Moderation Management is a sexy idea. It’s particularly sexy if, like me and most alcoholics, you have moments of fondly remembering the good times you had with alcohol in the beginning (known as “romancing the drink”), and in these moments you conveniently forget the complete shit show Drinking made of your life in the end.
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Moderation Management was founded in 1994 and was an early but important part of the harm reduction movement. Its founder, Audrey Kishline, was open about her own struggles with alcohol and strove to use the tools she herself created to moderate her drinking.
The first of its “Steps to Change” requires keeping a drinking diary, the template for which is provided on the MM website. This diary allows you to record the date, number and type of drinks, time spent drinking, the occasion, as well as any feelings you may have or “positive activities/progress”. Further steps include researching healthy drinking guidelines, considering whether moderation or abstinence is a better alternative, gauging the severity of your drinking with a self-test, and listing both the problems that drinking has caused and the benefits that moderation might bring. The next step is a 30 day period of abstinence, followed by a resuming of drinking while using tracking cards provided on the website to record date and time, type and number of drinks, and outcomes.
This appears, at first glance, to be an excellent tool and viable alternative to total abstinence. It was even mentioned at my treatment centre by one of the counsellors, and several therapists noted that for some clients moderation and harm reduction is the goal they work towards, rather than abstinence.
I have several concerns about Moderation Management, however. First, those for whom drinking is not a significant problem should be able to moderate or stop on their own, without the use of this set of steps and tools. If drinking has escalated to the point where such assistance is necessary, I would argue that perhaps it’s a serious enough problem that abstinence is warranted, or at least professional guidance is needed. Second, many an alcoholic has been fooled into thinking they are not an alcoholic because they have been able to go a short period of time, such as 30 days, without drinking. Achievement of this goal, while certainly positive, isn’t necessarily proof of the absence of alcoholism, but rather evidence that the disease hasn’t progressed too far. Third, this approach and its emphasis on self-empowerment and personal responsibility could easily lead an alcoholic who absolutely should NOT be drinking to believe that this time, with these steps, moderation is possible. I was in treatment with a person who “didn’t identify as an alcoholic”, but had been charged with a DUI and narrowly escaped a second one through quick thinking and, quite frankly, some manipulation. The police brought him back to the centre that night, drunk and belligerent. He will never be able to drink in moderation, no matter what he would like to think.
It should be noted that in 2000, Audrey Kishline posted a notice on her website that she would be attending Alcoholics Anonymous. Two months later, in a blackout, she drove the wrong way on an interstate highway and caused a head-on collision, killing the driver and his 12 year old daughter. She was charged with vehicular manslaughter and served time in prison. Kishline committed suicide in 2014.
In the end, I think, those who are capable of drinking in moderation don’t need help to drink in moderation. They just do. Like my mother, who will drink two glasses of wine and stop somewhere in the middle of her third because she doesn’t like how she feels. She doesn’t have to think about it, or work at it, or space her drinks out, or chase them with water. She has an internal “stop” mechanism that never fails her and never will. She just drinks moderately because it isn’t in her to drink any other way. If drinking is something that needs to be managed, maybe it has become unmanageable, and moderation isn’t possible.
