Moderation Management (MM) was founded by Audrey Kishline in 1994. Kishline had suffered from issues with alcohol abuse for several years. She had been able to continue to work and function relatively independently and had become involved in Alcoholics Anonymous as an effort to control her alcohol use and abuse. Kishline found the approach of AA and other 12-Step groups, as well as the notion of the disease model of alcoholism adopted by the medical community, inconsistent with her experiences. She wanted to develop an alternative program. Kishline consulted with numerous professionals in the addiction treatment community regarding substance abuse issues to help her in developing the Moderation Management program.
Before going any further, it is important to complete the story of Ms. Kishline as it offers a valid perspective regarding her specific struggles with her alcohol use disorder. In early 2000, Kishline had come to the conclusion that abstinence was the only way to address her specific problem and that she would start re-attending meetings that included Alcoholics Anonymous (AA) meetings, Women for Sobriety meetings, and SMART Recovery meetings, which are all abstinence-based programs. She officially posted her decision on her formal email list and documented that she would continue to support Moderation Management for some individuals. While attending these abstinence-based support programs, Kishline was involved in an accident where she drove her truck down the highway the wrong way while inebriated, hit another vehicle head on, and killed a father and his 12-year-old daughter. Kishline was convicted and received a 4.5-year prison sentence, of which she served nearly 3.5 years and was then released.
The cases of Audrey Kishline and other MM members who have relapsed have been used by supporters of the medical model of addiction and abstinence-based recovery programs, such as AA, to discredit the MM program. However, if any of these treatment programs or philosophies were to be totally honest regarding their successes and failures, they would acknowledge that similar occurrences (e.g., relapses that lead to significant destruction, harm, and even the death of innocent individuals) occur with recovering individuals who are involved in any treatment program regardless of its philosophy. Relapse is a factor that occurs in individuals with substance use disorders regardless of the specific type of intervention they choose to engage in. If any program were to be deemed as ineffective or dangerous as a result of certain individuals in the program relapsing and causing harm to others, then no substance use disorder treatment program could be deemed effective or appropriate.
In addition, supporters of MM publicly state that the program is not for everyone and encourage individuals who cannot adhere to the MM philosophy to become involved in more stringent recovery programs that stress abstinence-based policies.
What Is MM?
MM is based on principles that are also used in Cognitive Behavioral Therapy. The primary focus of the program is learning moderation regarding alcohol, but the principles of the program can be extended to other drugs of abuse. The MM organization attempts to help individuals with alcohol abuse issues, who do not have physical dependence on alcohol, maintain moderate alcohol use.
The Moderation Management program is viewed as a method for problem drinkers who do not have serious substance use disorders to control their behavior before they develop a moderate to severe substance use disorder. The MM program recognizes that many individuals who have issues with alcohol abuse do not become involved in traditional treatment programs for fear of being labeled “an alcoholic” or “a junkie.” If individuals with problematic substance abuse issues can learn to use their substance in moderation, the program contends that the avoidance of moderate to serious substance use disorders may be possible.
Again, proponents of MM understand that their program is not for everyone. The MM organization reports that nearly one-third of the individuals who become involved in their program eventually transition to abstinence-based treatment programs.
- Individuals with substance abuse problems should have a choice regarding how they address their behavior.
- The most effective way to address alcohol abuse is to identify and intervene at an early stage.
- Many individuals who suffer issues from alcohol abuse can choose between getting involved in abstinence-based programs or moderation-based programs. The MM program is based on the harm reduction model that proposes that individuals can choose to use drugs, and policies aimed at dealing with substance abuse issues should be designed to help these individuals make informed choices about their behavior as opposed to forcing them into treatment. Reducing the harmful effects to others associated with an individual’s substance abuse is the main goal of harm reduction models.
- People should not be forced to change voluntary behaviors.
- Moderation in alcohol use is often the first step taken by nearly everyone who attempts to reduce problems they experience with their drinking. Even if individuals eventually turn to abstinence-based programs to help them, the majority of people who recognize that their alcohol use is problematic for them in some way will start to address the issue by attempting to moderate their alcohol consumption. MM is designed for people who are starting at this point.
- Some individuals can be successful at moderating their use of alcohol (or other drugs), whereas others may not be able to do so.
MM is also guided by the following philosophies:
- Members in the Moderation Management programs must take personal responsibility for their own behavior and for their own recovery program.
- Two strengths that drive the MM program are people helping other people, and people who help others also help themselves.
- Strong self-management skills and good self-esteem are essential to addressing issues with substance abuse.
