Moderation vs. Abstinence: What's More Effective?

By Ruth Fowler 07/13/11
Some experts claim that while total abstinence works best for 'true alcoholics,' moderation may be more effective for 'problem drinkers.' But is reality ever so simple? Not everyone thinks so.
Moderation and abstinence: is it all relative?

If you’ve heard of Moderation Management (MM), chances are you’ve heard of Audrey Kishline, the 30-something professional who founded the controversial group in 1994. Kishline self-identified as a problem drinker, but subscribed to neither the disease theory of alcoholism nor Alcoholics Anonymous’ abstinence-only approach, which she had abandoned after a period of months. Kishline’s innovation was providing an alternative to AA: a program that would teach problem drinkers how to effectively manage—to “moderate”—their drinking, without having to maintain abstinence, do the steps or attend AA.

In January 2000, after six years’ struggling and failing to moderate her own problem drinking—as well as fielding considerable hostility from AA members and controversy in the press as the public face of MM—Kishline, in a soul-baring letter posted on the site, confessed that she had come to appreciate that her problems with drinking were too severe to be managed by moderation. While she continued to support MM as a viable treatment, she had decided to pursue an abstinence-only program to treat her own alcoholism.

Just two months later, on March 25, the founder of MM and Dr. Stanton Peele’s one-time poster girl for harm-reduction—who now self-identified as an alcoholic and attended AA—got behind the wheel while drunk. The results were devastating.

That evening, Kishline, 43, driving her one-ton pickup on an interstate outside Seattle, Washington, caused mayhem as she drunkenly ran cars off the road, veered into the tree-lined divider, sped onto the interstate heading in the opposite direction, did a U-Turn and crashed head-on with a car containing a mother and child, killing both. It emerged in the investigation that Kishline had spent a great deal of time in Moderation Management neither moderating nor managing, but instead hiding her continuing struggles with binge drinking and alcoholism. This was hardly a revelation, given her announcement in January 2000. However, Kishline’s DUI homicides, combined with MM’s early promise, major press and high praise from advocates like Peele, well known for his frequent lambasting of AA and abstinence (though he had severed his ties to the group and to Kishline long before her crackup), inevitably cast a pall over MM, whose purported mission had never been even remotely militant: “MM empowers individuals to accept personal responsibility for choosing and maintaining their own path, whether moderation or abstinence. MM promotes early self-recognition of risky drinking behavior, when moderate drinking is a more easily achievable goal.”

Yet in the War between the Recoveries, Moderation Maintenance played the role of the young Turks plotting a palace coup of Alcoholics Anonymous. Peele’s provocative articles only exacerbated the antagonism as his have-it-both-ways program, Smart Recovery, confusingly redefined abstinence as a form of harm reduction.

Yet in the War between the Recoveries, Moderation Maintenance played the role of the young Turks plotting a palace coup of Alcoholics Anonymous. Peele’s articles only exacerbated the antagonism as his have-it-both-ways program, Smart Recovery, redefined abstinence as a form of harm reduction.

This whole sorry mess has served to obscure the obvious fact that Moderation Management is effective for many people who abuse alcohol and need help in maintaining limits with their drinking, while Alcoholics Anonymous works for those whose alcoholism is intractable except under the constant pressure of abstinence. Each treatment works, but only if the correct diagnosis is first made—a basic medical principle, after all.

The confusion, controversy and hostility arise only when either of the two approaches is held up as an alternative to the other. One has only to click on the testimonials link to sample the “grateful” people whose only hope before MM was—the horror! —AA.

“Don” writes: I went to a local "addiction" expert who wanted to know about my relationship with my parents, etc. and concluded after 40 minutes my only hope was AA. All I asked was some advice about moderation techniques which your site hit right on the button. It’s already making a difference— just needed help on focus on the issue.

“Debbie” writes:  I walked into this whole thing skeptical, thinking I was an alcoholic, unable to get the daily drinking out of my life, this will never work....I was wrong. The whole process has worked.  I won't say it doesn't take A LOT of effort and true willingness to change, because it does. But, what I've walked away with (from the whole study), the websites, the list, etc., is the knowledge I needed to change my drinking habit (and I will always call it a habit as opposed to addiction), it CAN be one, the mental need for alcohol CAN be replaced, the cravings CAN be diminished, the desire to overdrink CAN be eliminated.

The overt hostility to AA and to the label of alcoholic is evident—because alcoholism cannot be cured or even managed by MM, as Kishline’s experience demonstrates. To accept alcoholism is to close the door on moderate drinking forever. And as any alcoholic knows, saying goodbye to booze and drugs is like leaving the womb. It’s not easy, pretty or pleasant, but it’s essential in order to live and grow.

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Ruth Fowler is an ex-stripper, Cambridge-grad and writer. Find Ruth on LinkedIn and Twitter.