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Why Moderation?. 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

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rationale for moderation strategies
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
rationale for moderation strategies3
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
rationale for moderation strategies4
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)
rationale for moderation strategies5
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
rationale for moderation strategies6
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
rationale for moderation strategies7
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
rationale for moderation strategies8
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
rationale for moderation strategies9
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
rationale for moderation strategies10
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)
rationale for moderation strategies11
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
non abstinence goals rationale
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
principles of integrative approach
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!
rationale for moderation strategies14
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
slide16

1.5 ounces LIQUOR

5 ounces WINE

12 ounces BEER

“Standard Drink”

Each contains approximately 14g of pure ethyl alcohol

=

=

common drinks
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
champagne intoxicates more quickly
Champagne intoxicates more quickly!

Carbonation accelerates absorption of alcohol into the bloodstream and brain

bac levels alcohol effects for drinkers without significant tolerance
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

women become intoxicated on less alcohol than men
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
achieving legal intoxication limits women vs men
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%