I have yet to do an in-depth study of the support group known as Moderation Management, so I have no opinion on their program (except for the fact that I am wary of ANY self-help groups for substance users, because regardless of the quality of the message, people tend to use the meetings as a form of “medicine” instead of relying on themselves, or they use the meetings as a place to ride the fence and avoid deciding to change while telling themselves they’re “trying” or that they’re “doing something” about their problem). I do have opinions on the viability of moderate drinking for those we call “alcoholics”, and it goes like this: Moderation is certainly a possibility, and the data shows that the majority of those who were previously alcohol dependent eventually change their habits to a pattern of moderate drinking, thus in my opinion, it’s wrong and misleading to tell people that they must abstain or else powerlessly die in a fit of excessive drinking.
Most people in the recovery culture disagree vehemently with this opinion, and refuse to acknowledge the facts upon which it is based. They take great pride in mocking, belittling, and threatening with imminent death, anyone who has a drinking problem and would like to resolve it by simply cutting back on their use rather than completely abstaining from alcohol. It should come as no surprise then, that when a self-help group called Moderation Management (MM) popped up in the 90’s, many AA’s gave dire warnings about it, called it dangerous, and said that it would kill people.
Now we get to the myth. 12-steppers thought they’d found their smoking gun against MM when it’s founder, Audrey Kishline, got into a drunk driving accident and killed two people in the process. This has become a standard talking point for AA members who comment on any news article or online forum where the abstinence only approach of AA and treatment programs is criticized or discussed in any way. Here’s a recent comment on a Huffington Post article where Kishline is invoked to shoot down a criticism of the recovery culture:
There’s a huge market out there of alcoholics who would like to manage their drinking and drink socially. About 16 years ago there was a self help group started by a woman, I believe, called MM or Moderation Management (of drinking). Her group was receiving fair publicity and had some growth in the mid 1990’s. After all, there is a lot of appeal to the idea that one can gain control of a behavior or over consumption of a substance, even after much evidence is accumulated to the contrary. Unfortunately for the MM program, the founder was arrested for DUI, with four times the legal limit of alcohol in her. She killed two people in that accident. …Many ill people will suffer as they pursue controlling the uncontrollable.SOURCE
While it is true that Audrey Kishline did get drunk and kill two people in an accident, and this is a tasty fact, the logic of jumping to the conclusion that moderation is impossible and programs for moderate drinking are killing people doesn’t hold up. If it did, then we could just as well say that any drinking by anyone at all is deadly and causes drunk driving deaths. Of course there is no reason to believe such a claim, as there is no reason to believe this claim. It is a single incident of someone making a bad decision, but there is no evidence to suggest that everyone or even a majority of people who try to moderate their drinking will get themselves into a deadly disaster. There is only an isolated incident of this woman making a bad decision – we should keep this in perspective. I could just as well hold up one AA member who killed someone, and blame AA. I try not to do that though, because it’s not logically sound, my criticisms tend to highlight patterns of behavior, or look at a broader set of data. Any single person may make any sort of decision, people are fallible, but it’s a leap to say that a whole organization is evil based on the bad decisions of a single member.
But isn’t it pretty significant that she was the founder of MM? Well, yes, I guess it is. What’s also significant is that she started out in AA, then moved to MM, and then 2 months before her fatal accident she left MM, rejoined AA and some type of treatment program, and had concluded her drinking was “uncontrollable”. That’s right, she was subscribing to the ways of AA way when she killed two people in a drunk driving accident. This doesn’t condemn AA though, nor does it condemn MM, it just is what it is, an isolated incident which one could never use to make a full judgment on either program. I can find much better reasons to condemn AA. I just think it helps to know the full story, since the AA’s never present this part of it when they’re giving us dire warnings about the dangers of attempting moderation.
The controversy over MM, along with some research on it’s membership is documented in this study: A Research Based Analysis of the Moderation Management Controversy
And Stanton Peele discusses the case with Bill O’Reilly in this video:
Admittedly, I am a member of a 12 Step fellowship and have been for many years. The reason that I came there was that I had tried hundreds of times to control my drinking. And I could do it for periods of time. But there was always that time when I didn’t. I heard early on the the definition of an alcoholic was someone who “when you pick up the first drink you can’t predict the outcome”. That’s it for me!
AA has a saying “it works when you work it – sober”. And that’s the bottom line. It amazes me when I hear someone say that AA doesn’t work. They’re right! Just going to meetings does not keep you sober. You have to participate. And I don’t just mean the steps (which I personally don’t think are THE answer). And if you pick up a drink – no one (including your HP) is going to shoot it out of your hand. You have a part in this.
