Wholesome

I also really like how the model encourages people to shed their old addict skin and carry with their lives. I think that's so empowering. That is one of the things that appealed to me about AVRT, that I could declare myself recovered the moment I decided to quit drinking. A huge part of my mental shift was challenging many of my beliefs about my ability to quit. I always thought that something had to happen to me, for me to be able to change, but it was my internal world that needed a change in perspective and a lot of rejection of ideas I had accumulated through culture and society.

I guess I still don't have a question. I agree with the information you present. I do think there's Addictive Voice in the talk about moderation, but I understand why it's presented as a option, people do need to consider it, and I'm pretty sure every addict has explored it. I know I did! I failed every time, but I found drugs and alcohol very pleasurable, I always wanted more.

MesaMan

.
This. Essential Truth...

'I do think there's Addictive Voice in the talk about moderation, but I understand why it's presented as a option, people do need to consider it, and I'm pretty sure every addict has explored it. I know I did! I failed every time, but I found drugs and alcohol very pleasurable, I always wanted more'.
.

dwtbd

Moderation as a goal is achievable after one sheds their addict image and recognizes that heavy use won’t lead to the happiness they seek. Or at least that is basically the conclusion I’ve drawn from what I know of the model.

AlericB

Let's assume that is what it's saying. What would the objections be to that conclusion?

I'm not trying to argue either way btw, I'm just trying to understand what this model is saying because the goal of happiness seems a good one to me.

Just like to add that my understanding of the addict self-image is that includes the belief that you will loose control if you start drinking and the book very clearly and prominently says that if you believe this about yourself you should not drink at all.

And it also says that you would only be able to moderate if that is what you really want to do.

I think a fair summary of the conclusion you've stated is that you are and do what you think.

AlericB

Also meant to say to Steven Slate if there's anything he would like to say on this question.

JeffreyAK

Countless corpses in graves question the accuracy of the conclusion. Addiction (= chemical dependency) demonstrably exists, and can't be willed or desired away, no matter what we want to believe about ourselves. I think various forms of "moderation management" are absolutely viable for some fraction of the population with substance abuse problems, and they can and do help some people live happier lives - the problem is, they'll never work for the rest of that population, yet the belief that they might can be a central cause of the descending spiral of negative consequences that many of us have seen first-hand.

It's not at all about what you believe about yourself, it's the objective reality on the ground that matters, can you or can you not drink moderately and without alcohol ruling your life? A reality we unfortunately often cannot fully grasp when we're active addicts.

Having said that, I also don't know if the conclusion accurately reflects what is in the book. But if the authors are still drinking, that does suggest to me that there is a strong element of "moderation management" here, and after all MM also advocates abstinence if that winds up being the best path.

AlericB

A fairly random thought came to mind which is that while I have chosen abstinence I don't think I've ever thought "I really want to be abstinent" just as I've never thought "I really want to moderate" or "I really want to drink recklessly' even when I was doing so.

Does anyone really think like that? Don't we rather all just think "I really want to be happy" and then decide on our drinking option in the light of that?

StevenSlate

There are a lot of issues involved in the inclusion of moderation in this book, on which I could write forever. We try to present the facts, as best we can identify them. One important fact is that "loss of control" doesn't exist. In the appendix section on the topic, we laid out the best research we could find that attempted to test the loss of control theory. This is various priming dose studies done by Nancy K Mello, Alan Marlatt, Carl Hart, and others. They all show that when the options are stark, confirmed "addicts and alcoholics" demonstrate the ability to have a drink or hit (or a few) and stop. Crack users will turn down another big hit of crack almost all of the time when they have the option to take $20 that they'll receive a few weeks after the experiment is done. Drinkers will self-limit their drinking several days in a row when offered credits for doing so that they can save up for a binge on a later day. Drinkers who don't know they've consumed alcohol do not proceed to crave more, or even take more drinks from a pitcher of the concoction that is right in front of them and from which they can have as much as they want.

If "loss of control" were a biological reality, they couldn't do these things in the lab, but they do. You can't pay an epileptic to not have a seizure, but you can pay an "addict" to not have the symptoms of their "addiction."

The demand for abstinence from "addicts and alcoholics" is based on the idea that they are incapable of stopping. We are not incapable of it.

The fact that we often do keep using at high levels is not because we lack control, it's because we want to keep going. We want to keep going because of how wonderful we believe intoxication to be; we prefer using often/heavily more than using less. We prefer heavy intoxication more than a mild buzz. We, for example, think a 2 drink buzz sucks, but getting totally trashed with 12 drinks in a night is where it's at. Or, we don't think of heroin as a fun high to have once in while, we think that it's the only thing that makes life bearable and which we need every day. And so on.

