The Question of Moderation

abc123 hears her Loved One expressing a desire to reintroduce small amounts of alcohol into his life. He's been through program after program for the past year or so and has been back home for just a few months now. It's hard not to panic when he talks about wanting to try moderation… 

My loved one completed a 30 day stay in residential treatment in mid January for alcohol use disorder. This past year has been full of ups and downs with him being in and out of treatment. He has been doing fairly well being home since January as far as drinking is concerned. He had one slip that I am aware of since returning home. Over the last week he has been talking about how he would like to try and reintroduce alcohol into his life in a very limited amount. This of course has set every alarm in my brain off. I am very concerned this is the start of a relapse back into full on alcohol use. I would love some advice on the best way to handle this situation using the CRAFT method.

CRAFT is based on social learning theory. The family uses CRAFT to shepherd a Loved One into a position of recovery. The family helps to maintain the change by rewarding non-use and stepping back when they see use. They allow natural consequences, and remove themselves from the equation as best they can.

If your LO ends up needing to drink again to prove to himself that the problems of alcoholism are real and beyond his ability to control, this is part of his path. You may not have a choice in the matter.

We even argue in Learning Module 1 that efforts to moderate often fail, but that these failures can help teach abstinence; it is the social feedback described in social learning theory. Please revisit Learning Module 1 and see the set up I describe below. These perspectives may help you see the potential merits of going along with a call to moderate.

If your Loved One wants to moderate, then he should be willing to put in place a proper moderation plan that includes a recovery coach and a therapist who is on board and knows what they are doing. This by necessity must be a tight plan, for the chances are good that your Loved One will overdo things and put himself in jeopardy again. He would also need to agree to a plan for if/ when he does overdo it: detoxification, more residential or intensive level of services, and other measures as he and his coach/ therapist see fit.

If he is going to try to moderate, I would also suggest he get on Naltrexone (Vivitrol is the monthly shot). Naltrexone is a medication assisted treatment that discourages drinking as it blocks the euphoria of alcohol. You drink less because the alcohol isn’t giving you the same good feelings. See this article on the Sinclair method, featured in the resource supplement of this site. We have discussed the Sinclair method in a handful of other posts which may be helpful to read as well.

Once all of this is in place, then your Loved One could be in a stronger position to try moderation. Can you work this out, in partnership with him? What I am suggesting is somewhat unorthodox in mainstream treatment right now, but it agrees with what people in recovery have known forever: if you think you can go back out there safely, go ahead and do some more experimenting. No one can stop you. At least there is a safety net in place and you’re not going into it “blind.”

Good luck with moderation. Given his many years of alcohol use, there is not a strong likelihood that he will be successful. This means you step away a little, and let this play out. This won’t be easy for you. You will need to watch for signs of danger and be willing to step in various ways. Perhaps a call to the police if he is drinking and driving, calling police to the home if he is drunk, unresponsive, and/or potentially a danger to himself or others. You’d be setting up an intervention (see Learning Module 8) if/ when he steps over the line. Remember, as we outline in Learning Module 1, his efforts at moderation may be an essential part of his learning process. This ultimately could bring him to a more clear realization about his need for total abstinence.

You have been navigating so much with your Loved One’s use over the years. You undoubtedly still have so much to unravel, process and heal within yourself. Your concerns about trust, the alarms going off in your head, and all that you are carrying right now is 100% legitimate. It is also a cue to redouble your efforts to dedicate real time to caring for yourself. Seek out and lean on the supports that help you process, accept, and own whatever you are feeling. Accepting full responsibility for our own feelings, so that we don't end up asking (directly or indirectly) our Loved Ones to be responsible for them is a key part of practicing CRAFT.

You have done an incredible job weathering the storms with your husband’s use and you should give yourself credit for all that you have accomplished, held together, and learned. In the past year especially you have experienced so many ups and downs, but you have also both come a long way. It is very heartening that your husband completed the residential treatment successfully. This is huge, and we are glad to hear of his willingness to look at his use in different ways over the past year.

A relapse does not erase the lessons you have learned along the way. You become more savvy and better equipped to take swift action as needed. You become better aware of your own reactions, tendencies, strengths and weaknesses. Meanwhile, relapses can also be opportunities for a Loved One to come to a greater understanding about their relationship with the substances involved, and to ultimately arrive at a decision about their need to embrace abstinence. This can all be vital and valuable information, for everyone involved.

Whether or not moderation will work for your husband, this is for him to discover. Considering the approach I’ve outlined above should help you see how to adopt a strong yet flexible stance during his experiment with moderation. It is key to put those protective measures in place, and to be as open as you can in discussing the “plans” with your husband. Use the many resources here on the site, along with whatever else is available to you right now to support and fortify yourself. Thank you for reaching out. I hope this is helpful. You are not alone. We are all here for you. Sending you our love and support.