- Group members should always treat one another with dignity and respect.
- The MM program is not unlike other recovery programs, including 12-Step programs and even group therapy options, in adopting these basic assumptions.
Moderation Management meetings provide a supportive environment that encourages individuals concerned about their drinking behaviors to learn to control their drinking before it becomes too severe. Like many social support groups, MM meetings are free, and the program is supported by donations from individual members.
Basic Premises and Steps
Moderation Management assumes that all behaviors can be changed and that alcohol use is a learned behavior for problem drinkers and not a disease. MM also assumes that there are varying degrees of alcohol abuse and alcohol-related problems, and a reasonable option for some individuals early in the development of their alcohol use disorder is to find a way to return to moderation. Using alcohol or other drugs in moderation may be challenging, and some individuals may find that they need to become involved in more stringent programs. But the choice to engage in moderation or become involved in abstinence-based programs should be a choice and should not be forced on anyone, particularly when an individual is experiencing problems early in the progression of their alcohol use issues.
MM meetings operate on the basis of nine steps that are designed to help members learn to moderate their use of alcohol or other drugs:
- Members should attend meetings (either in person or online) and learn about the MM program.
- Members should abstain from the use of alcoholic beverages or other drugs for 30 days and should complete steps 3-6 during this period.
- Members should examine how drinking has affected their lives.
- Members should write down their personal priorities.
- Members should examine how much they drink, how often they drink, and under what circumstances they drink alcohol or use other drugs. This step often initiates the development of an alcohol diary that helps them to determine and understand these issues.
- Members should learn guidelines and limits for moderate drinking.
- Members should set moderate drinking limits and then start taking small steps weekly toward more balance and moderation in other areas of life.
- Members should review their progress and update their goals.
- Members should continue to make positive changes and attend meetings whenever they need support or wish to help others.
Moderation Management is a secular program that does not focus on surrendering oneself to a higher power, admitting that one is powerless, or the need to confess one’s wrongdoings to others. MM guidelines and limits to moderate drinking are designed to be flexible but do have some specifications, and it is suggested that members follow these guidelines:
- Have something to eat before, during, and after drinking.
- Do not drink faster than one drink per half-hour.
- Typically, a member does not drink to the point of having a blood alcohol content exceeding 0.55; charts are available at meetings that indicate the number of drinks leading to specific blood alcohol content values based on gender and weight.
- Members should be comfortable with their use of alcohol, not drink secretly, and should not consider alcohol use to be a cornerstone area of their life. Instead, they should consider alcohol to be a small part of their life and have numerous other hobbies and interests that do not involve alcohol.
The research investigating effective approaches to the treatment of substance use disorders, and of alcohol and drug use, indicate that there are numerous programs that demonstrate variable levels of effectiveness to cope with these issues. Proponents of Moderation Management consider this program to be a good place to start for most individuals, but it is not appropriate for everyone, and many members of MM progress to more stringent approaches. If the MM program does not work for an individual or if they are unable to follow the steps of the program, they should consider becoming involved in stricter programs that stress abstinence. Individuals who have developed significant physical dependence on alcohol or other drugs are not appropriate candidates for MM.
In general, the research suggests that the MM program is moderately effective, which is consistent with the effectiveness of most other research findings for substance use disorder treatment programs. Interestingly, the research regarding 12-Step programs (which tend to be some of the most stringent critics of programs like MM) is lacking and the available evidence suggests that their success rates are typically lower than or equivalent to success rates of other programs. While many proponents of 12-Step groups like Alcoholics Anonymous consider their approach to be the only appropriate means to deal with alcohol use issues, MM is very open and understanding in its approach and regarding its effectiveness. MM does not attempt to present itself as the only successful approach to deal with alcohol abuse issues.
In the final analysis, Moderation Management does offer an alternative approach for individuals who are beginning to have issues with their use of alcohol or other drugs and would not meet the formal diagnostic criteria provided by the American Psychiatric Association for a moderate to severe substance use disorder. In addition, individuals who have suffered significant issues in their personal relationships, financial situations, and occupations, or have become involved in legal issues associated with substance use (e.g., have received DUI citations), are probably not appropriate for Moderation Management. Certainly, the legal system would frown upon an individual who has received one or more DUI convictions attempting to continue to drink as most courts demand abstinence from these individuals while they are on probation.
Instead, MM may be appropriate for individuals who are experiencing issues with alcohol use that they wish to rectify and who can adhere to the practices of the program. Those with alcohol use disorders or who engage in regular alcohol abuse should seek out professional treatment.