This is what I think is correct, and so it's in the book. I also don't think our preferences are set in stone and unchangeable. People do change their infatuation with substances/intoxication throughout their lives. Half of "alcoholics" who get over their problems become moderate drinkers. That was found in the NLAES epidemiological survey of 1992, and NESARC in 2002. I've also learned tons of people's stories of moderation of all sorts of drugs, and there is even evidence of former heroin "addicts" becoming moderate heroin users in a decade long study by Zinberg. So, "addicts" can and do change their desire for these drugs and are not destined to continue using at problematic levels. I definitely wouldn't recommend moderate heroin usage, especially with the tainted supply currently going around, but to say it's impossible would be wrong. In 2016 I had to take a dozen percocets a day for a few weeks following surgery. I didn't "lose control." I definitely recognized the feeling from my days as a heroin user, but I didn't really find it pleasurable any more, and discontinued at will when I no longer needed them, because I wanted to be clear-headed again. I didn't become "re-addicted" because my preference had changed.

It is my belief that anyone who only wants to use moderately, will use moderately without "losing control." That isn't to say that everyone should, or that everyone would want to use moderately. Nor is it to say that people who want to be moderate users actually have a desire to use moderately. Many have a desire for heavy use only, while also wanting the lower costs of moderate use. This usually does not end well when they "try" to moderate. It becomes a losing game of resistance and management to stick within some kind of limits defined as moderate. If you prefer the intoxication of 12 drinks, two is not satisfying, it is a tease. From there, you either hate the experience while painfully resisting drinking more, or you say "screw it" and keep drinking more until you get the level of intoxication you prefer. It's still not a matter of "loss of control", it's just a matter of doing what you really prefer to do.

You can know about yourself that you only prefer constant/heavy intoxication, and that moderate use is not enjoyable to you, and you don't think that'll change. You can know that about one or all drugs. I haven't tried moderating cocaine because I'm pretty sure from experience that I would only like that drug in binge style use, injecting it for the quick headrushes every 15 minutes (before I used it that way, snorting it never turned me on at all). I also know those binges got boring and left me feeling worse at the end. I happily do not use cocaine. Not because I think I'll "lose control", but because I just don't see a place for it in my life that would enhance my life and be enjoyable. A middle ground is possible, but I don't see it as potentially enjoyable. I did however find a place for moderate drinking in my life after several years of full abstinence, I find it enhances my life in some times and settings, but it is not a feeling that I want all the time, by any stretch.

The point of that last paragraph is that we don't have to believe that we "can't" moderately use a drug to quit it altogether - we can just no longer want it for a variety of reasons. We don't have to scare ourselves into quitting. It's not the only way. Unfortunately, I think the abstinence or destructive-levels-of-use binary serves to coerce people into begrudgingly agreeing to abstinence as a goal, and robs them of the chance to make their own un-coerced choice for their own positive reasons.

We don't discuss moderation to promote it - we discuss it because it is a viable option, and because the abstinence only model serves to manipulate and coerce people into a choice, instead of letting them make their choice based on their own judgment of the options. When I say coerced, I mean that it instills fear to force an action. When a mugger points a gun and says "your money or your life", that's a coercive choice when yo hand over your money - it's not the same as you thinking "gee this guy has it rough, and I'd like to give him some money to help him get back on track." One is a coerced choice, the other is a positive self-initiated choice. The threat of abstinence or loss-of-control as the only two options is the gun in this analogy. We chose to take the plastic gun out of the interaction in our approach to helping substance users.

AlericB

I liked the distinction between wanting to "use moderately" and wanting to be a "moderate user".

I remember when I quit smoking several years ago one of the thoughts that really clicked with me and I believe made it possible was something I read in a give up smoking book. This was that our need to feel free is fundamental to who we are as persons and is greater even than our perceived need for nicotine, which is quite a claim!

So, if we tell ourselves that we "can't" smoke anymore we'll feel a sense of loss of freedom and there will be an impulse to smoke again just to show ourselves that we are free. The book recommended seeing it as a choice instead and to say "While I am free to smoke, I choose not to" to avoid this sense of deprivation, and this worked for me.

JeffreyAK

Steven, this is not correct in a general sense, though I'm sure it's true for *some* drinkers. I experienced it first-hand, about a month after I quit drinking, when I inadvertently tasted (just a taste) some champagne-based oyster dip and was served up with an instant strong and inexplicable craving. I experienced it again, much worse, about 6 months after I quit drinking, when I inadvertently sniffed (just sniffed) some alcohol-based hand santizer, and was served up with the mother of all cravings that left me utterly shaken. All I could think about, for maybe 5 seconds, was the urge to go buy a bottle of booze and get drunk.

Surely you do not deny these experiences, which many of us have had? But how can that objective reality be reconciled with the claim above, that suggests that cravings don't exist if you don't know what you're drinking/tasting/sniffing?

Carlotta

I posted earlier in this thread about those "animalistic" cravings which is way more than a thought or even some thoughts. I have experienced it myself only a few times but I can completely relate to what you are saying.

