Richard's drinking started in high school and accelerated through college. Alcohol made him feel comfortable, relaxed, more sociable. At age 33, he could down 10 to 20 drinks a night.
Sometimes he couldn't recall events the next day.
Four months ago, the Wilton Manors, Fla., man, who asked not to be identified by last name, stopped cold turkey.
Realizing he had a problem, but not wanting to give up alcohol forever ("I enjoy entertaining, I enjoy cooking, I enjoy a glass of fine wine"), he began to research the notion of a heavy drinker ratcheting down to a moderate level.
Richard discovered a handful of books affirming the concept, including Audrey Kishline's "Moderate Drinking" (Crown Trade Paperbacks, 1994, $14). But he could find no local support group advocating anything other than total abstinence. So this month, Richard launched a chapter of Moderation Management, a self-help program conceived by Ms. Kishline, an Ann Arbor, Mich., housewife.
In two years, 60 MM chapters have formed around the country.
Moderation Management is based on the premise that not all problem drinkers are alcoholics, and that with will and insight, a problem drinker can learn control. Its four main themes are: moderation, balance, self-control and personal responsibility.
Less than two months after reading Ms. Kishline's book, Richard was back to drinking. But he's drinking far less and enjoying it more.
So is Ray, a Pompano Beach, Fla., businessman who never considered the three, four or more scotches he put away each night a problem. But when he found himself repeatedly arguing with his wife about his drinking, it was time, he figured, "to do something about it."
He checked out Alcoholics Anonymous, and came away discouraged.
"Listening to the people in that room," he says, "I knew definitely this was not me." He could not identify with their problems or their lives. "These people had lost families, they'd lost friends, they'd lost their houses. One guy had been homeless. Some of them had serious drug problems."
He also was not comfortable with the spiritual element of AA, or the idea that only a power larger than himself could resolve his problem.
There had to be another way, he thought.
He remembered hearing of a program that did not demand abstinence. He did a search on the Internet, found information on Moderation Management (which now has its own home page at http://comnet.org/mm/), bought Ms. Kishline's book and in two days read it.
"The third day was the first day of my 30 days of not drinking," says the 37-year-old father of two. Thirty days of abstinence is the second step in MM's nine-step program. The timeout is designed to lower tolerance to alcohol, as well as encourage drinkers to establish new priorities and work on neglected life skills.
Like Richard, Ray contacted Ms. Kishline with the idea of starting a local MM chapter. He found that a clinical social worker, Deborah Hanna of Boca Raton, Fla., had beat him to it. Her fledgling group draws two to nine people to its monthly meetings.
Ray, who now helps lead the Boca meetings, still hoists a drink or two, but not every night, and not more than four in a single day, and never more than 14 in a week. The limits for women are no more than three drinks a day, no more than nine per week.
Ray broke his habit and, in the free time he has gained, taken up gardening.
Ms. Kishline's followers are quick to point out that Moderation Management is not for everyone. Ms. Kishline makes a distinction between the chronic drinker, who is physically dependent, and the problem drinker, who has a bad habit.
Alcoholics, chronic drinkers or anyone who experiences significant withdrawal symptoms when they stop drinking are not candidates for the program, Ms. Kishline says. "Nor is MM for former dependent drinkers who are now abstaining."
And drinkers who imbibe solely for the purpose of getting drunk will not benefit from the program.
Actually, Ms. Kishline says, the MM program is a first step for the 30 percent of her membership that goes on to the more intensive abstinence-based programs. (Ms.
While hers is the first free, widely available, lay-person support group aimed at moderation, Ms. Kishline admits the concept did not begin with her.
"Moderation as an early intervention alternative has been recognized in other countries for years," she says, speaking from her office in Ann Arbor. "But in our country, we've been so centered on the disease model and AA, we haven't really looked at anything else."
The theory offered by Ms. Kishline, who herself was labeled alcoholic, is that excessive drinking is a learned behavior that can be changed.
"It does not make sense," she writes, "to take every conceivable bad habit, tack on an 'ism' and call it a disease."
She regrets the years she spent in traditional treatment when she was diagnosed as alcoholic 10 years ago.
"I sought help through the traditional 30-day treatment programs," she says. First came hospitalization, then AA, which she was told she'd have to remain in "for the rest of my life." She also was told if alcohol ever passed her lips again, she'd be doomed to total relapse.
Lumping problem drinkers with bona-fide alcoholics discourages many drinkers "who know their problems are not that severe" from seeking help, Ms. Kishline says.
Just the fact of being identified alcoholic can have negative consequences.
"The alcoholic label can make it impossible for you to get medical or life insurance," writes Ms. Kishline. "It can ruin your chances for a job promotion. It colors how people think of you. And once you are labeled, it stays with you forever."
In MM, drinkers are helped to understand why they drink excessively. They then are encouraged to find other means of having fun, or relaxing, or coping with anger, loneliness, boredom or frustration.
The idea that the non-dependent drinker is capable of recognizing risky drinking and making healthy changes is slowly gaining ground, despite an existing bias favoring abstinence programs.
Two years ago, the University of Michigan Medical Center at Ann Arbor introduced DrinkWise, a program that has been in use in Canada for about six years. The service is available nationwide via telephone, (800) 222-5145.
The success rate is high, near 70 percent for those who complete the program, says counselor Nancy Maxwell. After completion of the two-month program, "about 80 percent choose moderation, another 20 percent choose abstinence," she says.
What is being taught, says Mark Sobell, a psychologist, is really nothing more than the natural recovery skills practiced successfully by many individuals on their own, without benefit of experts, therapists or structured groups.
Still, the concept is controversial.
"It's a dangerous idea," says Paul Wood, president of the National Council on Alcoholism and Drug Dependence in New York City. The diagnostic tools do not exist, he says, to separate the chronic alcoholic from the problem drinker.
"We say if you're at the point where you are having trouble, that alcohol is causing problems in your life, then don't take the risk. Be safe. You don't need alcohol for anything. Why not stop using it and be safe?"