Moderation March (Part 2)

In Part 1 of this series, I described my surprising slip into Alcohol Use Disorder (AUD). Unexpected, in particular, because I don’t even enjoy the taste of alcohol. As mentioned, I was slow to gain awareness that the unhealthy relationship I was developing with drinking was actually a problem. But once I recognized the truth, the question became what to do about it.

I considered giving alcohol up completely. After all, I didn’t even like it that much. And what began as a social habit was, by this time, typically a solo endeavor due to social distancing practices during the peak of COVID. It’s not like there was peer pressure or unavoidable temptations.

However, I recognized in this emerging drinking problem a troubling trend about myself in general: I suck at moderation. When I commit to quitting something, I typically succeed. After years of over-consuming television, I went on to spend over a decade living without cable or streaming services. When I eventually quit smoking cigarettes after nearly 20 years, I did it cold turkey without any relapses. When I go “off the sugar,” as I refer to it, I do so the most successfully when it’s complete abstinence, not just a reduction in my enjoyment of sweets.

It’s good to be able to quit things, but I didn’t like the idea of resigning myself to controlling choices and behaviors only through deprivation. I wanted to instead become a person who could eat a piece of cake without it turning into a three-month bender on sweets.

And so, while I considered quitting alcohol entirely, I ultimately decided to instead treat it as a playground of sorts, where I could experiment with strategies for moderating. It felt like a low-risk situation because if I succeeded, I could hopefully pick up the new skills and drop them into other areas of my life. If I failed, then I’d just quit drinking – not a huge loss since I didn’t care for the flavors anyway and was beginning to experience more negative effects like hangovers, headaches, heartburn, and sleep disruptions.

The choice to pursue moderation rather than abstinence is a risky one for many folks. I want to acknowledge that and say that I’m not suggesting this decision of mine is the right one for everyone.

That said, while abstinence-based programs like Alcoholics Anonymous (AA) may be thought of as the gold standard for addressing drinking problems, they actually have unimpressive success rates. First, it’s helpful to know that only about 20% of people with AUD seek treatment to begin with. Of those who make their way to programs like AA, around 40% remain abstinent one year in (according to AA; there is speculation that this figure is greatly inflated). This means no more than 5-10% of people suffering from AUD are helped by AA and other programs focused on abstinence.

There are many reasons for this, some of which I’ll share below and are based on both scientific research and anecdotal experience from my time among other folks in recovery:

• The reliance on a higher power alienates atheists and folks with religious beliefs different from the predominantly Christian AA groups.
• The acceptance of being powerless makes people feel… well, powerless, which may contribute to inaction, resignation, and shame, whereas other treatments focus on empowerment and developing skills to regain control over alcohol consumption.
• Many folks have AUD but are not yet alcoholics, which may deter them away from the all-or-nothing approach of AA.
• Not everyone agrees that alcoholism is a disease, let alone incurable.
• While abstinence may ultimately be what many folks suffering from AUD need in the long run, going straight for that goal does not set everyone up for success compared to harm reduction approaches that encourage limiting alcohol rather than restricting it, which can kick off erratic binge-restrict cycles.

A final critique I want to explore in more detail is related to the recognition chips that AA members receive on the anniversary of their sobriety’s beginning date. While the fancy medallions are certainly a nice way to acknowledge the hard work AA members are putting into abstinence, there are drawbacks to the mentality that any slip-up wipes away steady progress.

The very premise of this aspect of AA seems to be completely out of touch with the well-documented Stages of Change that include the step “relapse,” where mistakes and setbacks occur and result in the need to recalibrate and resume efforts to change behaviors. Rather than seeing behavior change as a linear progression forward into “maintenance” with the expectation of staying there forever, Step 6 being relapse puts forth the more likely case that growing through the stages will resemble an upward spiral.

Every phase, including relapse, is a vital step in the trajectory forward. No step taken eliminates progress or wipes away achievements. For me, and many others, this is a far more empowering and positive way of looking at recovery from AUD, alcoholism, and pretty much any other nasty habit one is trying to eliminate.  

For anyone interested in learning more about the drawbacks of abstinence-based recovery programs or the merits of other approaches, I’m linking some articles below that may be of interest:

• AlcoholAwareness.org – What are Some Complaints on Alcoholics Anonymous?
• NPR – New Review Finds Alcoholics Anonymous is Effective, but not for Everyone
• Wired – The Most Popular Treatment for Alcoholism Might be Ineffective
• VeryWell Mind – The 6 Stages of Change

In the next installment of this series, I will describe the strategies that helped me recover from AUD without the 12-step approach.