How Do Drug and Alcohol Moderation Management Programs Work?

Knowing your limits when it comes to drinking.Moderate or “controlled” drinking is a harm reduction approach tailored toward people with a drinking problem who do not exhibit the symptoms of physical dependence on alcohol. The majority of programs are web-based and rely heavily on motivating people to take responsibility for creating change in their own lives. Read on to learn about the philosophy and method of moderation, as well as programs that currently implement this approach.

The Philosophy

Alcohol moderation management is a form of harm reduction for those struggling who do not have an alcohol use disorder. Drinking problems, in general, do not respond well to a one-size-fits-all approach to treatment because every person is different and has a distinctive relationship with alcohol. For some people, a zero-tolerance policy keeps them sober and on track. For others, moderate drinking is the best approach in preventing further harm in the form of driving drunk, risky sexual intercourse, violence, or other potential alcohol-related problems.1

Moderation—sometimes called controlled drinking—is a useful tool in motivating people to reduce alcohol use or give it up all together. So, instead of forcing someone into abstinence or a treatment program, or shaming them for their alcohol use, moderation programs tackle alcohol abuse from a different angle. They let the person reflect on their behavior and come up with their own system. Research shows that working on moderation can help a person to seek help before they continue further down a harmful path. The goal is to help people create goals and personal drinking limits who have not yet developed a pervasive pattern of alcohol abuse.2 Taking note of your drinking habits.

Moderate drinking is designed specifically for people who do not have an alcohol use disorder, as previously mentioned.1 People with severe alcohol use disorders may find it difficult to attempt to reduce harm with drinking moderation and may have a better chance of recovery at a professional treatment center. If you aren’t sure what your level of alcohol dependence is, you can take a questionnaire like the one available on the moderation.org website, called “Alcohol Dependence Questionnaire.” If your dependence score is 20 or above, moderation may not be the right choice for you. If you have a lower score, a harm reduction approach could entail trying moderate drinking in conjunction with therapy, but always consult with a medical or mental health professional before beginning any form of treatment.3

Productive Methods Used

Different people may be drawn to trying a moderation approach for a variety of reasons. For example, most college students don’t want to give up drinking altogether. But if they have a problem with alcohol, taking a harm reduction approach could be a constructive way to help them take a look at the negative consequences of their behavior and motivate them to make positive changes. Most people who seek out MM have already tried and been unsuccessful at stopping drinking or cutting down on their use.

MM breaks down the process of quitting drinking using this step-by-step approach:3

  • Start keeping a diary: Record the times of day that you drink. This will help you become more aware of your habits and patterns. On a full-sized piece of paper write down at the top: Date / # of Drinks / What drink / Time Spent Drinking / The Occasion / Feelings at the Time. Keeping a record of your drinking can help you identify the times of day where you feel particularly triggered to drink, or with whom you are more likely to drink. While you are keeping the journal, you don’t have to change anything, simply observe and reflect your behaviors.
  • Observe moderate drinkers: Look at people who practice moderate drinking. Observe when they stop and how they step away from drinking. This can help you learn strategies that you can adopt in your own life. Once you understand what moderate drinking looks like, do an honest check-in and ask yourself whether moderation or completely staying away from alcohol is the better option for you.
  • Create a list: Think back through the times when your alcohol use has caused problems. Listing these out is not meant to cause you pain, but to help you get a grasp on the extent of your troubles with alcohol. Write down what happened and how it made you feel. Think back through how drinking has played a role in your physical health, emotional health, relationships, work life, family, and legal issues. After writing a list of problems that are tied to your alcohol use, you are ready to create a list of the benefits you can imagine experiencing when you start drinking in moderation. This may include positive changes to your physical, emotional, and mental health, your finances, your spiritual life, and your social life. You can display this list somewhere in your house to remind you of your goals.
  • Take a conscious step away from alcohol for 30 days: The beginning of a moderation program begins with a commitment to 30 days or more of not drinking. During this time, you will learn to say “no” to cravings for alcohol and tune into how your body is feeling. You can take a step back and observe how people act when they have drunk too much and possibly reflect on how you do not want to do the same. Allow your body to experience what it feels like to not have alcohol. If you don’t feel ready to go a full 30 days without drinking, you can start slow. Maybe start with a few days, work up to a week, and see how you feel. Only attempt something like this with the clearance of a medical professional, since some people with significant physiological alcohol dependence may be at risk of dangerous withdrawal complications like seizures.
  • Learn skills to avoid drinking: As you embark on your 30 days of abstinence, you can’t just try to power through without a plan. You have to learn what to do instead of drinking. If you are with your friends or family who know that you are a heavy drinker, they may question why you’re not drinking. It’s best to let them know ahead of time so they can support you in your attempts to cut down on drinking. You might also come prepared to any social gathering with responses ready to offer anyone who asks why you aren’t drinking. It will become very apparent who supports your new, healthy lifestyle and who does not. Pay attention so you can learn who will fit into your journey of recovery.
  • Create your own set of rules: Come up with a list of personal rules that you will follow when practicing moderate drinking. Try to make this list as precise, realistic, and short as you can. Write down your limit of drinks per occasion. List out a few strategies that you can use while drinking moderately. Keep in mind this list can change as you evolve. Have a copy of your rules with you and update it as necessary.
  • After 30 days of abstinence, you can try drinking in moderation: As you ease back into drinking, it should be done mindfully. Now that you are aware of your limits and triggers, you should be prepared to handle urges and cravings for alcohol better than before. Pay close attention to your drinking following abstinence and continue taking detailed notes in your diary.
  • If you relapse or over-drink, do an honest check-in with yourself: It is normal and human to slip back into drinking. Don’t beat yourself up over it and know that it happens to people every day. Instead, be curious about what led you to drink heavily again and come up with a way to deal with this situation in the future without alcohol.
Attending meetings for recovery support.Controlled drinking receives its fair share of pushback from people who believe these sorts of programs attract problem drinkers. For example, organizations that promote abstinence-only approaches may find moderation to be too loose in its approach to recovery. Groups such as Alcoholics Anonymous (AA) or professional 12-step treatment programs may not support the idea of moderate drinking in a controlled environment.4

