Do Moderation Programs Encourage Alcoholic Drinking?
Our view of recovery is distorted and leads to gaps in treatment offerings.
Posted Sep 15, 2014
By Adi Jaffe, Ph.D. and Marc F. Kern, Ph.D.
This article was originally posted on rehabs.com (find it here)
As you may recall, the first part of this series focused on the introduction of a number of myths that are the main cause, according to us, behind the paucity of non-abstinence treatment program in the United States (Europe and Australia don't have such an obvious gap).
To review, the reasons we had named in the last piece were:
- The notion that moderation programs give permission to “true alcoholics” to continue drinking.
- The fear is that people who are currently abstinent will decide to try drinking again thinking they should be able to moderate.
- The belief that use of a mind altering substance,especially by individuals who have previously struggled with them, is a means of escape and therefore unhealthy even if it is currently non-problematic.
We tackled the first of these last time so we're ready to move on to #2 on the list…
Abstinent alcoholics everywhere will try to return to drinking
Firstly, I have to say that this specific argument is troubling in that it suggests a real paranoia, in certain circles, about the very light grip members of the recovery community have on their life. Indeed, this is nothing but a Red Herring. That is to say - if you truly believe that the mere availability of drinking options will cause an abstinent individual to throw away their current program. you are also suggesting that such an individual is not at all satisfied with their present experience. That would seem to support the view that there is a problem with the current system that specifically requires new thinking!
Now sure, I'm positive diabetics would jump at the chance to stop injecting insulin, but the freedom to take on such an experiment is always available to them regardless of our recommendations. The same is true for abstinent individuals in recovery - they can always decide to drink again, and many in fact do. This is why success rates for complete abstinence 12-months post-treatment are in the 5%-15% range.
Additionally, this particular fear is one that can easily be handled by ethically-sound admission principles. For instance, Alternatives simply does not accept abstinent clients who are seeking to find out if they can drink again. As I have personally told the 2-3 callers we have had who expressed interest in this, "We treat individuals with current drug and alcohol problems." If a person wants to try their hand at drinking after an extended abstinence period they are welcome to attend some self-help and peer-support meetings that are specifically meant for that (such as Moderation Management). Since less than 0.5% of our phone calls have even proposed such a course for treatment, I'm not too worried about this problem on a large scale.
The truth is that many people who have been successfully abstinent are very satisfied with their new life and are not at all interested in reintroducing alcohol into their lives. This is barely the issue at all. Instead, the problem is that most people who struggle with substance use (90% to be exact) never even enter treatment (SAMHSA, 2010; Center for Substance Abuse Research, 2012) and that a tiny proportion of those who do enter treatment find successful recovery. We are dealing with approximately 1% of substance use problems being successfully handled now - The goal is to introduce treatment option that increase the reach of treatment and abstinence-only approaches are simply not doing it.
And research suggests that introducing non-abstinence options would open up treatment to millions more! The Center for Substance Abuse Research found that 40% of individuals who did not enter treatment cited “Not ready to stop using” as a major reason. My own UCLA and NIDA research (Jaffe, 2013) supports that finding in a group on people seeking treatment online. All of this suggests that rather than serving as an excuse, offering non-abstinence methods is a necessary step to open up solutions for the tens-of-millions of Americans struggling with substance use problems. Their struggles with depression, anxiety and other co-occurring conditions (Jaffe, 2007) will be considerably eased if we stop sticking to outdated dogma that simply isn’t enough.
Head out of sand now please.
CESAR (2012). Lack of motivation to quit and health coverage: Top reasons for not receiving needed alcohol or drug treatment.
Jaffe A., Colman A., & Strahl W. (2014, August). Not ashamed but still too poor: Longitudinal changes in barriers to treatment entry for online treatment seekers. Paper presented at the 3rd Annual Addiction Research and Therapy Conference, Chicago, IL.
Jaffe, A., Shoptaw, S., Stein, J. A., Reback, C. J., & Rotheram-Fuller, E. (2007). Depression ratings, reported sexual risk behaviors, and methamphetamine use: Latent-growth-curve models of positive change among gay and bisexual men in an outpatient treatment program. Experimental and Clinical Psychopharmacology, 15, 301-307.
Substance Abuse and Mental Health Services Administration (SAMHSA), Results from the 2007-2010 National Household Survey on Drug Use and Health: National Findings, 2010
© 2014 Adi Jaffe, All Rights Reserved
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