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Tough lessons
Alcohol treatment programs debate abstinence vs. moderation

By Connie Goldsmith, MPA, RN
September 25, 2000

What defines alcoholism and how best to treat problem drinking are questions that divide the health care community.


	You've read the article. Now tell us what you think. Choices Abstinence only Alcoholics Anonymous (212) 870-3400 Promotes abstinence through the Twelve-Step Program and reliance on spirituality. Secular Organizations for Sobriety (310) 821-8430 Promotes sobriety through empowerment and self-reliance, without regard to religion. Women for Sobriety (215) 536-8026 Believes psychological and emotional needs of women drinkers are different. Moderation possible Addiction Alternatives (310) 275-5433 Believes excessive drinking is a bad habit that can be controlled. DrinkWise (800) 222-5145 Intervenes with problem drinkers before alcoholism sets in. Drink/Link (888) 773-7465 Guarantees reduction of alcoholic consumption upon completion of seven-week program. Other Web sites Nurses in Recovery International Nurses Society on Addictions (919) 783-5871

Audrey Kishline killed two people while driving drunk March 25. This accident rekindled a continuing controversy. Six years ago, Kishline founded a program and wrote a book that promotes drinking in moderation as an option for problem drinkers. In January, she renounced her own program, saying that moderate drinking wasn’t working for her. Apparently, abstinence didn’t work for her either.

Alcohol consumption has declined steadily in the past 25 years in the United States, yet the National Institutes of Health reports that one in four children faces family alcohol abuse. Are all heavy drinkers alcoholics? Can alcoholics and heavy drinkers consume in moderation or is total abstinence the only choice? Even health care professionals cannot agree. Underlying these questions is another – is alcoholism a disease or a bad habit that can be broken?

"I believe it’s generally more useful to consider alcoholism as a habit rather than a disease," said Marc Kern, Ph.D., director of Addiction Alternatives. "Some people who don’t have a family history of alcoholism have gotten into the habit of relying on it as a social lubricant. Moderate drinking is an earlier stage of intervention for those who refuse abstinence. It’s an important first step that gives people a chance to explore their relationship with alcohol. Ultimately, many of my clients elect to move on to abstinence."

Just what is a moderate intake of alcohol? Moderation Management, the organization Kishline founded, sets the weekly limit for drinks at 14 for men and nine for women. "That’s the maximum any moderation program would recommend, and most recommend much less," Kern said.

"People can make poor choices about alcohol and not be alcoholic," said Donna Dotson, ACSW, counselor for the University of Michigan’s DrinkWise program. "We sometimes indiscriminately label people as alcoholics when many of them only lack the knowledge and skills to manage their drinking. It makes sense to have programs in the alcohol service continuum that allow people to deepen their understanding of their alcohol use and to learn lower-risk alcohol practices. If we want to reduce harm and promote discussion, such programs need to exist."

Alcoholics Anonymous defines alcoholism as a progressive disease that can never be cured, but can be arrested by total abstinence. AA stresses that each drinker must decide whether he or she is an alcoholic.

AA has helped millions reach and maintain sobriety through its Twelve-Step Program. While the Twelve Steps emphasize spirituality, AA says there’s room for people of all shades of belief and nonbelief.

"Abstinence is probably the best way to maintain sobriety," said Glenda Walker, DSN, RN, director of the Division of Nursing at Stephen F. Austin State University in Nacogdoches, Texas. "Abstinence helps to remove the person from triggers that lead to relapse. Alcoholism has environmental and biological components, and individuals born with a sensitivity to alcohol may experience environmental factors that contribute to its continued use as a coping mechanism."

"The disease of alcohol dependency is defined by the individual taking larger amounts of alcohol than intended and failing to cut down or control alcohol use despite repeated attempts," said Linda Ryan, a certified addictions registered nurse with the International Nurses Society on Addictions.

"People who cannot moderate their drinking clearly demonstrate the disease of alcohol dependency. Abstinence for them is the treatment of choice."

"I limit myself to one or two glasses of wine a month, and I never drink socially," Kern said. "My addiction problems once undermined my professional practice and marriage. I was referred to 12-step programs, but found no relief. I’ve enjoyed moderate drinking for over 20 years now and I support it because it works for me."

"I felt like I was dying," said Elizabeth Lampman, RN, a California nurse proudly celebrating 11 years of sobriety. "After I found recovery, I was grateful that the Twelve-Step Program worked for me. As for the question of moderation vs. abstinence, alcohol is not necessary to life, like food or water. Those alcoholics hoping to be able to continue to drink are in denial. They’re unwilling to face life without the use of some form of mind-altering chemical."