Many women face this dilemma, wanting to reduce alcohol consumption without placing severe limits or labels on themselves.
It took years for Jenny (not her real name) to discover there was a “middle way” between total, eternal abstinence and the discomforting lack of control she was experiencing. For her, it was a program called Moderation Management, which emphasizes personal responsibility and balance.
Similar programs have varying guidelines, but what unites them is that they give people the tools to cut down and take control, without telling them they are hopelessly in the grip of a disease and that they must abstain forever to recover.
Moderation Management, a support group founded in 1994, believes “self-esteem and self-management are essential to recovery.” It distinguishes between “problem drinkers” and alcoholics, and encourages its adherents to set their own drinking goals. (Moderation Management has its own troublesome history: Its founder ultimately rejected her own method, turned to AA, and then caused a drunken driving crash that killed two people.)
HAMS, a New York-based group that functions primarily online, offers support for “anyone who wants to change their drinking habits for the better.” HAMS uses the “harm reduction” model, a philosophy in public health that focuses on reducing the risks of overdrinking, much like condoms reduce the risks of sex.
Rather than push adherents to abstain, it asks them to identify the negative consequences of their drinking (like risky sex) and come up with a plan to avoid them (like always carrying condoms). Willenbring now runs a treatment facility in Minneapolis that offers help to a much broader spectrum of people with alcohol and other substance abuse disorders. And some doctors prescribe an “opioid antagonist” called naltrexone that has been shown to reduce heavy drinking simply by decreasing cravings.
It’s hard to find reliable success-rate comparisons for these approaches, but with AA’s long-term success rate between 5 and 10 percent, who could argue against making alternatives more widely available? Meanwhile, these non-abstinence approaches are earning plenty of fans, particularly among women. One 2004 survey found that 66 percent of participants in Moderation Management were female, double the percentage in AA.
Brooke, who works in telecommunications in Atlanta and has a part-time job in the restaurant industry, attends occasional AA meetings just to listen in. “As far as being an honest person, trying not to lie and not to be selfish, those principles helped me to become a better person,” she said.
But she wasn’t physically addicted to alcohol, and AA made her feel guilty every time she had a drink, even though she wasn’t convinced she needed to quit cold turkey. She has made more meaningful progress to take control of her own drinking by taking Wellbutrin, starting cognitive behavioral therapy, and connecting online with Moderation Management.
These days, her goal is to drink no more than about 12 drinks a week, no more than four a day. (Moderation Management suggests no more than three a day for women, but Brooke says “it’s a struggle at times.”) She tries to abstain completely for four days a week.
And it’s not just about counting drinks; it’s also important to her to feel good about her behavior while she’s drinking. That means no severe misbehavior, like driving under the influence, but also no acting “obnoxious or bitchy.”
Jenny, who is now in her 50s and working in the arts, leads a Moderation Management group for women in New York, where members gather to share their stories and support each other’s goals.
Last year, she started seeing a new therapist. Within a week, she was able to cut down to just one drink a day. (In the beginning, Jenny’s therapist discounted her bill if she stuck to her intake goals.)
Lately she has been having as few as two or three drinks a week, using concrete tools like delaying her first drink until later in the evening, eating first, arriving late to parties, and pouring the rest of a bottle of wine down the drain if she’s home alone.
Donna Dierker, who lives in the St. Louis area, decided she wanted help getting her drinking under control the year she turned 40. But the “steps” in AA just didn’t resonate with her and she didn’t identify as an alcoholic. After seeing an article in the local newspaper on Moderation Management, she reached out to the organization, and got involved.
Today, Dierker helps keep herself in check by abstaining completely every January, April, and either August or September. She enjoys those months because she concentrates better and eats more healthfully, and the abstinence serves as a “reset” to her tolerance level. But she also enjoys the taste of wine and beer, and the social aspects of drinking.
For drinkers like Donna, Jenny, and Brooke, aiming for moderation is empowering. Every year Dierker hosts a tasting party with friends, where they sample two-ounce servings of unfamiliar varietals and discuss them. Plus, she said, “Dry red wine makes lasagna taste better.”