The Abstinence vs Moderation Debate

In the early 60’s a debate began that still continues today. Is controlling problem drinking in moderation a possibility, or is abstinence the only way for these people.

Most people when going to alcohol/drug treatment for the first time usually do so with the intention of finding a way to cut back in moderation on their drinking instead of abstaining. Those who haven’t developed alcohol dependence, showing high tolerance or withdrawal symptoms, are at a higher risk for developing dependence.

Although most studies have been done with alcohol and alcohol dependency, it can also be applied to other addictions as well

Definitions

Problem Drinking VS. Alcoholism

Many people use the words “problem drinking” and “alcoholism” as if they have the same meaning, but they do not. In comparing the two, problem drinkers have less alcohol-related problems, have more stability in their life, and don’t drink on a daily basis. Also they have faced less consequences, and personal losses due to their drinking.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and other public health agencies, there are up to four times as many problem drinkers as alcoholic. And yet most treatment programs are focused on people with severe drinking problems. Many people who are just problem drinkers avoid getting help or going to treatment for the fear of being labeled as and “alcoholics” or they don’t want to follow, or don’t believe in the program these treatment centers offer, such as attending AA meetings, or believing the only way to live is through abstinence for the rest of your life.

Even today there is a lot of labeling, and stereotyping when it comes to the issues about those with alcohol problems. You are either an alcoholic who does not have the ability to control their drinking, or you are someone that drinks socially, and has no alcohol problems. When actually this couldn’t be farther from the truth. There are different levels and severity of drinking problems, not everyone is an alcoholic. As a matter of fact the word “alcoholism” was removed from medical diagnosis in 1979. By replacing it with “alcohol use disorders” they can now differentiate between alcohol abuse, and alcohol dependence.

Abstinence VS Moderation

Abstinence is self-enforced restraint from indulging in bodily activities that are widely experienced as giving pleasure.
Where as Moderation is the avoidance of excess or extremes, especially in one's behavior.

Abstinence

Just the word itself “abstinence” can be very scary to many who are alcoholics and addicts, even more so for those in the early stages of recovery. Your whole being fighting you through cravings, urges and withdrawals, begging to do anything but to quite forever. When these feelings are the strongest remember your commitment to be open to new ways and thinking that didn’t work before, so you can have a healthier lifestyle with a greater quality of life ahead for you.

Why abstinence?

Years of studies have shown that after one has developed a severe addiction, the easiest, and safest way to break the cycle of repeating past behaviors is total abstinence. This doesn’t mean it’s going to be easy, and will find yourself remembering to take things “One day at a time” and implement a "harm reduction" plan. If you really want to minimize the problems in your life, the best idea is eventually abstinence. You may find it easier to just quit altogether than putting yourself through the same torture and anguish by trying to moderate or control your addictive behavior. Studies have shown that over all other methods and theories, that the number one reason for sobriety is a permanent commitment to stop drinking/using permanently; through a commitment to abstinence.

Abstinence as the only choice

Not many of those with a serious addiction can use and drink in moderation. In some who try moderation find it only leads back to the cycle of risky behaviors and the consequences that come with them. So if you find yourself in that situation why continue the cycle, especially when you find moderation leading you backwards, it’s time to make the choice to abstain.

Committing towards abstinence

The first thing in making a commitment towards abstinence, is being sure you are ready to make a life changing decision. Second you need to realize the road to sobriety is going to be easy, and you may even relapse. It takes a strong will, endurance, determination and practice, especially when dealing with urges.

If you have a relapse

Learn from it and move on. Learn from it by being aware of what events led up to the lapse/relapse. What were the excuses you gave yourself to use, write them down and challenge that thinking in case it happens again. And one slip up doesn't mean you’re not committed to getting clean. Use it as a learning experience and forgive yourself, none of us are perfect.

What to expect after making the commitment

Continuing to use, will only lead to your past dictating your future. By making the choice to commit to abstinence means you no longer have to go through the vicious cycle that moderation can lead you through. Only you have control for your decisions and behaviors; only you can make the choice for lifetime of abstinence and sobriety. Once you commit to abstinence the feeling of hopelessness from the vicious cycle your where leading subside and new feeling of freedom takes its place. Where you find the urges to drink/use are less frequent & intense over time, and become much more manageable.

