
For decades, the conversation around alcohol use treatment has centered primarily on abstinence. Many well-established treatment centers and 12-step programs, such as Alcoholics Anonymous (AA), advocate for a zero-tolerance approach. However, there is a growing body of research—and practical, clinical experience—that shows some individuals can successfully learn to drink in moderation rather than quitting entirely. In my private practice, I’ve witnessed positive outcomes for certain clients who pursue this alternative. Below, we’ll explore the concept of moderation, look at supporting research, and discuss how clients can determine whether moderation is a viable option. Moderation is not an option for everyone and always starts with a period of abstinence to reduce tolerance.
The Science Behind Moderation
Emerging Research
Several studies suggest that a subset of individuals with alcohol use disorder (AUD) can reduce their drinking to safer levels without necessarily eliminating alcohol altogether.
National Institute on Alcohol Abuse and Alcoholism (NIAAA): The NIAAA’s guide, Rethinking Drinking, encourages people to examine their patterns of consumption and consider whether cutting down or quitting might be appropriate. While it does not prescribe moderation for everyone, it acknowledges that harm reduction and moderation can be valid goals for some individuals.
(NIAAA, 2021)
Journal of Substance Abuse Treatment (2019): Research indicates that certain cognitive-behavioral interventions, coupled with motivational interviewing techniques, can help individuals establish guidelines for safer drinking patterns.
(Marlatt & Witkiewitz, 2019)
Individual Variation
It’s crucial to recognize that not everyone can or should moderate. Factors such as family history of alcoholism, length and severity of alcohol use, co-occurring mental health conditions, and personal preference all play a role in determining whether moderation is feasible. A thorough assessment is essential before committing to a moderation-based approach.
Private Counseling vs. Traditional Treatment
In many residential or group-focused treatment settings, the rigid structure often does not allow clients to explore moderation. Similarly, AA and other 12-step programs emphasize total abstinence. In a private substance abuse counseling setting:
Personalized Approach: We work one-on-one to identify your specific needs and alcohol use patterns.
Flexibility: We can adjust the treatment plan over time, exploring moderation for those who may benefit and shifting to abstinence if moderation proves unsustainable or detrimental.
Evidence-Based Methods: Counseling often involves Cognitive Behavioral Therapy (CBT), motivational interviewing, and regular monitoring of drinking behaviors to ensure safety and progress.
The Importance of Abstinence for Illicit Substances
While moderation may be possible for a subset of people struggling with alcohol misuse, it is not recommended for individuals using illicit substances such as opioids, stimulants, or other dangerous drugs. These substances present a different and often higher level of risk due to their potency, illegal status, and potential for severe withdrawal or overdose. In my practice, I only explore moderation strategies with clients whose primary issue is alcohol misuse.
Medications That Support Moderation
For those attempting moderation, certain medications can significantly assist in reducing cravings and the euphoric “reward” from alcohol:
Naltrexone (Oral and Extended-Release Injectable Vivitrol): Naltrexone blocks opioid receptors involved in the rewarding effects of drinking, thereby diminishing the desire to consume more alcohol.
(Anton et al., 2006)
Acamprosate (Campral): While more commonly used to support abstinence, it can help stabilize brain chemistry for some individuals, potentially reducing the urge to overdrink.
The Sinclair Method
A noteworthy approach to moderation is the Sinclair Method. Developed by Dr. David Sinclair, this method involves taking naltrexone about one hour before drinking alcohol. Over time, many individuals who follow the Sinclair Method experience less craving and alcohol-related pleasure. Gradually, this can lead to a decrease in the amount of alcohol consumed.
How It Works: By pharmacologically blocking the endorphin reward from drinking, the brain “unlearns” the habit, leading to reduced cravings and intake.
Research Support: Studies have shown that individuals using naltrexone in this targeted manner report significantly lower levels of heavy drinking compared to those not on the medication.
(Sinclair, 2001; Mann et al., 2018)
When Moderation Isn’t Possible
Despite best efforts, some individuals find that moderation simply doesn’t work. In these cases, the focus shifts to an abstinence-based plan. Recognizing that moderation is no longer a healthy or viable option can be an empowering step toward full sobriety, and the counseling process will provide continued support to ensure a smooth transition.
Steps to Explore Moderation
Initial Assessment: We discuss your drinking history, family background, and goals to determine if moderation is a reasonable option.
Set Specific Goals: We identify a target level of consumption, including guidelines such as standard drink limits per day or week.
Identify Triggers: Together, we develop strategies for avoiding or managing high-risk situations.
Medication Consideration: If suitable, medications like naltrexone (oral or Vivitrol) may help reduce cravings and make moderation more achievable.
Ongoing Monitoring: Regular sessions allow us to monitor progress, adjust goals, and address any challenges that arise.
Reassess: If moderation stops working, we switch to a more traditional abstinence-based model, ensuring continuity of care and support.
Alcohol Causes Cancer
It is also worth noting that recent studies show no amount of alcohol consumption is considered completely safe, as alcohol has been linked to an increased risk of certain cancers, including breast and colorectal cancers. Research published in The Lancet found that even moderate drinking can carry health risks, challenging the long-held belief that light or moderate alcohol use might be benign. From this perspective, one could argue that intentionally consuming alcohol—especially if there is a known cancer risk—may not be worth the potential harm to one’s long-term health. This is a critical consideration when weighing the pros and cons of any moderation approach.
Moderating alcohol consumption is an emerging possibility that some individuals can safely and successfully pursue with professional guidance. While not universally advisable, nor recommended for illicit substances, a carefully monitored moderation plan may offer a middle path for those who are good candidates. In my private practice, I collaborate with clients to tailor treatment to their individual circumstances—whether that ultimately involves moderation or a more traditional abstinence-based approach.
If you’re curious about whether moderation is right for you, consider reaching out for a thorough assessment and personalized treatment plan. Change is possible, and you don’t have to navigate the journey alone.
References
Anton, R. F., et al. (2006). Naltrexone and combined behavioral intervention for the treatment of alcohol dependence. JAMA, 295(17), 2003-2017.
Marlatt, A. G., & Witkiewitz, K. (2019). Harm reduction approaches to alcohol use: A review of controlled drinking and moderation training. Journal of Substance Abuse Treatment, 105, 58-65.
Mann, K., Bladström, A., Torup, L., Gual, A., & van den Brink, W. (2018). Extending the treatment options in alcohol dependence: A randomized controlled study of as-needed nalmefene. Biological Psychiatry, 74(12), 896-904.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2021). Rethinking Drinking: Alcohol and Your Health. Link
Sinclair, J. D. (2001). Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol and Alcoholism, 36(1), 2-10.
Disclaimer: This article is for informational purposes only and does not constitute medical or legal advice. If you are considering any changes to your alcohol use, please consult a qualified healthcare professional for personalized guidance.