CCSAD | Alcohol Moderation Offers Alternative to Abstinence-Only Model

More than 70% of Americans consume alcohol within normal limits or not at all, Insight Into Action Therapy and Insight Recovery Centers co-founders Cyndi Turner, LCSW, LSATP, MAC, and Craig James, LCSW, LSATP, MAC, told Cape Cod Symposium on Addictive Disorders attendees on Saturday.

About 6% of the US adult population has a severe alcohol use disorder that requires an abstinence-based approach to treatment. But in between, there are about 90 million Americans (22%) who experience mild to moderate alcohol use disorder, Turner and James said. And for those individuals, moderation is both potentially feasible and a reasonable goal, they said.

Alcohol is the substance of choice for 74% of those with substance use disorders, and research shows 90% of those with AUD don’t seek help. Their reasons can include wanting to avoid the label of “alcoholic,” concerns over being placed into an inappropriate level of treatment, facing the prospect of giving up drinking forever, and potentially leading a more mundane, unhappy life.

An alternative to full abstinence, alcohol moderation is a form of harm reduction that focuses on positive changes, uses motivational interviewing techniques and looks for ways to get—and keep—patients engaged in treatment.

“With moderation, we take away the word ‘abstinence.’ It’s not the main goal,” James said. “We’ll get there, but we find the value is education and information. Through that, people are more open to understanding themselves and not being defensive. We don’t focus on ‘don’t drink.’ We focus on ‘why.’ What’s the benefit, what’s the value? If we can get to that, we can get away from the behavioral focus and focus more on the emotional components and the values that are driving some of that behavior.

Before patients begin alcohol moderation, Turner does recommend a 4-month period of abstinence. This, she said, allows patients to begin “dealing with life on life’s terms” and develop a support system, practice change, learn to manage risky situations and cravings, and identify new coping skills. After the 4-month abstinence period, about 50% of patients choose to continue abstaining from alcohol consumption, Turner said.

For those who wish to eventually resume consuming, Turner and James have patients complete a 20-question assessment prior to engaging in moderation to determine whether it is an appropriate course of action. The questions look at patients’ consumption patterns, co-occurring physical and psychological issues, other non-prescribed substance use, family and personal history with alcohol (including age of initiation to alcohol consumption), and past consequences of alcohol consumption. The assessment also covers the patient’s family support system, alcohol-free hobbies/outlets and willingness to go through period of abstinence. Before implementing an alcohol moderation plan, patients should also:

• Understand the biological, psychological and social consequences of drinking
• Have not developed a physical dependence on alcohol
• Commit to not engaging in unsafe or destructive behavior after consuming
• Not use other drugs
• Identify triggers and have a plan for responding to them
• Satisfy legal, probationary, work, family and friend obligations
• Understand why they wish to resume consumption (and ensure it is for healthy reasons)
• Identify a support system

Once patients are ready to move forward, an alcohol moderation plan should include:

• Why the patient is choosing moderation
• Situations in which patient will not drink, as well as times patients will not drink before or after
• A beverage to alternate with alcohol
• Consumption limits
• A person to review their plan with
• Behaviors or concerns to watch for and what to do if those issues are observed

Once this plan has been documented in writing, Turner encourages both the patient and the person with whom they are reviewing the plan to sign it like a contract.

“It really helps family members when they know what the plan is, what to expect, and what their role is in the alcohol moderation plan,” Turner said.