No discussion of drug and alcohol treatment would be complete without mentioning the moderation programs that are now available. Proponents of these models generally believe that if one catches a drinking problem in the early stages, rehab and abstinence may not be necessary. Instead, they believe with the right type of support, a “problem” drinker may be able to stave off the harmful consequences by adjusting his behavior and monitoring his intake. While these may be options for some, it is believed (even by moderation facilitators) that once one’s alcoholism has become fully entrenched, abstinence is still the only option. Moderation enthusiasts believe rehab is not always necessary.
Also referred to as M.M., Moderation Management was founded in the ’90s by Audrey Kishline, who believed that not every problem drinker needed to practice abstinence or take on the label of “alcoholic.” This 9-step program incorporates the values of self-management, balance, moderation and personal control by using face-to-face meetings augmented by online tools and moderate drinking guidelines. In this non-judgmental format, it is the client who decides whether he needs complete abstinence or not. This program was meant to be of value to the problem drinkers, said to be four times as many as full blown alcoholics. The benefits are that it is not as intense and costly as traditional treatment, and the duration of involvement is much shorter than in more traditional programs like Alcoholics Anonymous. While M.M. boasts a high success rate, about 30% of those realize moderation is impossible, so they choose abstinence. The abstainers are welcome to continue in the M.M. Program.
Members of this free program begin with 30 days of abstinence, something that could prove to be difficult for those later into the progression of alcoholism. Some of their values are similar to those in 12-step programs, such as peer mentoring, taking personal responsibility for one’s drinking and lifestyle choices, and meeting face-to-face with others of like mind. They use a statement of purpose read at their meetings and they don’t believe that one should be “forced” to change anything they don’t care to change. Members choose their own goals for harm reduction, so that even if moderating proves impossible, the process can be a shorter route to discovering if one is, in fact, an alcoholic.
Here are the ground rules and steps of Moderation Management as outlined in their meeting guidelines:
MM Meeting Ground Rules
- An M.M. meeting is a safe, protected and confidential space. If you are concerned about your drinking, you are welcome here.
- We are here to help each other. The appropriate attitude is one of mutual respect and tolerance.
- People should not come to M.M. meetings intoxicated and we suggest abstaining from drinking altogether on meeting days.
- We discourage our members from socializing together in drinking situations, and alcohol is never allowed at meetings or official M.M.-related activities.
- We share our experiences and our knowledge; we do not stand in judgment of others and we try to avoid giving personal advice.
- We understand that individuals may choose paths other than ours; they are welcome if they are concerned about their drinking.
Nine Steps Toward Moderation and Positive Lifestyle Changes
- 1. Attend meetings or on-line groups and learn about the program of Moderation Management.
- 2. Abstain from alcoholic beverages for 30 days and complete steps three through six during this time.
- 3. Examine how drinking has affected your life.
- 4. Write down your life priorities.
- 5. Take a look at how much, how often, and under what circumstances you had been drinking.
- 6. Learn the M.M. guidelines and limits for moderate drinking.
- 7. Set moderate drinking limits and start weekly “small steps” toward balance and moderation in other areas of your life.
- 8. Review your progress and update your goals.
- 9. Continue to make positive lifestyle changes and attend meetings whenever you need ongoing support or would like to help newcomers.
This is how M.M. Defines a moderate drinker:
- considers an occasional drink to be a small, though enjoyable, part of life.
- has hobbies, interests, and other ways to relax and enjoy life that do not involve alcohol.
- usually has friends who are moderate drinkers or nondrinkers.
- generally has something to eat before, during, or soon after drinking.
- usually does not drink for longer than an hour or two on any particular occasion.
- usually does not drink faster than one drink per half-hour.
- usually does not exceed the .055% BAC moderate drinking limit. (see Note 1 below)
- feels comfortable with his or her use of alcohol (never drinks secretly and does not spend a lot of time thinking about drinking or planning to drink).
