Problem drinking: Moderation or abstinence?

http://www.vancouversun.com/health/Problem+drinking+Moderation+abstinence/9682391/story.html

BY DR. MICHAEL POND, VANCOUVER SUN MARCH 31, 2014

Clients wrestling with alcoholism often will ask me, “Do I need to stop completely?”

VANCOUVER — Clients wrestling with alcoholism often will ask me, “Do I need to stop completely?” When I first became sober, with the help of Alcoholics Anonymous, the answer was a resounding, “Yes. Why would you keep taking something that is killing you?”

After countless attempts to manage my consumption of alcohol, I stood at the threshold of death’s door, one hand on the door frame to hold myself up. After 29 days in the hospital, I wanted to be sober more than anything else in my life. Finally. I was motivated enough to quit. Complete abstinence became my final option.

What if I had accepted professional help sooner? Early research suggests some problem drinkers can learn to drink in moderation. I’m almost fearful of putting this out there, as I just hear some problem drinkers now turning to their spouse and saying, “see, I can so still drink like everyone else.”

The key is a professional with expertise in substance use and mental illness complete a thorough assessment and make a correct diagnosis.

In the DSM-5, Substance Use Disorder is now determined on a spectrum: “mild-moderate-severe.” If you fall in the mild/moderate range, a moderation approach may be a viable option. Research shows drinkers in the mild/moderate range out-number the severe dependent drinkers 4-1.

Reid Hester, Ph.D., of the department of psychology at the University of New Mexico developed the moderation management moderatedrinking.com Internet and online programs.

Moderation management uses many of the techniques of cognitive behavioural therapy and encourages people to take “personal responsibility for choosing and maintaining their path” of recovery. The idea is addiction is a learned behaviour. A habit. Habits can be unlearned and new habits can be learned. Here a some of the programs tools and strategies:

• An assessment of your chances for success with moderation

• Set a system of rewards to keep you motivated

• Goal setting and self-monitoring

• Discovering events that trigger drinking

• Graphical feedback comparing your self-monitoring and progress to your goals

• Learning to deal with social pressures to drink

• Techniques to keep you from lapsing into old patterns

Studies demonstrate MM is more effective than abstinence based programs for motivating mild/moderate drinkers to change their drinking habits and that 30 per cent of those eventually chose abstinence.

Which is the most effective model: abstinence or moderation? I wish I could tell you definitively, but we don’t know, because not enough evidence-based research has been done on either model.

We know AA has worked for many. But because AA is anonymous, there is no follow up research, nor do we know how many go to AA meetings and never come back, finding their solution somewhere else.

My job as a clinician is to explore all the options and find the best fit for my client. For severe drinkers, total abstinence is the only solution. But if you’re not there yet — if you work with a trained professional — moderation may work for you.

Michael Pond is a Vancouver psychotherapist and a recovered alcoholic. His new book The Couch of Willingness: An Alcoholic Therapist’s Battle With the Bottle and a Broken Recovery System is to be launched May 8. See michaelpond.ca.

http://www.vancouversun.com/health/Problem+drinking+Moderation+abstinence/9682391/story.html

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s