However, research shows that when a person has a strong belief in their ability to drink moderately and reach the goals they set for themselves, they will work harder to reach these goals. This is in line with social cognitive theory, which states that people view themselves as more capable of reaching goals if they themselves were in charge of creating them. Moderation helps people become mindful and aware of their own harmful drinking patterns, creating rules around drinking, and continuously reflecting on their progress. For many in moderation programs, they eventually chose goals of abstinence after practicing moderation first.4 According to research studies, web-based approaches of moderation management help people reduce their drinking, especially in the short-term.4

Programs That Use This Approach

In 1990, the Institute of Medicine noted that people who had a problem with drinking but were not dependent on alcohol were an underserved group. In response, different face-to-face and web-based interventions were created, including:5

  • Moderation Management (MM): MM operates as a mutual support group that believes that drinking is a habit that can be changed in a group setting. Initially, MM was designed to be conducted in a face-to-face setting, but now online groups are popular as well. According to studies, the majority of MM members are female, white, college-educated, US citizens, middle-class, and mildly dependent on alcohol. Before starting an MM group, the average number of drinks among MM members was 35 per week. As more and more of the average person’s daily life shifts to online networks, MM may hold increasing appeal for those who have a preference interacting online. For people who are curious about whether to practice moderation or abstinence, attending an MM meeting may be a good place to start. Drinking in a controlled environment can be helpful in helping a person learn where their edge is and whether they need further treatment.5
  • Moderate Drinking.com (MD): Similar to MM, ModerateDrinking.com focuses on self-control and balance. You can visit the website to monitor behavior, set goals, and chart your journey. The site also offers trainings on identifying triggers to drink, how to develop alternatives to drinking, how to deal with relapse, and how to motivate yourself to practice moderation or abstinence. You can enter your self-monitoring data in a daily log and receive feedback on your progress.5
Regulating your alcohol consumption for a healthier lifestyle.The goal of a moderation program is to support a person’s journey toward understanding their drinking behavior and create a safe environment for them to explore how to drink moderately.

Drinking moderately is not for everyone, but if you think that you want to try a moderation program, an online search can help you locate a meeting in your area or you can sign up for a virtual or telephone meeting. For some, it is exactly the program they need to shift their heavy drinking habits to moderation. For others, they attend a group meeting online or in person and realize that they need additional support at a treatment center.1

Sources

  1. Marlatt, G. A. & Witkiewitz, K. (2002). Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment.Addictive Behaviors27(6), 867–886.
  2. Harvard Medical School. (2009). Alcohol abstinence vs. moderation.
  3. org. (n.d.). Guide to Moderation Management Steps of Change.
  4. Kosok, A. (2006). The Moderation Management Programme in 2004: What type of drinker seeks controlled drinking? International Journal of Drug Policy17(4), 295–303.
  5. Hester, R. K., Delaney, H. D., & Campbell, W. (2011). com and Moderation Management: Outcomes of a randomized clinical trial with non-dependent problem drinkers. Journal of Consulting and Clinical Psychology79(2), 215–224.
Last Updated on June 18, 2019
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Meredith Watkins, M.A., M.F.T.
Meredith Watkins is a licensed marriage and family therapist who specializes in dual diagnosis and eating disorders.
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