For Drinkers, Is Abstinence All There Is? : Maybe there’s another way. Moderation Management, a renegade program for alcoholics, wants to teach problem drinkers how to control how much they imbibe.
You enjoy drinking alcohol. Or at least you thought you did. Now you wonder about those hangovers, that string of failed relationships, the drunk-driving conviction, your glaring absentee record at work.
You begin to ask questions. Is my problem a disease or just a bad habit? Should I swear off the sauce or just try to cut down? And most important: If I do quit for now, must I stay sober forever?
Depends on whom you ask.
Most experts--and probably many of the 2 million people who attend Alcoholics Anonymous meetings worldwide--will say you probably suffer from the progressive disease of alcoholism. Your only real hope includes abstaining for life, they’ll say.
A small group of other experts--considered in alcoholism circles to be renegades--will say that you suffer only from your own misguided decisions and that you can learn to drink wisely.
Now, Audrey Kishline, a Michigan homemaker who was once treated for alcoholism, has fueled the historically controversial issue with a new book, “Moderate Drinking--The New Option for Problem Drinkers” (See Sharp Press).
The 166-page paperback--endorsed by several addiction experts--details the genesis of and rationale behind Moderation Management (MM), a program that prescribes 30 days of abstinence followed by a moderated drinking regime.
The basic idea behind MM--which has groups in Florida, Illinois and Oklahoma, with others forming in California and Wisconsin--is that only a minority of abusive drinkers require total abstinence. These “chronic drinkers” are defined in the book as those who are “severely dependent” on alcohol, have been harmfully drinking for more than a decade and have severe withdrawal symptoms if they stop.
The rest are “problem drinkers,” defined in the book as those who drink excessively and suffer one or more alcohol-related problems, such as drunk-driving arrests, occupational or social dysfunction and health problems. Unlike chronic drinkers, problem drinkers may be able to control their alcoholic intake, Kishline and others argue.
While MM’s views are not new, Kishline’s handbook--which includes her personal story and review of controlled drinking studies--has attracted the attention of the media and many alcoholism experts.
“It’s an idea that’s been around from the beginning of the field and the same old stuff,” says Paul Wood, president of the National Council on Alcoholism and Drug Dependence in New York City. “We’ve never found the idea that one can learn to control their drinking to be anything but a recipe for disaster.”
“Every time something like this comes out, many of my patients relapse,” says Dr. Richard Frances, chairman of the American Psychiatric Assn.’s Council on Addiction Psychiatry. “Every alcoholic wishes they could learn to control their drinking . . . only about 1% can. But every alcoholic thinks he or she’s special and part of that 1%. And I have no way of knowing which of my patients are that 1%.”
AA’s headquarters in New York has no comment about MM. Says a spokesperson: “Part of our long-held traditions is not to be drawn into public controversy.”
But the other side believes that an important point is being missed.
“We need to confront the myth that any drinking problem requires in-patient treatment, a disease diagnosis and lifetime abstinence,” reads the book’s introduction, penned by Stanley Peele, co-author of “The Truth About Addiction and Recovery: The Life Process Program for Outgrowing Destructive Habits” (Simon and Schuster, 1991).
Los Angeles clinical psychologist Marc Kern agrees. The former substance abuser who has been teaching moderated drinking techniques for more than 15 years, will start California’s first MM group next month in Los Angeles.
“In the reality of the world, people do moderate their drinking,” Kern says. “But you don’t hear about these people because they don’t go to AA. It’s a very personal and private issue.”
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Dr. George Vaillant, professor of psychiatry at Harvard Medical School and author of “The Natural History of Alcoholism” (Harvard Press, 1983), says studies repeatedly show that a return to social drinking for anyone except those who don’t meet, or barely meet, criteria for a diagnosis of alcohol dependence is “like trying to drive a car without a spare tire--it only works for a while.”
And even for those who are just borderline for meeting dependency criteria, abstinence is best, he says.
Not necessarily so, counters Kern.
“Abstinence is easier,” he says. “But 5% to 20% of people with alcohol-related problems can eventually learn to moderate. I believe people are going to continue to drink and we need to deal with that fact intelligently and get away from black-and-white stereotypes.”
