In recent weeks I have queried the effectiveness of controlled or moderate drinking as a treatment for alcoholics.

I cite and use excepts from an article in The Fix on Audrey Kishline the founder of Moderation Management.

It is a very revealing piece, the extent of alcoholic denial and how this denial (or delusion) can manifest in the most elaborate plans to convince one they are not alcoholic is very apparent.

Secondly  she originally identified herself not as alcoholic but as a “problem drinker” because she had not gone as a far in her drinking or caused as much damage as other alcoholics she had met.

In AA parlance this is the “yets”, you haven’t gone as far in your drinking and related damage to yourself and those around you, yet!?

This use of the expression, the “yets” clearly shows the progression of this condition of alcoholism. The progression is often measured in terms of negative consequences experienced by the alcoholic and those loved ones around them or in the surrounding society at large.

Kishline did not advocate Moderation Management for alcoholics per se. Although this would not preclude it’s application with alcoholics as many alcoholics identify themselves as problem drinkers not alcoholics.

I was one of these people.

I did not know what the difference between alcoholic and problem drinker was and I am sure many other alcoholics are the same. Plus like many AAs, I thought AA could teach me how to drink in a controlled manner.

So many alcoholics want help moderating without realising this ship has sailed, that this treatment outcome is not realistic. That it is abstinence only if you have progressed to being an alcoholic.

So for Kishline to have said that it was not for alcoholics but only problem drinkers does not cut it for me.

“On December 19th, 2014, a 59-year-old woman almost nobody had ever heard of named Audrey Conn died in her mother’s home in Happy Valley, Oregon. Audrey Conn, however, was better known under another name: Audrey Kishline, the well-known founder of Moderation Management who later killed a 12-year old girl and her father while driving in an alcoholic blackout.

Moderation Management was founded by Audrey Kishline in 1994—it has been described by many as the first harm reduction mutual aid support group. (“Harm reduction” is an approach that seeks to reduce dangers posed by risky behavior through management of those behaviors, rather than abstinence.) Kishline identified herself as a “problem drinker”—not an alcoholic per se—and in 2006, 18 years later, said in an interview with Dateline, “Of course, after I had been there (rehab) for about a month, I said, ‘There’s no way I’m as bad as these people. They’ve lost their homes, their jobs, their this and their that. I’m not that bad. I’ve been mislabeled.’”

Moderation Management was born from her rejection of the label of “alcoholic,” and the goal of MM was to use cognitive-behavioral tools—a psychotherapy method that emphasizes practical problem-solving—to help problem drinkers achieve and sustain moderate, controlled alcohol use. And, in December of 1995, Kishline’s book Moderate Drinking: The Moderation Management Guide for People Who Want to Reduce Their Drinking was published.

The program offered online as well as face-to-face meetings, and Kishline was a spokesperson for the program as well as its most outspoken success story. Kishline was always careful to point out that MM was not intended for “alcoholics” but rather for “problem drinkers” and in her book said that those who were already sober were not encouraged to try MM.

Jeffrey A. Schaler, Ph.D (who wrote the introduction to Audrey’s first book—now removed in reprints—and also among the founders of MM) severed all ties with Audrey and MM in 1996.

Schaler agreed to be a part of the MM movement because he and Kishline were in agreement that there was no “disease” of alcoholism and all “problem drinkers” could learn to moderate.

As criticism of MM grew, Kishline began to speak out that MM was not meant for alcoholics (a designation Schaler and Kishline initially opposed) and that “alcoholics” should pursue the path of sobriety. In 1998, more controversy followed Kishline and MM.

What would become clear in the years following the founding of MM, however, was that Kishline’s own drinking—MM’s growing popularity and the success of her message notwithstanding—was “out of control.” By January of 2000, Kishline recognized—publicly—that despite MM’s philosophy and methods, for her, at least, it wasn’t working. She posted a message to an official MM email list, saying that she had concluded that her best drinking goal was abstinence, and that she would begin attending Alcoholics Anonymous, SMART Recovery, and Women for Sobriety meetings, while continuing to support MM for others. Her email read:

“Hello Everyone, fellow MMers,

I have made the decision recently to change my recovery goal to one of abstinence, rather than moderation.

 As you all know, Moderation Management is a program for beginning stage problem drinkers who want to cut back OR quit drinking.

