuse OR addiction, wouldn't good 'ol common sense tell us that moderation is not a goal that we should persue at the moment. It appears that we are more concerned with our own conceptions than what is best for our patients.

Thank you Mr. Cook- your logic is very refreshing.

You can not be mildly dependant on alcohol or any other mind or mood altering drug. It is like being a little pregnant! What you can be is a chronic alcohol abuser who mimics all the signs and symptoms of an alcoholic, However, One of the biggest differences between the two is that the chronic abuser has some of the signs and symptoms of an alcoholic but once he decides to moderate his use he can. The alcoholic can not moderate his use and will die from his disease if he does not stop completely. I am a proponent of Moderation Management for people who have had a problem with alcohol or are medically diagnosed as alcohol abusers. Even Moderation Management will tell you that if you can't stay with your program, you need to quit drinking. The thing to do is proceed with caution. Get the client involved in his treatment plan. Make sure that he understands the pitfalls of moderation management write his moderation plan down and get a commitment of total abstinence if his own plan fails

Total abstinance is the only answer for some, but not all. I run a drinking and driving related non-profit aimed at teaching responsibility. The best way to describe the reaction we get from the 'AA' crowd is disdain. Fortunately, that attitude stays within the walls they have built around themselves. In community meetings I have attended, most people seem open to the concept of teaching responsibility although I can always see one or two individuals whose level of discomfort shows.

What does it mean to encourage "moderation" while sending the drinker out into a world dominated by overdose advertising? Have you ever seen a beer ad which specified a dosage smaller than 12 ounces? (If the common language were honest that would be "12 beers".) Check out today's other story, the one about virtuous NCAA and their dependence on beer advertising-- aimed of course at vulnerable students under peer pressure to binge.

For many years I have been under the impression that total abstinence is the only way .Right or wrong I find it refreshing that some are willing to challenge the dogma of total abstinence .Is there any other reasearch that has been done in regards to Moderation theroy . hphughey@yahoo.com

I agree that we must be aware of under-reporting and minimized alcohol use. Alcoholism tends to be a family disease. A comprehensive assessment utilizing reliable valid tools to determine the severity of use and engaging family members generally proves meaningful prevention.

Hugh check out Moderation Management out of Canada. They nine steps to moderation management. This steps help if you can moderate your drinking. They also give you advise on what to do, if you can not keep the plan that you set for yourself or keep having problems with alcohol despite your best efforts. Good Luck.

Drug use by any name is self-poisoning and, with most of our clientele, illegal. Promoters of “moderation” are encouraging self-destructive behavior and criminal actions, are by their endorsement as “treatment specialists” encouraging a life of serial relapse and likely periods of incarceration. Rather than admit failure as agents of change, try (I’m certain this is a word common to your practice) another, less lethal for others profession!

Just to be clear on this, of all drugs alcohol is the most insidious and likely the most damaging to the user. Many drinkers use alcohol to relieve stress and depression. In addition to the long-term damage it causes the drinker’s body, it happens also to be a serious mood depressant, in small doses (one to two drinks for the average person) reduces impulse control and judgment and is implicated in violent crime, from rape and murder to suicide. The drug seriously disturbs sleep further aggravating depression and its consequences on inability to deal realistically with the issues for which the drinker is supposedly trying to not think about. Simply because this drug is not illegal is no reason to treat it separately from other drugs. In terms of its costs to the individual in terms of damage to health and the reduced average life expectancy, its costs to society, this country alone, is in the hundreds of billions of dollars.

I have seen the damage that alcohol does to family's and relationships. I know so many that are "functional" alcoholics. They go to work every day and manage a career, but cannot do without the weekend binge. Their memory is terrible, they are extremely tired and they justify their drinking because they work hard. It is an entitlement of some kind. I am from a family that has had problems with drinking. Every relationship I have been in, I have dealt with alcohol problems of my partner. It is soooo frustrating, but I have learned to take care of me. His choices are his choices and there is nothing I can do about those choices except educate and always protect myself. My husband thinks he can drink in moderation and doesn't need to quit. He has proven over and over that he can't but still thinks he can make me believe it. It is ironic that I am in the field of Mental Health and can't help him.

Chafetz outlined 12 rules for safe drinking in 1982. I've rarely seen those used to educate students at any level, so young people grow up without a model of what represents "moderate" drinking. This is a mission which belongs in health education at the secondary school level, before young people start to make their drinking decisions. As to the "mindset" of AA, I will only observe that "AA has no opinion on outside issues" and this is one of them.

did you ever consider maybe dating someone who is not an alcoholic. you know you have control over these things, right?

At the very least we, as professionals, are obligated to consider the boundaries not only of our technical competence, but of our professional ethics.

Again, speaking about professionals encouragement of the "moderate" use of any "recreational" intoxicant, be it alcohol or heroin or cocaine or marijuana is still speaking about the use of a know poison. How does one use any known poison responsibly and in moderation; and to what end. Working with substance abusers may not be the easiest of mental health populations to achieve the satisfaction of success for the professional, but enabling failure through employing half-baked treatment measures fails also to promote client self-responsibility, self-confidence and self-esteem, the outcome of taking control of ones life, which can and should be the foundation for success in other important life areas. It is this outcome of change which I understand to be the underlying goal of the mental health treatment process. And as regards self-confidence and self-esteem as successful agents of life change for our clientele, the papering over treatment failure with half-measure and denial is the direct corollary of our target population of intoxicants users wrapping themselves in the denial of, “I’m not an addict because I only use in moderation.”

Hum. From the vehicular homicide of the head of Moderation Management, to my being conscious of my craving for a glass of wine, which I miss a great deal, it seems like I'll stick with AA. I was a 2 drink a nighter for years, so I guess I could be considered moderate, but had to have it, and though a little by some standards, caused me problems. Not sure though that the moderate approach for someone who even thinks they have a problem is practicable.

Look at the facts. the failure rate for AA and total abstinence is ridiculous. Yes it has helped some but for percentage wise it is overal not effective. Nothing is more effective than the Sinclair Method to control a drinking problem. Period!!!