Why Moderation?

1. Why Moderation?

2. Rationale for Moderation Strategies • Most people with alcohol problems are not alcoholics • The more severe a person’s alcohol/drug problem, the better it conforms to the disease model • Most people with alcohol problems are not in treatment • There are FOUR times as many problem drinkers as alcoholics in the U.S. (NIAAA & IOM studies) • For every alcoholic, there are 3 problem drinkers at risk for developing more serious problems

3. Rationale for Moderation Strategies • Majority of problem drinkers are not in treatment • One size does not fit all, no approach is best for everyone • Population of problem drinkers is highly diverse: • Severity of alcohol use & its consequences • Nature and severity of co-occurring disorders • Motivation and stage of readiness for change • Desired treatment goals

4. Rationale for Moderation Strategies • Research shows that moderation is a realistic and achievable goal for many drinkers, especially non-dependent drinkers with less severe problems • Progression to more severe drinking problems is NOT inevitable for all problem drinkers • Traditional treatment providers often fail differentiate alcohol ABUSE from alcohol DEPENDENCE (Clients reporting less severe drinking problems are typically viewed as either alcoholics in denial and/or alcoholics in the making)

5. Rationale for Moderation Strategies • There are FOUR TIMES as many problem drinkers as alcoholics in the U.S.; i.e, for every alcoholic there are at least three problem drinkers at risk for developing more serious alcohol-related health problems (NIAAA & IOM studies of primary care patients) • Moderation is a realistic and achievable goal for many drinkers, especially nondependent drinkers with less severe problems • IOM suggested that treatment should be expanded to offer options better suited to the needs of nondependent problem drinkers • to reduce or eliminate a person’s alcohol consumption and prevent further alcohol-related consequences. • To create programs aimed at people on the less acute, less severe end of the alcohol problem spectrum

6. Rationale for Moderation Strategies • Unfortunately, appropriate alternatives for nondependent drinkers remain hard to find in the U.S., although more widely available in other developed countries (e.g., Europe, Australia, etc) • At least 95% of treatment programs in U.S. are based on an abstinence-only disease model • Many if not most people who seek professional help for a drinking problem do not want to stop drinking completely or forever and are unwilling to adopt identity of “alcoholic” • Lifelong abstinence is not their goal

7. Rationale for Moderation Strategies • At least 95% of treatment programs in the U.S. are based exclusively on an abstinence-only disease model • But many if not most people who seek help for a drinking problem do not want to stop drinking completely (or forever) and are unreceptive to seeing their problem as a “disease” or themselves as “alcoholics” • Permanent abstinence and adopting an AA-oriented lifestyle is simply not their goal • Regrettably, countless people with less severe alcohol problems stay away from treatment due to the absence of more attractive and appropriate alternatives

8. Rationale for Moderation Strategies • Countless people with less severe alcohol problems categorically avoid seeking/entering treatment not seeing themselves as needing or wanting what traditional abstinence-based disease model treatment offers/requires • Lacking attractive treatment alternatives, many drinkers avoid getting help while their alcohol problem and its consequences continue to get worse • Current treatment system geared mainly toward treat people with more severe problems (i.e, dependence rather than abuse) • Clients with less severe and earlier-stage problems are likely to be seen as resistant, unmotivated, and in denial

9. Rationale for Moderation Strategies • Many drinkers: • Do not want to stop drinking completely and/or permanently • Lifelong abstinence is not their goal • Do not see their problem as a disease • Reject the identity of “addict-alcoholic” • Perceive their problem as not severe enough to warrant what traditional treatment requires

10. Rationale for Moderation Strategies • IOM has suggested that alcohol treatment should be expanded to offer options better suited to the needs of nondependent problem drinkers • These options should aim to reduce or eliminate an individual’s alcohol consumption so as to prevent further alcohol-related consequences • IOM called for creation of programs at at people on the less acute, less severe end of the alcohol problem spectrum • Unfortunately, appropriate alternatives for problem drinkers remain hard to find in the U.S., although more widely available elsewhere (e.g., Europe, Australia)

11. Rationale for Moderation Strategies • Providing flexible alternatives to abstinence-only can attract many more people with drinking problems into treatment before they develop more serious problems • Moderation is a realistic and achievable goal for many people with less severe drinking problems who are not alcoholics • Many who start with moderation, end up choosing abstinence, including many who would not have entered treatment at all

12. Non-Abstinence Goals: Rationale • Although abstinence is the safest course, it is far better to engage people in a process of incremental change than to turn them away until they “hit bottom” or cause more harm to self and others • Clinicians can encourage abstinence without making it a pre-condition of providing treatment • A professionally guided attempt at moderation is often the best way for clients to learn through their own experience whether moderation is a realistic goal. • Those unable to succeed at moderation often become more motivated to abstain

13. Principles of Integrative Approach • Non-dogmatic, client-centered, atheoretical approach • Avoids adherence to any single treatment orientation or philosophy in favor of doing “what works” • Utilizes a toolbox of different treatment models, approaches, strategies, and interventions some of which may seem incompatible • Do “what works” • Above all, do no harm!

14. Rationale for Moderation Strategies • Empirically-supported treatment approach • Research studies conducted in universities and medical schools in 12 different countries from 1970s to present • Actively supported and advocated by NIAAA • Sensationalized accusations of faulty research methods turned out to be unfounded, after careful scientific review • The fact that the founder of MM (Audrey Kishline) was involved in a fatal DWI-related car accident says nothing about moderation strategies. • Reportedly, at the time of the accident she was involved in AA attempting to remain abstinent

15. Alcohol’s Effects

16. 1.5 ounces LIQUOR 5 ounces WINE 12 ounces BEER “Standard Drink” Each contains approximately 14g of pure ethyl alcohol = =

17. Common Drinks • Cocktails (mixed drinks) usually contain 2-3 standard drinks depending on how they are made • Bottle of table wine (750 ml) holds about 5 standard drinks • “Fifth” of liquor (750 ml) contains 17 standard drinks

18. Champagne intoxicates more quickly! Carbonation accelerates absorption of alcohol into the bloodstream and brain

19. BAC Levels & Alcohol Effects for Drinkers Without Significant Tolerance 0.02%Begin to feel some effect 0.04% Begin to feel relaxed 0.06% Judgment somewhat impaired 0.08% Definitive impairment of coordination and driving skills 0.10% Marked deterioration of coordination and reaction time 0.15% Obviously impaired balance and movement; risk of blackouts, passing out, & accidents increase markedly 0.30% Loss of consciousness, profound CNS depression, risk of death

20. Women become intoxicated on less alcohol than men Possible Mechanisms: • Women have lower total body water content which results in higher concentrations of alcohol in the blood • Women have decreased levels of alcohol dehydrogenase in their gastric mucosa which causes 30% more alcohol to be absorbed into the blood • Gonadal hormone levels during the menstrual cycle may affect the rate of alcohol metabolism, increasing vulnerability to physiological consequences of drinking

21. Achieving Legal Intoxication Limits: Women vs. Men • In women, it takes 3-4 standard drinks over 1-2 hours to produce a BAC of 0.08 mg% • In men, it takes 5-6 standard drinks over 1-2 hours to achieve a BAC of 0.08 mg%

24. Blood Alcohol Concentration (BAC)