I received a number of responses to a recent column (Can I get Sober Without AA?) in which I wrote that, for some problem drinkers, a return to controlled drinking is a realistic goal. Some readers were skeptical, a few were angry, and others asked for more information. As Pride month celebrations wind down, many in queer communities may be taking a serious look at their substance use. This might be a good time to talk about treatment options which focus on moderation, especially since they are generally less well-known than abstinence-focused programs.
Contrary to widespread belief, moderating problematic substance use is a very common experience. How do we know this? Well, research shows that many people in their late teens or early twenties drink or use drugs heavily, often despite serious adverse consequences. But if we look at these same people ten or twenty years later, the majority are drinking in a moderate, non-problematic way. As young people take on more adult responsibilities, most of them “mature out” of self-destructive use, and most do it without ever going to rehab, or therapy, or 12-step meetings. In other words, moderating is the rule rather than the exception, and most people have all the inner resources they need to overcome their substance abuse problems. Moveover, most are able to do it without becoming completely abstinent. This doesn’t mean that maturing out of addiction is some kind of automatic process which just happens as people get older. Any mature person knows how much effort and struggle is involved in emotional growth. But the process of outgrowing substance abuse is so common that I suspect anyone reading this column either knows someone who has done it, or is someone who has done it. This is one of the reasons that we can say with confidence that moderation is a realistic treatment goal for some people with substance abuse problems.
So who can do it? Not surprisingly, the less severe the problem is, and the shorter the amount of time that a person has been drinking or using excessively, the more likely attempts at moderation will succeed. But other factors also effect the outcome. In general, people are most likely to succeed when they are strongly committed to values and personal goals which are incompatible with heavy alcohol or drug use.
There was a time when it would have been hard to find a therapist who would support moderation as a treatment goal. This all began to change in the ‘80’s, when the “harm reduction” philosophy began to influence the treatment community. Harm reduction rejects the presumption that abstinence is the only acceptable goal for all problem drinkers or drug users, and focuses instead on helping clients reduce the harm that substances cause in their lives.
Research has shown that people usually do best in therapy when they can set their own treatment goals, and less well when counselors dictate the goals. Harm reduction therapists respect the right of their clients to decide their own goals, and accept that abstinence is one possible goal among a number of options. So, for instance, if someone wants to stop using or cut down on using, crystal meth, but feels that his or her alcohol use isn’t problematic, a harm reduction therapist will accept this goal rather than insist that the client commit to abstinence from all mind-altering chemicals. Client goals can, of course, change, if experience in treatment demonstrates that the initial goals are unrealizable. Clients for whom abstinence is the only realistic goal usually only discover that fact after repeated failed attempts at moderation. That process of self-discovery can be speeded up if they work at achieving moderation with another person rather than alone. For some, it turns out that abstinence is the only harm reduction option they have, but harm reduction proponents believe that it is unethical to push a one-size-fits-all treatment program for everyone with a substance issue.
Anyone interested in finding a harm reduction therapist can call the toll free number for the Harm Reduction Psychotherapy and Training Associates (888-227-7542) to get a referral to a trained professional in their area. Those interested in moderating their use of alcohol will find valuable information and resources at the Moderation Management website, www.moderation.org. Those who work well with self-help books might profit from reading Over the Influence,The Harm Reduction Guide for Managing Drugs and Alcohol, by Denning, Little, and Glickman. I would also highly recommend Dr. Stanton Peele’s 7 Tools to Beat Addiction, which outlines the author’s self-help program based on scientific research.