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July 10, 1995 Volume 146, No. 2
For Audrey Kishline, 38, of Ann Arbor, Michigan, the moment of truth came one evening several years ago, when she consumed a single glass of wine with dinner. According to the most cherished tenets of all the A.A. meetings she had attended since her late 20s, that tiny slip off the wagon should have been enough to condemn the young mother of two to repeat her history of uncontrolled drinking. Instead, she says, "I realized that it was my choice. That this one glass of wine was a small, though enjoyable, part of my life." She found that she could limit her alcohol consumption to a few glasses of wine a week and returned to the ranks of responsible social drinking.
Heartened by her discovery and angry that she had suffered A.A.'s rigid discipline for so long, Kishline decided to create a support group and treatment approach of her own. A little research quickly revealed that controlled drinking, as opposed to total abstinence, is an acceptable therapy in many parts of the world. Her own program, Moderation Management, begins with a month of abstinence. After that, members are given drinking guidelines: for men, no more than four drinks on any given day and a maximum of 14 drinks a week. Women, whose smaller size means they metabolize alcohol differently, are advised to stop at three drinks a day and consume no more than nine in a week. Neither sex should drink every day.
Although Moderation Management claims just 400 adherents at present, Kishline, who recently published a book on the subject, is already something of a pariah in recovery circles. Antialcohol groups have issued press releases condemning her approach, and individual members of A.A. have blasted her thinking as just another form of denial. It is almost as if she had called for the abolition of A.A. itself. In fact, Kishline has merely helped bring into the open one of the most contentious and enduring debates in addiction research: whether most people who repeatedly abuse alcohol suffer from a disease over which they have no control, or whether they are engaging in a freely chosen, if unhealthy, pattern of behavior.
On the one hand, many scientists take issue with A.A. dogma. Says physician Stanton Peele, an addiction expert: ''Every major tenet of the disease view of addiction is refuted both by scientific research and by everyday observation.'' Treatment programs in Canada, Britain, Germany and Australia have long distinguished between problem drinkers, who consume too much alcohol but can cut back if they get help, and hard-core alcoholics, whose only hope is a lifetime of sobriety. Even the most avid proponents of abstinence admit that some former alcoholics have successfully navigated the road to moderate drinking.
On the other hand, the two camps disagree profoundly on whether it is a small or large number of people who can make the switch. In Kishline's view, there are four times as many problem drinkers as hard-core alcoholics. "Moderation Management becomes a weeding-out point for chronic drinkers," she maintains. "If they can't handle our limits, then it's obvious that they have a more serious problem, and we refer them to an abstinence-based program." But her critics argue that less than 10 percent of people who abuse alcohol, and perhaps as little as 1 percent, can maintain moderate-drinking habits the rest of their life. ''Nobody in the trenches is impressed with [controlled drinking]," says George Vaillant, a professor of psychiatry at Harvard Medical School who is an expert on A.A. "Every time someone makes a good case, just wait 10 years, and you'll see they're wrong."
As anyone whose life has been affected by problem drinking knows, the stakes in the debate are high. And the success or failure of a moderation approach can only be measured over many years, one drink at a time.
By Christine Gorman. Reported by Lisa McLaughlin/New York and Sam Allis/Boston
Copyright 1995 Time Inc. All rights reserved.
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