Do you want to cut down on your drinking rather than give up alcohol completely? Dr. Washton offers personalized concierge care that can help you move to moderate drinking.
Moderate drinking is a highly controversial issue. To be clear from the start – we do not believe that alcoholics and others with severe drinking problems can learn how to reliably moderate their alcohol intake. For these individuals, abstinence is without question the safest course. However, if your drinking problem is less severe, and if you flatly reject abstinence, a professionally guided attempt towards moderate drinking can make significant improvement in your life.
Learning to drink in moderation as a treatment alternative
Abstinence is not the only solution or necessarily the first solution if you have a drinking problem. In some cases, learning moderate drinking will be an end-goal. In other cases, moderation serves as a stepping-stone toward accepting the need for abstinence.
Rarely, if ever, do heavy drinkers choose permanent abstinence as their goal until they are convinced by their own experience that moderation is simply not realistic and attainable for them. And rarely, if ever, do they decide to abstain simply because others proclaim that moderation will not work for them. Unfortunately, countless people with drinking problems unwilling to accept abstinence as their only goal right off the bat do not get the help they need when treatment programs insist that giving up drinking for good is the one and only acceptable goal. This lack of treatment alternatives has resulted in a great deal of unnecessary suffering as heavy drinkers continue to drink and suffer increasingly severe consequences. Rather than ignoring or abandoning these people, our approach provides them with a “launching pad” for changing drinking behavior and gaining a more realistic perspective on the way they use alcohol and the problems it is causing in their lives.
Moderation can be a realistic goal if you have less severe drinking problems
This is an established fact supported by decades of scientific research. In our view, any steps taken to reduce the harm associated with drinking are steps taken in the right direction. As described below, not everyone with a drinking problem is alcoholic. It is now recognized that there are many different types of alcohol problems, rather than a single condition (“alcoholism”) that is either present or absent. And research shows that among people with less severe drinking problems many are capable of cutting down on their alcohol consumption and of learning how to consistently moderate their drinking within safer limits.
As part of the evaluation process, we help clients understand where they are in terms of the nature and severity of their alcohol problem and their chances of succeeding at moderation. We explain the benefits of not drinking at all and routinely encourage all new clients to start with a period of abstinence, even if their ultimate goal is moderation. When given a chance to try moderation with professional support and guidance, clients either learn how to drink moderately or they learn that moderation is not realistic for them and that they should stop drinking entirely. Clients who choose abstinence after being unable to moderate consistently are often more motivated and personally invested in making abstinence work for them.
“Problem Drinking” is not the same as alcoholism
Although the terms “problem drinking” and “alcoholism” are often used interchangeably, they are not the same. As compared to alcoholics, problem drinkers usually have shorter histories of alcohol-related problems, more social and economic stability, and less severe consequences associated with their drinking. Most problem drinkers do not drink every day and have not experienced major losses or other severe consequences related to their drinking.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and other public health agencies, there are at least four times as many problem drinkers as alcoholics in this country. However, most alcohol treatment programs are designed for people with the most severe drinking problems. Many individuals with less severe problems avoid seeking help at these programs because they do not want to be labeled as “alcoholics”, attend AA meetings, or accept abstinence as the one and only legitimate goal, especially when giving up drinking forever may not be necessary to resolve their problem.
There is still a great deal of “black and white” thinking about alcohol problems that divides drinkers into only two groups: alcoholics who are seen as constitutionally incapable of controlling their drinking and the rest of the drinking population who can drink socially without losing control. Now we know, however, that anyone who consistently and repeatedly drinks above certain limits is at greater risk for developing alcohol-related problems. We also know that there is a broad spectrum of alcohol problems that can vary in severity along a continuum ranging from mild to moderate to severe. In other words, not everyone with an alcohol problem is an alcoholic. In fact, the term “alcoholism” was officially removed as a medical diagnosis in 1979 and replaced by the broader category of “alcohol use disorders” that includes alcohol abuse and alcohol dependence.
Are moderate drinking strategies effective?
Alcohol researchers at universities and medical schools in the United States, the United Kingdom, Australia, Canada, and Norway have extensively studied the moderation strategies that form the basis of our treatment approach. Results of these studies, summarized in a recent book on controlled drinking, were as follows:
- People who sought help to moderate their drinking were already experiencing significant problems related to their drinking, but were not as seriously dependent on alcohol as those who sought help from abstinence-based programs.
- Individuals who received moderation training substantially reduced their alcohol consumption on average by 50-70% and as a result significantly reduced health and social problems related to their drinking.
- These positive results were seen not only in drinkers who received professional treatment, but also those who worked on their own using a self-help guide.
- Follow-up studies as long as 8 years showed that the people who were most successful in maintaining moderate problem-free drinking were those with less severe alcohol problems at the start. Many of those starting off with more severe problems succeeded with moderation for a period of time, but eventually decided to abstain from alcohol completely.
- Overall, approximately 25% of those who tried moderation with this program ultimately chose to abstain instead.
Who is most likely to succeed at alcohol moderation?
According to recent studies, problem drinkers most likely to succeed at moderating their alcohol intake are those who:
- Have shorter drinking histories and less severe alcohol-related problems
- Have never been physically addicted to alcohol
- Have never been addicted to or had severe problems with other drugs
- Are not currently grappling with severe life problems such as divorce, job loss, bankruptcy, debilitating or life-threatening medical illness, death of a loved one, depression or other psychiatric illness, etc.
