I can't even think of how many times I've heard the notion that complete, total, abstinence should be the only goal for all people who abuse drug or alcohol. This idea is so pervasive that most addiction treatment providers actually expel clients for relapsing, a notion that makes no sense to me especially if you believe in the idea that addiction is a chronic disease. In fact, even most research institutions and well-informed providers use total abstinence as the marker for addiction treatment success. The thing is that the amount of alcohol or drug use per se is not a part of the definition of addiction or abuse (other than in the "using more than intended" factor but even there an absolute amount isn't introduced) and I don't think it should be a necessary part of the solution either.
When I first set about writing this article, many of the issues I was going to bring up had to do with research on alcohol relapse patterns, my own story, and other evidence I've already introduced on All About Addiction. Fortunately for us, some recent research about Moderation Management and a newly developed website application component introduced me to some new evidence regarding moderate alcohol drinking that will allow us to look even more deeply into the problem.
Moderation Management - Drinking alcohol like a gentleman
In case you've never heard of Moderation Management (MM), you should check out their website at www.moderation.org. Moderation management offers face-to-face and online meetings, a listserv, a forum, online alcohol drinking limit guidelines, a self-help book that can be ordered through the site , and an online calendar where users can report their drinking. The population of people who use MM is pretty well educated and is made up for the most part of problem drinkers rather than those meeting full-blown alcohol dependence criteria. The idea is to teach problem drinkers more responsible drinking habits so that they don't devolve their habits into all out alcoholism.
Not only is there evidence that the moderation approach works, but with the addition of a new website application that helps problem drinkers through an interactive web-experience it seems that moderation management may be a real option for people who want to learn how to control their alcohol consumption instead of going into full abstinence. For all we know it might also be an option for people who do meet criteria for alcohol dependence but since the study we're about to assess didn't talk about it, we'll leave that for later.
Can moderation management work for heavy drinkers?
This recent study assessed the effectiveness of using the Moderation Management approach alone or along with an interactive website that help people monitor their drinking and make changes towards moderation. The idea was simple - use technology to guide behavioral change in interested individuals along MM rather than abstinence principles.
The 80 people who volunteered for the study were around 50 years old and were drinking alcohol pretty heavily: They were consuming around 35 drinks a week at an average of about 5 drinks per day, meaning they were essentially all daily drinkers. But the range was pretty big here with some people drinking more than 50 alcoholic drinks a week or almost 10 drinks a day. They were managing about 16% of every month without drinking (approximately 5 days) but again the range here was wide with some reportin essentially no abstinence and others being abstinent for half of every month on average.
The researchers used baseline assessment and then followups at 3, 6, and 12 months. There was no inpatient treatment component, just use of the MM website alone, or in conjunction with the new interactive web application. Most of the information collected was self-reported by the participants, which is known to be somewhat problematic, so the researchers also contacted significant-others who were used to corroborate the drinking behavior reported by the participants. The results were pretty interesting:
Participants who used the Moderation Management website alone drank a little less in each of the followups and were able to raise their average percent abstinence from 16% to a little over 20%. They were also able to reduce their scores on instruments assessing problem associated with drinking alcohol and their overall drinking problem severity. All changes lasted throughout the 12 month study period. Importantly, even on drinking days these participants reduced their blood alcohol content (BAC) levels by almost 50% !!!
Results were even better for the group that used the interactive site. This group achieved 40% abstinence days, essentially doubling those of the moderation management group alone, while keeping all the other benefits mentioned earlier including reduced BAC average on drinking days and reduced problem drinking overall. For the 30 participants in the combined experimental group, drinking had taken on a much less troublesome form now - Non-daily moderate alcohol drinking that resulted in a reduced number of problems associated with drinking.