Some of the sticky debate revolves around just how to define an alcoholic--a daunting task with which professionals have struggled for decades.
According to most official definitions, a diagnosis of alcoholism is based on criteria including impaired control over drinking, continuation despite adverse consequences and preoccupation; once a person meets these criteria, they must abstain from alcohol because the disease only gets worse.
The National Institute on Alcohol Abuse and Alcoholism says there are about 10.6 million American adults who can be classified as alcoholics. An additional 7.3 million are alcohol abusers.
But in MM’s view, “problem” drinkers outnumber “chronic” drinkers 4 to 1, and even some persons who would in mainstream circles typically be classified as alcoholics can learn to modify their drinking.
Take the case of Kishline herself. Speaking from her Ann Arbor home, the 38-year-old mother of two young children details her history with alcohol, which started in her teens.
“I drank when I was happy, when I was sad and when I was bored, but mostly I drank because it became a habit.”
She began to feel ill, did not eat well and slept poorly.
“I drank daily, the amounts gradually increasing, hangovers becoming more frequent. I didn’t perform to the best of my abilities at work, and began to have difficulties keeping up with courses I was taking in night school. I started to postpone everything--studying, projects, hobbies, even getting together with people I knew who did not drink as much as I did. I drank irresponsibly, risking other people’s lives when I drove.”
Finally, after a long-term relationship dissolved, she started to drink alone, becoming “depressed, scared and lonely,” she says.
Kishline sought help from two treatment centers and an after-care program. She was told that she was an alcoholic and that she would have to attend AA meetings for the rest of her life.
“And if I didn’t? The dire prediction was that I would end up dead, in jail, insane or in the gutter,” Kishline says.
So she attended “hundreds of AA meetings” on and off for about four years.
The result? “I became a binge drinker, suddenly obsessed with either drinking too much or not at all. I felt disgraced and demoralized, forever branded with the alcoholic label that became my entire identity.”
But then, as time passed, she did “what a lot of other people do naturally, with or without treatment: I began to grow up. . . .
“It gradually dawned on me that the decisions to abstain or drink, and how much or how little to drink, had been mine to make all along.”
Kishline then chose to drink moderately, a goal she’s maintained for more than three years, she says.
So why did she write the book and start a support group?
“If I had been properly assessed as a problem, rather than a chronic, drinker and offered the option of moderation as a self-management goal when I first sought help, I believe I never would have experienced so many years of inner conflict and emotional pain.”
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“Ridiculous,” says Dr. Nicholas Pace, assistant professor of clinical medicine at the New York University School of Medicine and author of “Guidelines for Safe Drinking” (Fawcett Publishing, 1985).
“Who needs alcohol?” he asks, citing statistics on the damaging social, emotional and physical effects of alcohol. “We know alcoholism is a complex disease. We know that alcohol has an adverse effect on every single system in the body, above all the liver and the brain. You can’t turn a pickle back into a cucumber.”
But what about the notion of “problem drinkers” who may not yet be alcohol dependent?
“It’s ridiculous semantics and a way to stay in denial,” Pace says. “You don’t have to be dependent on alcohol to be an alcoholic and it doesn’t matter how much you drink--it’s what happens when you drink. The problem drinker is an alcoholic in the early stage. If you’re having a problem with alcohol, you shouldn’t drink, period.”
Kishline says she doesn’t understand what all the fuss is about.
“It’s not like we’re asking people to reduce the number of times they rob banks each week,” she says. “We are asking people who drink too much to reduce the number of drinks they consume per week.”
She does admit that it’s too soon to tell what the long-term outcome will be. But based on the first year, about 10% of the 250 people who have been exposed to MM have moderated their drinking, she says.
“Like those who try AA, a lot of people just aren’t ready,” Kishline says.
But anyone who is unable to attain MM’s goals of moderation (for men, no more than four drinks on any one occasion, no more than four occasions a week, no more than 14 drinks a week; less for women) is referred to abstinence-based programs, she adds.
Says Kishline: “Problem drinkers will seek help sooner when they are given access to programs that match their needs. And those who cannot achieve moderation are more likely to accept abstinence when they’re convinced that moderation is not a workable solution to their problem.”
