Problem drinking: Moderation or abstinence?

Problem drinking: Moderation or abstinence?

I found this piece in the Vancouver Sun which interested me. Dr Michael Pond talks about the different stages of problem drinking at matching people to a solution which will help them most. I think this is a good idea as many are sent to AA when they are really young and I do not feel that its life long solution of meetings, abstinence and its spiritual solution are going to be much help or even at all suitable.


I think that more people could be helped by methods such as harm reduction, especially those who are binge drinkers, if they are reached at an earlier stage. Although he says AA has worked for many, I also think it has caused problems for a lot of people as well, such as binge drinking after relapse and I left a comment about that.

He talks about the need for more evidence on what works for people in recovery and I really agree that this is something that should be done. I do not think that AA would score very well if you really examined the numbers of people who pass through it. Very few stay and many of those who do relapse multiple times, so you may as well start with a moderation program to begin with anyway, to see what happens. A moderation program would take a lot of work in some cases compared to just sending people to AA, but would probably benefit more people.

Here is a section:

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.

Here is a link to the piece


Commenting area

  1. I can see why moderation programs could have a higher success rate.If all people are given is a choice between lifelong abstinence or drinking, it is just too overwhelming of a choice for many to make. If they do not choose AA then many are told of no other options. It does not surprise me that 30% that start out moderating end up deciding to abstain. While they are moderating they have a clearer head and might see that abstaining for them is best.

    This all or nothing mentality has just harmed the entire addiction treatment industry for decades, and it continues to. I hope I get to see sweeping changes globally on how addictions are viewed and treated. Including throwing out the whole disease theory. Every time I hear Dr. Phil say addiction is a disease I want to barf. What really gets me is on top of that is the others he is speaking with on a show are nodding their heads in agreement. I have NEVER heard myself anyone challenge him. This is 2014 and Dr. Phil goes unchallenged?

  2. Thank you for the post Michael D. We’ve reached the tipping point in substance use treatment. Actually I believe we are tipping over into the realm of evidence based treatment. Please consider reading my new book – “The Couch of Willingness: An Alcoholic Therapist Battles the Bottle and a Broken Recovery System”
    Preorder on Amazon.

  3. Thanks for getting in touch! There are so many people writing at the moment which is incredible. You are the third author who has got in touch this week! I will read all the books when I have time, usually when I am travelling, which is when I do the blog. I just had a quick look at your site which looks really good so I will put a link up soon. Thanks for getting in touch!

  4. Anecdotal evidence just isn’t enough anymore. AA lost its intimacy long ago, it is no longer about fireside chats and one alcoholic helping another. Now it is more about Instilling fear with cliches and humiliating people who struggle. Most AA members I have met can’t stand having an active drunk in a meeting or anywhere around them. So much for the 12 step calls. They hand out opinions like they are chips.
    For reasons not all known to be there is a major disconnection going on in AA today. The younger generation does not want to hear they are alcoholics or drug addicts. Most believe they are in a bad way, they are on a bender, having a bad time etc……and IMO in most cases that’s all it is.
    Moderation worked for me and I don’t presume to know what will work for others. I do know this though, it was not a decision I chose lightly.
    Thanks for the topic Mike D and also a big thanks to Dr. Pond. I look forward to reading your book.

  5. Hi RC, you are right- even though AA and NA are aggressively going after our youth to join the religious cult, the young our the hardest to get to follow the steps. They do have way too many brainwashed, but not close to what they want. Young people have a hard time getting past step one.

    Now AA and NA are stepping it up and trying harder by going into are schools more than ever. It makes me sick.

  6. On my first comment on this post April 3rd I meant to say Dr. Drew not Dr. Phil. Even though Dr. Phil could be as bad I just hardly ever listen to him. Every time they bring on Dr. Drew after a famous person dies it is nauseating.

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