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Alcoholism

Moderated Drinking: A Creative Strategy to Treat Alcoholism?

Complete sobriety might not always be a realistic solution for heavy drinkers.

Key points

  • Fear of needing to cope without alcohol can deter efforts to stop drinking.
  • Moderating alcohol use can allow someone to deal with both the drinking behavior and underlying issues that power their drinking.
  • Moderated drinking may empower some people to ultimately give up drinking entirely.
Photo by Henry & Co. on Unsplash. Used with permission.
If your drinking controls you, learn to put down speed bumps. You may be able to learn to drink in moderation.
Source: Photo by Henry & Co. on Unsplash. Used with permission.

Over the past few decades, research has demonstrated that complete abstinence isn’t always the most effective approach for treating alcohol abuse. While total abstinence is necessary in some cases, in other cases people are able to reduce their drinking to moderate levels without needing to abstain totally. For people who have not been able to maintain sobriety through Alcoholics Anonymous (AA) or other 12-step programs, they may wish to consider if moderation may be a more effective path for them to take.

Fear of an Inability to Cope Without Alcohol Can Deter You From Trying

If you use alcohol to manage stress or self-medicate, fear of how you’ll cope without alcohol might hamper your efforts to regain control of your drinking. If you consider alcohol as a coping strategy, then it makes sense why heading straight to abstinence would be terrifying.

Moderation offers a path to sobriety without completely eliminating drinking. Limiting the amount of alcohol you drink, or taking breaks from drinking alcohol, are ways to get your alcohol problem under control while providing space for you to address the issues that power your drinking.

Addressing the Issues Masked By Drinking

Drinking is often a coping strategy subconsciously used to avoid having to deal with uncomfortable or painful issues. Moderated drinking could give you the space to address those issues you’ve been pushing aside.

When your drinking is under control, you may have the internal bandwidth to accept the professional psychological support that can help you develop healthier ways of coping. You could also get help to better manage your emotions, address past trauma, and understand how anxiety, depression, or other emotional difficulties have powered your alcohol abuse.

12-step programs alone do not usually address the underlying need that’s been suppressed through alcohol. Without addressing those needs, it’s like trying to cap an active volcano with a giant boulder. Sooner or later, the pressure will build up and the volcano will explode—or you will relapse.

Moderation can open a window for you to defuse the emotional challenges that create the craving for relief that alcohol provides. While you are taking a break from drinking or limiting your drinking, you have an opportunity to develop better coping skills, address your drinking behaviors, and find healthier ways of dealing with the issues that drinking is covering up.

Henry Weaver/Unsplash. Used with permission.
Learn to slow down and control your alcohol consumption. Don't let your drinking control you.
Source: Henry Weaver/Unsplash. Used with permission.

Tools and Support for Moderation

Professional guidance is an important part of learning moderation. It is best to find a psychologist who is informed about the best practices for learning moderation and who can support your progress. Some of the techniques to tools that you may learn or access include:

  • Keep track of the amount you drink, and how often you drink.
  • Identify what triggers episodes when you feel like drinking excessively again.
  • Take steps for incremental change.

Another possible option is using medications such as naltrexone or disulfiram along with psychotherapy. You may be able to gradually decrease the amount you drink without needing to go for full abstinence from alcohol.

What Moderation Means in Practice

Moderation gives you control of your drinking and allows you to take back control of your life. While complete abstinence often requires you to avoid any circumstances or people that might tempt you to drink, moderation allows you to still participate in work functions and social events while empowering you to have more control over when and how much you drink.

Successful moderation involves understanding yourself (what factors trigger excessive drinking), planning (how much you are going to drink and how you are going to stop), and taking concrete steps to exit or avoid situations where you won’t be able to moderate. Limited social drinking is a realistic goal for some people who struggle with alcohol, and should definitely be considered by people who have not been able to successfully adhere to abstinence.

Moderate drinking can be more sustainable than abstinence. Once you are able to control how much you drink, you may find that you're better able to enjoy family gatherings, social events, and work events.

Moderate Drinking is About Having More Control Over Your Drinking

Maintaining moderation in drinking means starting out with a specific goal. The specific goal will depend on the individual's particular situation. For example, someone might want to cut back on the amount they drink, or maybe slow down their rate of drinking. Not all goals will work for everyone. The best plan is the play that suits you.

Setting up personal guidelines and expectations—and tracking results—can make maintaining moderation easier. You will keep track of what was accomplished and what still needs work.

Seek skilled guidance from an addiction psychologist to get feedback when selecting goals, assessing progress, and setting appropriate boundaries.

Moderated Drinking May Empower You to Give Up Drinking Entirely

Moderated drinking is, in many ways, easier than complete abstinence. When your goal is only one drink instead of no drinks at all, the temptation to stray can become less powerful and you can more often enjoy positive reinforcement from your successes.

Moderation can allow you to feel in control and like you are making progress. Many who practice it find that they are better at understanding how much they are drinking, are able to reduce or eliminate binge drinking, and suffer fewer negative consequences from alcohol abuse.

Learning to drink in moderation can be the goal, or it can be a way station on the way to abstinence. Once you are able to allow yourself some alcohol in controlled circumstances, you may ultimately choose to give up drinking entirely. Abstinence is a worthy goal but it does not have to be your goal. Even moderate drinking can be life-changing.

Take Advantage of "Getting Back to Normal" to Revisit Your Relationship with Alcohol

While the pandemic seems to have triggered substantial increases in alcohol consumption, and in alcohol abuse, this is true on a macro level. For some people, the pandemic created more opportunities for reducing drinking. More time at home may have contributed to less peer pressure to drink, less time in a “wet” culture, and lifestyle changes that might support a shift towards moderation.

As we get back to more social events, business meetings, and situations where you may have abused alcohol in the past, it may be time to consider how you can achieve moderation.

“For some participants, lockdown served as a catalyst or opportunity to re-evaluate their relationship with alcohol and make striking changes to their drinking practices. There was evidence of using lockdown as an opportunity to drink more lightly or abstain completely.”
(Nicholls & Conroy, 2021)

Take this “getting back to normal” as a chance to rethink your relationship with alcohol. Doing a reality check with a simple online self-assessment might be the first step. Take the Alcohol Use Disorders Test (AUDIT) developed by the World Health Organization (WHO) online.

© 2022 Dr. Arnold Washton. All rights reserved.

References

Caluzzi, G., Pennay, A., Laslett, A. M., Callinan, S., Room, R., & Dwyer, R. (2021). Beyond ‘drinking occasions’: Examining complex changes in drinking practices during COVID‐19. Drug and Alcohol Review.

Nicholls, E., & Conroy, D. (2021). Possibilities and pitfalls? Moderate drinking and alcohol abstinence at home since the COVID-19 lockdown. International Journal of Drug Policy, 88, 103025.

Washton, A. M., & Zweben, J. E. (2006). Treating alcohol and drug problems in psychotherapy practice: Doing what works. Guilford Press.

Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J. S., & Carroll, K. (2019). A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. Journal of consulting and clinical psychology, 87(12), 1093.

Murphy, C. E., Wang, R. C., Montoy, J. C., Whittaker, E., & Raven, M. (2022). Effect of extended-release naltrexone on alcohol consumption: a systematic review and meta-analysis. Addiction, 117(2), 271-281.

Bahji, A., Bach, P., Danilewitz, M., Crockford, D., Devoe, D. J., El-Guebaly, N., & Saitz, R. Pharmacotherapies for Adults With Alcohol Use Disorders: A Systematic Review and Network Meta-analysis. Journal of Addiction Medicine, 10-1097.

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