Saturday, April 30, 2011

The Question of Moderation?

The fact is that each drinker has the responsibility to figure out for him or herself if moderation is a realistic option or not. How long that takes is how long it takes. Every person who came to embrace abstinence as the most self-affirming goal struggled with this question for a long time. Moderation/harm reduction therapists offer these people professional support and guidance to figure out if moderation is possible for them. Many people who attempt moderation fail because they are not equipped with the information, skills, strategies, support and a conducive attitude to be successful. It is akin to asking someone to try driving a car safely with not training, practice, support and experience learning to drive. If problem drinking is due to a mix of biological, psychological and social factors that are unique to each drinker, a serious attempt at moderation would need to assess this complex constellation of factors and offer a personalized, comprehensive, integrative treatment plan. Otherwise it is simply a set up for failure and more "evidence" for the "disease" and "powerlessness". Many people I have treated with very serious drinking problems have been very successful at achieving stable, long-term moderation. The NIAAA studies suggest this is much more common for treated and untreated "dependent" drinkers than people in this group have suggested. I have also worked with many less serious drinkers who, given the complexity of factors related to their problem drinking, chose long-term commitments to abstain because it was easier and they found that they felt better not drinking. I believe it is our job as helpers to support our clients on their paths toward healing, growth and positive change. We are to support them in discovering what is true for them not impose what we believe to be true on them. This derails true growth and empowerment if not any chance that the treatment will be helpful. It also risks re-traumatizing people as it sets up and replicates power dynamics that were traumatizing in earlier relationships. I have discussed these ideas in a book and papers you can download for free on my website, I look forward to further exchange of ideas on this topic.