License to Drink

Six years ago, Audrey Kishline wrote the book on Moderation Management. Moderate Drinking: The New Option for Problem Drinkers set guidelines so that people with alcohol problems could continue drinking--as long as they were careful.

Kishline wasn't. Last March, two months after she left the program she founded saying that it wasn't working for her, she drove the wrong way on a Washington State highway and smashed her pickup truck into a two-door Dodge, killing a man and his 12-year-old daughter. State troopers found Kishline unconscious, with a half-empty bottle of vodka by her side. Her blood-alcohol level was 0.26, more than three times the legal limit.

Kishline's devastating meltdown has reignited debate, and outrage, over an already controversial treatment approach. Moderation Management, which has volunteer chapters in 14 states, allows a weekly quota of nine drinks for women and 14 for men. Designed for mild-to-moderate problem drinkers, the program consists of meetings similar to those of Alcoholics Anonymous, but it has fewer rules. Participants are usually encouraged to keep a journal documenting their drinking and to limit and pace their intake of alcohol. Understandably, and perhaps wisely, since she faces sentencing next month for vehicular homicide, Kishline is now a sharp critic of the movement, dismissing it through her lawyer as a "program for alcoholics covering up their own alcoholism."

She has plenty of company. The Smithers Addiction Treatment and Research Center in New York City, renowned for its attempts to treat the likes of Truman Capote and, more recently, Darryl Strawberry, edged out its director after he spoke out in favor of managed moderation. Center officials issued a statement reaffirming their commitment to abstinence as the only viable treatment.

"There isn't an alcoholic around who doesn't wish he could drink moderately," says Dr. Ernest Noble, director of UCLA's Alcohol Research Center. He adds that similar attempts at moderation, such as Controlled Drinking, Drink Watchers and Rational Recovery, have a long history of failure. Dr. Nicholas Pace, co-founder of the Alcoholism Council of New York, agrees that such experiments are doomed because alcoholism, as abstinence advocates have drummed into the public's consciousness, is a disease. People who drink heavily over a long period of time permanently alter their livers, which means that they can no longer metabolize alcohol normally in the event that they do resume drinking. "The disease is progressive," says Pace. "If you put people on an island and give them alcohol every day, they will become alcoholics."

Proponents of moderation counter that not all problem drinkers are alcoholics, and that the abstinence-only crowd makes the mistake of lumping everyone into the same category. Marc Kern, director of the Los Angeles-based Addiction Alternatives, accuses "A.A. nudniks of acting like fundamentalists" in their insistence on abstinence. He believes their all-or-nothing approach can backfire and turn off problem drinkers who may need a less drastic form of help. "It's not a black-and-white issue," says Kern.

Carl, 40, who has attended moderation meetings in Manhattan for the past three years, believes he falls into that gray area. Though his family convinced him that he was drinking too much, he didn't think A.A. was right for him. "I'll always have to watch myself," he concedes, noting that he abides by the 14-drink weekly limit. He adds, "This program offers better tools than A.A."

Despite his testimonial, there is no evidence to support that moderation works--or, for that matter, doesn't work. Medical studies have consistently shown that abstinence for alcoholics can lead to improved health and a longer life-span. But those findings don't address the crux of the matter: Are all problem drinkers alcoholics? Related to that is another question: Are problem drinkers more likely to fail at moderation or abstinence?

"Alcoholics in recovery have tried moderation," says Adele Smithers-Forcani, whose late husband founded the Smithers center. "Kishline's tragedy shows [such attempts] don't work." On Aug. 11, at her sentencing, Kishline will probably be sent to jail for up to 54 months. According to her lawyer, Kishline may spend her time behind bars writing a sequel to her first book. This one will stress that moderation is not an option.