- Have no medical or psychiatric problems that would only be made worse by drinking alcohol, even in moderation
Should you cut down or stop drinking completely?
Although moderation may be a good starting point for many drinkers, it is not the best approach for everyone with a drinking problem. People with severe drinking problems generally find moderation difficult to maintain and often do better with abstinence. No one solution is best for all problem drinkers. There are many different pathways to success, and the key lies in finding which particular pathway works best for each person.
In general, heavy drinkers who are physically addicted to alcohol and/or those who have suffered serious alcohol-related problems should stop drinking entirely, as moderation is less effective. It is also not intended for formerly dependent drinkers (i.e., alcoholics) who have been abstaining. Studies indicate that people most likely to succeed at moderation are those who:
- Have shorter drinking histories and less severe alcohol-related problems
- Have never been physically addicted to alcohol
- Have never had serious problems with other drugs
- Are not currently dealing with serious life problems such as divorce, job loss, bankruptcy, medical illness, death of a loved one, depression, etc.
- Have no medical or psychiatric problems that would only be made worse by alcohol even in moderation
People who should not drink at all
Moderate drinking guidelines exclude individuals who are strongly advised by public health officials to not drink alcoholic beverages at all:
- Women who are pregnant or trying to become pregnant
- Anyone who plans to drive, operate other potentially dangerous machinery, or engage in any safety-sensitive activities requiring coordination, attention, and skill
- Individuals taking medications, including over-the-counter medications, that may interact adversely with alcohol
- Anyone who tends to lose control of their behavior (for example, become aggressive or violent) when they drink even moderate amounts of alcohol
- Anyone who drives while intoxicated, have been arrested for driving while impaired, and/or have been in an alcohol-related accident
- Alcoholics in recovery and others with a history of serious alcohol problems who have already been abstaining from alcohol
- Anyone under the age of 21
- Anyone with a medical or psychiatric condition that would only be made worse by drinking, even in moderation
The potential benefits of taking a break from drinking (at least for a while)
As stated above, abstinence is the safest course for anyone who has developed a serious problem with alcohol. Taking a break from drinking for a few weeks or longer is also the best way to get started with moderation. Here are some of the reasons why:
- Abstinence is clearly the safest choice. There is no guaranteed “safe” level of drinking that will cause no harm. If you do not drink at all, you eliminate the possibility of incurring any additional adverse consequences (e.g., legal problems, health risks, etc.) caused directly or indirectly by your alcohol use.
- Abstinence provides a unique opportunity to see things through a “different set of eyes” and to acquire valuable information about the ways you think, feel, and behave in the absence of alcohol that is simply not attainable by other methods. It helps to reveal the nature and extent of your attachment to alcohol, including the degree to which you rely on chemically altering your mood to cope with stress and other negative emotions.
- Abstinence gives you greater access to your emotions and an opportunity to learn how to deal with them more effectively
- Abstinence gives you a chance to break old habits, experience a change, and build some confidence.
- Abstinence helps you to identify more clearly the internal (environmental) and external (emotional) “triggers” associated with your alcohol use
- Abstinence can help to reduce conflicts with family members and significant others (e.g., spouse, parents, etc.) caused or exacerbated by your alcohol use.
- Abstinence provides an indication of how easy or difficult it is for you to stop drinking
- Abstinence exposes voids and unmet needs in your life that you may be filling up or distracting yourself from with alcohol.
- Abstinence may enhance or restore the effectiveness of prescribed medications you are taking for other problems such as depression, anxiety, etc.
We can help you cut down or quit
We offer two types of treatment options for people who want help for drinking problems. One option is abstinence-based treatment for individuals who have decided to stop drinking completely and want to stay stopped over the long term. Their decision is often the result of failed attempts at controlled drinking and/or suffering severe alcohol-related consequences.
The other option is moderation-focused treatment. This option is generally intended for “problem drinkers”; i.e., non-alcoholics with less severe drinking problems who have not suffered life-damaging consequences from their drinking and have no prior history of alcohol dependence (alcoholism).
You’ve probably been told that controlled drinking is simply not a safe or realistic option for anyone who’s developed a drinking problem. And that it is a setup for failure based on the assumption that drinking problems always progress and inevitably gets worse. According to this view, lifelong abstinence is the one and only way to deal successfully with a drinking problem.
Scientific evidence does support the notion that people with severe drinking problems are NOT good candidates for moderation (controlled drinking) and generally do much better with abstinence. And it goes without saying that for anyone who has developed a really serious drinking problem, abstinence is by far the safest course. However, research also has shown that with proper help “problem drinkers” (non-alcoholics with less severe drinking problems) can and sometimes do successfully learn how to moderate their drinking and reliably keep it within safer limits.
We will help you decide
We will help you decide whether moderation-based treatment or abstinence-based treatment is best for you. Our evaluation process will give you objective feedback about the nature and severity of your drinking problem and its impact on your life. And we will help you develop a more useful perspective on the problem. We will work collaboratively with you to formulate a treatment plan that is effective, feasible, and makes sense. We are not here to coerce, badger, or humiliate you. We will discuss with you the pros and cons of abstinence and the pros and cons of moderation. And we will respectfully offer you our professional advice and recommendations. But the final choice is yours. You get to choose your own treatment goals.
We encourage you to take the Alcohol Self-Assessment Tests on this website to start developing a better perspective on your drinking behavior and whether abstinence or moderation might be best for you. Keep in mind, however, that no self-assessment test or quiz can substitute for a face-to-face clinical evaluation by a treatment professional.