M.M. Also has clear definitions of what they regard as non-alcoholic drinking, again listed from their guidelines as follows:
- Strictly obey local laws regarding drinking and driving.
- Do not drink in situations that would endanger yourself or others.
- Do not drink every day. M.M. suggests that you abstain from drinking alcohol at least 3 or 4 days per week.
- Women who drink more than 3 drinks on any day, and more than 9 drinks per week, may be drinking at harmful levels.
- Men who drink more than 4 drinks on any day, and more than 14 drinks per week, may be drinking at harmful levels.
So while M.M. Has clearly defined criteria and boasts a high success rate, there is still much controversy. It’s founder, Audrey Kishline, was convicted vehicular homicide for driving the wrong way on an expressway, while under the influence, and causing an accident that killed a man and his 12-year-old daughter. Kishline was sent to prison. It has been said she was struggling with binging so she began attending Alcoholics Anonymous meetings herself before the accident happened. And as the above guidelines show, one’s drinking needs to be relatively in control to even attempt moderation, which Kishline found herself unable to do. In a Dateline interview with Dennis Murphy, Kishline herself admitted she may have devised her moderation program as a way to legitimize her own drinking. As a rule, people who drink at the above guideline levels don’t seek out treatment to begin with.
So does this work? Perhaps if you meet the guidelines, but if you believe in the disease model and progression of alcoholism, perhaps not. Best to seek the help of a professional.
Drink/Link Moderate Drinking Program
Founded by Psychologist Donna Cornett in 1988, Cornett claims to have created the first moderation type drinking program. Cornett’s model is done in the privacy of one’s home, incorporating techniques that psychologists have found work for those wishing to overcome other bad habits such as smoking and overeating. She guarantees success to those who follow her guidelines and practice her techniques.
How Drink/Link Works
Basically, Drink/Link allows users to identify the patterns and triggers that precede a binge or over- drinking session. She does this with a multiple-tiered, at home abuse prevention program incorporating safe drinking guidelines and behavioral management.
In a nutshell, Corbett’s Self-Study program begins with a “free” personal phone consultation with Corbett herself (included in the $195 initial cost), followed by the use of a workbook written by Corbett (7 Weeks to Safe Social Drinking), motivational tapes, drinking graphs & diary, reading material, nutritional supplements and general health guidelines.A more intense plan is her Phone Consultation Program. For $695 you can have a program tailored specifically to you. Included would be weekly 50-minute consultations with Corbett scheduled at your convenience, plus all that’s included in the self-study program.
Then there’s the Sensible Drinking System, a pared down over-the-counter program which skips the professional consultations but includes the workbook, motivational tape, drinking diary and graph for a mere $79.98.Of course, there are other “tools” one may purchase as additions to any of the tiers. There’s the Drink/Link breathalyzer for $399.95. Individual consultations with Corbett run $150 for 50 minutes. Add to that books written by Corbett, workshops, nutritional supplements ($49.95 for a 50-day supply), and even gift certificates that concerned (or co-dependent) family members and friends may purchase for the drinker in their lives! How much help you receive may realistically depend on what you can afford.
Corbett’s credentials, in addition to her M.A. in psychology and California teaching credentials, include being the founder of the Responsible Drinking Institute of America, a non-profit devoted to the sensible use of alcohol and preventing alcohol abuse. Their motto being “find what drives you and fix it” seems almost too simplistic, since people tend to seek help for what they can’t control themselves. Still, for those opposed to the structure, abstinence and spiritual aspects of A.A., this may prove a reasonable alternative. As a caution, it should be noted that moderation programs may work well for some, but for those whose drinking has crossed the line into chronic use, there tends to be little, if any, successful ways to moderate.
