Think of something in your life that you really enjoy. Going for hikes, writing in your journal, cheering on a sports team, baking cookies—this is something that brings you comfort, helps you relax, and allows you to feel more like yourself. Now imagine that you can never do it again.
The way you feel when you imagine giving up that beloved activity is very similar to the way a person with a mild to moderate alcohol use disorder feels when they’re confronted with the idea of giving up drinking completely. That thought alone can be a major deterrent to seeking treatment. That’s where moderation comes in.
What is moderation?
Moderation means that a person with addiction doesn’t completely stop using a substance but instead follows a program to limit, monitor, and report any drug or alcohol use. This treatment strategy has been proven to be effective specifically for those who have problems with alcohol but have not yet developed dependence, and who want to get their drinking under control. Moderation programs ask participants to take a realistic look at their drinking behaviors and the problems that alcohol use creates in their lives, and then the programs provide behavioral tools and support for making changes.
There are two widely-supported moderation programs, and they’re often used together: Moderation Management and Moderate Drinking.
Moderate Drinking is on online platform that helps participants to set limits on how much they drink. As part of their subscription, users have access to evidence-based tools and strategies that are designed to help them reduce both the frequency of their drinking and the amount of drinks they consume. The program helps users to determine if moderation is an appropriate form of treatment based on their drinking patterns and emphasizes that a key component of moderation is to enjoy drinking without getting drunk.
Moderation Management combines behavioral changes with peer support, and is a complement to Moderate Drinking. The program incorporates meetings (both online and in person), drinking limit guidelines, a group forum where users can offer support or ask questions, chat rooms, a drinking diary for recording alcohol consumption, and other elements. This program receives funds generated from Moderate Drinking subscriptions and is free to users.
Does moderation really work?
These programs are evidence based, and there’s research that shows their success. Both Moderation Management and Moderate Drinking are included on the SAMHSA National Registry of Evidence-Based Programs and Practices (NREPP), and Moderation Management is also included as a resource on the National Institute on Alcohol Abuse and Alcoholism (NIAAA) website “Rethinking Drinking.”
Research shows that moderation can be effective for people who aren’t dependent on alcohol and haven’t developed symptoms like high tolerance or withdrawal. The higher dependence level someone has, the lower their chances of being able to drink moderately over a long period of time. If a moderation program is started before someone becomes clinically dependent, the program can be effective.
One study found that a group of heavy drinkers who consumed an average of 35 drinks per week were able to reduce their drinking over a 12-month period. Those who used the Moderation Management program alone were able to achieve 20% abstinence days, or roughly 6 days per month without drinking at all. For those who also used the interactive website, moderation was even more effective, with 40% abstinence days, or roughly 12 alcohol-free days per month. For both groups, users had lower blood alcohol levels on days they did drink (from consuming fewer drinks) and reported fewer problems associated with drinking alcohol.
Can moderation lead to abstinence?
Moderation has been shown to be effective as a motivator to encourage someone to seek treatment for alcohol use disorder. Roughly 25% of people who haven’t sought treatment say they aren’t ready to give up drinking. Alcohol is pervasive in our society, and for many people, it’s hard to imagine life without happy hour, beers during the game, or a glass of wine with dinner.
However, when someone admits they “have issues” with alcohol or expresses a desire to cut back, that’s a sign they’re open to making behavioral changes. Moderation allows these people to start taking steps toward treatment with being labeled “alcoholics” or forcing them to confront their denial. In some cases, it can lead to more controlled drinking. If it doesn’t, then simply trying moderation first may help the person with alcohol use disorder realize that they need to try abstinence.
Which is better, moderation or abstinence?
When it comes to treatment for addiction, one size doesn’t fit all. Treatment must always be individualized. With moderation and abstinence, one isn’t better than the other. It all depends upon the individual person’s needs, the severity of their alcohol use disorder, and any number of other contributing factors. Ultimately, you should talk with your doctor or a drug and alcohol treatment professional to decide if abstinence is necessary or if moderation might work for you.
Abstinence comes with its own set of challenges, the most significant of which is maintaining it over a long period of time. Rates of relapse for substance use range from 40% to 60%, which is in the same range as relapse for other chronic conditions like asthma or diabetes. Relapse simply means that treatment needs to be adjusted, but for some who follow an abstinence program, it can feel like failure—either to themselves or to their friends and family.
The National Institute on Alcohol Abuse and Alcoholism estimates that fewer than 25% of people who abuse alcohol get treatment. Of those who do, 90% of will relapse at least once in the four years after treatment. Offering a wider variety of evidence-based treatment options, like moderation, can only help improve those numbers.
Will moderation work for drug use?
Each substance use disorder is different, and addictions to different substances vary widely. People who are addicted to prescription or illicit drugs have a higher risk of overdose death. While a relatively small percentage of people die from alcohol poisoning, the risk is far lower than deaths caused by illicit substances like heroin. In 2015, there were nearly 35,000 deaths from opioid use alone. An alcohol user has to consume substantial amounts of alcohol before death occurs, but overdoses from cocaine, heroin, and other substances can occur with just one use. For these reasons, moderation has not been endorsed or recommended by SAMHSA or other national organizations for treatment of substance use disorders involving drugs.
Let’s open our minds to moderation
Many people equate recovery with 100% sobriety, so it can be hard to wrap our heads around the idea that moderation can be an effective way of treating alcohol use disorders. If someone you love is considering adopting moderation, be supportive and know that research has shown that it can be effective – both at managing drinking, and at encouraging additional substance use treatment down the road. If you have issues with alcohol but can’t imagine giving it up completely, don’t be afraid to seek help. Talk with a doctor or treatment specialist to see if moderation is appropriate for your situation. Ultimately, any step toward reducing alcohol use is a step forward.
Note: The headline of this article has been updated for clarity.