Why Can't Alcoholics Learn to Drink in Moderation? Because that's not how alcoholism works

Slug Signorino

Credit: Slug Signorino


I have a dear friend who’s an alcoholic. When he came out of treatment, I told him I couldn’t see why he wasn’t able to condition himself to have, say, a single glass of beer and stop at that. He said it didn’t work that way, but never got specific. Why can’t an alcoholic learn to drink in moderation? —Name withheld

Because alcoholics, by definition, are incapable of drinking in moderation. Sorry if that seems like a kiss-off answer, but research and experience tell us that’s how it is.

Alcoholism is no trivial problem. The estimated 75 million or more alcoholics worldwide cost society from 1 to 5 percent of its gross domestic product. In Russia, where the problem is especially acute, male life expectancy is only 60 years, 15 years less than for U.S. men, largely due to alcohol abuse.

The question of how to control heavy drinking—abstinence or moderation—has been controversial for about 60 years, even though the basic facts have never been in dispute.

The dominant school of thought favors abstinence, arguing that alcoholics are too fragile to resist temptation and that a single drink can trigger a binge. Alcoholics Anonymous, the largest alcoholism support and treatment organization in the world, is a strong proponent of abstinence, which has an impressive success rate. But some say it’s not the only way.

Investigation into alternative approaches was kicked off by a study of 97 English heavy drinkers in the 1950s, who were tracked for several years and generally found to be able to control their alcohol consumption without abstinence. In 1978 a Rand Corporation followup of U.S. heavy drinkers who’d received abstinence treatment found that 18 months later 22 percent could drink in moderation without problems, and after four years 18 percent were still doing so. Other work in the 1970s found that some with seemingly severe alcohol issues could be successfully trained to drink moderately, and had better life outcomes than those who stuck to abstinence.

These findings aroused bitter argument, for an obvious reason: if 18 percent of heavy drinkers can learn to drink in moderation, 82 percent presumably can’t. Nonetheless, over the years strategies were developed to teach heavy drinkers to control but not necessarily halt their consumption.

An approach that became a lightning rod in the 1990s was Moderation Management, a nine-step self-help program. “Prominent figures in the treatment and research communities denounced MM as a ‘dangerous temptation to alcoholics’ that was ‘built on the illusion’ that alcoholics could return to controlled drinking,” writes Stanford addiction researcher Keith Humphreys in a 2003 review of the program’s effectiveness.

Exhibit A: MM’s founder, Audrey Kishline. She “left MM, joined AA, and several months later caused the deaths of two people in a horrific car accident while severely intoxicated,” Humphreys reports.

But he points out the MM and AA crowds don’t fundamentally disagree. MM participants are told initially to abstain from drinking for 30 days, then switch to moderate consumption. If moderation fails, then a return to abstinence is recommended. The implication is that some heavy drinkers can control their habit and some can’t.

AA, he notes, says the same thing. Both groups “make explicit distinctions between problem drinkers who are able to return to controlled drinking and alcoholics. Both [groups] also concur that failure at the goal of moderate drinking indicates that a drinking problem is serious and is best addressed by abstinence.”

So what’s the dispute about? A key element in AA theory is alcoholics’ capacity for denial, and its advocates see only the potential for tragedy in a system that lets drinkers decide they’re capable of drinking on occasion.

Humphreys, though, says his research showed people who sought help for excessive drinking for the most part tended to correctly self-sort. AA members were more likely to be older males with severe alcohol-related problems. No doubt partly for that reason they had a greater chance of being jobless or otherwise socially and economically unstable.

MM participants, on the other hand, tended to be younger, female, and white, with fewer indications of severe alcohol abuse. But not all of them. About 15 percent of MM members, Humphreys reports, had major alcohol problems—“shaking when not intoxicated” and “cravings for alcohol upon waking,” plus alcohol-related job issues. These people, he says, fit the profile for alcoholism—they just don’t admit it.

Thus your friend’s response. You don’t say whether he was in AA, but the first of the 12 steps is to acknowledge you’re powerless over alcohol. The research suggests no one arrives at this stark conclusion unless it’s true. —Cecil Adams

Our Readers Say

The idea that one can not return to "moderate" or "social" drinking is simply not true. Are there some people who can not/should not/don't want to ever drink again? Of course. It is a real possiblity for the majority of people to do so as long as they avoid seeing themselves as "Powerless" and "alcoholics." Powerless and alcoholics are probably much more accurately replaced with "wretched sinner."

The idea of abstinence from alcohol being the one and only way to deal with a drinking problem did not come from science. It came from religion. Not any religion, but from very bad religion. There is no science to back an absolute need for absolute abstinence.

There is, however, science to back up the value of letting people setting their own goals and helping them build their confidence in being able to acheive whatever goal they wish for themselves.

Of course, that sounds good, but what are we to do then to help all the people who have the "wrong" god find the right one if they can't be forced to work the 12 Steps, to find AA's "Higher Power."
@Ken Ragge

Ah, words of wisdom from another alcoholic in denial. An habitual attitude of contempt prior to investigation is another hallmark of the still suffering alcoholic so I won't try to dissuade some drunk from his misinformation about AA's premise of a higher power.

I will encourage an open mind to the idea that we each have within just us, apart from any concept of a god, a capacity to draw on a self higher than the alcoholic, country club or gutter drunk, self. The AA steps can provide a structure to strengthen that self.

The best argument for AA is that it is the only practice that has a record of success.

You response to my post is typical AA propaganda without anything stated for which there is an scintilla of evidence. Is it what you said what most everyone in "recovery" says"? Sure. But number of people saying something, no matter how certain they are of what they are saying, is not proof. The flat earthers, intelligent design people, Scientology, and the Moonies all are very insistent that they have The Truth. Of course, probably none of them would be so insistent on _bluntly_ calling it the The Truth.

You say, "The AA steps can provide a structure to strengthen that self." That is just plain silly. How does a "program" whose 3rd Step prayers is, "God, relieve me of the bondage of self. . ." "strengthen" the self. What the Steps do, as the "program" of any other cult, is to make the person a "true believer" at the expense of the "self."

How can you accuse me of "contempt prior to investigation" without even knowing me? Are you sure that it isn't you and other AA members (actually all 12-Step group members) who are suffering from contempt prior to investigation? Answer for yourself. How much have you read about alcoholism that wasn't at root really from 12-Step sources? Can you even think about alcoholism in non-Step terms? Do you know of _one_, just _one_ methodologically-sound study which shows that AA is better than _nothing_? Of course not. There is none.

Please, prove me wrong. AA has been around for 70 years. There have been thousands of studies done ranging from one by the Veterans Administration to show if communication skills could improve 5th Step confession to counting how long people who have been going to AA for decades are abstinent. Neither means anything.

Without confirmation from study (AA can't really allow study because they have failed at every legitimate attempt to prove themselves worthy) pro-Step slogans are worth no more than all the "evidence" brilliant minds in the Middle Ages gave for the number of angels that can dance on the head of a pin.

Please, just ONE methodologically-sound study.

Of course, I'm inviting you into a trap. If AA, NCADD, JoinTogether, and the rest of the 12-Step and front groups can't come up with one, you won't either. But you could show that you don't have "contempt prior to investigation" by reading material _not_ from 12-Step sources. At the URL below my signature is a book critical of the Step groups on line free to read.

If you do decide to read it, don't tell your sponsor. He probably won't let you investigate. The bit about "contempt prior to investigation" is only said by AA members in response to criticism of AA. It is never, ever, said implying that one should be aware of what the criticism of AA is about before criticizing it, rather than inventing and destroying a straw man.

Ken Ragge

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