Is Moderate Drinking Possible for People With Alcohol Use Disorder?

People with alcohol use disorder who try to quit drinking often ask whether they have to stop consuming alcohol forever—or if they can learn to drink in moderation. Until recently, experts saw no room for social drinking or "just one." However, programs such as Moderation Management (MM) now allow for a certain level of controlled drinking and have helped many learn to drink safely. However, these programs are not meant for everyone.

Moderation Management Programs

Those who commit to an MM program must undergo a 30-day period of abstinence during which they learn strategies for identifying and controlling triggers, adopting healthy behaviors and activities to replace drinking, and managing moderate drinking in the future. Participants are asked to take a realistic look at their drinking patterns and reasons.

The MM approach has been found most successful for those who have a problem with drinking but do not meet the criteria and have not been diagnosed with moderate or severe alcohol use disorder.

Drawbacks of Moderating Drinking

Many people with alcohol use disorder who try moderate drinking realize that, for them, abstinence is the only option. Here are a few reasons why moderate drinking may not work for people with alcohol use disorder:

• They may experience withdrawal symptoms when trying to reduce alcohol intake.
• They tend to forget the downsides of drinking, such as hangovers, blackouts, upset stomach, and remorse.
• Once they start drinking, they often can't predict or control how much alcohol they end up consuming.

Withdrawal Symptoms

If you have an alcohol use disorder, you may experience a variety of withdrawal symptoms if you try to reduce or quit drinking, including:

Psychological

• Anxiety
• Bad dreams
• Depression
• Difficulty thinking clearly
• Fatigue
• Jumpiness or nervousness
• Irritability or becoming excited easily
• Insomnia
• Rapid emotional changes
• Shakiness

Physical

• Clammy skin
• Elevated blood pressure
• Hand tremors
• Headache
• Insomnia
• Loss of appetite
• Nausea and vomiting
• Paleness
• Rapid heart rate (palpitations)
• Sweating, especially on the palms of your hands or your face
  

Tips for Moderating Drinking

Small changes can make a big difference for someone whose alcohol use is problematic but hasn't risen to the level of official diagnosis, according to the National Institute on Alcohol Abuse and Alcoholism.

Track Your Intake

Whether you carry a physical card in your wallet or use your smartphone, track your drinks to get a better handle on your consumption. Similarly, make sure your drinks are standard sizes (12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits). This is easier to do at home, but you can try communicating your needs to the bartender or waiter.

Set Attainable Goals

Designate a few days as no-drinking days. Take some time to decide which days are OK to have a drink and which days are off-limits.

Inquire About Medication

The medication naltrexone (commonly sold under the brand names Revia, Depade, and Vivitrol) has been found to help people learn how to drink in moderation by blocking the pleasurable effects of alcohol. This reduces cravings for alcohol when used consistently (i.e., each and every time the person drinks).

In the Sinclair method, the participant takes Revia or Vivitrol one hour before drinking. These medications minimize the endorphin release in the brain that usually accompanies drinking. Because this makes drinking less pleasurable, people are less likely to crave alcohol.

Seek Healthy Alternatives

One of the best things about moderating your alcohol use is filling newfound time with fun hobbies and activities. By doing so, you may even identify triggers that cause you to drink—for example, certain social situations, stress from work, or even boredom. 

Plan Your “No” Script

Drinking in moderation means you’ll likely need to turn down a drink now and again. Planning exactly how you’ll say no—in a quick, polite, and convincing way—can make it easier for you to stick with your convictions and avoid a spiral of uncomfortable excuses.

Talk Through Urges (aka Urge Surfing)

Whether via self-talk or a conversation with a trusted friend, family member, or healthcare professional, it’s important to talk about your urges and remind yourself why you chose to moderate your drinking in the first place. Accepting, embracing, and then distracting yourself from these feelings in a healthy way will help you fight the urge to drink.

Replace Alcohol

Plan the non-alcoholic beverages you'll order or make instead of alcoholic versions. Enjoyable, non-alcoholic alternatives include virgin mojitos, kombucha, mocktails, and soda with fresh fruit or lime juice.

Try Other Relaxation Techniques

If you've been using alcohol as a way to unwind, try these healthful alternatives:

• Deep breathing
• Exercise
• Meditation
• Mindfulness
• Progressive muscle relaxation
• Outdoor activities
• Yoga