Alexander DeLuca, M.D.
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Some General Comments About Moderation Management

by Alexander DeLuca, M.D., 7/5/2001.  Originally posted 10/10/2002. [] -- This essay became the basis of a talk delivered at the 109th American Psychological Association, 8/01 in San Francisco.  [The slide show of that talk can be viewed or downloaded].

[Print version]

I'll just make a few comments on the subject of Moderation Management. I've spent a lot of time, over a decade, in the traditional treatment world. This was preceded by and overlapped with spending a lot of time, years, in regular AA attendance. I've stayed closed to MM in several ways over the past two years, monitoring their ever-ongoing-listserv  meeting, I tried to lead a meeting a month in NYC for over a year, and I try to stay in touch with Ana and Cannon. I have no official position in MM, I am on none of the 'boards,' but I do try to attend MM-NYC leadership conferences and meetings.

I've noticed a few things about MM and the people it attracts so repeatedly that they bear stating:

-- People who come into MM run the gamut from those who are clearly alcohol dependent 'alcoholics' by anyone's definition all the way down to people who have no discernable problem with alcohol at all; literally. It is not that uncommon for people to come into MM because they drink one or two glasses of wine every day, and they are, for
whatever reasons, (sometimes frankly baffling to me,) uncomfortable with the daily-ness of it, or maybe the feeling that they somehow 'need' it; but really nothing you could hang a symptom on, much less a 'problem' or a diagnosis.

-- People who come into MM and start to work that program drink less, DRAMATICALLY LESS in most cases. This can not be bad.

-- People who come into MM are very often refugees of the traditional treatment system in this country which is, (can we admit this?) rather monolithic. They resent the way that every degree of problem and every person showing up on our doorstep is crammed into the same box of "alcoholic in or out of denial." They resent the reductionism so common in the traditional approach wherein peoples' particular occupational, family, social, emotional, and physical problems are all
reduced to "alcoholism."

-- People who come into MM don't like being called names, especially when the same name is applied to wildly different persons and cases in what appears to them, with some justification I think, a somewhat random, scattershot way.

-- People who come into MM tend to resent, or find puzzling, that 'radical abstinence' is the first and usually only response, again, to any level of problem. This is, of course, the opposite of the commonly understood general medical approach of trying non-medicinal approaches first, and working progressively up through medications to more intensive and invasive interventions and procedures.

-- As for the group of heavy drinkers who will probably never be able to moderate their drinking to the rather strict MM standards for any length of time, this group will repeatedly fail at Step 2 being unable to complete a 30 day abstinence period, and will repeatedly fail to be able to control their drinking within MM limits. If they don't notice this themselves, the larger group will. Such people are gently coaxed to either leave MM for AA, or to become permanently abstinent members of MM, or they continue to kid themselves and enter into a binge / relapse cycle; just like we so commonly see in AA and in our treatment centers.

I've been in both programs, and spent 90% of my professional life in addiction treatment - MM, AA, professional treatment -- all of these approaches are full of people who take half measures, who delude themselves, and whose conditions more or less rapidly deteriorate. None of us do so well with the addictions that we have any cause for

A point I am trying to make, is that I believe that MM is a rational place for a person concerned about their drinking to find out whether or not they have a problem with alcohol, to determine the severity of that problem, and to attempt moderate, socially reasonable drinking, in the somewhat protective environment of the collective. I do not find this crazy. I find this very sane and would like nothing better than to see it available to people earlier and earlier on the curve of problematic drinking.

I would love to see the questioning of one's drinking, without stigma or labeling, become normative in America. This is a personal dream I have, a vision I pursue; it has little to do with MM as it currently exists.

The system we have fails to engage the majority. The system we have tends to push people away, to become potentially sicker. The system we have does a poor job of engaging people early on the continuum of
illness as is standard medical practice for any of the other 'chronic, relapsing, diseases.'

Moderation Management tries to fill the huge gapping hole in our treatment system that really has very little or nothing to offer the person with, say, three alcohol-related problems. MM tries to address the people who are the MAJORITY of the alcohol problem, (personal, family, occupational, and societal;) call them 'problem drinkers,' 'alcohol abusers,' or whatever.

One of the interesting things about MM, as compared to AA or traditional treatment, is that it is soft and yielding, non-directive. There is little to push off against, little to get one's back up about, little to resist, to resent, or to run away from.

Personally, I have very recently noticed in myself, coming from a background of severe alcoholism and drug addiction, AA, and traditional treatment, that I know a lot about quitting things, and about engaging other desperate people into taking the necessary first steps. But the people who come into MM and who seriously begin, by-the-book, the process of assessing the meaning of alcohol in their lives, and their relationship with it, I am finding that these people much more rapidly start to address the im-moderation in other areas of their lives - and they get to this more general point of self
examination and learning, in "the pursuit of positive lifestyle changes," (perhaps *the* major step of Moderation Management,) far earlier than I did in my own recovery.

This last point could of course be a function of severity of illness, or perhaps that level of change has just come particularly slowly to myself. But I see it regularly in those who diligently apply the MM program, and it is a difference in the approaches that I continue to perceive, and believe is significant.




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Alexander DeLuca, M.D., FASAM.

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Originally posted:  10/10/2002

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