Moderation Approaches to Alcohol Problems

Moderation training and the concept of moderation of drinking at safe levels as a resolution of problem drinking have a long history. Although still somewhat controversial in the United States, moderation training and moderation as a goal of treatment for problem drinkers have wide acceptance in most Western European countries, as well as in Canada and Australia. Historian of addictions treatment William White has identified self-help groups whose aim was promoting moderate drinking rather than abstinence as long ago as the 1880s in the United States. These groups, however, were overwhelmed by the political power of the American Temperance Movement, which focused on abstinence as the only acceptable goal for problem drinkers, and the notion of moderation as a resolution of drinking problems did not surface systematically again in the United States and in Europe until the second half of the 20th century. In 1962, D. L. Davies reported on a series of alcohol dependent individuals who seemed to have achieved moderate drinking after years of problem drinking.

Since Davies's first report, and with the advent of behavioral and cognitive behavioral approaches to treating problem drinking, moderation training has gradually become a mainstream approach outside the United States, although still controversial among U.S. clinicians who espouse Twelve-Step approaches. Nonetheless, because research has supported their effectiveness, moderation approaches have garnered significantly more research attention and significantly more research support than virtually any other treatment approach for alcohol problems. In a 2000 paper in the Journal of Studies on Alcohol, Nick Heather and colleagues described behavioral self-control training (BSCT), one form of moderation-focused treatment, as perhaps the most researched single treatment modality in the alcohol problems field and as supported by the second largest number of positive studies of any treatment modality in the literature. Despite having been developed and extensively studied by William Miller and colleagues at the University of New Mexico in the United States, BSCT has been largely ignored by mainstream alcohol treatment providers. Researcher Harold Rosenberg, who has reviewed both predictive factors associated with successful moderation and the acceptance of moderation approaches by clinicians, has documented that outside the United States, moderation-focused treatments are much more widely accepted and used.