The next AA? Welcome to Moderation Management, where abstinence from alcohol isn’t the answer
So this was a headline that was kindly bought to my attention in March by a kind person on Mumsnet. It’s an American piece featured in The Guardian.
Upstairs from one of my favorite Oakland dive bars, 10 people of varying ages and backgrounds are sitting in a circle, talking about their drinking problem.
“I make plans for my non-drinking days so that I’m not thinking about it so much – I work out, I schedule late work meetings, so it’s not even a temptation,” a tall, thin older woman says. Later, she explains that there was a time not long ago when the idea of getting through any day without five or six drinks seemed impossible to her.
“Go out later, hold off on that first drink, set up a game for yourself like ‘I can only buy one drink and then I have to get any others I want bought for me’,” adds a young man in stubble and a newsboy cap. “Hold off on your second drink, too,” adds the older man sitting next to him. “I used to order my next drink halfway through my first, so I’d be halfway through my second before the effects of the first one would kick in and then forget about it.”
This is Moderation Management (MM), a program whose rising popularity and success rate is posing the first real challenge in decades to the traditional, black and white approach to addiction.
The program typically starts with 30 days off booze altogether – “doing a 30” in MM parlance – followed by a slow reintroduction of alcohol, and eventually a plan to limit your intake: no more than 14 drinks a week for men, nine a week for women, and no drinking more than three or four days a week for either. There’s increasing talk of applying MM to marijuana use as well, although that’s not officially condoned by the nonprofit of the same name, which administers the program.
“People do come in lately who want help moderating marijuana and because it’s still illegal in California, we shy away from it,” explains Marc Kern, the organization’s director. “That doesn’t mean they can’t come to meetings and listen and stuff like that. But in states that have legalized it, I can see a time where there’s a different MM – Marijuana Moderation.”
While there is a framework to MM, based on Kern’s book Responsible Drinking, it’s also a program that prides itself on flexibility and enabling people to find their own paths forward. Three out of the 10 people at the meeting I attended said they weren’t ready to do a 30 yet, but were planning shorter breaks. One man celebrated the fact that he’d taken one day off from smoking weed and drinking. He does both in moderation daily, and his concern was more about the frequency and the fact that he can never seem to take a day off than the amount of any particular substance consumed.
Another woman nearly started to cry when talking about issues with her son, her marriage, and her stressful job. She said the only thing getting her through was the bottle of wine she drinks every night. She’d had a few occasions recently where she blacked out from drinking, then spent days in bed depressed. The group gave her ideas for ways she could take a few days away from all of it – the stress, the husband and the drinking – and suggested more therapy to deal with the psychological triggers of her drinking and depression.
A young man in the group explained that he had bipolar disorder, that he was feeling great on his new medication, but that there might be a problem when it comes to alcohol. “I’m not someone who drinks when they’re depressed, I drink when I’m up,” he said. “If I’m feeling good, I want to be out being social, and that means drinking.” The group offered some tips and tricks for sticking to the four-drink-a-night maximum, and for finding ways to be social without drinking. When the older man sitting next to him talked about his daily marijuana use and how it keeps him from being too irritable about anything, the bipolar man raised an eyebrow and gently suggested that using marijuana as a mood stabilizer was different, and more problematic, than just smoking pot because you like it and think it’s fun.
There was no therapist in the room, and the moderator, a two-year MM “veteran”, gently steered people away from delving too deeply into issues that might be better addressed in therapy.
Moderation Management has been around since 1994, but it was living more or less in the shadows from 2000 to 2012, mired in controversy over its founder, Audrey Kishline. After starting MM, Kishline left the group, realizing that she could not moderate her drinking after all. She returned to AA, then fell off the wagon, drunk-driving in March 2000 and killing a man and his 12-year-old daughter. She was released from prison in 2003, and in 2014, plagued by guilt and other demons, Kishline killed herself.
In the year since since Kishline’s death, MM has had something of a resurgence, bolstered by the launch of the US National Institute of Health’s Rethinking Drinking program and a 2014 report from the Centers for Disease Control calling out “excessive drinking” as something both independent of alcohol dependence and a major public health issue that is not being addressed by currently available tools and programs.
MM began to add more in-person meetings and last year, the organization launched a campaign around Dryuary, encouraging people to take the month of January off from drinking. It was so successful, they now plan to do it every year.
“Historically, MM has been looked upon as enabling alcoholics, and then the tragedy with Audrey knocked us in the stomach and we really pulled back after that,” Kern says. “Only now, in the last year and a half to two years, have we started to come out again. The notion of figuring out if you can moderate, rather than going straight to abstinence as step one of dealing with an alcohol problem, is pretty universal. I haven’t talked to every single person in AA, but I’m sure they’ve all tried moderation on their own. But before MM there was no book or guidelines or anything, so people would just go out and try moderation naively on their own, and without any support a lot of them would fail.”
You can read the full article here. As you can imagine the comments were a riot!!
Here were two that resonated with me:
1. “The challenge surely is that problem drinking isn’t a quantitative thing; it’s more about why you drink rather than when, where and how much you drink; the old saw has it that having a glass with dinner is fine, not being able to have dinner without a glass isn’t. If that’s the case then moderation (as to amount) misses the point, because if the intention is still palliative, or celebratory or any one of the myriad reasons we’re told we (… ah, go-on) should let ourselves go a a little, then it’s the perception we need to moderate.”
2. “What the author may be alluding to is the application of harm reduction to alcohol.
Harm reduction is generally thought to be an effective approach to minimising the biological and social harms associated with illicit drug use.
Alcohol? Well maybe it works.
But we may also wish to consider the possibility that alcohol harm reduction is a concept that has been captured by alcohol interests. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260782/
Thus, both NGOs and researchers are drawn into the advocacy web woven by an industry sector understandably nervous of abstinence talk.”
And another commentor summed up my position nicely:
“The harm reduction model is a good place to start for a person who is in the ‘pre-contemplative stage’. This person is up against it, but not hard enough to see that the choice of whether or not to use has been completely lost, that the body is making the decision and bypassing what the person thinks of as his will or mind or whatever”
In my experience a phase of attempted moderation was part of the journey so any approach that encourages someone to look at their drinking is a good thing. It will be interesting to see how MM develops in this country …….
What are your thoughts?