Moderation vs. Abstinence: What's More Effective? - Page 3

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?

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How do you decide which program—AA or MM—is right for you? Dr Keith Humphreys, a Stanford Professor who studies addiction and the role of self-help groups, compares the diverse range of AA’s membership with the comparative homogeneity of the much smaller MM. “The typical MM member is employed, has a college degree and has few or no symptoms of alcohol dependence (e.g., blackouts, shakes, sweats). This is exactly the sort of person who has the best chance of becoming a successful moderate drinker,” he says. “AA members in contrast tend to show signs of physical dependence on alcohol and have also had their lives more damaged by alcohol, e.g., they have blown out their marriage/job/housing situation. They are the sort of people who are unlikely to become moderate drinkers and would be better off abstaining.” Kosok noted similar disparities in her research.

It’s worth noting that both MM and AA agree on fundamental principles. MM’s primary text, “Moderate Drinking,” and AA’s “Big Book” both make explicit distinctions between problem drinkers who are able to return to moderate drinking and alcoholics who are not. Both texts also agree that failure at the goal of moderate drinking indicates that a drinking problem is serious, harmful and best addressed by abstinence.

Inevitably there will be those who end up in the wrong place. Dr Keith Humphrey’s notes in his MM paper that “about 15 percent of MM members had experienced three or more of the following symptoms at least once in the six months before joining MM: shaking when not intoxicated, delirium tremens, blackouts, convulsions or fits after drinking, and cravings for alcohol upon waking. The vast majority of these persons also reported that drinking had caused problems with their job, health, and family situation. This subgroup of MM members would almost certainly meet formal diagnostic criteria for alcohol dependence.

Even MM’s website points out that many attempting MM will decide that it’s not for them and abstinence only is required: “Not surprisingly, approximately 30% of MM members go on to abstinence-based programs."

The take-home, then, is plain: To argue for or against AA or MM is an exercise in futility unless you are arguing in the case for a particular person who is either an alcoholic or a problem drinker. Successful treatment depends, once again, on correct diagnosis.

Dr. Keith Humphreys sums it up: “Tragedies such as the deaths in the car accident involving Audrey Kishline can occur when alcoholics fail to abstain, but they can also occur when nondependent problem drinkers are denied assistance because they have not deteriorated enough to become committed to a goal of abstinence. Of course, these potential benefits of MM must be viewed in light of the probability that some individuals who participate in MM will fail to attain moderate drinking.”

Just as individuals who attend AA may fail to attain sobriety.

When it boils down to it, both MM and AA are, at their core, programs reliant on the individual’s ability to take responsibility for their actions. Blaming the program for individual failure is simply a dodge. So the alcoholic must avoid the biggest trigger of all: alcohol. And the problem drinker must be cursed with the fiddly online tools, counting methods and drinking diaries in order to safely enjoy what the normal drinker takes for granted.

Although as an alcoholic, I have to say, I don’t envy the problem drinker one bit. Enjoy counting your drinks and keeping your diaries, kids!


Ruth Fowler has written for The Village Voice, The Guardian, The Huffington Post and The Observer. Her memoir, No Man's Land, about her pre-sobriety experiences as a stripper in Manhattan, was published by Viking in 2008. She is a frequent contributor to The Fix.






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