A Toast to Moderation

One afternoon, as I was driving home on the freeway, a question crossed my mind. There are thousands of support groups in our country for chronic drinkers who have made the decision to abstain from alcohol. Why aren't there any support groups available for problem drinkers who have made the decision to reduce their drinking?

Drinking too much, after all, is not like being pregnant. You either are or aren't pregnant, whereas drinking problems lie along a continuum ranging from very mild to life threatening. Problem drinkers have at least some health, personal, family, job-related, financial, or legal problems due to alcohol use. But unlike many chronic drinkers problem drinkers do not experience significant withdrawal symptoms when they stop drinking. And they' normally have most of their resources intact and possess the skills necessary for self-change.

When I finally realized why there were no support groups for problem drinkers, I became very upset. Then, after I calmed down, I did two things: I started a group called Moderation Management (MM) for problem drinkers who want to moderate their drinking. And I wrote a book, Moderate Drinking.

The basic concepts of MM are derived from brief behavioral self-management approaches to alcohol abuse, which in turn are based on controlled studies with problem drinkers. The guidelines MM uses have been carefully reviewed by professionals in the field. But most important, MM was born from the real-life experiences of former problem drinkers who have returned to moderate drinking, including myself.

Bona Fide Boozer

I will now provide you with my "credentials" as a former problem drinker. Though this is something I would prefer not to do, it is necessary because there are those who believe that a return to moderate drinking is impossible for anyone who has ever had a drinking problem. They will say I never was an "alcoholic" And they are correct, if by "alcoholic" they mean a chronic, severely dependent drinker. But if they mean a person with any type of drinking problem, then saying I was never an alcoholic would imply that I never had a "real" drinking problem--in which case, they are wrong.

Like many people, I first tried alcohol in my late teens at home and began drinking socially in my early twenties with friends. From my early to late twenties, however, over a period of about six years, I gradually drank more, and more often. Drinking became a central activity in my life: The people I associated with were mostly heavy drinkers, my evenings were planned around drinking, and having fun meant alcohol had to be involved.

I drank when I was happy, sad, bored, or when I didn't know how I was feeling. But mostly I drank because it became a habit. Naturally this began to cause problems in my life. I did not eat right, and slept poorly. I did not perform to the best of my abilities at work, and began to have difficulties keeping up with the courses I was taking in night school. I started to postpone everything: studying, projects, even getting together with people I knew did not drink as much as I did. I drank irresponsibly, risking other people's lives when I drove after I had too much. Finally, after a long-term relationship fell apart, I started to drink alone. I became depressed, scared, and lonely.

I decided to seek help. For those who say I was never an alcoholic, I want to stress that two treatment centers, an aftercare program, and conservatively 30 to 40 professionals had no problem saying that I was. With my new "alcoholic" label, I experienced traditional treatment first hand. For my "medical disease" I received the following treatments for 28 days as a "patient" on the third floor of a hospital: group psychotherapy, confrontation counseling, and life-skills training. My "detoxification" consisted of sleeping in a room separate from the rest of the clients where a nurse could take my blood pressure and temperature regularly for 24 hours. It is important to note I did not experience any significant withdrawal symptoms when I quit drinking--a point either ignored or considered irrelevant by treatment personnel.

In addition, I was introduced to the institutionalized version of Alcoholics Anonymous while still in the hospital. I was told to fill out workbooks based on the treatment center's interpretation of the first five steps of the AA program. These steps instructed me to do the following: admit that I was powerless over alcohol and not sane; turn my will and my life over to the care of God; write a moral inventory; and confess my wrongs to God. Thus, spiritual training was another aspect of the treatment for my supposed medical disease.

Treatment personnel emphasized that I would have to attend AA meetings for the rest of my life, or else I would end up dead, in jail, insane, or in the gutter. With this kind of advice, I made sure that I went to meetings for several years after inpatient care. I attended literally hundreds of meetings.

The result of all this "treatment?" At first, my drinking became far worse. Hospital staff members had told me I had a physical disease that I had no control over. In possibly the most defenseless and dependent stage of my entire life, I began to fulfill some of these prophecies. I became a binge drinker, suddenly obsessed with drinking too much or not at all. I accepted that I was indeed powerless over my "condition" and my old self-esteem and confidence gradually disappeared.

Then, as time passed, I began to do what a lot of other people do naturally, with or without treatment. I began to grow up. I took on life's responsibilities. I got married, had children, and became a full-time homemaker. Though initially told to stop drinking, I eventually chose to abstain from alcohol for long periods of time.