 MM provides moderate-drinking limits based on research, and a fellowship of members who work the program’s steps together. Some of our members have been able to stay within healthy limits, some have not.

Those who acknowledge they cannot stay within moderate guidelines have always been encouraged to move on to an abstinence-based program. 

I am now following a different path, and to strengthen my sobriety I am attending Alcoholics Anonymous, but will also attend Women for Sobriety and SMART Recovery. I am sure I can learn much from all of these fine programs. 

Initial results from a National Institutes of Health funded study on MM out of Stanford University show that indeed members of MM are highly educated, have jobs, families, and most of their resources are intact. It is also very unlikely that they would define themselves as ‘alcoholic’ and, in fact, shun any program that would label them as such. But they are concerned about their drinking. They are attracted to MM because they know they will be allowed to take responsibility for making their own choice of recovery goals. 
For many, including myself, MM is a gateway to abstinence. Seven years ago, I would not have accepted abstinence. Today, because of MM, I do.

Whether abusive drinking is a disease or a learned behavior does not matter. If you drink too much and this is causing problems in your life, you need to do something about it. We’re intelligent people, but sometimes we need to quit debating in our heads, and look at what’s in our hearts.
 If you, like myself, find eventually that you cannot stay within our guidelines there is no shame in admitting this. In fact, it is a success.
 A big success, because you have found through our program what you need to do to really live life to its fullest. As Dr. Ernest Kurtz, one of the foremost experts on AA who wrote the forward to our handbook, once predicted ‘MM will one day refer more people to AA than any other program.’ He may be right!
 My heartfelt best wishes to each and every one of you as you discover your own recovery goal.

— Audrey Kishline; Founder, Moderation Management”

Two months later, on the way from her home outside Seattle to her father’s home in Spokane, Kishline drove her truck the wrong way down an interstate in Washington State. She hit another vehicle head-on, killing both the driver and passenger in the other car – Richard “Danny” Davis, 38, and his twelve year old daughter LaShell. Kishline’s blood alcohol content was 0.26 – more than three times the legal limit, and she admitted to “driving a hundred miles an hour in a total blackout,” causing the vehicular manslaughter.

In the 2006 Dateline interview, Kishline reversed much of what she’d said publicly about her own drinking in previous years, and during the rise of Moderation Management:

Dateline: As you look back on it, was MM something you devised to give yourself license to drink because you didn’t want to abstain?

Kishline: I do think that deep down as an addict that was the purpose.

Dateline:  All the good research that you did and the presentation of it to a national audience, it was really to justify it for you as a drinker.

Kishline:  It would legitimize my drinking.

Kishline was released on parole in August 2003, after serving 3 ½ years, but was unable to resist the temptation to drink, and one night, walked into a liquor store; a friend called her parole officer, and as any drinking was a violation of her parole, she returned to prison for 42 days. Kishline later said that this marked the end of her life with her family, although her marriage had already been crumbling prior to the accident. She and her husband divorced, and she began to live alone in Portland, Oregon. As a convicted felon, finding work was a struggle and it was only after months of fruitless searching that she finally found her first job—at a dry cleaner’s, a half-hour walk from her home. (Kishline was forbidden by the terms of her parole to drive, but she said that at the time she vowed never to get behind the wheel of a car again.)

In 2007, Kishline and Sheryl Maloy—the wife and mother of accident victims Richard Davis and 12-year-old LaShell—co-authored the book Face to Face,which chronicled both the fatal accident and the subsequent forgiveness and friendship that grew between the two women (Maloy had visited Kishlane in prison). In the book, Kishline frankly admitted that she was still drinking regularly…

Ironically, it seems a self-proclaimed alcoholic founded a program that works effectively for the problem drinker. The skill lies in identifying the difference.”

The last line is the heart of the issue.

Identifying someone as an alcoholic or self identifying as an alcoholic. There are a few diagnostic scales out there that can aid in this self diagnosis but as Kishline says herself this self diagnosis comes not from the head but from the heart, “sometimes we need to quit debating in our heads, and look at what’s in our hearts.
 If you, like myself, find eventually that you cannot stay within our guidelines there is no shame in admitting this. In fact, it is a success…”

In fact subsequent recovery continues this journey from a deluded head to a contented heart.  Who in there right mind would not want that?  

Reference

http://www.thefix.com/content/remembering-audrey-kishline#