The session title clearly amused several attendees at the National Conference on Addiction Disorders (NCAD): “Shhh! Let's Talk About Moderation for Mild Alcohol Use Disorders.” But judging from the Aug. 18 breakout's healthy attendance, and the positive reaction the co-presenters received, serious progress was being made in understanding how certain patients with alcohol-related problems might be suited to a life path that includes occasional drinking.
At the outset, session leader Cyndi Turner, LCSW, acknowledged her satisfaction over being at a conference where her presentation bio hadn't been altered to remove any references to moderate drinking, or her presentation simply being rejected altogether.
“We're at an addiction conference and we're talking about alcohol moderation,” said Turner, co-founder of private outpatient practice Insight into Action Therapy in Ashburn, Va. “That's pretty cool.”
Turner and business partner Craig James, LCSW, made it clear from the start that their wide-ranging practice takes a measured approach to the subject of alcohol moderation. The definition of moderate consumption that they use is substantially more restrictive than the National Institute on Alcohol Abuse and Alcoholism's (NIAAA's) standard. They use numerous predictors to judge whether a patient might be a good candidate for moderation (many factors, from daily drinking to drinking alone to also using drugs, raise red flags that usually can't be overcome). And they prescribe four months of total abstinence, with tools to cope during that period, before moderation is pursued.
Most importantly, they explore the “why” of drinking for the patient, saying that once this is identified, problem drinking often can be resolved—as long as a patient is not at the severe end of the continuum. For the latter, moderation is never an option.
“Addiction is on a spectrum,” said Turner. “Why isn't treatment on a spectrum?”
Failing to acknowledge that not every patient presents with the same level of severity results in some people being sent to intensive treatment that they don't need, and others choosing not to pursue any help at all, said James.
He added that according to research, around one-third of individuals who pursue moderation will end up stopping their drinking entirely. “It provides hope,” he said, for people whose use might be leading to problems with their work, relationships or other life issues.
Turner, author of the book Can I Keep Drinking?, shared with the audience a quiz that patients can take to see if moderate use is even a possibility for them. She also laid out details of what a moderate drinking plan would look like for a patient, specifying the circumstances, quantities and monitoring from another individual that would be included in such a plan.