Moderation Management: Does Controlled Drinking Work?
There’s a common saying in 12 step meetings: “Once you’re a pickle, you can’t turn back into a cucumber.” This means once someone crosses the line into alcoholism; they cannot turn back into a normal drinker with a non-alcoholic brain. Controlled drinking, many people say, is impossible for people who experience alcoholism or addiction.
Is Controlled Drinking Possible?
Controlled drinking, many people say, is impossible for people who struggle with alcoholism or addiction. There is a general consensus among scientists and clinicians that addiction and alcoholism are brain disorders and follow a disease model. They also believe that professional treatment is the most effective way to treat the disease. However, there is some disagreement about whether or not lifelong abstinence from alcohol and drugs is the only solution. Moderation Management is a program that claims it can teach problem drinkers to engage in controlled drinking to improve their lifestyle, rather than abstinence. But does controlled drinking work? Can you unpickle a pickle?
What is Controlled Drinking?
Moderation Management is a support group system developed by Audrey Kishline, a self-identified “problem drinker” in 1994. Kishline developed the program because while she struggled with drinking too much, she did not identify with abstinence-based programs. She didn’t feel that she had a disease nor did she like 12 step fellowships. Kishline wanted access to a program that could help her to cut back on drinking and moderate because she didn’t believe she was an alcoholic. However, she saw the potential for developing full-blown alcohol dependence if she didn’t change her behavior.
Moderation Management is a program that seeks to help people identify problems with their drinking patterns before they develop into alcoholism, and to make choices to engage in successful controlled drinking, to moderate intake, or to choose abstinence, based on what they feel they need. Moderation Management offers meetings that function as a support group as well as nine steps of action towards healthier choices.
Does Controlled Drinking Work for Alcoholics?
Evidence on the efficacy of abstinence-based programs, such as Alcoholics Anonymous, is hard to come by because the nature of these programs involves anonymity. Thus, data collection is difficult. However, thirty percent of MM members end up choosing to move on to abstinence-based programs. This is because many find that MM cannot help them reach their lifestyle goals.
Comparing the recovery statistics of the two programs is actually a moot point because 12 step programs and Moderation Management have different goals. Twelve step programs advocate lifelong abstinence, while Moderation Management leaves the choice between controlled drinking and abstinence up to the individual who uses the program.
In fact, MM claims that its program is not a great choice for full-blown alcoholics. They state it’s a “less-threatening first step toward a healthier lifestyle.” MM also claims that programs like theirs fuse moderation, or controlled drinking, with abstinence, are more effective than abstinence-only programs.
It’s hard to measure how effectively different programs are treating a condition when the two different programs are entirely different. In the case of Moderation Management, the diagnosis for members is “problem drinking,” not full-blown alcoholism. For members of Alcoholics Anonymous, the program treats full-blown alcoholism. There is a big difference between the two. Attempting controlled drinking as a full-blown alcoholic can be extraordinarily damaging.
Alcoholism vs. Problem Drinking
Alcoholics Anonymous differentiates between problem drinkers and full-blown alcoholics. According to AA, very heavy drinkers can give up drinking, “given sufficient reason.” Alcoholics, by contrast, cannot stop drinking even with the consequences, without a profound mental, physical, and spiritual intervention, and controlled drinking for this population is impossible. Arguing over which program is more effective misses the point that moderation is, by nature of the disease of alcoholism, impossible for alcoholics.
It may be effective for people who drink too heavily; but, ineffective for those who need training to become dependent. But, for the population of drinkers that have already crossed that line, Moderation Management is an exercise in futility. The two programs are different methods for two very different problems. In fact, the founder of Moderation Management, Audrey Kishline, admitted that for her the program had not worked. Later, she killed two people while drunk driving and committed suicide.
For Kishline, full-blown alcoholism was likely the case. She admitted in interviews that part of her reasoning for forming MM was to justify her decision not to pursue abstinence. For some members of MM, the program may be useful in making better choices. As for alcoholics, this may lead a decision to abstain. However, for others, it may provide dangerous justification to continue alcohol abuse. Clearly, for Kishline, controlled drinking was not enough to solve her alcohol problem. For alcoholics like her, alcohol abstinence is the only way to guarantee a healthy life and avoid alcoholic drinking.
Every Addict’s Needs Are Unique
For people who struggle to make healthy drinking choices, but are not alcoholics, Moderation Management may be a good program to help them learn decision-making skills that can improve their lifestyle. However, for alcoholics, it can be a dangerous temptation. Controlled drinking is not in the alcoholic skill set; to attempt it prolongs the pain of alcoholism. Moderation Management and 12 step programs clearly treat two entirely separate conditions. To apply Moderation Management to alcoholism is to fail to treat the disease.