Over 6 percent of the adult population in the United States struggled with an alcohol use disorder in 2015, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes. Alcohol is the most frequently used addictive substance in America, the National Council on Alcoholism and Drug Dependence (NCADD) further explains. Nearly 90 percent of Americans aged 18 and older have consumed at least one alcoholic beverage at some point in their lifetime, and NIAAA reports that around 70 percent of adults in the United States reported drinking in the year leading up to the 2015 national survey.
Not everyone who drinks alcohol will suffer from harmful consequences, however. Alcohol can be enjoyed responsibly by adults of the legal drinking age of 21. Problems can arise when alcohol is consumed in what are considered high-risk patterns of abuse and excessive use.
The Centers for Disease Control and Prevention (CDC) warns that excessive drinking contributes to nearly 90,000 American deaths each year. The most common form of excessive drinking is binge drinking, which the CDC explains is when a person brings their blood alcohol concentration (BAC) up to 0.08 g/dL or above. Usually, this occurs when a man drinks five or more beverages, or a woman drinks four or more beverages, in a two-hour time span. When a person binge drinks at least five times in a one month period, this is classified as heavy drinking. Binge and heavy drinking can create a multitude of health, social, and emotional problems, not the least of which is alcohol dependence and the potential for alcohol addiction.
Many of the most common forms of alcohol addiction treatment promote complete abstinence and sobriety; however, alcoholism is a complex and highly personal disease, and this method may not be ideal for everyone. Moderation management programs accept that some people may not agree with complete abstinence from alcohol; as a result, they allow for a certain level of continued, controlled drinking. These programs address patterns of problematic and excessive drinking, and work to teach individuals how to direct and manage these episodes, allowing individuals to then drink in moderation. Moderation Management (MM), a nonprofit organization, is the primary program that uses the technique of moderating drinking rather than stopping it altogether.
Less than 10 percent of those who need treatment for alcohol abuse and addiction actually receive professional help in a specialized treatment facility, and the majority of those who don't seek help do not see the need for it, the 2013 National Survey on Drug Use and Health (NSDUH) explains. A moderation management program may provide an alternative to traditional 12-Step programs that require complete cessation of alcohol use forever. As a result, moderation management programs may help people make a commitment to change self-destructive behaviors and make positive alterations in their lives without expecting 100 percent sobriety throughout all of recovery.
How Moderation Management Programs Work
A moderation management program may be beneficial for a person who is not physically dependent on alcohol and does not suffer from significant withdrawal symptoms and cravings when alcohol wears off. Only about 9 percent of alcoholics in the United States are classified under the subtype of "chronic severe," NIAAA publishes. This group of individuals will need to abstain from drinking completely.
The group Moderation Management usually asks a person to evaluate their drinking, often through use of a journal or "drinking diary," for a period of time initially. A person is to write down when and how much they drink, as well as any issues that alcohol has caused in their lives. Individuals are to explore moderate drinking limits, which CBS News reports is no more than 1-9 standard drinks a week, to decide if maintaining these will be possible for them. Then, MM will ask that the individual stop drinking altogether for at least 30 days.
Alcohol is a substance that can have significant withdrawal symptoms for a person who is physically dependent on it; therefore, it should never be stopped "cold turkey" without a professional medical detox protocol if dependence is present. If physical dependence is not present, then a person may safely stop drinking for a month to assess their situation. A person may decide that an abstinence-based program is better for them at this point.
If a moderation management program is chosen, during the 30-day period of abstinence a person will explore alternative activities other than drinking and learn to manage potential triggers that encourage drinking. They will also learn to cope with stressors without alcohol, how to avoid drinking when desired, and how to control drinking and keep from overdrinking when drinking is reestablished.
A program that uses moderation management techniques may be part of an alcohol abuse treatment program that includes behavioral therapies and counseling sessions that teach coping skills and the management of self-destructive thoughts and behaviors, including excessive and problematic drinking. For a person who is not dependent on alcohol, the Journal of Consulting Clinical Psychology reports that a moderation management program can reduce the amount of alcohol a person drinks and also minimize problems that are related to alcohol consumption.
Alcohol moderation management programs may be primarily web-based, such as Moderate Drinking, or offer both in-person meetings and online support like Moderation Management.