A Woman’s Path to Recovery
This model of treatment is for women with substance abuse problems using A Woman’s Addiction Workbook: Your Guide to In-Depth Healing as the basis of its content. Led by professional clinicians, women go through twelve 90-minute sessions over an eight-week period, addressing the issues in their lives that lead to addiction. This program explores gender as it relates to addiction, and looks at recovery barriers unique to women. This is a two level process based on the book. In the exploration section of the program, women address five specific areas: body and sexuality, stress, relationships, trauma and violence, and thrill-seeking. It is in this exploration part where women may identify and evaluate co-occurring mental health disorders as they are uncovered. In the healing section of the book, women are guided through a four-domain recovery method – relationships, beliefs, actions and feelings. A series of exercises go with each domain, supporting a woman’s efforts through an understanding of the underlying psychology beneath female addictive behavior. This method is also said to work well with process addictions (addictions such as shopping, gambling and eating) – among others.
Here’s a unique take: purchase this timed (from one minute to 999 days) padlocked safe as a way to moderate or terminate your addiction, for a one time fee of only $129.99! For substance abusers, it is suggested by the manufacturer to put your alcohol or drugs into the safe and set the timed padlock to the time you decide it will be reasonable for you to use again. The manufacturer suggests that this is a way to lock away your addictive substance, “for any length of time you select, from one minute to 999 days, any item that is harming you, any item that is allowing you to continue an unhealthy habit, any item that might ultimately cause you serious health issues… even death”
The idea that you may want to go out and buy more of your substance of abuse is dismissed by the claim that “for every individual, the time, trouble and personal humiliation of going back out to the store are just enough to prevent you from doing it.”This concept is novel but most likely useless when it comes to a serious (or even moderate!) addiction. One wonders if the device’s founder has any education or experience with addiction at all, as evidenced by it’s claims.
Moderate Drinking Options
Founded by Arnold M. Washton PhD., who is known for developing individualized psycho therapeutic treatment approaches, this moderation model combines many of the current clinical practices used to treat substance abuse. His strategy is a four phased approach as follows:
- Phase #1 – Suggested abstinence (two to four weeks) to enhance motivation to change while assessing drinking history. Washton believes it’s beneficial to abstain to: a) break one’s drinking pattern; b)establish an alcohol-free baseline; c) have some experience of life without alcohol; d) pinpoint triggers and set the stage for moderation.
- Phase #2 – Learn and practice self-control skills by: a) keeping a log of drinking times; b) avoiding high-risk situations; c) finding healthy alternatives to drinking and easing boredom.
- Phase #3 – Learn to maintain moderation by: addressing and dealing with “slips” appropriately while preventing future relapse.
- Phase #4 – Address life issues that contribute to and are part of one’s drinking. These include: a) anxiety, depression and negative feelings; b) communication and relationships; c) self criticism and guilt or lack of self acceptance; d) anger management and assertiveness; e) job and career crisis.
Washton is a believer that there is a continuum of alcohol problems rather than the black and white school of thought that asserts you either are an alcoholic or a non-alcoholic. Once one is an alcoholic, however, abstinence is the only option. These are people who should not attempt modification. Below are Washton’s criteria for those who would not qualify for a moderation program.
Moderate drinking guidelines exclude the following persons, who are advised by public health officials not to drink alcoholic beverages at all:
- Women who are pregnant or trying to become pregnant
- People who plan to drive, operate other potentially dangerous machinery, or engage in any safety-sensitive activities requiring coordination, attention, and skill
- Individuals taking medications, including over-the-counter medications, that may interact adversely with alcohol
- People who tend to lose control of their behavior (for example, become aggressive or violent) when they drink even moderate amounts of alcohol
- People who drive while intoxicated, have been arrested for driving while impaired, and/or have been in an alcohol-related accident
- Alcoholics in recovery and others with a history of serious alcohol problems who have already been abstaining from alcohol
- Anyone under the age of 21
- Anyone with a medical or psychiatric condition that would only be made worse by drinking, even in moderation
Washton’s program is cash and credit card only.
Moderation Oriented Cue Exposure
While this is a model of moderation treatment, it’s premise is different than the above mentioned groups or treatment methods. There are no steps, workbooks or online activities to achieve results, this model uses therapy that has been commonly used to help those with obsessive-compulsive and anxiety disorders.
