Moderation in Drugs: A Dangerous Road or Logical Harm Reduction?

moderation in drugs

moderation in drugs

 

Is moderation in drugs or alcohol even feasible if you have an addiction? It’s controversial, and the topic leaves people sharply divided. Most drug addiction treatment programs subscribe to the modality of total abstinence, meaning they abstain from all use of drugs and alcohol. The belief is that if you have addiction in your genes you are powerless against it, and unless you remain completely sober, you will eventually succumb to your addictive behavior. 

Total abstinence may be the best chance to prevent relapses for a person with a history of drug abuse, or alcohol abuse, but some people don’t like to subscribe to the idea that they are powerless. You may feel like a slave to your addiction, or like you will always be “an addict” if you can’t control yourself to have a drink occasionally in appropriate circumstances; some of these people may try to exercise restraint and practice moderation.

Moderation in drugs is a skill that involves great discipline, knowing when it’s okay to use, and knowing when to stop. Most people who struggle with addiction lack these skills, and for this reason, substance abuse treatment centers generally avoid this thinking and tell you to focus on long-term sobriety. 

 

Understanding Addiction Recovery

Before you can delve into moderation in drugs when someone is technically in addiction recovery, it’s important to understand how addiction works.

  • Addiction is a disease affecting the brain, body, and behavior. When someone first uses a substance, that’s ultimately a choice. Then, their brain develops a tolerance to the drug, affecting their brain’s reward centers.
  • When your brain feels like something is creating positive or pleasurable effects, it may compel you to keep seeking it out. That compulsion can develop into an addiction. Compulsive substance use of addiction is characterized by continued use, even when there are harmful consequences.
  • There are changes in the brain structure that cause intense cravings, changes in personality, alterations in movement, and other effects. Researchers have done brain imaging studies and found that the parts of the brain related to decision-making, learning, judgment, memory, and behavioral control are all affected by substance use.
  • The complexity of addiction as a psychological and medical condition highlights some of the reasons why it can be dangerous to consider moderation in drugs or alcohol if you’re in addiction recovery.
  • The majority of people who use drugs or alcohol don’t become addicted. However, some people are predisposed to addiction for one or more reasons, or their brain responds to the stimuli of drugs and alcohol differently. Someone with an actual addiction can have a triggered brain response, even when they think they’re using moderation or when that’s the plan.  

Some of the same symptoms medical professionals use to diagnose addiction address this topic. For example, one of the symptoms of addiction is using more of a substance than intended or being unable to stop using drugs or alcohol even when you try or want to. That lack of control and compulsive substance use makes moderation difficult if not impossible for many people with a substance use disorder.

 

Comparing Moderation in Drugs and Abstinence

  • Abstinence is a concept in addiction recovery where you avoid all substances. There is no gray area.

  • Moderation requires self-discipline and control, and you theoretically could practice moderation in drugs or drinking, meaning that you limit yourself.

There’s a term called Moderation Management or MM that may be interesting to some people. Moderation management is an approach that offers an alternative to the abstinence of 12-Step programs. Moderation management teaches problem drinkers more responsible habits so that their drinking doesn’t become compulsive. Moderation can work, possibly, but not for everyone. It typically won’t work for someone with a full-blown addiction. Instead, it might be a good option for someone whose use of drugs or alcohol is problematic and who wants to make a change without being abstinent.

Demi Lovato recently coined a phrase that garnered a lot of attention— “California sober.” After a nearly fatal overdose, many were surprised to hear her refer to herself with this term because there’s a pretty common opinion that sobriety has to be all or nothing. California sober can mean different things to different people, but the general idea is that someone in recovery might still drink occasionally or only use “soft drugs” like marijuana.

In some cases, controlled drinking or moderation in drugs is utilized to get to complete abstinence. This controlled drinking or drug use can be beneficial for someone resistant to the idea of treatment initially.

What About Using a Substance to Treat An Addiction To Another?

Sometimes, in addiction recovery, one substance is used to treat another substance addiction. 

  • For example, opioid addiction often uses prescription medications, that are explicitly approved to treat opioid use disorder (such as methadone, naloxone, and buprenorphine) to ease the dependence off of the opioid addiction 
  • With alcohol, someone might use naltrexone or disulfiram to treat withdrawal symptoms 
  • Nicotine addiction uses drugs like bupropion that can help with cravings

These medications can help reduce cravings and restore normal brain function. Some medication-assisted treatments also block the effects of substances on the brain and body.

This area of addiction treatment is controversial; the idea is somewhat in line with harm reduction principles. The ultimate goal of using medication-assisted treatment (MAT) is typically to help the person get off all substances, although it might be gradual.

 

Are There Benefits to Moderation?

For some people, there are genuine benefits to a moderation approach. It can be intimidating and overwhelming to stop drinking or using drugs suddenly; moderation may make quitting seem more manageable. Also, going back to the idea of harm reduction, any steps that a person can take to lower the risks and harms associated with substance use is a positive thing.

We’re learning more about the fact that not everyone who uses drugs or alcohol has an addiction, and there are many types of problems that exist on a spectrum. For some, that can mean that full-fledged abstinence isn’t needed.

 

Moderation vs. “True Addiction”

Recognizing the differences in problem substance use and addiction is very important when discussing the concept of moderation. Someone with a less severe problem may shy away from taking steps to help themselves because they fear abstinence. On the other hand, moderation is probably not a viable option for someone with an addiction to drugs or alcohol, and it may be dangerous.

There is something that tends to happen when someone completes treatment. They may begin to think they can exercise moderation in drugs or alcohol, leading to relapse. There’s a false sense of security or comfort, and that slippery slope quickly appears. With that in mind, someone who is most likely to benefit from moderation or be successful at a moderation approach could include:

  • A person with a shorter history of substance use
  • Someone without physical dependence on substances
  • An individual not experiencing severe life problems as a result of substances
  • A person without co-occurring medical or psychiatric problems

On the other hand, abstinence is likely a better choice if:

  • You’ve been diagnosed with a substance use disorder
  • You lose control when you use substances
  • You become violent or aggressive
  • There have been legal issues resulting from substance use
  • You have a mental health disorder made worse by drinking

The benefits of abstinence over moderation include:

  • Abstinence is the safest option. There’s no safe level of drug or alcohol use that eliminates all harm.
  • You can take on a new perspective with abstinence and see the actual effects of substances on your life and what it’s like to live without them.
  • You can learn how to control your emotions and process them without relying on substances.
  • You may discover voids in your life that you were filling with drugs or alcohol.

So, with all that being said, is moderation in drugs or alcohol an option in addiction recovery? For people who have a genuine, diagnosable addiction, moderation is probably not an option. For someone like Demi Lovato, who experienced a near-death overdose, the concept of “California sober” may be a hazardous one.

Whether you’re completely sober or plan on practicing moderation Anchored Tides Recovery can help equip you with the aftercare resources you need to be successful in your recovery goals, contact us today for more information.