BY CYNDI TURNER, LCSW, LSATP, MAC
The COVID-19 pandemic has been life-altering in many ways. As people are working from home, spending unprecedented time with loved ones, and educating and cajoling students of all ages, many are turning to drinking as a way to cope with the additional stress, isolation, and depression. We know that as alcohol use goes up, so do the related consequences. However, it is hard to determine who may be developing an alcohol use disorder versus just bad habits. I developed the Alcohol Moderation Assessment to help people answer the question: Can I keep drinking? I have spent much of my career practicing harm reduction and have extensively researched the concept of alcohol moderation. There is over 50 years of research that proves that alcohol moderation is an effective treatment option for the majority of drinkers. Study after study has shown that with a brief intervention focused on moderation skills, many drinkers can return to safer levels that no longer meet diagnostic criteria for an alcohol use disorder. This is a major paradigm shift for the treatment community that is often met with resistance. My goal is to educate clinicians about alcohol moderation and help clients have a healthier relationship with alcohol. For some this might mean giving it up and for others it is learning how to enjoy alcohol with reduced consequences. This is the heart of harm reduction: accepting that people use substances in ways that may harm themselves or others, but that a client and clinician can collaborate to reduce the negative effects.
The Alcohol Moderation Assessment offers predictions on who would be a good candidate to practice alcohol moderation. Alcohol moderation has also been called low-risk drinking, controlled drinking, and moderate drinking. Alcohol moderation is a harm reduction strategy where individuals who are struggling with their alcohol use understand why they were overdrinking, develop alternative coping skills, and learn to drink within moderation guidelines. There are a number of definitions of moderation put out by the National Institute of Alcohol Abuse and Alcoholism, Sensible Drinking, American Heart Association, and Dietary Guidelines for Americans. All generally agree that moderation is no more than one drink a day for women and older adults and no more than two a day for men. Moderation Management further recommends that drinkers: have no more than one drink per hour, keep their Blood Alcohol Concentration (BAC) below .055%, consider a drink to be a part of life not the main focus, have hobbies and other ways to relax, and do not drink in secret.
The assessment includes twenty questions. Many of them have to do with diagnostic criteria while some are protective factors. Some of the most negative predictors of being able to successfully drink in moderation include:
- Experiencing withdrawals
- Having blackouts
- Drinking on a daily basis
- Using alcohol to deal with mental health symptoms
- Having legal, probationary, or employment conditions
On the flip side, there are some positive aspects that increase a person’s likelihood of being able to drink moderately. These include:
- Going through a period of abstinence to develop and implement coping skills
- Delaying drinking until after age 21 thus reducing the potential for addiction
- Monitoring the amount and frequency of drinking
- Consuming when alcohol is part of a celebration, not the main event
- Utilizing a support and accountability system
As clinicians, the assessment can be a valuable resource in your tool box. Many have used it as a talking point in sessions. If you or your client are worried about their alcohol use, they can go online and take the Alcohol Moderation Assessment. Sometimes having an instrument that validates the seriousness of an issue can be eye opening for clients and motivate them to take action. You don’t need to be an expert in treating substance use disorders. Simply helping your clients understand why they are turning to alcohol and then teaching them alternative coping skills can reduce the need for the escape of alcohol, thus reducing consequences. By doing this, you are practicing harm reduction. If you have tried less restrictive methods and your client is still struggling with overdrinking and associated problems, then it may be time to refer them to higher level of treatment. Have them complete an evaluation with an expert in dual diagnosis treatment and harm reduction who can then determine what level of care is appropriate.
The Alcohol Moderation Assessment is available online at no cost at www.insightactiontherapy.com or www.insightrecoverycenters.com. More information about harm reduction can be found in The Clinician’s Guide to Alcohol Moderation: Alternative Methods and Management Strategies and the accompanying workbook Practicing Alcohol Moderation: A Comprehensive Workbook.
Cyndi Turner, LCSW, LSATP, MAC, has been a therapist for almost three decades. She is the Co-Founder & Clinical Director of Insight Into Action Therapy and Insight Recovery Centers in Ashburn and Fairfax. She is a nationally recognized trainer on alcohol moderation and has written numerous articles and three #1 New Release books on alcohol moderation.