Reality of urges

Whether urges go away for good is different for everyone, but be prepared that the possibility is there, that they could return even years from now.

The Potential Benefits of Abstaining

As we already know abstinence is the safest choice for anyone with a serious problem with drinking or drugs. Stopping for a few weeks or longer, can be beneficial, and is a good way to get started practicing moderation. Here are some of the reasons why:

• It is the safest choice. If you stop now you avoid future consequences and personal losses due to your addiction.
• It lets you think clearer, allowing you to open up to new ways of thinking about your problem. It gives you the opportunity to realize how bad you addiction is, how it chemically changes things affecting your mood and ability to cope, and all the other negative consequences related to drinking.
• It allows you to think more clearly, and feel the emotions you have been avoiding. It gives you the opportunity to learn how to deal with them in a better way.
• It allows you to finally break the cycle and change your life, building self-esteem, and confidence in yourself.
• With these changes and learning new tools it gives you the chance to identify the triggers that caused you to drink or use, and how to deal with those emotions.
• It gives you the opportunity to mend relationships, and reduce conflicts with family and friends, that have had to deal with your drinking in a negative way.
• Abstinence opens you up to look at your life, and identify the underlying problems of why you drink or use, and help you find new ways of coping with these issues.

Moderation

Moderation motivating change

Moderation can be used, to motivate people to change. Many people that are indecisive about giving up alcohol, even though they see that their drinking is causing negative effects in their life. Someone who decides they want to cut down on their drinking in a more controlled way, show they have the desire to change their behavior. One tool used to help facilitate this change is motivational interviewing, whereas you and a therapist run through scenarios listed out in a specific agenda to prepare you for these situations.

Telling someone they must quit indefinitely before they are ready to accept change will alienate them, just when they were ready to seek a change. When someone wants to find a way to moderate, or control their drinking, it tells those who are trying to help them that this is a good time to teach new ways. Although people who try this and fail may soon discover they are addicted, and are dependent on alcohol or drugs. This realization may be all it takes for them to realize abstinence is the only way.

Be Realistic about your goals

The subject of moderate drinking is very debatable topic among professionals. Many therapist and doctors do not think that the alcoholic/addict will be successful in using moderation, abstinence is the only, and safest way to deal with a severe drinking/drug problem. To them it is unrealistic to think an alcoholic could learn to control their drinking.
For those that will not even consider the idea of abstinence can get professional help to teach them moderation, using this as the first step towards abstinence. Hardly ever does an alcoholic realize the need for abstinence until they have attempted moderation and failed, being an unrealistic goal. Some refuse the idea when entering treatment, and are given only one path to choose, abstinence. This leads to many who have serious alcohol/drug problems from seeking help, and end up struggling through life with the negative consequences of drinking/using, not realizing they have other choices.

Moderation for those with less severe problems

Scientific research says that any step towards harm reduction related to drinking, is a step towards the right path. Grouping everyone into one category of alcoholism has been found to be untrue. Not everyone who drinks, or has problems with drinking is an alcoholic. It has been recognized there are several types of alcohol problems. People who have a less sever drinking problem are very good candidates for controlled drinking, and learning how to moderate drinking in a safe way.
When someone undergoes an evaluation of their drinking, they learn at what level of severity their problem is, and how well they would do using moderation. With professional help, some actually learn how to drink in moderation and have a fulfilling life, while others will learn moderation is not a realistic option for them and that abstinence is their only choice. Those who choose abstinence after trying moderation and having it fail, are more motivated to stop drinking than in other cases.

