For Problem Drinkers, A Moderate Proposal

Michael Andes had been a social drinker since high school, but when he and his wife separated three years ago, he began to indulge nearly every day. The Ann Arbor (Mich.) social worker, 53, was downing roughly 35 glasses of beer or wine a week when friends expressed concern. Finally, a year ago, he enrolled in DrinkWise, a controversial new program that teaches drinkers to reduce their alcohol consumption before it gets out of hand. Andes says he feels much better now that he has cut his drinking by more than half.

But the controlled drinking approach advocated by DrinkWise and Moderation Management (MM), a self-help group with chapters in eight cities, is considered heresy among those who adhere to 12-step programs such as Alcoholics Anonymous. In the U.S., abstinence has long been the only accepted treatment goal for heavy drinkers, unlike some European countries where moderation is widely accepted. "Since the 1960s, we've thought there are two kinds of people," says Dr. William R. Miller, professor of psychiatry at the University of New Mexico. "Either you're an alcoholic or you aren't."

MISLABELED. However, nearly 20 years of research suggests that drinkers encompass a broad spectrum and that many were mislabeled alcoholics. Studies show one-third of the U.S. adult population doesn't touch the stuff. Of the remaining two-thirds, 75% are considered social drinkers who imbibe occasionally. Some 20% are problem drinkers with some physical dependence on alcohol, which may have led to job, relationship, health, or financial strains. The last 5% are severely dependent on alcohol and suffer withdrawal and other symptoms typically associated with alcoholism.

The problem drinkers are the ones moderation programs target. Of the 73 DrinkWise graduates, 72% hold professional or managerial jobs, and 52% report that prior to entering the program, their problem drinking had gone on for two years or less, suggesting their habit is not chronic. "People who find our program appealing don't think they're powerless over alcohol," says Keith Bruhnsen, program manager for DrinkWise, which originated last year at the University of Michigan.

If you enroll in DrinkWise or become an MM member, abstinence is necessary only if moderation doesn't work. Both programs offer similar guidelines. Men are allowed a maximum of 12 drinks a week and women 9, with no more than 4 on any day for men and 3 for women. The guidelines are based on studies by Toronto's Addiction Research Foundation, which show that drinkers who stay within those limits experience few, if any, alcohol-related side effects.

DrinkWise (800 222-5145) offers one-on-one meetings with trained counselors or group sessions in Ann Arbor and Philadelphia. It plans to open offices in Detroit in November. A nationwide program is also available via telephone. You must first submit to an interview with a counselor, who ascertains your suitability for the program and sets goals. After you abstain for two weeks, you'll speak in person or by phone with a counselor for three 45-minute sessions over eight weeks. The counselor will teach you strategies for curbing your drinking, such as keeping a diary of temptations and how you coped with them. The program costs $595 in person and $395 by phone and includes two follow-up sessions at three and nine months.

MM will soon start support groups in 40 more cities. If you join, you must abstain for one month. Then, MM recommends nine steps to help achieve moderation and "make positive lifestyle changes." You'll discuss what you've learned and how you're coping at weekly, one-hour group meetings. Most members don't attend every week after the first couple of months. There's no cost, although MM accepts donations. Many participants buy founder Audrey Kishline's 1994 book Moderate Drinking: The Moderation Management Guide for People Who Want to Reduce Their Drinking (Crown, $14), an updated version of which will be published in January. For a list of groups in your area, send a self-addressed stamped envelope to MM at P.O. Box 6005, Ann Arbor, Mich., 48106.

HARMFUL? Although male participants in moderation programs have cut back to 7 drinks a week on average from 25, and women to 8 from 17, many experts have serious reservations. "There might be potential for harm because alcoholics would love to be able to drink moderately," says Dr. Richard Fuller, director of the division of clinical and prevention research at the National Institute on Alcohol Abuse & Alcoholism. AA declines to comment, citing the tenth of its Twelve Traditions: "AA has no opinion on outside issues...."

But Kishline says neither AA nor a detox program helped her when she first sought treatment for her drinking 10 years ago--because they offered unrealistic goals. "They don't help the far larger group that doesn't want to recover by abstaining," says Kishline. "Those people have been left out in the cold."

Steps to Controlled Drinking

-- Abstain from alcohol for two to four weeks.

-- Scrutinize your drinking habits--how often, how much, where, and with whom. Keep a drinking diary.

-- Examine what triggers you to drink.

-- Take no more than 12 drinks per week if you're a man, 9 if you're a woman.

-- Drink no more than 4 alcoholic beverages on any given day if you're a man and 3 if you're a woman.

-- Imbibe a maximum of three days a week.

-- Don't drink more than 1 drink per hour.