Participants work with a therapist who interviews and assesses the client’s drinking habits and motivation to cut down. He also notes triggers, drinking patterns and habitual situations that precede the urge to take that first drink. The therapist then has an overview with which to establish a “baseline” goal of how much the client’s target consumption level should be. This initial interview is followed by the the first phase of exposure.
The client’s priming dose is initially considered the amount of alcohol it takes to trigger the client to move into lack of control over continued drinking. He may always be able to say no after two drinks, but once he’s had the third, all bets are off. He finds himself intoxicated time after time, unable to explain why. That client’s priming dose, then, would be three drinks. So the belief held with this model is that it isn’t necessarily the first drink (as 12-step programs believe) that leads to loss of control, but more an amount that is different for each individual.
What happens next in Phase One is that the client ingests the amount needed to set off the craving (his priming dose) for more, then he denies the urge, even though it’s right in front of him. Much like a person afraid of snakes may be treated to gradual and then more intense exposure to snakes – even touching the snake eventually – to condition away the fear, the drinking client is exposed to alcohol after consuming (in a controlled setting with a therapist) his baseline amount. This is what’s called cue exposure. To do this the therapist uses visual (looking at the drink, bottle etc.), tactile (client holds the glass, interacting with it so to speak) and olfactory (the client may be instructed to smell the liquor at intervals) – all in an attempt to resist these cues by repeated exposure while reinforcing motivational reasoning. Once these responses are habitualized, the client moves into Phase Two, where the practice is moved from the clinician’s office into the client’s outside world. Finally, in Phase Three, the client practices what he has learned without the supervision of his therapist.
While this model has shown some success in reducing problem drinking, long-term efficiency studies are needed to really confirm this. As evidenced in other moderation programs, for those who have crossed over the line into alcoholic drinking, this may be of only modest help. In assessing what type of alcohol intervention is needed, one is best served by consulting a professional with knowledge of substance abuse issues.
Abstinence or Moderation Programs
There are some moderation programs that are also abstinence programs. It’s up to the client to choose, and as with the moderation only programs, when one finds it impossible to control his drinking, it helps confirm for the alcoholic that quitting is the only thing left. Since busting denial is a significant part of recovery (denial tells the addict/alcoholic they can handle this – there is no problem), moderation may be a reasonable place to start for some. Recovery can’t be achieved as long as one is harboring denial. These programs are covered in greater detail in the Recovery Support Options, but here is a brief list of those dual function support groups.
HAMS (Harm Reduction Abstinence and Moderation Support) HAMS uses a combination of methods for either abstaining or moderation. To do this they use peer support, meetings, education (they have their own book), and online support to meet members where they’re at, rather that forcing clients to label themselves. They claim non-judgemental support, or “harm reduction.”Behavioral Therapy Associates This psychologist based treatment uses information compiled by healthcare professionals to determine what does and does not work. Their program uses online courses augmented by therapy. They were the ones who pioneered the Drinker’s Check List developed for military personnel to asses their drinking. College students also commonly use the list.
My Way Out This method may be used for both moderation or abstinence. They use pharmaceutical, herbal, amino acids and hypnotherapy as adjuncts to treatment, as well as placing an emphasis on diet and exercise. Meetings and online support are added options. The program may be used with other 12-step programs.
Chemical Options for Moderation (or Abstinence)
This heading isn’t outlining one specific program for moderation, but rather to address chemical interventions that claim success in moderating (or ending) one’s alcohol or drug consumption. There are no guidelines per se of who these herbal or pharmaceutical treatments will help (some don’t seem to differentiate the moderate drinker from the alcoholic in their claims), but instead jump right into touting varying levels of success. Some of these pharmaceuticals address drug use, while others are specific to alcohol.