Moderation, is it right for you or should you stop entirely

Even though moderation is a good place to start, it isn’t the best method for everyone that has a problem with alcohol or drugs. Those with serious addiction problems find that it’s hard to sustain moderation and find that abstinence is the better choice. There is no one answer for all those with addiction, it’s finding what works for you, and sticking with that plan.
Moderation is not right for those who drink heavily and are physically addicted to alcohol. It’s also not right for alcoholics that have been abstinent.
Those people who have a better chance practicing moderation are those who:

• Whose drinking histories and alcohol/drug related problems are less severe.
• Have no physical addiction to alcohol
• Don’t have a drug problem
• Have no other life altering events that they are currently dealing with. (Example: divorce, loss of job, medical issues, death in the family.)
• Those that do not have any medical or psychiatric problems that they are using alcohol/drugs to self-medicate with.

Those whose only choice is abstinence

Those where moderate drinking guidelines suggest total abstinence is the only way are:

• Women who are pregnant or trying to become pregnant
• Anyone taking medications, including over-the-counter medications that may interact badly when mixed with alcohol or drugs.
• People that become more aggressive, violent, or other behavioral problems when drinking, even a little bit.
• Anyone who drives while intoxicated, has prior arrests for DUI, or has been in an accident linked to alcohol
• Those in recovery, or have had a severe drinking problem and is currently abstaining.
• Anyone under the age of 21
• Anyone with a medical or psychiatric condition where alcohol or drugs causes the condition to get worse.

Summary

The debate continues over abstinence vs moderation, and which one is better. The truth is, there is no one single answer for everyone. Instead depends on many factors including the person themselves how bad the addiction is and how determined they are. For some, it’s trial and error, till they see which is best for them.

References

1. Werner, M. Abstinence vs. Moderation. Retrieved February 13th, 2014 from http://www.smartrecovery.org/resourc...moderation.htm
2. Cohen, M., Liebson I., Fallace L., & Speers W. (1971) ALCOHOLISM: CONTROLLED DRINKING AND
   INCENTIVES FOR ABSTINENCE1. Psychological Reports, 1971, 28, 575-580.
3. Morgan, P., & Cohen, L. (1993). Controlled-drinking advocates challenge use of abstinence model in treatment of addiction. Canadian Medical Association J 1993: 149 (5)
4. Alcohol abstinence vs. moderation. The Harvard Health School Family Health Guide. Retrieved on February 13, 2014.
5. CHOOSING BETWEEN MODERATION AND ABSTINENCE. Recovery Options. Retrieved February 13, 2014 from: http://www.recoveryoptions.us/resour...-or-abstinence
6. Fowler, R. (2011 July 13). Moderation vs. Abstinence: What's More Effective? Retrieved February 13, 2014 from.
7. Abstinence vs Moderation What Are Your Recovery Options? Retrieved February 13, 2014.
8. Abstinence versus Moderation in Drug Addiction and Alcohol Recovery. Retrieved on February 13, 2014.
9. Ulmer, C. (2004). MINDFULNESS AS A MODERATOR OF COPING RESPONSE AND THE
   ABSTINENCE VIOLATION EFFECT: A TEST OF THE ROLE OF MINDFULNESS IN THE RELAPSE PREVENTION MODEL FOR EXERCISE. Department of Psychological and Brain Sciences University of Louisville, Louisville, KY December 2006
10. Burman, S. (1997). The challenge of sobriety: Natural recovery without treatment and self-help programs. Journal of Substance Abuse, 9, 41-61.
11. Cahalan, D. & Room, R. (1974). Problem Drinking among American Men. New Brunswick: Rutgers Center of Alcohol Studies.
12. Cunningham, J., Sobell, L., Sobell, M., Agrtawal, S., & Toneatto, T. (1993). Barriers to treatment: Why alcohol and drug abusers delay or never seek treatment. Addictive Behaviors, 18, 347-353.
13. Cunningham, J., Sobell, L., Sobell, M., & Kapur, G. (1995). Resolution from alcohol problems with and without treatment: Reasons for change. Journal of Substance Abuse, 7(3), 365-372.
14. Dawson, D.A. (1996). Correlates of past-year status among treated and untreated persons with former alcohol dependence: United States, 1992. Alcoholism: Clinical and Experimental Research, 20(4), 771-779.
15. Grant, B.F. (1997). Barriers to alcoholism treatment: Reasons for not seeking treatment
    in a general population sample. Journal of Studies on Alcohol, 58, 365-371.