Can an Alcoholic or Addict Learn to Drink Moderately?

Alternatives in Beverly Hills, California (Los Angeles area), offers abstinence and moderation based treatment for alcoholism and drug use disorders. This program opposes the 12 Step based approach that complete abstinence from all drugs of abuse, including alcohol, is required for sobriety. Not only may alcoholic drinkers, under this Program, be taught to drink moderately (without consequences), but the drug addict whose primary drug is cocaine, heroin, sedatives, or other drug, will have abstinence from use of those drugs as their recovery goal, but may be helped to learn to use alcohol moderately. The standard position of probably 95% of drug and alcohol treatment programs in the U.S. is that once an individual has crossed the line into loss of control over one class of drugs (for example, sedatives, alcohol, or opiates), he/she can no longer safely use any class of substances of abuse, regardless of his/her positive or negative experience with the drug class. Thus, according to this model, a heroin addict in an abstinence recovery from heroin addiction cannot safely use alcohol or marijuana, even if he/she has no history of problematic use with these substances. Under this abstinence, usually 12 Step, based model, sobriety means complete abstinence from any substance of abuse.

The model just described is considered by the Alternatives Program to be inappropriate for many persons with drug or alcohol use disorders: 

Per Alternatives, sobriety does not mean abstinence. "Traditional addiction treatment programs often confuse these two terms. Abstinence is the avoidance of consumption, whereas sobriety is a condition of control. Most addiction treatment programs would have you believe that abstinence is the only road to sobriety, and for some it is, but Alternatives can offer many another choice… moderation."

According to the Alternatives website, the term sobriety has been erroneously defined to require abstinence. Thus the site states:

"The word ‘sobriety’ is actually a very old English term that has been resurrected and has gained a modern meaning due to its usage within 12-step programs. Sobriety in Alcoholics Anonymous and the 12-step community imples [sic] the requirement of 100% total Abstinence from all mind-altering substances – to call oneself ‘sober’. According to the dictionary, “abstinence is the avoidance of consumption” whereas “sobriety is the condition of control”. The traditional 12-step based treatment programs for addiction define these two terms inaccurately – using them interchangeably and synonymously. Because of this error, most people unintentionally get confused, which often results in them falling easy prey to a type of ‘psychological recovery gridlock’.

"If you look up the word ‘sobriety’ in the dictionary today, you will find that most definitions actually do not even include references to ‘abstinence’. *** By honestly understanding the distinct definitions of these two different words, a new more realistic mindset is possible. This difference explains why when I [the Alternatives representative] speak of ‘sobriety’, I am not necessarily talking about ‘total abstinence’, but rather only the ‘trait of avoiding excesses’. *** Sobriety is really a psychological or emotional state of self-management – not really having anything to do with abstinence. Sobriety is available to drinkers and non-drinkers alike, and is seen when people relate to their world in a rational, calm and mature manner.

" 'The goal is to stop the consequences, right?' The approach Alternatives offers is to help you learn to acquire feelings of joy or satisfaction from the more typical activities of life. Our goal is NOT necessarily to have you stop your drug or addictive behavior as would be required from most addiction treatment programs. We focus on trying to teach control and moderate use.

"Recovery can be observed…

-When the individual is not utilizing their addictive substance or displaying their addictive behavior   to a point that it interferes with their life and future.
-Where there is an internal emotional resilience to the typical ‘ups and down’ of life – without immediately defaulting to their addiction.
-When they can foresee the typical upcoming triggers, and adjust their behavior and thinking to act appropriately without relying on the drugs.
-When an individual is able to tolerate uncomfortable feelings without ‘tipping over’ and reverting back to their compulsive addictive behavior.compulsive addictive behavior."

I do not object to a harm reduction approach whereby the treatment provider helps the individual with an alcohol or drug use disorder to see if he/she can in fact use without negative consequences, with an abstinence goal should the individual discover he/she cannot use successfully. That is a sensible, practical approach to counseling the the addict or alcoholic in denial. I do, however, have concerns that under the Alternatives approach a true addict or alcoholic may be seduced into moderation management and waste a lot of time and cause a lot of pain (even death) to him/herself and those in his/her path while seeking to use moderately. As is stated in the AA basic text (Big Book): "The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The
persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death (Alcoholics Anonymous, page 30)." As always, comments are invited. Jan Edward Williams, 06/20/2013.