Moderation Is Better Than Abstinence

I’ve long believed that AA, while obviously effective for some, is not the only way to treat problem drinking. Especially given that drinking moderately can increase one’s longevity over those who abstain, I’ve always believed that a better goal would be to take people who can’t moderate their drinking and teach them how to do just that. That’s an approach often taken in other countries, but is one that can’t even be discussed here in the U.S. without an uproar from the addiction community and the anti-alcohol wingnuts. Several years ago, I wrote about this in a long post entitled Tipping The Sacred Cows Of Addiction. And Adi Jaffe, Ph.D. echoed the same sentiment in All About Addiction, a piece for Psychology Today.

The New York Times published an op-ed piece on New Year’s Day entitled Cold Turkey Isn’t the Only Route. In it, author Gabrielle Glaser also noted how entrenched Americans are in abstinence as the only cure for alcoholism.

The cold-turkey approach is deeply rooted in the United States, embraced by doctors, the multibillion-dollar treatment industry and popular culture. For nearly 80 years, our approach to drinking problems has been inspired by the 12 steps of Alcoholics Anonymous.

Developed in the 1930s by men who were “chronic inebriates,” the A.A. program offers a single path to recovery: abstinence, surrendering one’s ego and accepting one’s “powerlessness” over alcohol.

Despite the fact that studies have shown that AA doesn’t work, it’s undoubtedly the dominant treatment method in America. So much so, that most people do in fact believe that if you’re an alcoholic you can never ever touch a drop of alcohol for the rest of your life. But the obvious problem with that point of view is that it suggests that a cure is not only difficult but actually impossible. Because learning to deny yourself something you have trouble moderating is hardly a cure. It’s a band-aid at best that may remove some of the negative aspects of one’s drinking problem, but being based on the concept of “powerlessness” means not only giving up on yourself but it actually removes any possibility of real help. It’s a bad bargain, in my opinion. But that’s where the money is, sad to say. Addiction clinics, retreats, programs, along with insurance companies, etc. don’t make their money by curing people, they make money by treating them. And if the treatment lasts the rest of their lives, then that’s the best thing for the bottom line.

Despite the dominance of abstinence-based treatments, there are a growing number of alternatives, apparently, including Moderation Management, Moderate Drinking and others. Amazon now lists many books claiming to help people achieve moderate drinking, which is encouraging.

But I love her conclusion. “We don’t treat cancer, depression or asthma with the same tools we used in 1935. We need to get away from the one-size-fits-all approach to drinking problems.” Indeed, A.A. has changed little since its inception, while our understanding of addiction, its underlying causes and the benefits of moderate drinking have all grown immeasurably. It would be great if as a society we could eradicate alcoholism, but we can’t do that by simply burying our heads in the sand and just removing alcohol from the equation. If prohibition taught us anything, it’s that such an approach is doomed to fail. It’s time to change the goal from abstinence, a nation of teetotalers, to a society filled with only moderate drinkers. That would certainly make the world a better place.



  1. Liz says

    I have thought along these lines as well. How is it helpful to say you are an alcohlic every time you go to an AA meeting? To say it over and over. Basically, I’m not responsible, I have no responsibility for what I do because “I have a disease”. It just makes me feel like a parriah of society, no good etc. so hey I might as well do what is expected, and feeling horrible about myself makes abuse more attractive…the “I don’t care” attitude. There has to be a better way.

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