Can a problem drinker learn moderation?

November 18, 2007
BY JIM RITTER, Chicago Sun Times

For years, Phil was a normal social drinker.

“It’s a nice, simple pleasure,” he said.

But a few years ago, Phil’s casual drinking took an ominous turn. Instead of stopping after two or three beers or glasses of wine, Phil would have four, five or six drinks.

He would wake up exhausted. He’d be too tired to jog. He had to drag himself to his carpentry job.

“It was really starting to drain me,” he said.

If Phil had entered a conventional treatment program, he almost certainly would have been counseled to quit altogether. Complete abstinence is the prevailing philosophy of most programs, and the bedrock of Alcoholics Anonymous.

Moderation “is a good idea, but it’s never worked,” said Mercy Hospital alcohol counselor Peter Chapman. “The only effective long-term treatment for addiction is abstinence.”

But a minority of counselors have long argued that some problem drinkers — with an emphasis on “some” — can learn to drink moderately.

Michael Levy, an alcohol counselor and Harvard Medical School lecturer, sums up the philosophy in the title of his new book, Take Control of Your Drinking . . . And You May Not Need to Quit.

While moderate-drinking advocates such as Levy remain out of the mainstream, they are gaining adherents through the Internet, several recent books and a network of support groups called Moderation Management.

No use for the 12 steps

Earlier this year, a Moderation Management support group began meeting in Evanston. It was started by Phil, who did not want to give his last name.

Phil enjoys drinking and doesn’t want to quit. And he has no use for AA, especially AA’s emphasis on spirituality. In AA’s 12-step program, six steps mention God or a “Power greater than ourselves.”

Phil also doesn’t buy into AA’s Step 1, in which the drinker admits to being “powerless over alcohol.”

Phil has the opposite philosophy. “They say you have no control over alcohol,” he said. “I say you have complete control.”

Moderation Management recommends men drink no more than three or four days a week, and not exceed four drinks per day or 14 drinks per week. For women, who have smaller body sizes, the limits are three drinks per day and nine per week.

Except for stumbling over the holidays, Phil has stayed within MM limits. (He had six drinks on New Year’s Eve and six on Jan. 1.)

He’s sleeping better at night and jogging in the morning. Drinking, in smaller amounts, continues to be a simple pleasure.

“Just because you fell into a habit of overdrinking doesn’t mean you can’t break the habit,” he said.

MM has about 1,000 members in 25 to 30 groups around the country. By comparison, AA has 1.2 million members and more than 50,000 groups in the United States.

Both MM and its critics agree that moderation is not for everyone. A hard-core alcoholic will probably never be able to control his or her drinking.

MM’s founder in deadly crash

MM founder Audrey Kishline offers a sobering example of the perils of trying to drink moderately.

After founding MM in 1993, Kishline wrote a book, Moderate Drinking: The New Option for Problem Drinkers.

But Kishline was unable to control her own drinking. In 2000, she pleaded guilty to vehicular homicide. After an episode of binge drinking, she had driven the wrong way down a freeway and smashed head-on into another car, killing a father and his 12-year-old daughter.

Kishline said afterward through her attorney that MM was just a bunch of alcoholics “covering up their problem.”

Before her accident, Kishline had quit MM and joined AA. One proponent of moderation management told the New York Times that AA “didn’t have answers for her, either.”

(Kishline and the mother of the girl she killed recently wrote a joint memoir, Face to Face. A description on the cover calls the book an “astonishing true story of tragedy and forgiveness.”)

Abstinence-only as old as the nation

The belief that alcoholics can’t control their drinking has been around a long time. One of the nation’s Founding Fathers, Dr. Benjamin Rush, argued that alcoholism is a disease, and the only cure is abstinence.

Jump ahead to 1935. Two alcoholics, William Wilson (known as Bill W.) and Dr. Robert Smith (Dr. Bob) embraced the disease model and founded Alcoholics Anonymous.

The bible of the AA movement, known as the Big Book, argues that for an alcoholic, moderation is impossible:

“Our drinking careers have been characterized by countless vain attempts to prove we could drink like other people. The idea that somehow, some day he will control and enjoy his drinking is the great obsession of every abnormal drinker. The persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death . . .

“All of us felt at times that we were regaining control, but such intervals — usually brief — were inevitably followed by still less control, which led in time to pitiful and incomprehensible demoralization.”

But is this true for all problem drinkers?

Studies conducted over the past 30 years in the United States and other countries “have very clearly demonstrated that people with even fairly significant levels of alcohol dependence can and do learn to moderate their drinking,” said Frederick Rotgers, co-author of the 2002 book, Responsible Drinking: A Moderation Management Approach for Problem Drinkers.

Two examples:

†Rand Corp. researchers who followed 922 male alcoholics for four years after treatment found that 40 percent of those who had not relapsed into alcoholism were able to drink socially.

†A 1996 study in the American Journal of Public Health reported even more striking findings. Researchers conducted two large telephone surveys in Canada that included more than 12,000 adults. Among those who said they had resolved past drinking problems, between 38 percent and 63 percent reported they were able to drink socially.

In an understatement, researchers concluded: “These findings may be seen as inconsistent with the traditional model of alcoholism.”

Such studies have flaws. In the Canadian study, for example, there were no independent checks to determine whether drinkers were telling the truth about themselves.

But whatever its strengths or weaknesses, research that suggests many problem drinkers can become moderate drinkers has failed to sway most alcoholism counselors.

“The treatment industry is ideologically driven, not science driven,” Rotgers said.

Levy added that many counselors are themselves recovering alcoholics. “They’re abstinent, and they believe that’s the only way to do business.”

Moderation feeds denial

Dr. Daniel Angres, medical director of Resurrection Addiction Services, agrees that some problem drinkers probably can learn to drink socially.

But, he said, it’s not easy to distinguish between problem drinkers who can cut back successfully and those who are genetically predisposed to alcoholism and will never be able to drink in moderation. In the latter group, he said, alcoholism wipes out the rational part of the brain that decides that two drinks are enough.

Moderation management might work in the short run for an alcoholic, Angres added. But in the long run, it could simply feed the alcoholic’s powerful denial system.

“You run the risk of doing more harm than good,” he said.

But abstinence can backfire, too. There are legions of alcoholics who have fallen off the wagon after trying to quit completely.

“When people are faced with all-or-nothing approaches, they tend to avoid the nothing,” Rotgers said.

Phil said that telling a problem drinker to abstain completely is like telling a fat person to never have as much as a single french fry or bite of ice cream.

“Wouldn’t some people resist this and say: Hey, wait a minute, I like this stuff. I want to occasionally eat some limited amounts of these kinds of foods rather than completely abstaining?” Phil asked. “I think the answer is yes.”

Reporter Jim Ritter writes about health issues for the © Chicago Sun-Times.


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