More people than ever are recognizing the negative effects of drinking alcohol and re-evaluating how it shows up in their life. As a physician on the Monument platform, I speak with patients every day who are looking to change their drinking habits in order to improve their health and happiness. Once they’ve decided they want to make a change, a question many people find themselves asking is whether sobriety or moderation is a better option for them.
To evaluate this question, it’s important to recognize that alcohol use disorder (AUD) is diagnosed on a spectrum, and can be addressed in different ways depending on the individual. While working with a clinician is the best way to determine what goals and treatment approach is appropriate for you and your medical history, here are some useful pointers to consider when reflecting on the question of abstinence vs. drinking in moderation.
First, let’s dive into the difference between abstinence (AKA sobriety) and moderation.
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What is sobriety?
Sobriety is more clearly defined than moderation. When a person chooses to be abstinent, it means that they refrain from all alcohol consumption for a duration of time. However, when someone starts on a journey of sobriety, it doesn’t necessarily mean they are committing to a lifetime of abstinence. They may have adopted a sobriety challenge, such as Sober September or Dry January in order to gain the space to re-evaluate their relationship with alcohol. They might practice sobriety regularly with interspersed episodes of moderation. Or, they may have decided on sobriety as a permanent change in their lifestyle.
From a health perspective, complete abstinence is recommended for certain populations. This includes those managing liver disease, bipolar disorder, abnormal heart rhythms, or chronic pain. It’s also recommended for people who are pregnant or trying to become pregnant, people younger than 21 years of age, individuals who take medications that interact with alcohol, and those who find they cannot maintain moderate drinking over time.¹ Alcohol also increases the risks of other health conditions, including cancer. While sobriety can be achieved by anyone, it’s important to check in with your healthcare provider before making significant changes to your drinking patterns. For individuals with severe alcohol use disorder and possible physical alcohol dependence, quitting cold turkey can cause withdrawal symptoms that may be dangerous or even life-threatening. It’s vital to discuss your goals with a physician to determine how to stop drinking alcohol safely. Treatment professionals can advise if supervised detox is required, and provide next steps tailored to your needs.
Though sobriety has a clear definition, you may still be asking yourself, what is sobriety, and what will it mean to me? How do I create an abstinent lifestyle? Oftentimes it can mean learning how to manage cravings, engaging in alcohol treatment, finding community, and introducing alcohol alternatives into your daily life. A sober lifestyle is something to be proud of, and the team at Monument is here to provide answers and encouragement throughout your journey.
What is moderation?
Total abstinence is not the only option when changing your relationship with alcohol. For some people, drinking in moderation can be a viable pathway to a healthier life. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the definition of moderate alcohol use differs for men and women.
- Moderate alcohol use for men is defined as drinking 14 or fewer units of alcohol per week, and no more than 4 per occasion.
- For women, it’s defined as drinking 7 or fewer units of alcohol per week and no more than 3 per occasion.
A standard alcoholic beverage (or ‘unit of alcohol’) is defined as 12 ounces of 5% beer, 5 ounces of 12% wine, or 1.5 ounces of 80 proof liquor.² While no amount of alcohol consumption is considered healthy, reducing alcohol intake in line with these amounts can reveal the benefits of moderate alcohol consumption (instead of heavy drinking).
The moderation approach to alcohol treatment is also referred to as the harm reduction model. As defined by the National Harm Reduction Coalition, harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug or alcohol use.” Alcohol recovery is not an all-or-nothing process. Moderate alcohol consumption can be lifelong, or may serve as a “step-down” approach to quitting alcohol either temporarily or permanently. Either way, exploring moderation and aiming for more controlled drinking can be a hugely meaningful step. Working with a physician and therapist in an online alcohol treatment program can help you set moderation goals, make progress towards them, and evaluate what’s working for you over time.
A moderation approach may be recommended for those who prefer a gradual approach to progress. Here are additional reflection questions from a therapist to help you understand your own relationship with alcohol, and if moderation meets your needs and preferences.
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How do you decide between sobriety or moderation?
Remember that goals are flexible
First, know that your decision isn’t carved in stone. There is no “one size fits all” approach to changing your relationship with alcohol, and all pathways are unique. One person may start out with a moderation goal and later decide that a sober lifestyle more closely supports their aspirations and wellness. Another individual may pursue sobriety and later decide that they want to try to drink in moderation once they’ve clarified their boundaries.
Regardless of your path, working with a physician and therapist can provide answers, reassurance, and guidance throughout the process. You also don’t need to have a clear understanding of your goal to start making progress.
Reflect on the alcohol use disorder criteria
Research indicates that while the likelihood of avoiding heavy alcohol consumption is highest in abstinence-focused individuals, those with moderation objectives were also able to reduce their alcohol use. An individual’s ability to avoid excessive drinking is also influenced by other factors such as past alcohol consumption, as reflected by an alcohol use disorder diagnosis. Alcohol use disorder (AUD) is diagnosed based on 11 criteria. Depending on the number of criteria met, an individual will be diagnosed with mild, moderate, or severe AUD.
