A Moderate Proposal on Moderation

By Amy Dresner 01/09/14
Finally making a year sober AGAIN after 20 years of relapsing, I wake up to an article telling me I didn't need to be abstinent after all. Not so helpful. A rebuttal from somebody who's been abstinent with and without AA.
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Earlier this year an author named Gabrielle Glaser published a book called Her Best-Kept Secret which read as both a defense of Moderation Management and an attack on the philosophy and culture of AA. According to Glaser, AA is an abstinence pushing religious group wherein predatory males prey on vulnerable female victims rendering the entire society of AA a sexual abuse free-for-all not adequately monitored by AA’s World Services office. The reaction to her book was a modicum of outrage from AA members along with some debate and discussion about the merits of her argument, much as any public airing on the subject of AA tends to invite. Based on the book, Glaser is now an expert on the subject of a fellowship of which she is not a member, and as such recently wrote an op/ed for the New York Times titled “Cold Turkey Is Not The Only Route,” inevitably doing nothing but restating the points made repeatedly in her seven-month old book.

By coincidence I was celebrating my one-year sober anniversary last weekend—after 20 plus years of relapsing and attempting to get sober through various methods including but not limited to—medication, psychotherapy, exorcism, shamans, biofeedback, acupuncture, bodywork, herbology, dialectical behavior therapy, IV amino acid therapy, among others—when a friend forwarded the story to me. I read the piece, no stranger to the cure she was peddling: the opioid antagonist Naltrexone along with a moderation drinking strategy called the Sinclair Method. It was so nice to read that after struggling to achieve absolute perfect abstinence from anything that could alter me from the neck up for the last year, that now Glaser, the self-proclaimed expert (maybe on drinking but certainly not on sobriety), tells me I could have just MODERATED. Like I haven't tried that 900 fucking times before. EVERY single trip to rehab or the psych ward was preceded by one of my good-hearted attempts to "moderate" my drinking.

Granted I didn't take the magical Naltrexone as a) it wasn't offered to me and b) I'm not sure it works when you're an alcoholic AND a crack head AND an IV drug user AND a tweaker AND a gong head who gets arrested for assault or 5150'd every time she drinks. I'm convinced the entire city of Los Angeles feels safer when I am ABSTINENT. But it was irritating to read that after a year of daily boring meetings, hours of step work, shameful crying and deep soul searching, that according to her I could have just popped a pill and taken the short cut, like I've done every other time in my life. So thanks for making me feel stupid and fundamental in my law-driven family galvanized "choice" to get sober.

 Uhh, newsflash: women get raped everywhere. Wherever there are men, women get raped: in the military, in the police force, in prison, in the church, in the office. Why would a bunch of drunks be any different or better?

Now I am no expert as Glaser proffers to be, but I do have experience. Not only have I been sober with—and without AA—and been in treatment over a dozen times but I was married for 3 and a half years to an LCSW who owned a rehab and who was open to alternative methods of sobriety aside from 12 step. I am aware of  “Harm Reduction” (which is what the Sinclair Method is) as well as the many non-12 step models for recovery: SMART Recovery, Moderation Management, Women for Sobriety, LifeRing Secular Recovery and Secular Organizations for Sobriety. (By the way, AA does not and has never claimed to have the monopoly on getting sober.) For most of us who end up in AA, we’re not skipping happily into the front door to some creepy church or crappy community center. We are dragging our feet, head hung low, into the “last house on the block” and thinking “I cannot believe I ended up HERE.”

Glaser might consider leaving it up to somebody who’s actually IN AA to bash AA properly. I am far from a Big Book Thumper. I have rebelled against AA the entire I time I have been a member. But I do know that the book says “If anyone who is showing inability to control his drinking can do the right­ about­ face and drink like a gentleman, our hats are off to him…..We do not like to pronounce any individual as alcoholic, but you can quickly diagnose yourself, step over to the nearest barroom and try some controlled drinking.” If that “controlled drinking” includes Naltrexone, get on that shit. I sure as hell wish I had tried this new pill before I got sober this last time, but I didn’t. And I’m certainly not going to throw away a hard earned year of sobriety to try it out now in the hopes that it might work. My luck has been poor lately. I have no plans to go to Vegas.