Moderation Management (MM)
Founded by Audrey Kishline in 1994, MM is a program that provides an alternative to most traditional alcohol abuse recovery support groups, such as the prominent Alcoholics Anonymous (AA), a 12-Step spiritual program that asks its members for complete abstinence in recovery. MM accepts that alcohol can create problems in a person's life, but instead of admitting to powerlessness over the substance, individuals are empowered to learn how to manage and control their drinking. Many people may not identify with the label of alcoholic even though they have issues with alcohol and problems involving drinking.
Through Moderation Management's Steps of Change, individuals are able to assess how drinking impacts their lives and learn how to better manage drinking-related problems. Through the Steps of Change, a person is asked to initially chart their drinking, write down all the issues that alcohol has created in their life, and keep a drinking diary of how much and how often they drink. Through this diary, a person can then look at how alcohol is involved in their daily life and identify potential problems.
Individuals are also introduced to what it means to drink in moderation. MM sets drinking limits of no more than four drinks in an sitting for a man (not to exceed 14 a week) or three in a sitting for a woman (not to exceed nine in a week), and no more than three or four days of drinking per week. Someone in a moderation program will typically keep their BAC below 0.055 g/dL even when drinking, even though the legal limit is 0.08 g/dL. A standard drink is defined by the Dietary Guidelines for Healthy Americans 2015-2020 as:
- One 5-ounce glass of wine containing 7% alcohol
- One 12-ounce beer containing 5% alcohol
- One shot (1.5 ounces) of distilled spirits at 80 proof (containing 40% alcohol)
- Any drink containing 0.6 ounces of pure alcohol
After evaluating drinking patterns and possible concerns related to alcohol consumption as well as gaining an understanding of what moderate drinking entails, a person may then decide if this program will work for them. Some individuals may opt to go with an abstinence-based program instead while others may decide that moderation will work for them.
Moderation Management is a form of harm reduction, which means that negative consequences associated with risky behaviors are managed, leading to positive behavioral change instead of stopping these actions altogether. Once a person commits to a MM program, they will "do a 30," which is the month-long period of abstinence during which a person learns how to control triggers, avoid drinking when possible, replace drinking behaviors with other activities, and manage moderate drinking behaviors in the future. After the 30, a person may slowly add moderate drinking back into their life. Some people may remain abstinent for longer than 30 days; some may decide to enter into an abstinence-based recovery program; and others may be able to drink on occasion without incident.
Individuals participating in MM will continue to assess their drinking. If a relapse occurs, they may need to reevaluate drinking levels or even return to a 30-day abstinent period. Moderation Management groups may meet in person or through an online forum, and meetings are held all around the country. MM also offers an online chat room and a public hub curated blogging site for its members.
Funded with money from NIAAA and developed by Dr. Reid Hester, Moderate Drinking is a web-based service for individuals wishing to manage their drinking and control alcohol consumption and potential related issues. Moderate Drinking is a subscription-based (monthly or yearly) online program that offers more structure than Moderation Management and may be used in tandem with MM for optimal results. The Journal of Substance Abuse Treatment publishes clinical trials indicating that individuals using the web-based Moderate Drinking application and participating in a Moderation Management program were able to reduce their number of days drinking and the amount of alcohol consumed, thereby minimizing problems relating to alcohol abuse.
Moderate Drinking provides a Chances of Success online questionnaire that individuals can use to find out if the program is right for them. The Drinker's Checkup is another web-based tool that individuals can use to assess their drinking and get nonjudgmental and objective feedback on it. This tool then provides resources and recommendations that are personalized to help a person decide if they want to work toward positive change through moderation. Highlights of the Moderate Drinking program include:
- Setting drinking goals and limits
- Creating motivation and building self-confidence
- Doing a “30”
- Personal drinking goals, limits, and rules
- Personalized feedback on self-monitored drinking
- Controlling drinking urges with feedback
- Recognizing and managing triggers
- Creating alternatives to drinking behaviors
- Learning how to monitor and regulate emotions and moods with feedback
- Developing problem-solving skills
- Coping with and managing potential relapses
- Keeping abstinence as an option
Moderate drinking works together with MM to control and manage negative and destructive thoughts and behaviors, helping to modify them for positive change. After a period of abstinence and evaluation of drinking patterns, a person may be able to reintroduce moderate drinking occasionally.
Moderation management programs could potentially be helpful for those who do not struggle with alcohol dependence. They can provide methods and tools to promote responsible and safe alcohol consumption in moderation. If a person struggles with ongoing alcohol abuse or dependence, moderation is not enough; they will need comprehensive care in an abstinence-based treatment program.