Welcome to the February edition of Tips and Topics and to Black History Month.
In SAVVY, STUMP THE SHRINK and SKILLS, I respond to a question about Alcohol Moderation and its implications for how to work with people not yet ready to embrace abstinence and recovery.
In SOUL, it has been five years since losing my wife suddenly. Embracing retirement has opened up opportunities to travel and with companions to make that fun. One special companion has raised my awareness about African Americans and their ancestors....a fitting connection in Black History Month.
Earlier this month, I got this message from a Drug and Alcohol Therapist:
Have you heard of Alcohol Moderation as a Harm Reduction method of treatment for those with mild to moderate Alcohol Use Disorder (AUD)? I keep getting a lot of negative feedback from 12-Step based treatment programs and the 12-Step members that make up the majority of the staff in these facilities - even medical directors. It's concerning to me.
I would love to hear your thoughts.
My response:
Hi:
Back in the day, there was Moderation Management and this sounds similar, though I haven’t heard any presentations on “Alcohol Moderation” itself.
Consider someone who has severe AUD but is at Precontemplation or Contemplation stage of change in terms of readiness to consider abstinence, sobriety or recovery. “Alcohol Moderation” can be a useful motivational enhancement strategy: Develop a treatment plan that I would call a Discovery, Dropout Prevention plan that has the client collaborate on if and how they could moderate their use: “I’ll cut back, but I don’t need to totally stop. I can stop anytime”.
So then you experiment with the client to do as Alcoholics Anonymous says, “attraction, not promotion”. Work on attracting the person into recovery as s/he discovers that they may not be able to successfully cut back or stay abstinent for a trial period of time. This raises consciousness to their “loss of control”.
If you go to my newsletter Tips and Topics and in the Search on the right hand side put in Harm Reduction, you can read what I’ve written in previous editions; and also if you put in Discovery, Dropout Prevention and Treatment planning, you should come up with other ideas I have written about.
David
Tip 1
SMART Recovery has a useful, succinct summary of Abstinence vs Moderation.
The SMART Recovery article starts nicely with: “This word “abstinence” can be an intimidating word to many, especially those in the early stages of recovery.”
Take a look at the full article, but here are a few highlights in their words:
• Why abstinence?.... the simplest, easiest, safest and surest way to keep from repeating past behaviors is total abstinence. This is not to say one may not go thorough a period of “day at a time,” or “week at a time,” or even try a “harm reduction” approach. Still, if you want the easiest way to minimize the problems in your life, go for abstinence eventually.
• Is abstinence the only way?... Studies have shown that in some cultures there are a small percentage of people who can return to moderate drinking....Attempts at moderation may not be worth the effort or the risk when considering the consequences....What has the empirical evidence in your own life been? Have you tried to moderate and not been successful? Then that’s your answer.
• What if I lapse or relapse?... Learn from it and don’t beat yourself up...Your commitment isn’t broken and you can renew your resolve. If you do slip...it can be a powerful learning experience. It does not mean that you will repeat this behavior in the future. Forgive yourself, learn from it and remember that a commitment applies to what we plan for the future.
Tip 2
If a person is not convinced they need to be abstinent, what does a Discovery, Dropout Prevention Treatment Plan look like?
Years ago, I remember hearing couples therapist, David Treadway, Ph.D. say something to the effect: “The trick is not to have the light bulb go off in your head. It is the have it go off in their head”. You may be absolutely right that this person with severe addiction needs to be abstinent. But if they don’t see it, we have to work with them until the light bulb goes off in their head.
“I’ll cut back, but I don’t need to totally stop. I can stop anytime”.
Therapist (T): OK, so how much are you willing to cut back? Or since you can stop anytime, how would you feel about doing a diagnostic trial of abstinence for a few weeks just to prove you don’t even have an addiction problem?
“Well, yes I’m not an addict. I can stop whenever I want. So OK, I’ll stop for a few weeks just to show you I’m not out of control.”
T: OK, if you are a social drug user, it should be no problem to go 3 or 4 weeks without using. We’ll do random drug testing to document being drug-free; and check in with your family weekly to see what they notice about how you are doing.
“Wait...drug testing and checking with my family?! Don’t you believe me?”
T: I believe you, but I don’t know about believing addiction. So this is just a lab test to track if your plan is working. We do the same with diabetes to test blood sugar; psychotropic medication blood levels to get the right dose of medications etc. We also check in with families to see if the diabetes or Bipolar Disorder is stable or not.
How does this sound for your Treatment Plan?
“OK, that sounds alright and won’t be a problem because you’ll see that I can stop anytime. I’m not an addict and don’t need treatment.”
With a Discovery, Dropout Prevention plan, we want to keep the client engaged in treatment to discover any out of control substance use and “have the light bulb go off in their head.” It is most simple to start with a diagnostic trial of abstinence. But if the client insists on a “cutting back” Discovery plan, then start there. This will require more family or significant other check-ins to get feedback on whether s/he appears to be actually cutting back on substance use.
Every February, I have acknowledged and remembered the loss of my wife of 46 years and the mother of our three children. If you want to track my grief process you can go to Tips & Topics and look at the February edition of every year in the Archives starting with the February 2019 edition when I announced her sudden passing.
Now five years later, how am I and our children doing? While we of course still miss her and think of her often, we are all thriving....carrying on the legacy of her vitality and zest for life; her love of learning and exploring different models of communication, health, fashion and music. While I value my alone time and don’t plan to marry again, I am not a depressed, withdrawn, grieving widower.
Quite the opposite, I have been mostly retired, which has opened up lots of fun international travel time. I traveled alone in over 25 years of full-time training and consulting. Now I want companionship while exploring the world.
Happily, I have developed some meaningful and multidimensional relationships with a network of wonderful women....one in particular happens to be African American. With this being Black History Month, I am acknowledging and appreciating her raising my awareness of a whole variety of stereotypes and biases that have seeped into my thoughts and beliefs by cultural osmosis. It has been quite an educational and illuminating process that is only just beginning. (Of course it hasn’t all been in-person school. There’s been lots of fun companionship and travel too.)
In particular we recently traveled to Ghana and the Cape Coast where it was sobering to stand in the very dimly lit and poorly ventilated dungeons where thousands of African men and women were imprisoned.
“Cape Coast Castle is one of about forty "slave castles", or large commercial forts, built on the Gold Coast of West Africa (now Ghana) by European traders.... It was later used in the Atlantic slave trade....They were used to hold enslaved Africans before they were loaded onto ships and sold in the Americas...This "gate of no return" was the last stop before crossing the Atlantic Ocean.”
As I stood at the Door of No Return (see the plaque at the top of the door photo), I could only faintly imagine how those ancestors of Black America must have felt. I lost my wife. They lost their families, homeland, and freedom enduring unimaginable inhumane treatment that robbed them of their dignity, culture and for many, their lives.
Thank-you for joining us this month. See you in late March.
David