Moderation management is another strategy for the treatment of alcohol abuse that has a following, but it is viewed with skepticism by many addiction professionals, and I am among them. The idea behind moderation management is that alcoholics can learn to drink socially if given enough support and input. The problem I have with this approach is that it flies in the face of what we know scientifically about addiction and the changes that occur in the brain. People who have been successful in moderation management programs may be people who were abusing alcohol, but did not develop actual addiction.

Most addiction treatment centers introduce patients to the concepts of 12-step recovery and include AA or NA meetings in their schedules. But anyone can go to an AA meeting.

According to the AA preamble, “the only requirement for membership is a desire to stop drinking.” Closed meetings are for alcoholics or addicts only. Open meetings, which often feature a speaker, are open to family members or other interested individuals as well.

Anonymity, or confidentiality, is stressed in 12-step groups.

The opening announcements often include this directive: “Who you see here, what you hear here, when you leave here, let it stay here.” Only first names are used, and people are encouraged to drop the usual social barriers; a lawyer might be sitting next to a pipe fitter who is sitting next to a society matron, and so on.

Several varieties of 12-step meetings exist: speaker meetings, when one or two members relate their stories, discussion meetings, which involve the entire group and usually center on a topic, and step study and Big Book meetings, where detailed study of the 12 steps and other related material is undertaken.

These are not “group therapy” sessions. Highly personal issues are generally not discussed, and “cross talk” - one member addressing another - is frowned upon. Members are encouraged to talk about their own experiences with recovery and share their “experience, strength and hope.”

A good 12-step meeting has a warm and accepting atmosphere. Most addicts have had problems with social anxiety, and the fear of being confronted or shamed keeps many people away from these meetings. Recovering people know this, and will usually go out of their way to welcome newcomers and help them feel comfortable.

When you start out in 12-step recovery, it is suggested that you choose someone as a sponsor. A sponsor is another person in recovery who helps with working the steps and dealing with more personal problems on a one-to-one basis.

A sponsor should be someone of the same sex who has had several years of good recovery. At first, you can request telephone numbers of people available as temporary sponsors or phone contacts and take time to get to know the group before choosing a sponsor.

When you’re starting out in 12-step recovery, it’s also a good idea to check out a number of different meetings. Meetings have different atmospheres and personalities; it’s not a “one fits all” situation. Go several times to a meeting before you decide whether or not you like it. You might hit one on a bad night or a good night. You want to be familiar with what’s average for that meeting. Some people attend different meetings in different locations on different nights.

That way they have a chance to hear a variety of points of view. If you find a group that you like you can choose it as your “home group.”

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information