Can Alcoholics Learn to Drink Less?
July 21, 2000 -- Must heavy drinkers "admit powerlessness over alcohol" -- the first of Alcoholics Anonymous' 12 steps -- and strive for abstinence, or can they, through force of will and pharmaceuticals, learn to "moderate" their drinking? Although moderation is an accepted treatment goal in Europe, the approach is generally viewed with a skepticism approaching rancor by much of the U.S. medical establishment.
The long-standing debate returned to the fore this month, when two heavy-hitters from the world of addiction treatment made headlines.
First, Audrey Kishline, founder of alcohol treatment organization Moderation Management (MM), pleaded guilty to vehicular homicide after killing a man and his 12-year-old daughter while driving drunk. The accident occurred shortly after Kishline renounced MM's controlled-drinking approach and began attending AA.
Also, Alex DeLuca, MD, former director of New York's renowned Smithers Addiction Treatment and Research Center, which has treated such celebrities as Truman Capote, resigned his post after the St. Luke's-Roosevelt Hospital governing body rejected his appeal to adopt MM as a "kinder, gentler" alternative to the center's abstinence-based approach.
Though unrelated, the incidents underscore the seriousness of the controversy, "at the crux of which is ignorance of or refusal to accept that problem drinkers differ from alcoholics," says National Institute on Alcohol Abuse and Alcoholism (NIAAA) spokeswoman Ann Bradley. "The press has lumped them together," fueling the controversy, she says.
To clarify, "alcohol abuse is a constellation of problems related to alcohol use that stop short of ... addiction, [whereas] alcoholism entails dependence [or addiction]," Bradley says. "In this country, most doctors believe that abstinence is the appropriate treatment for alcohol dependence," while extensive data indicate that "for alcohol abusers, cutting back is a reasonable goal," she says.
"We in Moderation Management agree fully with that statement," says Marc Kern, PhD, member of MM's board of directors, and founder and director of Addiction Alternatives in Los Angeles. "I don't know if it's the Puritan ethic or what," he says, "but there is a fundamentalist view of alcohol treatment in this country." Those who are "up in arms about this have preconceived notions that we're prescribing [moderation] for everyone, which is not the case," he tells WebMD.
Kern says that his approach suggests moderation as the initial goal for all drinkers, but for some, it simply will not work. When, after repeated failures, they realize that moderation is not possible for them, the idea of becoming abstinent becomes a bit easier to take than it might have been were it offered as the first, and only, option, he says. "Every single person in AA has tried moderation management," he says. "They just did it on their own, without the [World Health Organization] guidelines, techniques, and tools we provide to support them."