Why Don’t We Have More Non-Abstinence Programs?
Excessive alcohol use is now the fourth leading preventable cause of death in the United States and 1 in 10 adult deaths is due to excessive alcohol abuse.
Pretty scary right?
The problem is that most people don’t know how to determine if their own drinking is excessive, or if it’s the sort of drinking the American Medical Association believes is “good” for your health?
It’s an alcohol-filled minefield out there.
…women are considered “heavy drinkers” if they have 8 or more drinks a week, while for men the number is 15.-Adi Jaffe
Fortunately, I have some numbers for you to consider. According to the Centers for Disease Control and Prevention (CDC) and the National Institute on Alcoholism and Alcohol Abuse (NIAAA), women are considered “heavy drinkers” if they have 8 or more drinks a week, while for men the number is 15. And any episodes of binge drinking (more than 4 drinks for men, more than 3 for women) qualify you as well – so no partying. There is some debate among researchers about the specific numbers here, but the range should give you a general picture.
Those numbers indicate that about 1 in 13 Americans are heavy drinkers, while almost 1 in 2 college-aged Americans qualify!
It’s important to note that the recent CDC report does not refer to these heavy drinkers as “alcoholics.” Instead, it uses the level of drinking as the problem indicator without the disease attachment. Unfortunately, 99 percent of the more than 13,000 alcohol abuse treatment options available in the U.S. begin by assuming that patients (or “clients” as we call them at Alternatives) are alcoholics. What’s a good-old heavy drinker to do?
[CDC] uses the level of drinking as the problem indicator without the disease attachment.-Adi Jaffe
Individual therapists and psychologists do work known as harm reduction on a regular basis – trying to get clients to drink or use less instead of quit completely. In the rest of the world this concept is almost standard practice. But in American treatment centers the concept of moderation and harm reduction is essentially non-existent. I believe there are some specific ideas about problem drinking and addiction that drive the paucity of moderation offerings and I’d like to tackle them in this series. So let’s go!
Why don’t we have more moderation treatment programs?
There are at least three reasons why so few non-abstinence programs are currently offered in the U.S., including:
- The fear that moderation programs give permission for “true alcoholics” to continue drinking.
- The notion that currently abstinent individuals will decide to drink again.
- The belief that any use of a mind-altering substance by individuals who have previously struggled with them is a means of escape and therefore unhealthy even if it’s non-problematic.
These “reasons” are not only untrue, but are damaging to our entire industry. They’re probably at least partially responsible for the fact that only 1 in 10 individuals who struggle with a substance use disorder enter treatment.
We can do better! Let’s explore the first reason.
#1: Moderation programs give alcoholics “permission” to drink.
The truth is that every member of AA has tried to reduce or moderate their drinking. No one needs permission to drink or to stop drinking. Before people hit “rock bottom,” they will try anything and everything to reduce or moderate their drinking rather than being labeled an “alcoholic.” Even though they essentially have no formal support in these attempts, many individuals do successfully cut back and resume their lives as moderate drinkers (Dawson, 1996).
We know that many drinkers are reluctant to join AA because they fear they will be told abstinence is the only option and they are not ready to stop drinking completely.-Adi Jaffe
We know that many drinkers are reluctant to join AA because they fear they will be told abstinence is the only option and they are not ready to stop drinking completely. These people are unwilling to consider a life attending support group meetings that will take time away from work and family. They are ashamed and embarrassed and don’t want to be labeled an alcoholic. Possibly they think they will lose all their friends if they stop drinking, or don’t see their current drinking pattern as excessive. Right now we say these individuals are “resistant,” “in denial” or “unmotivated.” We say they don’t want help or otherwise discount their ability to change.
But research has repeatedly shown us that only 10 percent of those struggling with drug and alcohol problems enter treatment (Cunningham et al., 1993; Jaffe et al., 2013). This level of penetration is to be compared with the fact that over 70 percent of individuals diagnosed with diabetes seek and receive treatment for the condition (although it does take nearly five years to get there). That means that seven times as many diabetics seek treatment for their disease than do addicts. And their treatment is not an all-or-nothing proposition; diet changes, exercise and insulin are offered, clients rarely partake in all, and they have a relapse risk close to that of addicts (50 to 60 percent annually).
Combine all of this with the knowledge that individuals are far more likely to enter and participate in a treatment of their choice. I believe the only way to get heavy drinkers to really evaluate their drinking and decide to quit for themselves is to offer moderation as a goal. People need to feel personally invested in the conclusion that abstinence is their only option – being told so by a counselor or therapist is rarely news and rarely alters their stance.
So offering non-abstinence treatment is not about giving people permission to drink – it’s about giving them permission to reduce their drinking, rather than getting no treatment at all.
What’s Next: In Part 2 we’ll deal with the second notion that currently abstinent drinkers will seek moderate drinking if such programs are offered.
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