Dr. DeLuca's Addiction, Pain, and Public Health website
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
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
-- 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