Does Moderation Work?
So your Loved One wants to try moderating their use? You may be thinking, “Yeah, right, this will never work.” And you may be right. You may, however, want to consider going along with it.
Why? Because a) it may work or b) your Loved One will learn that they can’t control their drinking or drug use as easily as they thought. Your Loved One might even realize that this drinking or drug problem is bigger than they initially thought. These are good thoughts for your Loved One to have on their own! Trying moderation can lead to these thoughts.
Moderation is the practice of learning to consciously limit the amount one consumes of alcohol or drugs. The research on alcohol suggests that moderation may work for those with less severe addiction problems. Where the line is between severe and less severe problem use is not entirely clear. It depends on several things, including the amount your Loved One ingests, the reasons for their use, the context in which they use, and their biology.
For everyone who crosses that line into more severe use and for whom abstinence is likely the answer, moderating at some earlier point was probably part of the picture. So if your Loved One is saying they want to moderate their use, even if you believe the line has been crossed into more severe use, you may want to support a brief period of moderate use. Here’s how you modify this approach in support of moderation.
What is moderation, what is the science behind it, and how it is done? You can read more here.
A Case Study
We worked with a wife who agreed with her husband that he could drink safely. In exploring his history with us, she told us that the majority of the time her husband could and did stop after two drinks. She liked to have a couple drinks with him on some evenings and felt he could manage it. He thought so too, and wanted to try. The problem, she explained, was that every so often he drank more than two drinks and lost control over his alcohol intake. In those times, he would steal her son’s ritalin, a stimulant prescribed for Attention Deficit Disorder and for which her husband acknowledged having trouble.
So, in working together, she and I decided she would the draw line between one/two drinks, which she would consider as “non-use” (Learning Module 5), and more than two drinks, which she would consider as “use” (Learning Module 6). The strategy was for her to remain engaged and rewarding for as long as he didn’t go over the two drinks, and to remove rewards, disengage and allow natural consequences if she saw or sensed that he had drank more than two drinks or was using stimulants.
A year went by without serious incident. There had been a couple episodes of stimulant use, but it did appear her husband could limit his alcohol intake. Yet, when we next saw the wife, she told us her husband had hurt his back and had been prescribed painkillers, which he was now abusing along with the alcohol. His abuse had started with such secrecy that by the time he admitted the problem to her, he was dependent and had started purchasing drugs in the street. The wife moved into her studio as a way to disengage form her husband as needed. She limited her interactions with him. She moved the line from two drinks to the more traditional zero drinks, and continued the same approach: reward non-use, while removing rewards, disengaging, and allowing natural consequences when he did use.
Attempting to moderate his alcohol use had been important for her husband to try. It might have succeeded for him had it not been for his introduction to the painkillers. A month after learning of his opiate use, he entered outpatient therapy and began working on abstinence with both drugs and alcohol. His experience with the ritalin and now the painkillers made it clear to him that he was seriously susceptible to any drug and that had to include alcohol.