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The following is a reply to an Ask-An-Addiction-Doc question.

I am sending a copy of the reply to you, because of recent very misleading articles in New York Magazine, the New York Post, and New York Times - the latter two repeating the mis-information published by the first.

Dear _____,

Sorry to take so long to get back to you; I was on vacation this past week, and just getting around to catching up on Email today.

You asked:
"Is Smithers using "moderation management" in inpatient treatment?:

Very short answer: NO.

First of all, Moderation Management (MM) is a self-help group, not a treatment. Smithers has no relationship with MM except that MM holds a weekly meeting on our site, a courtesy we have extended to Alcoholics Anonymous (AA) for decades. These meetings are held during hours the space is not being used by any Smithers program, and are in no way part of the Smithers Addiction Treatment and Research Center.

There is research that shows that patients who attend self-help groups regularly stay in treatment longer and have better outcomes. AA and NA (Narcotics Anonymous) are routinely recommended to all patients at Smithers, and MM or other self-help programs suggested if the patient refuses to try (or return to) AA or NA.

The 'treatment' at Smithers is cognitive-behavioral in general. Some groups, especially those for people thinking about coming into treatment or those ambivalent about returning to treatment after relapse, are 'motivational enhancement' groups. That is, they are manual-driven, group implementations of a psychological approach known as "Motivational Interviewing" (see book of same name, I think, by Miller et al). Smithers motivational enhancement groups are employed on both inpatient and outpatient services.

The core of the Smithers treatment is what we call the "Core-20" - twenty semi-structured, manual-driven, cognitive-behavioral, group sessions constituting what we feel provides the clinical basics of self-understanding, and psychological techniques to achieve and maintain an abstinence-based sobriety. Abstinence is, *by far,* the safest and best approach for people with significant alcohol or drug related problems.

What makes Smithers different from a lot of treatment centers is that we work with people's ambivalence about their substance-use and about treatment, and we do not refuse to work with people who are not sure they are "addicts or alcoholics."

For example, a patient might be having just a few substance-related problems, or a loved-one feels they have a problem but they are not convinced they need to quit entirely. If such a patient is not judged to be a danger to themselves or others, and is not so medically compromised that *any* continued use would result in serious risk of acute medical problem, and if such a patient refuses to take the suggestion of immediate abstinence-oriented treatment, then I will sometimes do an intervention known usually as "a trial of controlled drinking" which involves strict limitations on alcohol intake and patient recording of the circumstances and emotions regarding any deviation from the "controlled" intake.

For example, the patient agrees to the instructions:
-- no more than two drinks on any drinking occasion, and
-- not more than one drinking occasion per day, and
-- if you have more alcohol than this, please write down a brief note including date, time, circumstances and feelings, so that we can review your experiences with this in (usually) two weeks.

The patient is often surprised that they are unable to stick to the limits and then has a better understanding of why they should strongly consider a 'trial of abstinence'  :-) as their next therapeutic maneuver.

At Smithers, such a "trial of controlled drinking" is *ALWAYS* an outpatient procedure because, by definition, inpatient treatment is abstinence-oriented, and anyone sick enough to need inpatient treatment is usually too sick for a trial of controlled drinking.

Thanks for the question, _____. It has given me a chance to clear up some confusion resulting from recent very misleading New York Magazine and New York Post articles.




Alexander DeLuca, M.D.
Chief, Smithers Addiction Treatment and Research Center