I also am a member of Alcoholics Anonymous. I also don’t listen to a lot of stuff that is set around the tables. I mainly go to meetings to find newcomers. Someone I can sit down with, read the big book with them, and answer any questions they may have about the steps as they go along. And I will tell you the answer is not in the meetings. You do not need to go to one Alcoholics Anonymous meeting to get sober. You don’t need emptying ashtrays. You don’t need to make coffee. You can even get a relationship the first year. But what is indispensable that the 12 steps. And from the book I read (Alcoholics Anonymous) that’s all you need to do. Now that same book also says that meeting with recovering alcoholics in a bright spot in their lives. That we feel kinship and fellowship. Which I do not negate as therapeutic value. But nowhere in that book does it stress camaraderie is sobriety. It talks an awful lot about finding that new guy and helping him out.
In the same book I read says “God is either removed your problem, or he has not”. So if you take a drink, he has not. And I got a few guesses why hasn’t.
First off, the term “alcoholic” and “alcoholism” are outdated terms. People in the healthcare field no longer use these terms, nor do they appear in the DSM-IV (used by psychiatrists and other doctors to diagnose mental illness). The modern terms are “alcohol dependence” and “alcohol abuse.” I personally beieve that the term “alcoholic” refers to dependence, not abuse. The goal of Moderation Management is to provide a program for people who are not yet dependent. From their own website:
“According to the NIAAA and many other independent researchers, there are four times as many problem drinkers as alcoholics in this country. Yet there are very few programs that specifically address the needs of beginning stage problem drinkers, while there are literally thousands of programs for the smaller population who are seriously alcohol dependent.
By the time people reach serious stages of alcohol dependency, changing drinking becomes more difficult, and treatment is usually costly. MM believes that this situation needs to be remedied in the interest of public health and human kindness with early intervention and harm reduction programs. Moderation programs are less costly, shorter in duration, less intensive, and have higher success rates than traditional abstinence-only approaches.”
It saddens me to hear professionals who continue to support moderation management as an alternative to abstinence based models of addressing substance use disorders. Many persons who develop a dependence on substances would absolutely love to learn how to use their substances in moderation, and many try for years. I have to ask why any continued use at all is so important to a person? Social users simply do not have this problem, and have no need to continue using substances, especially when the use of the substances results in problems or is contradicted for some reason. Continued use contains no value for the social user. Only those who develop a dependence are driven to find the justification for the continued use of a substance despite the use of the substance resulting in life problems. Drink in moderation? WHY? Let it go. The American Society on Addiction Medicine referred to substance dependence as a brain disorder. I have to say with all the recent research that demonstrates that substance dependence is a neurobiochemical condition, I am convinced that substance dependence is no more a choice than the plague. The choice isn’t in whether or not a person develops substance dependence, the choice is on how the person comes to terms with it. In my opinion, the only way one can effectively come to terms with it is to simply abstain. The brain doesn’t give a rip whether a substance is prescribed, or non-prescribed, legal or illegal, it only understands what happens when a person administers the drug and it’s path to the brain. The next time someone suggest substance dependence is a choice, suggest they take several laxatives at the same time and will themselves to avoid the results. A loss of control means the person loses the ability to predict what will happen once they introduce the substance into their system. Let it go.
You stated: ” I have to say with all the recent research that demonstrates that substance dependence is a neurobiochemical condition, I am convinced that substance dependence is no more a choice than the plague.:
Could you point me towards some of this research? I’m attempting to understand for myself what I believe and I have to say that Mr. Slates articles are making sense so far. I’m confused on what it is in the brain that can lead people to be “addicted” to so many different things, i.e., overeating, sex, hoarding, shopping, alcohol, meth, coke, etc. etc.
thank you,
I’m no fan of AA but it is not true that Audrey Kishline went to AA got our of control and then she had the accident. She had been drinking heavily through a lot of her time in MM. She was not drinking moderately who knows maybe she never was. She decided to attend smart, AA and other groups and then had the accident. This was not about AA, it was about the founder of THE moderation program who was not drinking moderately (which happens to a lot of people who try it eventually, she is a good model actually) eventually getting someone killed. People trying to pin this on AA are crazy. She was getting drunk during MM, it started way before she went to AA or smart. It was the drunkeness that did it, not AA.
