Controlled Drinking: More Than Just a Controversy

Michael E. Saladin; Elizabeth J. Santa Ana


Curr Opin Psychiatry. 2004;17(3) 

In This Article

Controlled-Drinking Self-Help

There are a considerable number of self-help organizations dedicated to helping individuals with alcohol-related problems. While the oldest, largest and most commonly accessed of these organizations is Alcoholics Anonymous,[87] there are several alternatives including: Self Management and Recovery Training, or SMART; Women for Sobriety; Men for Sobriety; Secular Organization for Sobriety, or SOS; Rational Recovery, or RR; and Moderation Management, or MM. Of these programs, only Moderation Management supports moderation or controlled drinking.[88*]

Moderation Management[88*,89,90] is a nine-step self-help program designed to assist individuals with mild to moderate levels of alcohol dependence achieve either moderation or abstinence. The program views moderation as a sensible and natural first step to change harmful drinking. Problem drinkers give themselves 30 days of abstinence before testing whether moderation will work. If a moderation goal proves to be unattainable, a goal of abstinence is typically recommended.

There are approximately 20 Moderation Management groups actively meeting across the US and Canada, as well as a number of Internet-based forums.[88*] (Moderation Management information is available online at At meetings, members provide each other with support, share experiences, and review Moderation Management guidelines for controlled drinking. Outside of the meetings, members are encouraged to examine how alcohol has affected their lives, identify and focus on life goals, and maintain an awareness of the guidelines and limits for moderate drinking. The guidelines for controlled drinking according to Moderation Management are as follows: (1) eat something before, during, or soon after drinking; (2) do not drink for more than an hour or two on any occasion; (3) do not drink faster than one drink per half-hour; (4) do not exceed the 0.055% BAC moderate drinking limit; (5) do not drink in situations that would endanger self or others; (6) abstain at least 3-4 days per week; (7) do not consume more than three drinks on any day and nine drinks per week for women; for men, do not consume more than four drinks on any day and 14 drinks per week; (8) for older adults (55+), do not drink more than one drink per day.[91]

There are no published outcomes studies evaluating the effectiveness of Moderation Management. However, two recent studies[88*,92] attempted to identify characteristics and motives of problem drinkers who seek help from the program. Together, the two studies contain survey results from 644 individuals who either attended face-to-face or on-line meetings[92] or who contacted the national Moderation Management telephone information and referral service over a 1-year period.[88*] The findings indicated that Moderation Management attracts mostly Caucasians (over 90%) who are generally below the age of 50 years (over 66%). They tended to have less severe drinking problems, were more educated, and have greater economic resources, than the majority of persons in addiction self-help groups. Less than 25% of meeting attendees had ever received professional treatment services. Although reasons for interest in Moderation Management varied, callers frequently expressed that the service was a better match for their (1) drinking problem, (2) life experiences, and (3) view of the importance of personal control in managing their drinking. The findings suggest that Moderation Management tends to attract young, white, mid to high socioeconomic status problem drinkers who are unlikely to use traditional, abstinence-based self-help services.