Researchers: Offering an alternative to strict sobriety could entice more to rehab

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Alex knew he was drinking too much — about a pint of vodka a day. After developing pancreatitis, he decided it was time to get help.  But the traditional 12-step, Alcoholics Anonymous approach that's dominant in the rehab field didn't appeal to him.

“It’s kind of an all-or-nothing approach, avoiding people, places and things that revolve around alcohol," he says, sitting in his Hollywood loft. "And realistically, in the world we live in, that’s not a great life.”

What finally got him into treatment was finding Alternatives Behavioral Health on Robertson Boulevard, one of a few handfuls — amidst the thousands of rehab facilities in the United States — that don't require complete sobriety as a goal for those addicted to drugs and alcohol. 

A model for moderation

He's not alone in his reluctance. A recent study from the Pew Charitable Trusts found that about 21 million Americans had  a drug or alcohol addiction in 2013 and only about 18 percent engaged in rehab.

Psychologist Adi Jaffe, who's also a lecturer at UCLA, says he founded the place after years of studying what prevents people from seeking help. 

"Part of the reason people don't seek treatment is because of the dogmatic notion that if you struggle with alcohol, the only solution available to you is a lifetime of abstinence," he says. "For some people it's just too big of a hurdle as the entryway into treatment."

Jaffe will take clients who struggle with any type of drug problem, so long as they don't require medical detox. Someone can come in seeking help with a heroin problem, but not want to ultimately give up alcohol or marijuana. 

After a period of complete sobriety, and lots of therapy, Jaffe will try out moderation with them if that's their goal.

"Whether alcohol is a part of the rest of your life or not is a secondary question — the real question is how do we get you a life that you like," he says.

Researchers are increasingly interested in the moderation approach. A recent Stanford University paper concluded that moderation management — a secular, moderation-friendly support group that Jaffe mimics in his clinic — is effective at getting to people who wouldn't otherwise seek help. But addiction professionals are also skeptical moderation is an achievable goal for serious addicts. 

"It’s risky, for most people," says Emily Feinstein, policy director at Columbia University's Center on Addiction and Substance Abuse. "I think it really only makes sense for people who don’t have a substance abuse disorder. But that said, you have to allow for variety and people are trying all kinds of different things all over the country."

Addiction is different for everyone and requires a tailored treatment plan, she says. In the meantime, if moderation gets more people in the door, then "great, anything that gets people into treatment eventually is fantastic," she says. 

"We need a tool that's a validated that will help us measure yes, this person is a good candidate for this type of intervention," says Christine Grella, professor of psychiatry and biobehavioral sciences at UCLA's Integrated Substance Abuse Programs.

There's not enough research to determine how effective the moderation approach is and who it's good for, she says. 

Could moderation work for heavy substance abusers?

(Caption: "Part of the reason people don't seek treatment is because of the dogmatic notion that if you struggle with alcohol, the only solution available to you is a lifetime of abstinence," said Dr. Adi Jaffe. Photo by Maya Sugarman/ KPCC)

Jaffe says he hasn't yet seen a correlation in his patients between the level of a person's substance intake and their ability to eventually moderate. 

"This absolutely is not a good fit for everyone," he says. But it might be for a lot of people. 

Take the example of a good number of college students.

"Every single week they binge drink, they black out, they get in fights, they have risky sex," Jaffe says. "By criteria of the DSM, they would at least be moderate alcohol disorder clients."

But the vast majority of these people grow up to have an okay relationship with alcohol.

"Why is it such a leap to think that somebody who you don’t think fits into that category might have the same exact experience — even if crack cocaine was something that they had experienced because that was what was prevalent in their neighborhood," Jaffe says.

They shouldn't be doing crack, he says. But that doesn't mean they should automatically be told they can never drink or smoke pot because it'll send them down a spiral back to crack. 

Jaffe himself had a meth problem, got arrested for it, and dabbled in total sobriety. Now, he has four to seven drinks a week. 

Alex, who's drinking was fairly severe, says he's doing well on moderation, about five months into the experiment. He doesn't keep hard liquor in the house, but he didn't cancel his wine club subscription, and is planing on wine tasting in Napa with his family. 

"I feel pretty solid with my feet planted firmly beneath me," he says. "But ‘cure’ implies finality to  it, and it’s always going to be an ongoing process.”

For now at least, he's happy to have a glass or two of wine with a nice dinner — and then put the bottle away.

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