Topamax (Topiramate) A medication initially used to treat diabetes, then used as an anticonvulsant, it was discovered that Topamax also shows promise as a treatment adjunct for treating alcoholism. It is known that using alcohol deadens the area of the brain that controls inhibitions (GABA – the main inhibitory neurotransmitter), but alcohol also increases glutamate (an excitatory neurotransmitter) and dopamine (somewhat similar to adrenaline, this neurotransmitter works with the brain processes that regulate motor skills, emotional response and the experiences of pleasure and pain). Topimax blocks the glutamate receptors and increases the GABA, essentially giving one back the ability to exercise more control while neutralizing the mood enhancement characteristics. The results of this combined effect have worked in decreasing alcohol cravings and withdrawal symptoms. Some have used this as a way to cut down on heavy drinking bouts. As a treatment, Topamax is a pharmaceutical and must be prescribed by a doctor. As with Naltrexone, this works best with cognitive and behavioral intervention.
Naltrexone is an FDA approved anti-craving medication, when used in conjunction with cognitive and behavioral treatment has shown promise in helping one to moderate the consumption of alcohol. This drug effectively reduces craving and blocks the pleasure responses (euphoria) that result from consumption, making it easier to resist taking that drink. Naltrexone is pharmaceutical and must be prescribed.
Acamprosate (Campral) Approved by the F.D.A in 2004, Acamprosate is another drug that works to balance neurotransmitters once one has detoxed from alcohol. While the exact mechanism isn’t quite known (this one isn’t an opioid antagonist so it doesn’t block the high), Acamprosatehas been used for decades in Europe. Again, because the brain’s neurotransmitter systems adapts to chronic alcohol use, once the alcohol is removed the whole system is thrown out of whack. That malfunction creates the hyperexitatory state (the insomnia, anxiety and restlessness associated with withdrawal) that Acamprosate seems to relieve by normalizing brain activity. This drug does not block the euphoria as Naltrexone, so they may be used together to enhance effectiveness. Acamprosate is not metabolized by the liver, so it may be safer for those who have liver disease in conjunction with their alcoholism. As with all the pharmaceuticals, this needs to be prescribed by a physician and works best with concurrent support.
Ondansetron (Zofam) Ondansetron is commonly used to combat the nausea experienced by chemotherapy patients, but researchers have discovered that in much lower doses, it may be especially effective in treating those with early-onset alcoholism (those who experience drinking problems before age 25). This drug appears to work by effecting one’s Serotonin, which along with dopamine is believed to create the craving for alcohol. Early onset alcoholics tend to be biologically predisposed and can be harder to treat. Their relapse rate and antisocial tendencies have proven challenging when it comes to the standard behavioral techniques, according to the National Institute on Alcohol Abuse and Alcoholism (IAAA), who funded the study that discovered the additional use of this drug. Again, this is RX only and needs a doctor’s supervision.
Baclofen This anti-craving medication was originally designed as an agent to treat muscle spasms, commonly prescribed for those with Multiple Sclerosis, but has been prescribed to quash cravings for alcohol. Some promise has been shown in the treatment of alcoholism based on it’s anti-craving and anti-withdrawal properties. There is a tolerance factor, so one may need to up doses to achieve a continued effect, and there are also withdrawal symptoms similar to those of benzodiazepines and alcohol, so discontinuance should be supervised.
Antibuse this drug is the granddaddy of chemical intervention when it comes to treating alcoholism. Chemically know as Disulfiram, this drug works by making one experience extreme discomfort if one drinks while taking this medication. It was the first medication to be approved for the treatment of alcoholism. When alcohol is broken down by the body, it first metabolizes into acetaldehyde (a toxic substance responsible for hangovers) before being further oxidized into acetic acid. Antabuse prevents the acetaldhyde from oxidizing further, so it increases the presence of the toxic drug in one’s system. How sick one will get depends on how long the drug has been taken (the longer it’s taken the more effective it is) and how much alcohol one has consumed. Either way, the effects are never pleasant. Though it has been used for many years as an alternative or adjunct to treatment, it’s effects haven’t proven to do much. It’s often prescribed as an enforcement of some consequence related to alcohol, but many return to old patterns once the drug is no longer prescribed.
