Moderation vs abstinence

I had a conversation in a pub car park in Newtown about three years ago with a friend who had decided he was going to "moderate". Two drinks on Friday. Two on Saturday. Nothing in the week. He said the plan with the calm certainty of a man who had drawn the diagram in his head and found it elegant. I nodded, because I had had the same plan two years earlier, and the same calm certainty, and the same diagram. Eighteen months later he was back to a bottle of red most nights. The diagram had not held.

This is the moderation question, which is the question every regular drinker eventually arrives at, and which almost nobody answers honestly the first time. The honest answer, for most heavy or regular drinkers, is that moderation is harder than abstinence, not easier. It is the path of more friction, not less. The reason men reach for it is that it sounds like the reasonable middle ground, and the reasonable middle ground is what we are trained to reach for. In this domain, the middle ground is the part of the road that is hardest to walk.

I want to make the actual case here, not the rhetorical one.

The "two drinks tonight" rule that becomes five

The diagram in your head says two drinks. The reality of any given Friday is that you arrive home tired, you have a glass of wine while you cook, you have another with dinner, you sit down to watch something, and now it is nine p.m. and the bottle has a quarter left in it and finishing it makes more sense than putting a stopper in for one glass. That is four drinks. The phone call from a mate at nine forty-five about a thing at work pushes it to five.

This is not a failure of willpower. It is the geometry of the evening. The decision to have the second drink is a different decision than the decision to start drinking. The decision to have the third is different again. By the time you are deciding whether to have the fourth, you have lost about thirty per cent of your prefrontal capacity to the first three, which is the part of you that was supposed to be enforcing the rule.

The rule was made by the morning version of you. The decisions are made by the evening version. The evening version is drunker than the morning version expected. The diagram does not survive the evening because the diagram does not have alcohol in it.

Abstinence has none of this. There is one decision, made in the morning, and it stays made all evening, because there is no evening drinking-self to renegotiate it.

The white-knuckle decision-fatigue

Moderation requires you to make a drinking-related decision multiple times a week. Tonight, how much. Tomorrow, whether at all. Saturday, whether two is enough. Whether to have one with lunch. Whether to have the second beer at the barbecue. Each of these is a small decision. Each costs a small amount of willpower. By Sunday, you have spent more decision-energy on alcohol than on anything else, and you are tired in a way you cannot explain to your partner.

This is the part of moderation that the diagram does not show. The diagram shows the outcome. It does not show the cost. The cost is paid in the currency of attention, and attention is the most expensive thing a man over forty has.

Abstinence collapses all of this into one decision. Made once. Held. The decision is harder in week one and easier every week after. By week eight, it is not really a decision any more. It is just what you do.

This is counter-intuitive. It is also robust across most of the men I know who have tried both. Almost every one of them found abstinence less effortful than moderation, not more, after the first three weeks. The first three weeks are real. After that, the diagrams flip.

The data on attempts

The research is not closed but the direction is clear. Men who attempt moderation after a long history of regular or heavy drinking relapse to baseline at higher rates than men who attempt abstinence over the same period. The numbers vary by study. The shape does not.

A reasonable summary, drawing on the Australian and UK clinical literature, is that something like sixty to seventy per cent of moderators relapse to baseline within eighteen months, while the equivalent figure for abstainers, with proper support, is closer to forty to fifty per cent. Both are hard. Abstinence is meaningfully less hard.

This is unintuitive because the moderator's task sounds easier. Two drinks is easier than zero drinks, in the simple counting sense. The reason it does not work that way is that the human brain is bad at "two" and good at "zero". Two is a quantity that requires monitoring. Zero is a category that requires no monitoring. The cognitive cost of monitoring is what eats the moderator alive.

When moderation does work

Moderation is not a fool's errand. It works for some men, reliably, over years. The men I know for whom it has worked share a profile, and it is worth being honest about what the profile actually is.

• Light drinker historically, never above ten standard drinks a week even at peak
• No underlying mental-health element, no anxiety driving the drinking, no depression underneath
• No family history of alcohol problems on either side
• The drinking has never caused a real consequence, no missed work, no hurt relationship, no lost evening they cannot account for
• They can already, today, drink two drinks and stop, on a normal Tuesday, without thinking about it

If all five are true, moderation is a reasonable strategy and probably the right one. If any one of them is not true, moderation will probably not hold, and the eighteen months of trying will end where it started, with the additional cost of eighteen months of decision-fatigue.

The honest test is the fifth point. Can you, today, on a normal Tuesday with no special occasion, open one beer, drink it, put the second one back in the fridge unopened, and not think about it again for the rest of the night. Not "could you with effort". Could you without effort. If the answer is no, moderation is not your tool. If the answer is yes, you may not have a moderation problem to solve.

The honest test, the harder version

There is a second version of the honest test, which is the one men avoid, and which is more useful.

Try abstinence first, for ninety days. Not as a permanent commitment. As a calibration. At the end of ninety days, you will know two things you cannot know now. You will know what your life looks like with no alcohol in it. You will know whether you can comfortably go ninety days without drinking, which is itself information about the relationship.

If you can do ninety days without distress, moderation is more available to you than you thought. You can return at day ninety-one with a much clearer view of what you actually want from drinking, and the return drink will tell you a lot. Most men who do this find that the return drink is smaller than they expected and that the urge to repeat it tomorrow is also smaller. Some find the opposite, and that finding is also useful.

If you cannot do ninety days, you have your answer. Moderation was never going to hold for you, because the relationship is closer than moderation can manage. The ninety-day test is the diagnostic that the moderation diagram skips.

This is the test I should have run before the pub car park conversation. I did not. My friend did not. We both arrived at abstinence eventually, by the long road, after the moderation diagram had failed. The ninety-day test would have got us to the answer sooner.

The unfashionable conclusion

The reasonable middle ground, in this domain, is the part of the road that is hardest to walk. The two ends are easier than the middle. Drinking openly and freely is easier than monitored moderation. So is abstaining. The middle is the place where you pay the most decision-cost for the least benefit.

Most men reaching for moderation are reaching for it because abstinence sounds extreme and they are not extreme men. The trick is that the labels are wrong. Abstinence is not extreme. It is structural. It is the version of the choice that asks for one decision and then leaves you alone. Moderation is the version that asks every Friday at six p.m. and again at seven and again at eight. Which of those sounds extreme depends on which one you have actually tried.

The ninety-day test is FREE. You have nothing to lose except a fortnight of bad sleep and a few awkward dinners. You have a clearer answer to gain than any amount of thinking will give you.

Run the test. Read the answer. Decide from there.