Sipping, Not Slipping

It gradually dawned on me that the choice to abstain or drink, and how much to drink, had been mine all along. These choices were not predetermined by a disease at all, but were entirely a result of my own actions, which I did have control over. So . . . I decided to shed my "disease." And I took back full responsibility for my own behavior.

Several years ago, after careful consideration, I made the choice to return to moderate drinking. I do not mean white-knuckled, super-controlled, "I really want more" drinking, as is often described by those who don't believe this is possible. I mean that I am comfortable with the role that alcohol plays in my Fife now. When I choose to drink, I drink responsibly. An occasional glass of wine is a small, though enjoyable, part of my life--not the center of it.

I don't want anyone else, ever again, to have to go through what I did. I spent years full of self-doubt, struggling with an alcoholic label that never felt like it fit. In my opinion, my "recovery," or ability to face up to, confront, and change my behavior, was delayed considerably because of traditional treatment methods. I went on a huge detour due to the disease model of alcohol abuse.

My long personal journey is not one I would wish on anyone else. But I began to wonder how many other people had had similar experiences. I also wondered how many problem drinkers were out there who could benefit from a moderation-oriented, layperson-led support group when they first realized that they have a drinking problem. To answer these questions, I had to do some research. One of my first discoveries was that professional moderation-oriented programs are common in countries such as Great Britain, Sweden, Denmark, Germany, Australia, and New Zealand. I also discovered that researchers have been reporting the occurrence of moderate drinking after treatment for a long time. In some journals, experts openly recommend that moderation should be the first line of defense, and that abstinence should be considered only if moderation doesn't work. I couldn't believe what I was reading!

The Disease/Habit Debate

I began to write to the authors of the professional literature and asked them for their assistance. I will never forget the flurry of journal articles that began to arrive in the mail and the number of calls and letters that I received in support of my early efforts.

One major revelation was that many experts do not believe that alcohol abuse is a disease. I had been under the impression that the disease model of alcohol abuse represented a biological and medical fact, proved beyond a shadow of a doubt. I was amazed to find out that the disease theory was just that, a theory--one that has been highly criticized, and discarded, by many researchers.

For example, the noted scholar Dr. Herbert Fingarette writes in his book, Heavy Drinking: The Myth of Alcoholism as a Disease, that "almost everything the American public believes to be the scientific truth about alcoholism is false." Dr. Stanton Peele, author of The Truth About Addiction and Recovery and a leading expert in the field, agrees: "Every major tenet of the 'disease' view of addiction is refuted by both research and everyday observation." Even Bill Wilson, cofounder of Alcoholics Anonymous, said in 1960: "We have never called alcoholism a disease because, technically speaking, it is not a disease entity."

If alcohol abuse isn't a disease, what is it? In layman's terms, it is a habit, a learned behavior that is frequently repeated. In psychological terms it is a pattern of excessive alcohol consumption which produces maladaptive behavioral changes in which drinking can become the central activity in an individual's life, usually after many years of heavy consumption. According to researchers Dr. Roger Vogler and Dr. Wayne Bartz, "Drinking itself, including heavy drinking, is not caused by disease but by learning. You must voluntarily consume alcohol in fairly large amount before you have an alcohol problem."

For the problem drinker, the disease/habit debate is extremely important because it directly affects the entire approach to treating people who are beginning to have alcohol problems. The "learned behavior" model of excessive drinking allows for what is called treatment matching, which means that the level of treatment is matched to the level of assessed problem.

For example, if you went to a doctor complaining of an earache, you wouldn't automatically be thrown into the hospital and hooked up to intravenous antibiotics. To start with you would probably receive less intensive medical help for your infection, say a self-administered course of antibiotics. Then, if that did not work, more aggressive measures would be tried. In alcohol treatment facilities today, however, it does not matter whether you are a college student who has experienced a few binge-drinking episodes at parties or a stereotypical gutter drunk, you will both be prescribed the same "strength" of "medicine": total abstinence and, in most cases, AA attendance.

The behavioral model of alcohol abuse allows for less intensive, limited intervention for people who have less severe problems with alcohol. Moderate drinking is a permissible, and accepted, treatment goal of professional programs that offer this alternative to problem drinkers.

Moderation Management

The purpose of Moderation Management is to provide a supportive environment in which people who have made the decision to reduce their drinking can come together to help each other change. That's it. It is very simple, and I admit that MM stole it from the forerunner of the mutual-help movement, AA. The idea of people getting together to help others who have, or have had, similar problems is an old but good one.

How does MM accomplish its purpose? First of all, the meetings are free. MM provides a supportive environment which encourages lifestyle changes. You can change a behavior (whereas you can't change an irreversible disease); and the sooner you recognize you are developing a problem with alcohol and seek help to change your drinking patterns, the better.