There is SO much anger towards AA and related 12 step programs here. These seem like very broad and sweeping strokes to define what I have found to be an incredibly diverse group with a very broad spectrum of beliefs. AA states that it is not in the business of diagnosing individuals with alcoholism, or addiction and if you decide or find a way that works better for you then by all means do what works for you and makes you happy. If drinking or using in moderation works for you then by all means do it. AA (or other related 12 step programs) is simply one option for the treatment of alcohol or substance abuse problems. It is an option that works very well for many people, either by itself, or in conjunction with other recovery tools depending on what works for the individual. The overwhelming message I get from AA is being accountable for your actions and choices and taking responsibility for your own life, and to get out into the world and live and experience and not to relegate yourself to the halls talking about being sober. My personal experience is that my many attempts at moderated drug and alcohol use have not worked out well for me, so I find that for me, a program of abstinence works better. I am much happier abstaining. I have tried both DBT, and CBT groups and found that skills alone were ineffective, although very helpful in a more comprehensive treatment approach. I did not want to go to a 12 step group, I valued critical thinking and self reliance above all things, but eventually it became worth it to me to give it a try, and I am glad that when I reached that point, a 12 step community was available and thriving. If I want to rationalize my drug and alcohol abuse, I can use anything up to and including the “disease theory”. We can also find a lot of hope and freedom there if we want that. No 12step program ever came beating down my door, I had to reach out, and freely choose to ask for help. I think there are probably as many different paths to recovery as there are people in recovery from substance abuse and I think we can all really only speak to our own experience,
This site is dangerous for alcoholics and drug addicts. This guy cracks me up with all his research and high sounding verbiage. He’s an elitist from the scientific community who thinks he is soooooo smart. If he has done anything for me, it’s to turn me off of scientific research!
He is probably an alcoholic who is trying to justify his drinking. I just hope he never gets behind the wheel, because the person he hits will not care how well he moderated his drinking.
I believe a lot of the moderation talk comes from people who have never had addiction problems. I’m not talking about people who have quit and want to moderate after, as I think everyone who quits wants to or considers the idea of moderation with the carcinogenic alcohol, and then usually finds sooner or later that they can’t, and usually at great cost. I’m talking about clinicians involved in the industry and policies for example that allow people who have no direct experience with addiction to counsel and provide advice those that do. This is what AA, which I am no fan of, is talking about by the way when they talk of powerlessness. It is not that you are powerless over your life. It is that you are powerless once you start to drink. If you have an alcohol abuse problem, you know that that is often true. Not 100% always. Sometimes and in certain situation you may be able to exert control. But most of the time, once you have that drink, it turns into 10 or a blackout. But this is turned into you are a completely powerless person to do anything and then this is argued against which is nonsense.
That is not to say that people who have no direct experience with something can’t be helpful, but someone who has not had and overcome an addiction themselves is not going to have the same level of insight and experience or empathy as someone who has, all things being equal. SMARTs policy of allowing anyone to facilitate, even allowing ex abusers who then moderate to facilitate, and especially as an abstinence based program, makes no sense to me. If it really is an abstinence program, shouldn’t the facilitators themselves be models of abstinence (which implies they don’t drink at all after recovering) since the program looks to provide a modeling experience? If I’m coming in to a smart meeting looking to abstain from alcohol and i have people around me who are still using, some even high, and facilitators who are drinking, how is that helpful? And how is that an abstinence program besides cheap talk?
Then you have the founder of MM. She was supported by credentialed people like Stanton Peele and others who had no alcoholism or abuse issues themselves. Just lots of fancy talk with CBT based ideas and in some articles, promotion of alcohol as a healthy substance. Look at the disaster that led to. And then after that the claim was we need AA and moderation. According to wikipedia, stanton for example gets grants from the distilled liquor and wine industry.
What we need are people who have been there, not theories that lead to disaster written by those who are not experienced funded by the industry in my opinion. Can some people eventually moderate? Maybe there are some. Sober for good describes people who were able to, but even there, it is only a small amount who can. I haven’t met anyone who pulled it off long term. But I’ve known many people who were doing well until they got the idea of moderation in their head. What happened with MM looks very familiar.
If someone wants to learn how to moderate, why shouldn’t they? And if the group is held by those of us that are on the way, and we have tools that MM give us, and we follow them, what is the problem? Who says only PHD’s know how to get someone to help themselves? I have been in MM for 10 years and held many groups and have had my fellow members hold or lead groups, it is a wonderful experience.