It's like getting hit with a ton of bricks, you just can feel it and taste it and you just WANT. Thankfully, like you noted, it passes fairly fast.

andyh

I don't think that's the point being made Jeffrey. the instances you cite were where you *were* aware you had consumed or been exposed to alcohol, even if it was just a taste or a smell.

my reading of what Steven is saying is that when alcohol was consumed *without the awareness of the drinker*, no craving resulted. I'm sure we all consume small quantities of alcohol without realizing it - in bread for example - without an urge being triggered.

StevenSlate

I'm not gonna deny you've had that experience. By your own admission though, it didn't send you drinking and it passed quickly. But even if it hadn't I don't think it serves as proof that you have a disease/allergy that makes this happen. It could just as well be seen as a learned response, and what is learned can often be unlearned. I'll also note that in many of the experiments I'm referring to regarding alcohol, the subjects weren't mild "alcoholics", they were extreme "alcoholics" who were repeatedly arrested for public drunkenness.

There were also iterations of these experiments where "alcoholics" were told a drink contained alcohol when it didn't, and proceeded to crave and drink more even though no alcohol was present in the cocktail. What all of this generated is the insight that the craving response is a highly cognitive thing. If you recognize a presence of alcohol, it can set off a response that you've learned to have to alcohol.

JeffreyAK

Steven, considering I didn't know there was alcohol in either the dip I was tasting, or the goo I was sniffing, this makes no sense. There's an objective reality here that many of us, including it sounds like Carlotta, have experienced that I think ought to be folded into your theories. That does not invalidate the experiences of those who have never had these kind of surprise cravings, but it does invalidate any claims that they don't exist, and might suggest that a more complete theory is needed.

JeffreyAK

Oh, forgot to add the follow-up story. About a year after my goo-sniffing incident, I very deliberately sniffed a bottle of the same hand sanitizer just to see what would happen, knowing based on the previous year and half's experience, it was not going to drive me to drink no matter what happened.

The result was interesting: Nothing. It very obviously smelled like strong booze, but there was no craving at all. So clearly there was some physical sensitivity, an allergy if you like, that subsided over time with continued abstinence. Perhaps there are other ways to make it subside, or subside faster, but that was my experience, and it was night and day: Intense gut-knotting craving, vs. nothing.

StevenSlate

It is folded into my theory (which isn't even my original theory - it goes back to researchers like Nick Heather) - the craving is explained as cognitive. I think you did recognize that there was alcohol contained in those items, even if you didn't think "there's alcohol in this" right away. It's like when food is served to me with a mayonnaise-based sauce (I can't stand mayo, even though I eat all of its base ingredients in other foods). My first reaction upon biting into a sandwich with a mayo-based sauce is complete and utter disgust and then to spit the food out - then think and ask "is there mayo in this?"

I'll leave the issue here, and reiterate the bigger point, which is that you still didn't "lose control."

Carlotta

This is my personal take on cravings and such, I think that there is definitely some kind of brain chemistry at work and that different people get affected differently not only because of their thought process and psychological make up but also because of their biology.

I have experienced some animalistic want (for no better words) but as a drinker, I could abstain or have at most one or 2 at parties then start obsessing and cut out early so I could drink heavily alone without outside restriction (which I guess is more of an happiness/thought process as described in Steve's book). I was able to defer instant gratification so I could "really" drink later alone.

I have also known many alcoholics who once they had the first one or even a taste would just be off to the races without delay.
My XABF was that way and I actually made the mistake to try to come between an alcoholic and his booze when he was in "Mr Hyde" mode. Very bad idea.
The minute he would take the first sip, it was like a switch was pulled, his face and body language would change and there was no stopping him (or him stopping) till it was all gone and he had passed out.

Sadly, he was never able to remain abstinent and ended up committing suicide. Part of him wanted to quit, part of him did not/could not and he was miserable whether he was sober or not. >sigh<

Anyway, I like seeing different and new methods being discussed even if I don't always click and relate to some of it. It might just be the thing which will make sense to someone who is struggling and give them the tools to free themselves from addiction.

Carlotta

One thing I wanted to add, I saw your video on FB about how the thought of negative consequences etc... does not work and I must admit that it made some sense to me as a friend and family member (much more than as a sober alcoholic myself for some reason).
He knew that if got violent when he drank and that eventually I would call the cops and throw him out yet he still chose to overlook the upcoming negative consequences.
Same goes when people in sober house who know they are going to be breathalized and put out still chose to go and pick up the first one.

andyh

I just watched your TEDx talk & liked it a lot, so here's a link in case anyone else wants to see it:

fini

Aleric,
Ja, i never thought" i really wantto be abstinent", but i sure thought "i so wantthis **** out of my life" and ' i want to be sober more than anything".
you may find it odd, but the thought of wanting to be happy never entered into it.
you can and might now argue or suggest or ask why i would want to be sober if i didn't ultimately expect it to make me happier than i was....but really, that is a circular argument going nowhere.

happiness has never been my number one goal, not in quitting nor now, years later.
so no, we don't rather all just think one thing.