When I was in my previous sober living I was “dating” (I use that term loosely) a guy who was taking Naltrexone for a voracious gambling and sex addiction. He noticed by accident when he relapsed on booze that it helped him “control” his drinking. He did some research and came upon the Sinclair Method which he insisted I read. (I never did.) His “moderate” drinking on Naltrexone included him drinking 15 beers in a few hours while gambling on the latest game and having sex with me so I was not too impressed with his new found self-control on any front. Not only is this guy not sober now. He’s dead. But that’s another story.

So if you can drink moderately, more power to you. Some of us in AA aspire to that but many of us crave complete obliteration. We aren’t interested in a glass or two of wine. We want violent naked oblivion. We want to snort lines off strippers’ tits and dance on tables and have black-out sex with strangers in dirty bathrooms. Okay, maybe I’m getting a little personal here….My biggest problem with Glaser’s piece is that she doesn’t make a real distinction between “alcoholics” and “problem drinkers.” “Problem drinkers” CAN moderate. They just have problems doing so or have problems that come along with their drinking. “Alcoholics," in general, cannot. I’ve been successful at moderating for a few weeks at most but soon it’s back to the morning drink (which is the most fun by the way) and then all bets are off. And what about those people who “hit the bottle and go straight to the rock” to quote Sublime (another dead drug addict)? For many, drinking a little bit lowers their inhibitions just enough to pick up their drug of choice and then they are away…..

In Glaser’s book, she mentions that a former AA board member told her, “Women have been getting raped since AA started.” Uhh, newsflash: women get raped everywhere. Wherever there are men, women get raped: in the military, in the police force, in prison, in the church, in the office.  Why would a bunch of drunks be any different or better? Glaser also mentions women being taken advantage of by predators in the group dynamic. Of course that happens as it does everywhere. But it goes both ways. I’ve known plenty a hot mess who've used wealthy old timers to get their financial, sexual and emotional needs met, breaking hearts along the way. Sex is messy. Love is messier. And when it’s amongst alcoholics, it’s mayhem.

Incidentally, if you are so concerned with being raped at an AA meeting, or by an AA member, you can always go to an all women's meeting, or a gay meeting. This is where sponsors send their wayward promiscuous sponsees who like to fuck their way through the rooms, or so a friend once told me. By the way, I have NEVER heard of a woman being raped in an AA meeting, not even in a Sex and Love Addicts Anonymous meeting where some people are just hoping for that kind of stuff.

It’s so nice of Glaser to explain why ALL women drink and how we can ALL regain control cause God knows we are all exactly alike, with the same chemistry and same upbringing. Excuse me but isn’t that the same bone she picks with AA?  Its one size fits all recovery?

AA clearly states, “Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this but it hasn’t done so yet.” If Naltrexone and this Finnish Dr. Sinclair marks that day….fantastic! I’m sure the ranks of AA will thin out considerably. There is no doubt in my mind that not everybody in the rooms is a full blown hope-to-die alcoholic. So let the “problem drinkers” get on Naltrexone and go grab a few cold ones.

“Sounds like one of those ‘eat yourself thin...with our miracle pill’ cures," says author and sober alcoholic Mishka Shubaly.  “I definitely have my issues with AA and the 12 steps but man, why is America obsessed with cures that involve taking a pill, even when the problem is that we take too many pills?”  

Somebody might tell Glaser that pointing out that Bill Wilson took hallucinogens or was a philanderer is nothing new. I have never considered the man a “saint” and openly question anybody who deifies him. He compiled some really cool universal ideas and tools from all over the world and put them together in a program to help people stop drinking. That’s it. I don’t have some creepy shrine of him in my bedroom at my sober living facility. I don’t have his picture in a locket on a chain. Bill Clinton was a great president. He was a fucking philanderer too. I still think he was a great leader, just glad I wasn’t married to him. Tiger Woods wasn’t “faithful” by any means but he still shoots under par and has a collection of trophies, not all of which are in the shape of women. 

So to clarify, Naltrexone is an opioid blocker which blocks the effect of the natural opioids found in the human brain known as endorphins. One major function of endorphins in the brain is to reinforce pleasurable behaviors and turn them into habits. But herein lies the rub. You should only take this medication BEFORE you drink. You should not take Naltrexone before you have sex, because it will make you lose interest in sex. (Who drinks and doesn’t have sex?) And you should not take it before you exercise because it will make you lose interest in exercise. (Ok, 'fess up. Who’s been putting Naltrexone in my cereal every morning for the last 20 years?)