Whatever road gets you there, don’t criticize what works for some and maybe not you. Be open that there are many different roads to the same place…or that all of us do not want to refrain. I love drinking responsibly, I am proud of myself, as are so many of my friends. We have worked hard to be able to be loving and kind to ourselves and if that means a martini or a glass of wine with friends or a lover, that than is terrific!
Because they get behind the wheel and kill people or lose control and kill their spouse. Also if you are getting a physical issue from drinking, your damaged liver or stomach or throat will not care that you cut back a little.
Ok, just cruised in through Google, I know this article was done a while ago.
I’ve been following MM for 2 years. It has done wonders for me. Alcohol abuse lies on a spectrum, and I think different solutions work for different people. My problem was mostly binge drinking – I started going to social functions and becoming embarrassingly intoxicated. I knew I needed a change. Learning the tools to count, space out, and limit my drinking has been nothing short of amazing. There are many at my meetings who agree, much of them have been doing it for a lot longer than I have.
If we have a first-timer who seems to be further down the path of abuse/addiction, we will welcome them but often try to steer them towards an abstinence based approach if MM doesn’t seem right. Also, right off the bat it’s recommended that MM users stop drinking altogether for 30 days in order to reset their tolerance, be aware of their triggers and stressors from a sober perspective, and decide if they want to return to drinking at all. Many don’t! Also, many moderate so strictly that they’ll only have a glass of wine a day, but having the MM meetings help them do that.
Different problems often have different solutions, and MM has certainly been one for me.
THANK YOU!!! I hold meeting here in Long Island and will be starting them in Florida. The meetings, as you know, help us with this addiction, bad habit, and those of us that do the work, it really works for. Again, thank you. How irresponsible that article is.
Romola
MM may work for some people, but it certainly doesn’t work for others… I have been married to someone in MM for over a decade who hasn’t been able to control the drinking and refused professional help outside of MM. In fact, he believes it is possible to moderate the drinking. Our marriage is about to end and I am convinced he would be in a better place if MM wouldn’t be there to justify the drinking. He doesn’t think he is an alcoholic and am convinced such a term is outdated. In fact, he believes AA is outdated, because his friends at MM doesn’t believe in abstinence. Yet, he is drinking 2-3 times the limits of what the US society defines as a “problem drinker” on a weekly basis. Every sign such as mood volatility, sleep problems, depression etc. that I can find associated with alcoholics is also present in his behavior. I will terminate our marriage as this third dimension caused by alcohol is so hard to live with. I am not blaming MM for it, but I am 100% convinced that MM has been a huge contributor to why he didn’t cut back on the drinking as he was surrounded by online friends in MM thinking you did an awesome job if you had a “white week” and then got back to drinking again vs. realizing that alcohol was permanently controlling your life.
The science of “resetting your tolerance” is a myth though. Once the brain has made the changes that longterm alcohol abuse causes, the tolerance is permanently higher.
I’ve tried 3 times to speak my mind, and every time I have something negative to say about Bill O’Reilly, it automatically diverts me and I get a blank page. Well, Bill O’Reilly….you do not dominate!!!! I joined MM specifically because of you. His name was Bill, and he was the biggest abuser of alcohol and marijuana that I had ever experienced, and I’m going on 60…..so take a flying leap and jump in your own shit!!! YOU are a hipocrite!!! Fuck you!!!
I think there are a few things worth responding to here. 1st, every major health organization in the country has endorsed the research that clearly establishes addiction (to alcohol or drugs) as a brain disease, specifically of the Mesolimbic/Dopamine center. 2nd, you cant teach or will the primal part of the brain to “behave”, because it has no moral/social hardwiring, that’s another part of the brain. 3rd, the 12 steps are not essential. I have been sober 28 years and never completed them. 4th, AA has no monopoly on success in recovery, the Washingtonians who preceded them and newer groups that are emerging also show success. A group I founded called SOAR has several members who have been sober more than a year and the group is barely a year old. 5th, I would agree that someone shouldn’t ‘live’ at a support group. Using a group as a substitute for drinking or having a life is no way to exist. The secret is comprehensively treating the illness.
You are aware that the founder of Moderation Management had already returned to A.A. after coming to the conclusion that, at least for her, moderation wasn’t working and, more importantly, that the accident in which she was involved happened **after** she returned to A.A. and was drinking while attending meetings.
Not to report that is beyond disingenuous, it’s dishonest.
