Alcohol & drug abuse: A research-based analysis of the Moderation Management controversy.

Abstract

Perhaps the biggest controversy of the 1990s in the U.S. alcohol treatment field concerned Moderation Management (MM), the only mutual-help organization to offer its members the goal of achieving moderate drinking. MM’s supporters argued that the option of this goal would attract problem drinkers who were not dependent on alcohol and not interested in abstinence-only organizations such as Alcoholics Anonymous (AA) and professionally operated 12-step treatment programs (1). In contrast, prominent figures in the treatment and research communities denounced MM as a “dangerous temptation to alcoholics” that was “built on the illusion” that alcoholics could return to controlled drinking (2). This debate only became more intense and bitter after MM’s founder, Audrey Kishline, left MM, joined AA, and several months later caused the deaths of two people in a horrific car accident while severely intoxicated (2). This column addresses the central debates about MM by summarizing the findings of a recently completed study of the organization, described in detail elsewhere (3), and other relevant research. Fundamental argument over MM MM’s primary text, Moderate Drinking (1), and AA’s Big Book (4) actually agree on several important points. Both books make explicit distinctions between problem drinkers who are able to return to controlled drinking and alcoholics. Both texts also concur that failure at the goal of moderate drinking indicates that a drinking problem is serious and is best addressed by abstinence. These shared assumptions have been supported in prospective studies showing that, broadly speaking, when problem drinkers recover, abstinence is more common among those who are highly dependent on alcohol, are male, are older, and are socially and economically unstable, whereas moderate drinking is more common among problem drinkers who do not belong to these sociodemographic groups— for example, young women with low levels of dependence (5–7). MM’s proponents differ from advocates of abstinence-only approaches in their views on who can be trusted to judge the difference between a moderation-bound problem drinker and an alcoholic rather than in their views on whether such a distinction exists. A large proportion of the 12-step treatment community in the United States has incorporated the psychodynamic concept of denial into its theory of alcoholism; AA’s texts describe alcoholics as having a grandiose penchant for overestimating their ability to control drinking (4). Thus many 12-step advocates fear that despite MM’s intention to serve only nondependent problem drinkers, the organization’s members are in fact alcoholics who are deceiving themselves into thinking that they can drink moderately. Severity of MM members’ alcohol problems