Alcohol Abuse, Abstinence and Moderation: AA and 12 Step Alternatives

No single idea keeps people from seeking help with their alcohol related problems as much as the mistaken belief that alcohol abuse, dependence, and addiction are always the symptoms of an actual "disease" and that there is only one "cure." However, just as everyone knows someone who currently has problems with alcohol, we also know someone whose problems seemed to disappear. How can a supposedly life-long, progressive, and fatal disease simply evaporate and not just occasionally, but often enough for remission to be more the rule than the exception?

Clearly something doesn't add up and, not surprisingly, misleading impressions can be directly traced to the treatment industry's advertising. Not that it's totally false, just as self-serving as most ads. Unhappily, the hype has also been so successful that nearly everyone has come to believe it, no matter how much the research and their own experience suggests otherwise.

As is often the case, the reality is more complex, and interesting, than the advertising suggests. There are, of course, people who need to stop drinking permanently and for whom moderation or a return to "social drinking" is impossible. They are much like most ex-smokers. Yet the need to abstain is not the same as being sentenced to a lifetime of meetings, medallions, rituals, and an alcohol focused life. That prescription works for a few, perhaps five to ten percent of those who try it voluntarily, and fewer of those who are coerced into it.

If the AA/12-Step model is ineffective for most, and a counterproductive dead end for some, what is someone whose alcohol use is slipping out of control to do? Mostly they should take a deep breath, exhale, relax, and consider all their options. As with smoking, there are a number of possibilities and none of them work for everyone. A few possibilities work for some people and others for still more and it's rare to get it right on the first try. You may be able to sort it out on your own or with the help of a few books, and your research should at least help you decide what counselor, program, or facility to enlist if you decide professional asistance is called for or desirable.

To start the process as objectively as possible, first decide what outcome you'd like best: abstinence or moderation? Outside of the U.S. moderation, also called Harm Reduction, is usually the first option to be suggested and explored. Here in America, with a mammoth industry founded on promoting disease, abstinence, and lifelong relapse, the focus is different, though there are options available from a few organizations like Moderation Management as well as educational sites like Addiction Information and Alcohol Problems and Solutions. Recognize that your choice at this point is a starting point. Don't limit your potential outcomes unnecessarily if you want real lasting solutions to your alcohol problems - ones more satisfactory than drinking your way to oblivion.

Going through changing a major element in one's life is unsettling, both for the person who's changing and for those around them. It is one of the reasons 12-Step formats work for some people - they are the least disruptive. The "problem" person and the designated "problem" remain comfortably identified. "I'm an alcoholic; I'm powerless; I have a disease; I'm working my program." Not a lot changes. Alcohol remains the focus, sponsors fill in for bartenders, meetings replace bars, and everyone is a bit safer on the streets. Drama at home is probably reduced too, though the drunk's relationship with alcohol probably continues to override intimacy with his or her family.

Most other options will probably be more disruptive because they involve transforming your life into one that focuses on things other than alcohol. It means getting a life, accepting responsibility for your past, assuming responsibility for your future, and acting on it. With that kind of change a lot of uncertainty appears and the anxiety that goes along with it. It's the time when a lot of people, not just the designated drunk, discover that they prefer the "security of familiar miseries" to an unpredictable future. It is one of those times that may require real support as multiple challenges appear that need to be sorted, prioritized, and dealt with. Platitudes, tokens, and bumper stickers aren't going to take care of it and some professional guidance may be called for. Still, that's no different than when you hire a coach, trainer, accountant or other specialist to see you through a rough transition or complicated problem and it certainly isn't a lifelong, thrice-weekly, commitment to self-flagellation.

The rewards of an examined and reconstructed life are many and varied. They usually surpass adherence to depressing powerlessness, endless alcohol fixation, periodic relapse, and victim-hood. It is more difficult to manage in the short run, but so is stopping smoking, altering your diet, controlling Type II diabetes, and most anything else worth doing. The choice is yours, of course, and there are no guaranteed outcomes, except, perhaps, life will be different. Argue all you want, but, if your life were already satisfactory, would you be reading this article?