The idea that moderating alcohol abuse is possible has never been popular in the United States. It doesn't fit well with the typical disease model. There are, however, good reasons to consider moderation among the available treatment options.
First, moderation isn't a fantasy. Just as everyone knows someone who needs to stop drinking, we also know someone else who has quit or moderated their use. Many binge drinking college students and military personnel undergo spontaneous remissions with graduation and discharge. Others people of all ages and conditions simply adjust their consumption to altered circumstances.
Next, the emerging use of Naltrexone, an FDA approved and SAMHSA (Substance Abuse and Mental Health Services Administration) recommended anti-craving medication, as an adjunct to treatment has extended the possibilities for treatment planning. Unlike Antabuse - an aversive drug that makes clients physically ill if they consume even trace amounts of alcohol - Naltrexone reduces the craving for alcohol and stops the pleasurable brain responses from alcohol. Importantly, it is compatible with continued alcohol consumption and has been used successfully in moderation programs. With the urges reduced and the effects blocked, drinkers tend to drink less, if at all, and may begin considering alternative activities.
Finally, moderation options allow people to explore possibilities, examine their own use, and determine their own outcomes. Those who find alcohol intruding in unwanted ways may be able to curtail their use and avoid dependence or addiction. Dependent drinkers may be diverted from addiction. Full-blown alcoholics may realize the extent of their addiction and proceed to get the help they wouldn't otherwise have accepted.
Those who find themselves losing control of their alcohol use - and usually this loss extends to other aspects of their lives as well - do better when they feel more like they have some control over their treatment. Exploring realistic options, using anti-craving medications, tracking responses, trying alternatives, engaging in short term cognitive behavioral therapy, and other strategies all help to keep people in treatment, away from heavy drinking, and more apt to successfully make long term changes, regardless of what the nature of those changes turns out to be.
This only works, of course, if the moderation option is real. Using it as a "bait and switch" marketing tactic does a disservice to clients and programs regardless of intention. Given an open and supportive environment, clients will reach their own conclusions with regard to their needs and make decisions accordingly. It's a time consuming and sometimes frustrating process, but clients who feel tricked into treatment won't benefit from it and won't ever return.
People looking for help, for themselves or others, will find that good programs will work with them and offer a range of outcomes, methods, and alternatives. Success is a matter of motivation, expertise, and adjustment. Looking to where the most options exist, and where staff will discuss preferences and alternatives, gives an indication of quality and responsiveness. Peoples' lives and problems deserve the best solutions, ones that will last, not ones that are predetermined. |