MM also offers a set of professionally reviewed guidelines, the Nine Steps Toward Moderation and Positive Lifestyle Changes. The steps include information about alcohol, empirically-based moderate drinking limits, self-evaluation strategies, drink monitoring forms, self-management strategies, and goal-setting techniques.

We need a support group like MM for several reasons. First, problem drinkers are more likely to seek help from a support group they believe fits their needs. It is ironic that when the disease model first became popular, health professionals thought people would more readily come forward for help if they were told they had a disease rather than some moral failing. Now the reverse is true. People are more afraid of the label than the behavior it describes, and for valid reasons. The "alcoholic" label can make it impossible for you to get medical or life insurance. It can ruin your chances for a job promotion. And once you are labeled, it stays with you forever.

Another reason we need a group like MM is that problem drinkers will seek help sooner when given access to programs that match their needs. Problem drinkers are often indecisive about taking that first step toward getting help. They know that programs exist for "alcoholics," but they don't believe their own problems are that severe, nor are they comfortable with traditional treatment goals or labels. So they often end up taking no action because their problems are not that bad--yet.

And third, there are far more problem drinkers than severely dependent drinkers in our country. Studies report that there are anywhere from three to seven times more people with mild to moderate drinking problems than people with severe drinking problems. Due to their larger numbers, it is problem drinkers who account for most of the alcohol-related costs to our society (automobile accidents, lost productivity, domestic conflicts, etc.). By addressing their needs, MM has the potential to make a substantial contribution toward reducing the harm caused by irresponsible alcohol use.

What about the chronic drinker who should be abstaining, but is still actively abusing alcohol? Won't MM just provide another excuse to continue drinking? In my opinion, those who should be abstaining but refuse to probably won't change their behavior due to the existence of any of the support groups. If such a person finds his or her way to an MM meeting, however, there can still be a positive outcome. Already in MM's brief history, I have seen people come to the meeting to try moderation, later acknowledge that they were not successful, and then go on to an abstinence program. This is preferable to no improvement at all. In line with the principles of "harm reduction" any progress an individual makes toward decreasing the amount of alcohol they consume, or the frequency of harmful drinking episodes, is a step in the right direction.

Why would people who have had problems with alcohol even consider drinking again? I have found that, most of the time, it is not in human nature to totally give up every behavior that has caused problems in the past. The more common response is for people to learn from their mistakes and to moderate their behavior in the future. People who have previously been overweight learn to eat less (and occasionally still treat themselves to fattening foods); people who used to work too much learn to spend more time with their family; people who used to shop too much learn to get rid of a few credit cards; and most people who have bad a drinking problem at some stage of their life learn to drink in moderation.

The solution to doing to much of something is not always an other extreme (quitting altogether). Many times the solution lies somewhere between the extreme, and it is called moderation.

PHOTOS (COLOR): Dining friends with wine served.

From: Moderate Drinking by Audrey Kishline. Copyright (C) 1994, 1995 by Audrey Kishline. Published this month by Crown Trade Paperbacks, a division of Crown Publishers, Inc.

HOW TO MANAGE MODERATION

The moderate drinking limit is a blood alcohol level of .055 percent. Most people are extremely intoxicated at a blood alcohol concentration (BAC) of .200 percent, and become unconscious at .300 percent, The BAC percentages contained in these tables can help you estimate your blood alcohol level based on the number of drinks you have over a specific length of time, The figures below are only estimates, because blood alcohol levels are influenced by factors as diverse as how much food you've eaten, your physical condition, percentage of body fat, and, for women, where you are in your hormonal cycle. In addition, as people get older, their percentage of body fat usually increases. On average, a 55-year-old will reach a BAC that is 20 percent higher than those shown in the chart.

WOMEN: Blood Alcohol Concentrations after Three Drinks[a]

Weight (lbs.) 110 120 130 140 150 160 170 180

Number of

hours

1 .126 .114 .104 .095 .088 .081 .076 .071

2 .110 .098 .088 .079 .072 .065 .060 .055

3 .094 .082 .072 .063 .056 .049 .044 .039

4 .078 .066 .056 .047 .040 .033 .028 .023

MEN: Blood Alcohol Concentrations after Four Drinks[a]

Weight(lbs.) 140 150 160 170 180 190 200 210

Number of

hours

1 .108 .099 .092 .086 .080 .075 .071 .066

2 .092 .083 .076 .070 .064 .059 .055 .050

3 .076 .067 .060 .057 .048 .043 .039 .034

4 .060 .051 .044 .038 .032 .027 .023 .018

a A standard drink equals one 12-ounce beer, one 5-ounce glass of

wine, or one and a half ounces of 80-proof liquor.