Individuals with severe AUD often find that in the long term, sobriety is the most achievable goal for them. Keeping alcohol in your life in a healthy way can be really challenging, especially for people who have exhibited more severe drinking habits and patterns.
While moderation may be more achievable for those with a mild or moderate diagnosis than those with severe alcohol use disorder, it’s also a great starting point for those exploring making a change. With the support of an expert Care Team, many people begin their journey by gradually reducing their weekly alcohol consumption.
The idea of moderation and mindful drinking is also a great way for people who are asking themselves “should I stop drinking?” to start reflecting on their relationship with alcohol. Proactively cutting back on drinking can start to illuminate how drinking less can give you more, and create the mental clarity to identify your goals and values. There are no requirements for changing your relationship with alcohol and seeking treatment.
Examine external factors
While your relationship with alcohol is entirely personal, reflecting on outside influences can be helpful when considering the relative benefits of sobriety or moderation. These influences may include family dynamics, workplace culture, friendships, strained relationships, and lifestyle elements.
Understanding how external factors will support or impede your success can help you determine if moderation is something that feels achievable within your current lifestyle and circumstances, or if sobriety is a more realistic goal. It’s also important to know that you can change certain circumstances, and therapy can aid in helping you set boundaries that empower your progress.
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Spend time self-reflecting
The choice between harm reduction vs. abstinence is most often made by an individual after careful reflection and introspection. This can include thinking about your common patterns and learning styles. Are you someone who likes to ease into things, or do you prefer an all-or-nothing approach to change? If you lean towards gradualism, moderation may be a more comfortable place to start.
Consider how alcohol is currently showing up for you. Is it a main character in your day, or more of an afterthought? If alcohol is playing a central role in your life, you might find more success exploring sobriety. A key component of goal setting is also identifying what feels achievable. Ask yourself questions like, can I drink moderation? Am I able to stop after a few drinks? Is a balanced relationship with alcohol an option for me? You know yourself and your drinking habits better than anyone, and putting thought into the decision can reveal powerful insights. It’s also important to remember that it’s not a permanent line between “moderate drinkers” and “abstainers.” You can always reevaluate your relationship with alcohol and revisit your goals.
Consider the health benefits
The benefits of sobriety or moderate consumption over heavy drinking are another factor in the decision-making process. Cutting back or quitting alcohol use can help prevent many health risks associated with unhealthy drinking habits. These health risks include but are not limited to:
- High blood pressure
- Alcohol poisoning
- Diabetes
- Cardiovascular disease
- Ischemic stroke
- Hippocampal atrophy
- Cognitive decline
- Cognitive impairment
- Liver disease
- Cancer
These health risks can be severe, and some even contribute to alcohol-related mortality rates. On the other hand, upon cutting back on drinking, many heavy drinkers experience improvements in sleep, cognitive function, weight loss, productivity, interpersonal relationships, energy, and overall mental health. Your specific health goals, health risks, and medical history may play a role in your choice to either moderate or abstain from alcohol. This is especially true if you suffer from specific health conditions or are cutting back to avoid increased risk of specific health consequences.
No matter which path you choose, you deserve resources and support. At Monument, you can meet with a physician, such as myself, to discuss if medication to stop drinking is appropriate for you. There’s also specialized alcohol therapy where you receive a personalized treatment plan catered to you and your goals. Lastly, you can join moderated alcohol support groups to get encouragement and gain accountability in a non-judgmental and secure forum.
The journey to changing your relationship with alcohol is about progress, not perfection. Whether you’re working towards sobriety or moderate alcohol intake, the most important thing is to keep going. Every day presents a new opportunity to define your goals and make progress towards them. Learning more about your options and the health benefits of cutting back is already a meaningful step.
Sources:
- American Psychological Association. “One Year on: Unhealthy weight gains, increased drinking reported by Americans coping with pandemic stress, https://www.apa.org/news/press/releases/2021/03/one-year-pandemic-stress.” Accessed Nov, 18. 2021.
- NIAAA. “Recovery From Alcohol Use Disorder: A virtual roundtable discussion of a new NIAAA Research Definition.” Accessed Nov, 18. 2021.
- NIAAA. “Drinking Levels Defined, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking.” Accessed Nov, 18. 2021.
- Library of Medicine. “Drinking Risk Level Reductions Associated With Improvement in Physical Health and Quality of Life Among Individuals With Alcohol Use Disorder, https://pubmed.ncbi.nlm.nih.gov/30395350/#:~:text=Conclusions%3A%20One%2D%20and%20two%2D,person%20%22feels%20and%20functions%22%20following.” Accessed Nov, 18. 2021.
About the Author
Dr. Elizabeth Klenk graduated from the University of Toledo with a BA in Biology and from the University of Cincinnati with a Master of Science in Biological Sciences followed by her MD. She was a hockey player and played goalie for several high level mens' teams. Dr. Klenk also reads avidly and enjoys spending time with her children, playing music, hiking, and participating in cattle herding competitions across the country with her Border Collies. She lives on a working cattle ranch in Ohio with her family and is an active part of the farm in her spare time.