Moderation Management:
 
A Physicians Perspective
       
Alexander DeLuca, M.D., FASAM
 
Presented at the 109th Convention
  
American Psychological Association,
  
August 25, 2001
  
doctordeluca.com 

 
  
Moderation Management:
 
 
 A Physicians Perspective
 
               
• My professional background is in the abstinence
  orientation embodied by AA and traditional substance
  abuse treatment
  
• More recently, over the past year, I’ve spent
  significant time with Moderation Management, NYC.
 
 – I monitor and participate in the ever-ongoing online
  meeting
  
 – I lead one or two MM meetings a month.
  
 – I hold no official position in MM, am not on either the
 board of directors or professional advisors.
 
• My personal recovery remains abstinence.


 People who come to MM…
 
          
• Run the gamut from those clearly alcohol
 dependent by anyone’s definition, to those with no
 clinically discernable alcohol problems at all.
 
 
• May have no discernable alcohol problem at all,
 may perhaps be uncomfortable with the daily-ness
 of their consumption, or with the sense that they
 ‘need’ it.
 
• Drink less, often dramatically less. This cannot
 be bad.



There is a  group of heavy drinkers who will be
unable to moderate their drinking…
 
• These will repeatedly fail to complete the Step 2 - 30 day
 abstinence and will fail to control their drinking within
 MM’s limits
 
• These will eventually be coaxed by the larger group into an
 abstinence based program or to become permanently
 abstinent members of MM

• It is my feeling that this latter function is better
 accomplished in F2F meetings than online, and that MM’s
 greatest need is to establish more ‘live’ groups.

 
“The Fear:” That MM will seduce  
people in recovery back to drinking
 
• Commonly asserted by critics of MM, this is largely
 unfounded and irrational:
 
 – The vast majority of recovering alcoholics are not and have
 never been interested in ‘controlled’ or ‘social’ drinking
 
 – People in stable recovery are generally grateful to be sober
 and guard their sobriety jealously
 
• MM strongly discourages people with a diagnosis of
 alcoholism or a history of alcohol dependence from
 running such an experiment

 
MM adds a needed dimension to our
 approach to alcohol problems
 
• It is an axiom of medicine that illness exists on a
 continuum of severity and that treatment should
 include low intensity interventions…
 
 – Diet and exercise precede medication, and it is only
 when these measures fail that we consider bypass
 surgery for people with cardiac problems
 
• Except in the addiction treatment:
  
 –  Which is characterized by a ‘one size fits all’ approach,
 designed for people with severe alcohol problems
 
 – Where any degree of alcohol-related problems is
 labeled “alcoholism, in or out of denial”



MM is a rational place for a person
concerned about their drinking…
 
       
• To find out whether they have a problem with alcohol
 
• To determine the severity of that problem
 
• To attempt moderate, socially reasonable drinking in the somewhat protective environment of the  collective
 
As an addiction medicine physician I find this eminently sane, and would like nothing better than to see it made available to people earlier and earlier on the curve of problematic drinking.



Clinical Experience working with
 patients in MM

• The lack of a mono-focus on abstinence:

 – Fosters a relaxed and open honesty about drinking behavior

 – Allows ambivalence to exist as an integral part of the therapy rather than as a threat to it

 – Permits the therapist to integrate a 'stages of change approach' in which pre-contemplative and contemplative stages can be directly worked with

• Working with patients in MM is enjoyable!:

 – The MM guidlelines and steps provide clear limits

 – Patients are charting intake and keeping journals; the therapist can focus on providing empathetic support

 

Continue to make positive lifestyle
changes…
  
MM’s emphasis on choosing one’s own goals, on
assessing the meaning of alcohol in one’s life, and on
one’s relationship to it, leads more quickly to a more
generalized self examination and awareness of im-
moderation in other life areas.