Studies did show that some people who use Naltrexone for alcohol dependence became moderate drinkers. Some lost all interest in alcohol and chose to quit drinking entirely. And 20% STILL abused alcohol. In my mind, THOSE are the people that have no choice but to pursue abstinence in whatever form you find palatable: AA, straight edge, join the Amish, whatever.

I met one alcoholic who finally realized—with the help of Naltrexone—that alcoholism “really is a disease.” For some reason, in AA, he felt like a “bad person,” that his childhood had created his alcoholism and that he should feel guilty for his “self-indulgence.” Funnily, I have never doubted that my alcoholism was a genetic disease with a very definitive chemical reaction completely out of my control. I felt badly for some of my behavior when loaded, but I never felt guilty for not being able to control my drinking or drug use. It is only in AA that I can recount horrific stories of using and we all laugh in identification. 

What this article—and its long version in Glaser’s book—fails to mention is that more than just abstinence, AA  taught me how to live. Left to my own devices, I am selfish and manipulative and fearful with very little understanding of how to be happy or manuever in the world. Drinking was only part of my problem. Self-pity, addiction to misery and self-absorption was the other part. Does Naltrexone help with that too?  And what about my mental obsession and romanticization of drugs and alcohol that is equal to or not worse than the physical craving? Will Naltrexone stop me day dreaming about doing blow with super-models, drinking Krug at glamorous Hollywood parties or shooting scandalously good dope with Sid Vicious? 

Glaser is a big proponent of Moderation Management with it’s emphasis on “taking personal responsibility.” Glaser accuses AA proponents of “not taking personal responsibility” and blaming the disease model but I don’t see AA members popping a pill to fix it all for them. In my experience,  AA is primarily about personal responsibility. Your childhood or your “disease” might not be your fault but they’re your responsibility now. AA encourages you to “see your part” and to “make amends.” What does she call that? Blame?

She’s also a big fan of Moderation Management for its “cognitive behavioral” approach. I have news for Glaser: AA, stripped down of its prayers and higher power stuff, IS “cognitive behavioral” therapy. “Fake it till you make it.” “I don’t care how you feel I only care what you do.” (A mantra I heard from my sponsor more than I’d care to remember.) “Feelings are not facts.” “Suit up and show up.” That is all about acting yourself into right thinking.

I asked Dr. Howard Samuels, founder and CEO of The Hills Treatment Center, his opinion on Glaser’s piece and the Sinclair Method. “I’m disgusted that the New York Times, a gold standard of journalism, would ever publish a piece that is so uninformed and ignorant about alcoholism,” he said. “For an alcoholic to get sober it’s not just about them taking a pill. The alcoholic can just NOT take the pill. They will never stop their self-destruction and change their life with a pill……Alcoholism is a symptom of a greater and deeper issue within the individual. The only way the alcoholic will ever change their life is when they step up and become the leader in the fight against their beast or inner demon.”

To echo Samuels’s point, doesn't the Big Book say "liquor was but a symptom of our disease"? (Why, yes it does.) And one of the first things medical students are taught is Osler's Rule: "Treat the disease rather than the symptoms." The Sinclair Method is the opposite of that rule: "Treat the symptoms, not the disease." Of course, Glaser is not a doctor, nor is she an (admitted) alcoholic.

And I have to agree with Dr. Samuels. Alcoholism, like depression, is a multi-pronged ailment with various physical and psychological components. And just like AA doesn’t work for everyone, one pill probably won’t either. Getting sober was the hardest thing I ever did.  But my way is not the only way. My mother has been abstinent from alcohol for 35 years without AA. I vote we stay open to everybody finding their own path with alcohol, be that moderate drinking or abstinence. Trying to moderate moderation is not a battle I choose to fight anymore. As Saint Augustine said, “Complete abstinence is easier than perfect moderation.” And my liver and the LAPD are thankful for that.

Amy Dresner is a columnist for The Fix. She last wrote about her sex addiction.

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Amy Dresner is a recovering drug addict and all around fuck up. She’s been regularly writing for The Fix since 2012. When she isn't humorously chronicling her epic ups and downs for us, she's freelancing for Refinery 29, Alternet, After Party Chat, Salon, The Frisky, Cosmo Latina, Unbound Box, Addiction.com and Psychology Today. Her first book, My Fair Junkie: A Memoir of Getting Dirty and Staying Clean was published in September 2017 by Hachette Books. Follow her on Twitter @amydresner.