Suboxone (Buprenorphine, Subutex) This medication is mostly used to treat opiate addiction, but is well known enough to mention in the context of other pharmaceutical addiction treatments. Suboxone produces only a slight euphoria while treating withdrawal, giving it an advantage over Methadone. Once ingested, this drug fills the same receptors as opioids do, effectively blocking one’s addictive substance from occupying the same space. Suboxone is what is called a partial opioid agonist (agonist means producing an action), meaning the addict won’t get the high, but the craving will disappear, causing the addict to only feel somewhat normal. But better than that, once Suboxone fills the receptors, should the addict use on top of that (entertaining the idea of relapse) he still won’t get the high since the Suboxone is parked there for 24 hours and won’t allow the full opioid (drug of choice) to replace it. Taking more won’t affect it’s blocking properties so, unlike Methadone, the addition of another opioid won’t get you the “desired” high. Suboxone produces a much milder euphoria, so there’s less chance of abuse, though it has been reported that some become addicted to Suboxone by taking more than is prescribed. Still, most who use the drug as prescribed can let it go as their physician dictates.
Methadone Due to an opium shortage in Germany, Methadone was developed as a synthetic alternative to morphine in 1937 by the Germans to help soldiers with pain and mood elevation. Unfortunately, what it really did was create lethargy and an unwillingness to fight, so it’s use was quickly abandoned. It was first used in the U.S. In 1947, when the drug was given it’s current name. It was thought that Methadone would produce a milder high and reduce the death rate and transmission of Hepatitis, HIV and other diseases spread through sharing needles used to inject heroin, since Methadone could withstand the human digestive system and didn’t need to be injected. Like Antibuse is the granddaddy of chemical intervention for alcoholism, Methadone was the first such approach addressing opiate addiction. It was meant to be a harm reduction measure rather than a cure, as methadone is said to be even more addictive than heroin and causes even more severe withdrawal symptoms. It’s use has been a cause of controversy since overdoses – usually when the drug is mixed with another opiate or benzodiazepines – continue to be a problem. Still, as an alternative to heroin for pregnant women, those incarcerated or on parole, it’s harm reduction and legal availability make it’s use feasible in some situations.
Last Call uses a botanically-based liquid, Sobrexa, which one mixes with water and drinks several times per day. The manufacturer claims the supplement was developed over a 16-year period and works with one’s brain chemicals to eliminate cravings. Eight weeks is all it should take to moderate or conquer your addiction, and then you have the option to continue using the product or not. This program boasts an 85% success rate and has been in use since 1993, though the product was packaged as an at home system for consumers in 2010.
NaturaClear is an herbal supplement designed to minimize withdrawal symptoms and help one achieve moderation or sobriety. Said to work in as little as 15 minutes to ease cravings, NaturaClear claims to eliminate insomnia, tension, irritability, weight gain, nervousness, and the fatigue that are common side effects experienced while detoxing. Taking a capsule twice a day for 90 days should do the trick. NaturaClear works by boosting serotonin, dopamine, norepinephrine and GABA, all neurotransmitters (brain chemicals) involved in mood enhancement. Claim is that once chemicals are balanced (90 days) one should not need to drink excessively again. These supplements are combinations of natural herbs, so there is no prescription needed and have no withdrawals when one stops taking them. Price ranges from 39.99 for sober fast capsules (said to eliminate hangovers or help one to sober up fast) to $199.99 for a year’s supply for those who have drank alcoholicly for 5 years or more. Their take is that the longer one drinks, the longer it takes to break down and correct the chemical imbalance caused by alcohol, so one needs to use the product longer. As with any supplement, one should consult a doctor or pharmacist to be sure the ingredients are safe and don’t conflict with other medications or illnesses.
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