As for trying to “pin it” on A.A., perhaps some people do. I don’t. Kishline was responsible for her own actions just as every member of A.A. and Moderation Management are responsible for theirs.
The notion, though, that A.A. is somehow “better” than MM, or that MM doesn’t work, or people who go to MM have never had addition problems simply goes against even what Bill W. wrote at various times in his letters and books. He was clear that A.A. is not for everyone, that other programs may help people, that doctors and medical treatment are compatible with A.A., etc.
A.A. is a great program. It continues to help millions of people. But it doesn’t work for all people. MM (now adapted in many ways by many treatment facilities and by addiciotn counselors) is the same. It works for some, not for all people.
No two addictions and recoveries of different people are the same. But that’s quite often what’s implied or state as the “facts” or “truth” in A.A. If you are an alcoholic and you “go out,” you will eventually drink again. If you leave and try MM you will eventually drink again. Both statements are simply not true for all people.
Perhaps A.A. would better serve the public and itself by recognizing that it is not the “be-all, end-all” of recovery. It’s just one program that works m for many and likewise doesn’t work for many.
An apology is in order form me: My previous post stated that you hadn’t reported the case of Audrey Kishline returning to AA before her accident. I failed to read the article fully and, in fact, you did report it correctly.
Again, my apology for my carelessness.
I do, though, stand by the rest of my post.
“She had quit Moderation after it, and she was a member of A-A-A when she drunk… drive druuunk.”
Go right ahead and call me a Grammar Nazi, folks.
Personally, little red flags tend to pop up for me when I hear someone stepping all over their privates like that.
People who candidly and honestly make statements on National TV usually aren’t thinking so hard about what’s coming out of their mouths that they suddenly can’t remember how to phrase a sentence in their native tongue.
I think everybody would agree Ms Kishline just wasn’t going to turn things around, be it in AA, MM, or anywhere else.
She was doomed.
What I do get a little irked at is the continuing pissing contest conducted by AA Demonizers and their absolute dedication to making AA to blame, no matter what.
Mr. Peele’s marble-mouthed stumbling exemplifies this perfectly, and I’m glad it was caught on tape and memorialized for as long as there is civilization and electricity.
I went to AA in 1977 and stayed sober with abstinence for 37 years. I attended meetings for 16 years and grew weary of the drunk-a-logs before then. There is an attitude in AA that once in you can’t leave and if you don’t show up for meetings you are accused of “graduating”. It is a cult in many ways. I decided to not go to meetings to avoid the petty behavior of the AA Nazis and to enjoy my life sober using the steps as I have always done. I stopped believing in god as well. Today I am a content and moderate drinking person. I am cautious about my intake of alcohol because I still have little voices in my head that feed me guilt. Those will diminish with time just like the uncontrolled desire to drink did when I was getting sober. I left AA and began drinking in moderation before I heard of MM. I think MM can work for many people. The Big Book does tell us that if we can drink like normal people “more power to us”. Thank you, Big Book.
It has been over 2 years. Are you still drinking moderately now? I doubt it.
This is quite an old post, but I’d like to leave my two cents.
MM works for me. I started drinking at 19, and was a daily liquor drinker for four years. Using MM, i’ve cut back to only drinking light beers on special occasions. I’ve been using MM happily for 3 years now. At first it wasn’t easy to cut down, it took a lot of self control, but I think I’m a stronger person because of it. I show a lot more self-control in other areas of my life as well since I’ve succeeded in moderation. Overall I’m very happy with my experience, I’m no longer consumed with thoughts of drinking or feel controlled by any addiction. I was led to MM by my mother’s boyfriend, who was an alcoholic during the vietnam war, and now as an old man never drinks more than one or two beers a week.
I’ve never been to AA or any kind of abstinence program, but I know it works for some people, and that’s great. For me personally the dogma of never being able to control yourself or have another drink without wanting more and more is a bit too extreme and limiting for me to accept, I started out with that mindset when I first wanted to quit drinking, and I think it became a self-fulfilling prophesy. Once I stopped thinking in such black and white terms, quitting drinking became much easier. But none of us can claim to know another person’s life or experiences. I hope we can all learn to be more open minded and accepting of paths that are different from our own.
Dateline: As you look back on it, was MM something you devised to give yourself license to drink because you didn’t want to abstain?
Kishline: I do think that deep down as an addict that was the purpose.
Dateline: All the good research that you did and the presentation of it to a national audience, it was really to justify it for you as a drinker.
Kishline: It would legitimize my drinking.