“ Thinking Out of the Box ” : Clinical and Practical Aspects of Moderate Drinking Strategies

1. “Thinking Out of the Box”:Clinical and Practical Aspects of Moderate Drinking Strategies Arnold M. Washton, Ph.D. & Scott Stern, LCSW, CADAC RECOVERY OPTIONS New York, NY & Princeton, NJ

2. Topics • Prefatory remarks • Why moderation? • How to enhance treatment attraction, engagement, retention • Alcohol’s effects • How much drinking is “too much”? • Research on moderation • Clinical assessment & goal selection • Moderation strategies & skills

3. To download copies of todays’ slides: • www.ModerateDrinkingOptions.com • Downloads & Links page • NASW Conference: “Moderate Drinking Strategies”

4. Some Helpful Resources

5. Websites • Niaaa.nih.gov • Moderation.org • ModerateDrinking.com • SmartRecovery.org • RecoveryOptions.us • ModerateDrinkingOptions.com

6. www.niaaa.nih.gov

7. www.niaaa.nih.gov/publications 7

8. Arnold M. Washton, Ph.D. Joan E. Zweben, Ph.D. Guilford, 2006

9. How I arrived at using moderate drinking strategies in my clinical practice • In 1975, started treating IV heroin addicts in an East Harlem clinic. Most continued drinking after stopping heroin. • Starting in early 1980s, started treating cocaine addicts who often did not want to stop drinking except after multiple alcohol-related relapses • Since the beginning, treated countless primary alcoholics who did not want to start with abstinence. Many refused treatment or dropped out prematurely.

10. How I got here • Regrettably, I too often took the stance of “come back when you’re motivated and ready to stop” • For past 10+ years, I’ve offered moderation training as an initial engagement strategy for patients with serious alcohol problems and as a primary treatment strategy for many with less severe problems • Since closing my outpatient clinic in 1998, I’ve been in full time private practice treating high-functioning adults with alcohol and drug problems

11. How I got here • Private practice affords me the flexibility to treat patients without being constrained by agency policies and politics • Patients seeking help with moderation or abstinence often find me through my website moderatedrinkingoptions.com and recoveryoptions.us

12. How I got here • Entering the field as a psychologist trained in both cognitive-behavioral and psychodynamic therapies, I gravitated naturally toward more individualized, integrative, non-dogmatic approaches • I place great value on establishing a good working therapeutic relationship with my patients, seeing this as the primary vehicle for facilitating positive change

13. Prefatory Statement • Total abstinence is without question the safest goal for anyone who has developed an alcohol problem • This is especially true for anyone who has developed a serious problem that qualifies for (or approximates) a diagnosis of Alcohol Dependence • Moderate drinking is generally NOT a realistic or appropriate goal for alcoholics

14. Prefatory Statement I am not here as a proponent of any singular approach, philosophy, model, or program: • Harm Reduction • Moderation Management • Disease Model • 12-Step • CBT/Social Learning • Psychodynamic (Self-Medication)

15. Prefatory Statement • I support and utilize any and ALL of these, depending on what makes the most sense for a given patient and most importantly what seems to work best!