Alcoholism isn’t what it used to be.
Glib? Perhaps. But don’t blame me. The National Institute on Alcohol Abuse and Alcoholism published an article almost 10 years go with that exact title. The gist is that the classic understanding of an alcoholic — someone who is addicted to alcohol and will forever have a problematic relationship with booze — is horrifically shortsighted.
Here’s what we now know:
- Many heavy drinkers don’t have alcohol dependence. For example, even in people who have five or more drinks a day (the equivalent of a bottle of wine), the rate of developing dependence is less than 7 percent per year.
- Most people who develop alcohol dependence have a mild to moderate disorder, in which they primarily experience impaired control. Basically, this means that they set limits but go over them or find it difficult to quit/cut down. In general, though, these people don’t have severe alcohol-related problems when it comes to their relationships, health or jobs.
- About 75 percent of people who recover from alcohol dependence do so without seeking any kind of help, including rehab and AA. In fact, only 13 percent of people with alcohol dependence ever receive specialty treatment.
All of which goes directly against the underpinnings of the longest-running recovery program in the nation: Alcoholics Anonymous.
The first step of AA’s famous 12-step program is that the problem drinker admits and acknowledges that they are powerless over alcohol and that their life had become unmanageable.
But what if that’s not true?
According to the NIAAA, only 7 percent of heavy drinkers become physically dependent on alcohol, and most people who drink more than is healthy (people who binge-drink, for example) don’t find that their relationship with alcohol impairs their relationships with people or their ability to work.
In other words, over 90 percent of problem drinkers don’t meet the criteria for AA’s first step.
Today, AA is no longer the end all be all of recovery. In fact, there are a number of ways to “quit drinking” — even if that means not getting fully on the wagon.
Moderation Management is possibly the most inclusive and flexible of such programs. It offers members something more like a non-binding contract, along with a come-as-you-are approach to bringing people who want to repair their relationship with drugs and alcohol without setting the bar at absolute sobriety.
Dr. Marc F. Kern, or the Habit Doc, chairman of the board of Moderation Management, talked me through how and why not quitting drinking altogether is the best way for some people to get a handle on their drinking problem.
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About 20 years ago, I had a drinking (and, if I’m being honest, a drug) problem. But I never felt I met the criterion for AA — that I was what most people consider an alcoholic — because booze and drugs didn’t interfere with my life; I just used them all the time. Plus, I’m atheist, agnostic, whatever you want to call it, and I couldn’t get behind the “higher power” portion of the AA philosophy.
When I started thinking about reevaluating my drinking, I thought maybe if I just got some guidelines and tools, I could cut back to a moderate position, drink like a normal person.
I was fortunate enough to find Moderation Management through the addiction-research community in L.A. where I was running a private practice called Addiction Alternatives, and I’m chairman of the board of MM today.
MM is, at its core, a self-help program. If you are interested in reassessing and possibly changing your relationship with alcohol, we’re happy to have you. MM looks at everyone with a drinking problem on a curve. We’ll accept anyone at any point in their lives, whenever they begin to think their drinking may be problematic.
We see a lot of people whose partners or family have suggested they look into changing their drinking habits, or people who maybe spent some time online and discovered, “Wow, I drink a LOT more than most people.”
That doesn’t mean you’re necessarily physically dependent, that you’ve had court-mandated rehab [or] that you get drunk every day — the typically accepted markers of what many programs consider alcoholism.
We don’t look at problematic drinking as a disease, as an -ism. We view it as a habit, and habits are learned behaviors. So, with the right tools, you can also unlearn them.
I mean, yes, we fully support the reality of what drinking too much can do to you, physically, and that there are diseases you can develop by drinking excessively, and there are what are called gamma alcoholics, people who are at the extreme end of alcohol dependency and abuse, that may be biologically predisposed.
But we don’t label anyone “an alcoholic,” or believe that substance addiction and abuse are lifelong behaviors, that once a person with a drinking problem, always a person with a drinking problem. That way of thinking is often a self-fulfilling prophecy. Habits can be broken, and the research shows that many people simply outgrow addictions, that over time they simply don’t view drugs or alcohol the same way.
So, we don’t judge. We don’t use terms such as “alcoholic,” which, because of its lifelong implications — once an alcoholic, always an alcoholic — is a big deal for many people looking to change their relationship with alcohol. You don’t have to be physically dependent or have your drinking ruining your relationships to want to drink less.
You don’t have to be “powerless over your addiction” to join MM. We don’t believe in relapses. If people want to drink, even drink a lot, that’s really a god-given right to get smashed. I don’t recommend it, but we’re not parental in that way and we understand and make room for the fact that abstinence isn’t realistic for everyone.
We promote self-recognition of risky drinking behavior. Getting shitfaced is unhealthy, but does doing it every once in a while make it a risky behavior for you? That’s really for you to decide.
There are certainly people that really should stop drinking altogether, let’s be frank. But they’re not going to, and better than to say “you’re hopeless” or “you’re not trying” or “you’re not going to enough meetings” or whatever, we’ll take them and meet them where they’re at, take them along a course, and teach them a course of action if they choose not to abstain.
It’s like a diet, or being in therapy: You have support and guidance, but you have to do the work yourself. We’re really there to walk you through why you drink and how you can change the way alcohol fits into your life.
We help people understand that their job, their spouse or their stress levels — the usual “I wouldn’t drink so much if it weren’t for this” responses — aren’t really the problems. It may be the trigger of the day, but it’s not the real cause.
The real cause is that they’ve learned that alcohol makes their lives seem and feel less stressful. Which, in moderation, is totally true. It’s when drinking is the only way you’re able to handle those stresses that it becomes unhealthy, you know? Even if it doesn’t seem unhealthy to you, psychologically, if nothing else it’s hard on your body.
At its core, MM is a self-help community focused on changing problematic drinking. But it’s really up to you to decide if it’s a problem. We don’t have a sponsor system, we don’t care how many meetings you come to. If people are motivated to change their relationship with alcohol they are welcome to consider themselves part of the community, and that change doesn’t have to be an end result of lifetime abstinence.
Meetings aren’t about revisiting the scene of your biggest drunken mishaps or counting how many days it’s been since your last drink, they’re focused on what challenges people are facing and what is working for them. It’s more like group therapy than anything else, a safe space to say, “This is hard. How are you making it less hard?”
There aren’t formal steps for MM but if you attend meetings or read the literature, which breaks down the basics of how we form habits and offers tools for breaking them, you start finding small changes you can incorporate into your daily life that make stepping away from relying on alcohol simpler.
We do have some structure. We ask new participants for 30 days of abstinence, and that’s really important, because without taking a step back and seeing how different your life is without the influence of alcohol, what’s the point? It’s like a sugar cleanse or a carb cleanse before starting a new diet, or giving up coffee for a month to see how your natural energy levels change.
And sometimes that’s too much for people. People who have had a serious problem with alcohol for a long time find reincorporating alcohol into their lives at a moderate level is too difficult. I hear all the time that drinking moderately is just too hard, and those people often find their way to an abstinence-only program.
MM is often the soft exploration into the idea of how bad your drinking is. Do you need an abstinence-only approach or can you really do MM? I would never want to put us in opposition to an abstinence-only program like AA, but saying that everyone with a drinking problem can only fix that problem by getting 100 percent sober just isn’t true.
You can’t fail MM. You are either successful through moderation or we hope you’re successful with abstinence. A lot of people who start in MM move to an abstinence-only program, but they do it because it’s a choice they’ve made for themselves.
That’s the goal, success and happiness. We don’t care how you get there. We don’t have a Bible of steps you must move through; some people just cut down.
And we’re happy with that.