Tuesday August 30th 2016

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When does drinking moderation work?

“Relax Honey, I’ll Only Have One”

If you’re the family member of someone with a drinking problem, you probably have strong opinions about whether your loved one can, or ought to, continue drinking. You know by now that it’s not up to you. You’ve likely spent countless hours and vital energy arguing, persuading, pleading, and threatening your loved one to find the motivation to stop drinking. It may feel like your life is on hold; like normalcy is beyond your reach.

So, how can you evaluate whether drinking moderation might be something you or a loved one can pursue? In what cases can cutting down (instead of eliminating drinking) work? We review here. Then, we invite your questions or comments in the section at the end. In fact, we try to respond to all legitimate queries personally and promptly.

Continue drinking…or not?

The difficult decision between moderation and abstinence was certainly the case for Mrs. D., a woman we worked with whose husband had a drinking problem. In their early 70’s and retired, the couple was at odds over his drinking, which had increased dramatically since his retirement. He was resistant to doing anything differently when it came to his drinking.

Mr. D. almost never lost control when drinking and had no blatant consequences to speak of. His health was good; he never got sloppy or embarrassing at family functions.

She, on the other hand, felt a growing emotional distance between them. He would withdraw when drinking and during hangovers. She was increasingly discouraged thinking about their future together.

To avoid hearing so many complaints about his alcohol use, the husband started hiding his drinking. He declared himself alcohol-free but his wife knew better. He would make excuses to go to the shed or to go off on a bike ride.

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Though this secret drinking wasn’t a long-term solution, we agreed with Mrs. D. that this was a step in the right direction. Her husband now had to lie and sneak around. He was probably drinking less overall, and when he did drink, it was alone in the back of a shed.

Mr. D. was increasingly uncomfortable about this hiding, and he eventually announced that he would attempt to drink normally by limiting himself to a glass or two of wine “like anyone else.” The couple was set to go on a cruise through Europe in a couple weeks and he wanted to enjoy the wine.

Moderate drinking management tactics

The idea of moderation is not new. The debate as to whether problem-drinkers can learn to moderate their intake has been ongoing since the 1960’s.

The psychologist Thomas Irvin makes the argument that moderation can be used to motivate a person to change. Individuals who find it hard to imagine life without drinking are likely to feel daunted by the prospect of abstinence. This is one reason they tend to resist getting help so vehemently. Expressing a desire to moderate can be a clue that your loved one is thinking about their relationship to alcohol and may be gaining motivation to address it.

Moderation management of a person’s drinking entails a number of tactics. The approach has been laid out and supported by the peer-led organization of the same name (http://www.moderation.org). Some of these tactics are:

  • alternating with non-alcoholic beverages,
  • keeping a track record,
  • holding off starting to drink ’til a later hour,
  • holding out through an urge.

Can moderated drinking work?

Study of moderation suggests that some individuals can indeed control their drinking. The key to success has to do with where the person falls on the spectrum of Alcohol Use Disorder (as defined by the Diagnostic Manual of Mental Disorders). The milder the drinking problem, the more likely the person is to succeed with moderation.

Pinpointing where along the spectrum your loved one falls is beyond the scope of the family member’s expertise. Instead, you’ll need to seek a professional medical opinion. But if your loved one declares their wish to try moderation, you may want to go along with it for two reasons. One: it may work. Two: if it doesn’t work, the failure may serve as a wakeup call.

If the moderation experiment fails, this will provide important (and neutral) feedback to your loved one that “controlled”drinking is not a promising option. It may lead them to realize that the problem is more serious than they initially thought. It can provide support for the idea of trying abstinence.

Planning an appropriate response

Let’s return to Mr. & Mrs. D…. He had suggested he could have a glass or two of wine on their upcoming cruise through Europe. With some trepidation, she agreed. She gave him Moderation Management’s website. Meanwhile, she was using our resources to prepare herself to respond appropriately to her husband’s attempts at moderation.

In our work at Allies in Recovery, we ask the family member to assess, in the present moment, whether their loved one is drinking or not drinking. How they answer that question determines how they should try to behave:

  1. Not drinking = provide a reward, such as a look in the eye with a smile, a meal, a flower…
  2. Active drinking = remove rewards, disengage, and allow for natural consequences.

When a family member wants to support their loved one’s efforts at moderation, we show them how to shift the line in the “not drinking” category from zero to include one or two glasses of wine.

Mrs. D. had become skilled in knowing when her husband had had something to drink and knew to disengage when this happened. For the first couple weeks of the cruise, her husband seemed to be succeeding. He appeared sober and slowly sipped his two glasses of wine with dinner. And then one night he didn’t stop at two. He ordered a brandy – a double – with dessert. He argued it was his right and that his wife should stay out of it. She left the table.

The next day he ordered a beer with lunch. He continued to drink more at each meal. She stopped eating with him. The rest of the trip she spent mostly alone, doing her best to enjoy the port of calls without her husband.

When moderate drinking DOESN’T work

Mr. D. was hugely embarrassed when they got home. Their children had heard about the moderation experiment and its failure. Everything was out in the open. The family asked him to see a drug and alcohol counselor. He agreed. He acknowledged being surprised he couldn’t moderate his drinking and explained to his family that the problem was a “little worse” than he first realized. The family expressed their gratitude for his effort at trying to moderate his drinking and for agreeing to talk to someone when it didn’t work.

In this case, the decision to try moderation helped move the loved one towards a more realistic appraisal of his own drinking problem. Trying to moderate showed Mr. D. he couldn’t consistently limit his drinking. Recognizing this made him more willing to speak to a professional about his drinking.

Though it wasn’t a picnic for Mrs. D. being on that boat with a man whose drinking was spinning out of control, it was a bold and effective move on her part. It unblocked the situation. It forced a step towards accepting help and helped him to realize that abstinence was the only viable option for him.

Do you need help in assessing a drinking problem?

We hope to have provided you with an understanding of how to prepare for, assess, and take action for problem drinking. If you still have questions, please leave them in the comments section that follows. We’ll do our best to respond to you personally.

Leave a Reply

One Response to “When does drinking moderation work?
Mike
6:04 pm March 6th, 2016

Hi,
I drink 2-3 drinks once or twice weekday nights, some weeks. Every few weekends I will have 10+ drinks on a night with friends and if I’m not out, I usually have 5+ drinks alone watching sports/tv. I struggle trying to not drink during the week, because I’m sluggish the next day. I also have had occurrences since I started drinking in high school (mid 30s) of blackouts, usually involving liquor, which resulted in fights, passing out, etc. I’ve tried moderation, with mixed success. I’d probably be considered fairly successful, although alcohol has affected my performance occasionally. I have a feeling moderation is not the right choice. Would you suggest drinking in moderation, once a week, once a month, once a year, not at all? Thanks for your help.

About Dominique Simon-Levine, PhD

Dominique Simon-Levine is a Ph.D. substance abuse researcher, who is in long-term recovery. She runs an award-winning program for families called Allies in Recovery. Founded in 2003, Allies in Recovery has helped hundreds of families to climb out of the abyss of addiction. Her work is featured on HBO and on alliesinrecovery.net.

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