Abstinence vs. Control Drinking

up-treePlease indulge me for a bit of a rant.  I came across a blog the other day A Different Path to Fighting Addiction.  After reading the post, I was a bit disappointed* in the reliability of the cited studies.  Although I could quibble with much in the post, like unreferenced studies** that question the effectiveness Twelve Step Programs, such as:

A 2002 study conducted by researchers at the University of New Mexico and published in the journal Addiction showed that motivational interviewing, cognitive behavioral therapy and naltrexone, which are often used together, are far more effective in stopping or reducing drug and alcohol use than the faith-and-abstinence-based model of A.A. and other “TSF” — for 12-step facilitation — programs. Results of an updated study have not yet been released.

Researchers elsewhere have come up with similar findings. In 2006, the Cochrane Library, a health care research group, reviewed four decades of global alcohol treatment studies and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.” Despite that research, A.A.’s 12-step model is by far the dominant approach to addiction in America.

The article goes on to question the rigidity, religious base, and all-or-nothing approach in AA.  I tend to shake my head at such proclamations.  For 30 years now I have attended AA meetings that typically open with reading “How it Works” where the steps are noted as being “suggested” and meetings typically close with the “take what you like and leave the rest” line.

I am also a very strong believer in seeking a range of support and treatment options beyond the limits of AA rooms.  I am well aware that there are some AA members who are extremely rigid, as there are some politicians, animal welfare advocates, personal trainers, members of religious denominations and a very long list of other rigid practitioners in their own fields.  However, in all of my time in recovery, I have never felt pressured into an AA activity such as getting a sponsor, etc. etc.  In fact as I noted in a guest post Kristen invited me to write over at Bye-Bye Beer I have a rather checkered AA history in terms of following traditional best practices.

I do take strong issue with one point raised in the A Different Path to Fighting Addiction blog post:

His father, who drinks socially, told him that people either were alcoholics or were not. But L.S. was unprepared to accept that label and began researching moderation on his own. He found a New York branch of Moderation Management, or M.M., a secular, peer-led support group that takes a cognitive behavioral approach. In contrast to A.A., which stresses a drinker’s lack of power in the presence of alcohol, M.M. encourages personal responsibility for drinking. The group, founded in 1993, encourages members to start with an alcohol-free month, and then allows for the reintroduction of moderate amounts of alcohol.

I would fail miserably at Moderation Management.  I have just been down that road too many times.  During a solid year of therapy in 1983 I tried and tried to “relearn to drink” wanting only to go into a bar, have three beers like everyone else, and go home.  It never worked.  It did not work after weeks of prior abstinence either.  My experience is certainly not unique and is heard regularly both within and outside of AA.  At the same time, I do know folks from my younger years who simply quit drinking and moved on with life.

I realize there is a certain circular logic in all of this for the proponents of AA.  If one continues to drink excessively, they are termed an alcoholic.  If one drank excessively, then drinks moderately for long-term, they are viewed as a non-alcoholic heavy drinker.  For the proponents of AA this logic works well, assures a certain infallibility in diagnosis, and preserves their hegemony for “true alcoholics” recovery.

But, I don’t get the need or desire for moderate drinking vs. abstention in the face of chronic alcohol abuse.  Were someone to offer me a pill or therapy and assured me that I could then drink moderately and successfully, I would not take them up on the offer.  What I have learned over the years, both within the Twelve Step Program, and outside, including years of therapy, from Day 1, my reason to drink alcohol was to escape.

I appreciate that for many others escape/getting drunk/wasted or whatever is not the primary reason for drinking.  I am not a Big Book Thumper or believer that AA is the only way.  However, I do find statements such as “No experimental studies unequivocally demonstrated the effectiveness of AA” akin to tobacco company lobbyists arguing that nicotine has not conclusively been demonstrated to be an addictive substance.

Would it not be easier to just say that AA does not work for everyone?  In fact, AA may only work for a certain type of alcoholic.  M.M. and the plethora of other possible alternatives are available too.  In my experience, AA seems quite happy to let everyone else in the world flourish in their recovery worlds.  I am surprised that those other recovery worlds do not reciprocate.

* Please note I am not taking issue with the individual who wrote the blog post, but the conclusions noted in the studies.

** If there is not enough information to track down the reference, and the vaguely reported data, as in this case, then it’s no better than the great anonymous “they said” authority.  The data reported leaves a myriad of unanswered questions.  The problem with reliance on such vague notions of authority is that one can find similarly reported studies that argue the exact opposite conclusion.  Then it gets to the devil quoting scripture and all that.

9 thoughts on “Abstinence vs. Control Drinking

  1. Yes, I saw this same article / post and had the same reaction. The possibility of discovering more types of treatment programs that can be tailored to more types of people sounds like more possibilities for success stories in battling alcoholism. The author’s implied need to put down some methods in order to build up others was simple unnecessary. I found myself feeling the need to defend my sobriety program, which is just hogwash.
    Thanks for pointing this out and calling the author out at the same time.

    • I agree with your sentiment. My biggest concern with the article was the active alcoholic who will read it and think that moderation is really the key. But then, perhaps for folks such as myself, where moderation is not going to cut it, we need to go through that process to be thoroughly convinced.

  2. I bought the first MM book around 1997 when I was in my early 20s and desperate to do something about my binges and blackouts. It helped me at that early stage of my drinking problem, though clearly not forever. I picked up the newer edition in early 2009 and read the sad story about the MM founder. Clearly, moderation doesn’t work for all of us. I stuck with it until I had the epiphany that moderation wasn’t enjoyable. I’m with you now that I wouldn’t take a pill that allowed me to drink moderately. I found my cure and it’s not AA, though is abstinence based. Btw, I have a relative who swore by naltrexone right up until he admitted defeat and quit for good. All anecdotal evidence, no more true for the next guy than a different approach, I suppose.

    • That all makes perfect sense to me. This discussion strikes me as comparable to a thought I had a few months ago. One of the reasons I enjoy working with students more than professionals is that students ask questions and professionals defend positions they have staked out. From academia to the Home Shopping Network, the payoff often seems to have the next great thing that people cannot live without, at the expense of everything else.

      As a general statement, I find that folks in the recovery blog world are talking about what works for them and there seems to be a good bit less “therefore you should do this too.” My next door neighbor has been sober about the same length of time as I and has never gone to an AA meeting. I have certainly never encouraged him to give AA a try and he has never suggested that I give up on the AA meetings, or this blog, which I think he reads.

      Thanks for your thoughts and experience on this.

  3. Pingback: M(3), 7/7: Women Suffer Too | themiracleisaroundthecorner

  4. The blogs name is “Sobriety is a journey, not a destination” & not “A Different Path to Fighting Addiction” that was the post title and the source for that is The New York Times.

    What works for one may not work for another. I had a terrible experience with A.A. and N.A.. They were always pushing their ideas and beliefs onto me and with a lot of the new members that would come in. I would even go to different meetings and they were all the same. I understand it works for some, but for others it doesn’t. I’ve had nothing but bad experiences with 12 step programs so my opinion is a negative one based on my personal experiences.

    My sister is a recovering alcoholic and she attends A.A. faithfully and it works for her, and I’m happy that she has found something that worked for her when nothing else did! I’m glad she’s working a program and staying clean because if something didn’t work, and soon, I’m 100% sure she would have died, and I’m extremely grateful for A.A. because it helped save her life.

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