Chapter 1: Moderation and the Debate

Responsible Drinking Chaper 1: Moderation and the Debate

Core message: unless you are alcohol dependent moderation is very likely to work BUT there is one key ingredient PAY SERIOUS/FULL ATTENTION to the issue

Notes

Recovery of individuals who have been severely dependent on alcohol predominantly involve abstinence and Recoveries of individuals who have not been severely dependent on alcohol predominantly involve reduced drinking.

• Have you noticed you drink more than your friends?

• There is a belief that alcohol problem inevitably progress.

• In the USA the concept of different treatments for different alcohol levels doesn't exist.

• The clinical diagnosis of alcoholism is called alcohol dependence.

• There are 32 million non-dependent problem drinkers on the USA (16% of the population).

• 5% of the USA population are alcoholics (a large number if you ask me: 15 million people!)

• 93% treatments are 12 step based.

• It makes sense to establish early intervention models aimed at alcohol problems in the less severe stages. There is a large body of science based evidence to support moderation.

• Brief interventions are the approach with the strongest evidence of effectiveness.

• James Prochaska defines stages (not steps) for effective change. Theory that change occurs in stages, detailed in the book CHANGING FOR GOOD
 by Prochaska, Norcross, and DiClemente 
The stages are conceptualized as:

1. Pre-contemplation: I don’t have a problem.

2. Contemplation: I might have a problem.


3. Preparation: I do have a problem. What would I have to do to change?

4. Action: I’m acting to make some changes.

5. Maintenance: You mean I have to do this forever?

6. Recycling: Learning from Relapse.

• What AA promotes is largely a moral cure. Confrontation based. Although the "Big Book" suggests a trial of control drinking if a person is not convinced that he or she is an alcoholic. 

Foreword

Responsible Drinking; Foreword

The opening statement is clear about the challenges, conceptual and methological, of moderation as an alcohol problem recovery tool. Reading a bit further into Sobell and Sobell you can tell how much of an uphill battle the practice of moderation management has been: 93% of US based recovery programs are 12 step based. Even though moderation is science based and backed with data strong resistance remains. A point is made that heavy/problem drinkers are not necessarily alcohol dependent.

Notes

• Moderation as a route to recovery from alcohol problems. A data driven evidence based field.

• Problem drinkers vs drunks - alcoholic label.

• Rarity of moderation approach, two factors: (a) " progressive and irreversible for all" assumption (b) unfounded concern moderation will be misused to rationalize heavy drinking.

• Alcohol abuse predicts a less persistent, milder disorder that does not usually progress to "dependence" 2001 Schuckit et al

• Classic reference cited: Obstacles to the adoption of low risk drinking goals in the treatment of alcohol problems in the United States: A commentary. Sobell and Sobell, Addiction Research and Theory February 2006; 14(1): 19–24

The result of this accommodation was that in the early 1990s a survey of 450 private-sector alcohol and chemical dependency programs in the US found that more than 93% were based on a 12-step model of treatment (Peele 1998). Although recent research suggests that treatment orientation may not be an important factor with regard to treatment outcomes (Allen et al., 1997), what is important is that in the US there developed a large and influential body of treatment providers whose allegiance was not only to a particular view but also at the level of strong personal beliefs associated with their personal recovery. Central to their recovery were the beliefs that they had lost the ability to control their drinking, that they must be forever abstinent, and that they must have faith that a higher power would help them because their ‘own willpower has been defeated by alcoholism’ (Nowinski, Baker, & Carroll, 1992, p. 2).

Given this context, it should not be surprising that moderation has not been embraced by an establishment that defines the disorder as based on powerlessness over alcohol and a key symptom of the disorder as denial that one has lost control over drinking (Pattison et al., 1977). Consequently, a factor that continues to hinder moderation goals has been that counselors invested in a 12-step model will be philosophically unlikely to adopt moderation approaches.

(...)  Although problem drinkers are unlikely to enter traditional treatment programs a large majority will see their physicians at least annually.

•  More info: Mark and Linda Sobell. Nova Southeastern University - The healthy lifestyles guided self-change program

• Assess Risk Form

This is an online journal of my personal experience working through the "Responsible Drinking: A Moderation Management Approach for Problem Drinkers" (RD) book.

One of the core tools on RD is to take a 30 days pause from alcohol and "do the work". Currently I am on day 19 out of 30 days (maybe more) of not drinking at all. Over the course of the last 10 years I have done these "thirties" several times. Each time you learn something new.

The RD book fits in a larger school called "Moderation Management" (MM). The core of the group's philosophy is located here Moderation Management™ I participate in the open listserve but the opinions on this blog are my own.

For more information here is a helpful document:

"Guide to Moderation Management Steps of Change"