“Thinking Out of the Box”: Clinical and Practical Aspects

of Moderate Drinking Strategies

Arnold M. Washton, Ph.D. & Scott Stern, LCSW, CADAC

RECOVERY OPTIONSNew York, NY & Princeton, NJ

Topics

1. Prefatory remarks2. Why moderation?3. How to enhance treatment attraction, engagement,

retention 4. Alcohol’s effects5. How much drinking is “too much”?6. Research on moderation7. Clinical assessment & goal selection8. Moderation strategies & skills

To download copies of todays’ slides:

www.ModerateDrinkingOptions.com Downloads & Links page NASW Conference: “Moderate Drinking

Strategies”

Some Helpful Resources

Websites Niaaa.nih.gov Moderation.org ModerateDrinking.com SmartRecovery.org RecoveryOptions.us ModerateDrinkingOptions.com

www.niaaa.nih.gov

77

www.niaaa.nih.gov/publications

Arnold M. Washton, Ph.D.Joan E. Zweben, Ph.D.

Guilford, 2006

How I arrived at using moderate drinking strategies in my clinical practice

In 1975, started treating IV heroin addicts in an East Harlem clinic. Most continued drinking after stopping heroin.

Starting in early 1980s, started treating cocaine addicts who often did not want to stop drinking except after multiple alcohol-related relapses

Since the beginning, treated countless primary alcoholics who did not want to start with abstinence. Many refused treatment or dropped out prematurely.

How I got here

Regrettably, I too often took the stance of “come back when you’re motivated and ready to stop”

For past 10+ years, I’ve offered moderation training as an initial engagement strategy for patients with serious alcohol problems and as a primary treatment strategy for many with less severe problems

Since closing my outpatient clinic in 1998, I’ve been in full time private practice treating high-functioning adults with alcohol and drug problems

How I got here

Private practice affords me the flexibility to treat patients without being constrained by agency policies and politics

Patients seeking help with moderation or abstinence often find me through my website moderatedrinkingoptions.com and recoveryoptions.us

How I got here

Entering the field as a psychologist trained in both cognitive-behavioral and psychodynamic therapies, I gravitated naturally toward more individualized, integrative, non-dogmatic approaches

I place great value on establishing a good working therapeutic relationship with my patients, seeing this as the primary vehicle for facilitating positive change

Prefatory Statement

Total abstinence is without question the safest goal for anyone who has developed an alcohol problem

This is especially true for anyone who has developed a serious problem that qualifies for (or approximates) a diagnosis of Alcohol Dependence

Moderate drinking is generally NOT a realistic or appropriate goal for alcoholics

Prefatory Statement

I am not here as a proponent of any singular approach, philosophy, model, or program:Harm ReductionModeration ManagementDisease Model12-StepCBT/Social Learning Psychodynamic (Self-Medication)

Prefatory Statement

I support and utilize any and ALL of these, depending on what makes the most sense for a given patient and most importantly what seems to work best!