He Wants to Try Moderation

Carolina has had success getting her Loved One to begin treatment. He wants to try moderating his drinking for now. Is supporting her Loved One in this effort a good idea?

I'm so grateful for this program and website. It has helped me so much in my relationship with my boyfriend and now I have a question. We've been together about a year and a half, and we don't live together. I think this program has been a big factor in his decision to seek treatment for the first time in his life at age 54. A victory 🙂 He's accessing treatment through Kaiser Permanente, which is a slow process with their bureaucracy and his unpredictable schedule working retail makes it hard to schedule appointments. But he's done an intake and orientation with their addiction medicine dept. and seen a psychiatrist. He's a binge drinker, and sometimes when he drinks, he abuses Ambien. In the aftermath of a binge, he will feel shame and remorse and may abuse Ambien to check out.

My question is about moderation, I see from the materials this can sometimes be part of this program. He's not sure right now whether his goal is moderation or abstinence. When he's with me, he doesn't binge, he can have a few drinks but not take it too far. He does get buzzed enough sometimes to have annoying behaviors like talking a lot and not listening to what I'm saying. He get very self-focused when usually he's a very considerate and empathetic person. When he's alone, he will binge, sometimes to blackout stage.

I have decided to consider moderation acceptable for now, and see what goals he develops in treatment. My question is, is this a good decision and how do I decide when he's crossed the line into too much drinking? We're invited to a family dinner and there will be drinking, my brother loves to make cocktails. We've been to their house several times without him drinking to excess, maybe 3 or 4 drinks at the most. (He has a high tolerance as you can imagine.) How do I handle this situation? It breaks my heart not to include him in these family events and it hurts him, too. He's not at a place where he can be the only adult not drinking. I so appreciate any guidance you can give. Thank you so much and sorry for the long post.

Thank you for your kind words. We are so glad your boyfriend is exploring his drinking and is accepting of treatment. Also good that he is getting treatment covered, though this can be understandably frustrating with the logistics as you note.

The studies of moderation show that some people can indeed moderate their drinking. The study outcomes demonstrate that the more one is in the habit of drinking, the less this holds true. This makes sense. It is as though there is an invisible line, and, once crossed, moderation is no longer a possibility. So where is your boyfriend? Has he crossed the line? We take a look at the case study of one couple who tried moderating in our resource supplement.

I’ll assume your boyfriend also wants to try moderation. To do this right, your boyfriend needs to be followed by a clinician (therapist, psychiatrist, etc.) with whom he is honest and who is on board with moderation. I would also recommend that he considers Naltrexone, an opiate blocker that reduces the euphoria of alcohol. There is a monthly shot called Vivitrol. With Naltrexone, you continue to moderate your drinking. The loss of the kick from alcohol naturally reduces the amount one feels like drinking. For more information, see this article on the Sinclair method in our Resource Supplement (be forewarned there is some unfortunate AA bashing in the article, but it is a valuable piece that is worth reading nonetheless).

If your boyfriend wants to moderate, has Naltrexone/ Vivitrol on board, and is working with a clinician who supports the effort, he may be able to pull it off. This is presuming that he hasn’t crossed “the line.” My concern is his age. He’s been binge drinking for a long time, and he may now be on the other side of that equation.

As his partner, you would do CRAFT, placing the line between use and non-use for yourself at 3-4 drinks. If he goes beyond that amount, you respond as CRAFT would suggest in Learning Module 6, as though he is using: remove rewards, allow natural consequences, and neutrally remove yourself. Before 3-4 drinks (and of course when he is sober), you step in with rewards as described in Learning Module 5.

Let your boyfriend and his clinician be the judge of whether or not moderation can work for him. If it can’t, let this teach him that drinking moderately won’t work, once and for all. You’ll need to stay out of the weeds on this one, even if you see him cross the line and get drunk. This is for him to figure out. You just keep up your CRAFT strategies. You’ll need to watch him over drink and get drunk perhaps. This would be part of the learning. When this happens, you’ll just step back as CRAFT suggests.

The Ambien, a sleep aid, is a prescription medication. Drinking on top of Ambien enhances the effects of the alcohol and is potentially life threatening. Can your partner put down the Ambien? The exercise of moderating the drinking should come with a real effort at not mixing it with Ambien.

This is for him to decide with his clinician, but it needs to be talked through and considered in the moderation equation. Any Ambien use is not moderating in my estimation. I don’t know how the Naltrexone and Ambien interact. If you google Ambien and alcohol you’ll quickly see that this has to be a non-starter. It’s that dangerous.

Hopefully, with Kaiser, your partner is in good hands and will have the treatment in place going forward. Kaiser can also make other suggestions about activities and a group process that will support recovery work.

Whether he is trying moderation in your company, when he’s at home alone, or in a social setting as in the family gatherings you describe, try to streamline your approach so that you are basically practicing the CRAFT principles the same way each time. You decide where to draw the line, and step in or step back accordingly.

In the case of the family gatherings, you’d still use the same CRAFT compass to navigate your responses to him, staying warm and engaged up to 3-4 drinks, and stepping back if he crosses that line. This is assuming you’re on board with his plan to try moderation. If/ when he crosses the line, you’d distance yourself, which may mean leaving the gathering itself and trying to provide him with a safe ride home.

It sounds like you are doing a terrific job of holding your boundaries and approaching this situation with love and compassion. The CRAFT approach also requires careful consideration of the day-to-day interactions, both ahead of time and in the moment. Good for you for maintaining this balance in your relationship. Good luck and please do let us know how it goes. Thank you for writing in!