Sobering Up: Alternatives to AA for Women

Alcoholics Anonymous is still the giant among alcohol recovery programs. But, turned off by its outmoded methods, many women are seeking alternatives. Here are some of their stories.

By Gabrielle Glaser
Also published in Reader's Digest Magazine March 2014

wine openerLevi Brown for Reader’s Digest
Donna Dierker, a neuroscientist in St. Louis, began drinking more in 2001 after having her first child. “If I had a bad day, alcohol was my reward after my son was in bed on Fridays or Saturdays,” she says. By the summer of 2002, that reward was a six-pack of beer followed by wine. While she tried scaling back on her own, she says, “drinking less turned out to be hard to do.”

Donna, now 51, got as far as reading AA’s 12 steps, but she was stopped by its demands: She didn’t think alcohol made her life unmanageable, she didn’t feel helpless against it, and she didn’t want to adhere to a lifetime of abstinence. “If you told me I could never drink again, that would be the only thing I thought about,” she says.

Donna read an article about Moderation Management (MM), a secular group founded in 1993 that, like AA, offers a program that starts with an alcohol-free period. But unlike AA, MM limits the ban to a month and doesn’t require that its members submit to a Higher Power to reach sobriety. Instead, it focuses on self-monitoring so that people can live better lives (which can include moderate amounts of alcohol). Its steps consist of commonsense exercises such as “write down your life priorities” and “take a look at how much, how often, and under what circumstances you drink.”

“MM taught me to pay attention to how each drink tasted and how I felt after it,” says the mother of two. Since 2008, she alternates one month of abstention with two months of moderate drinking (which MM defines for women as up to three drinks a day and no more than nine a week). “It works for me,” she says. “Drinking has become a treat again.”

“I like to drink,” says Jane, 54, who asked that her last name be withheld to protect her privacy. “I like the buzz.” Losing her job in 2008 led the Virginia businesswoman to seek comfort in alcohol. “I didn’t realize how much my identity was wrapped up in work. When I didn’t have it, I was lost,” she says. She liked to have a glass or two of wine at night to unwind, but over a year and a half, she switched from wine to vodka, polishing off up to a pint in a sitting.

Her turning point came when, she says, “I felt terrible all the time.” She was familiar with AA—some of her relatives were members—but its religious bent and insistence on powerlessness left her cold. “I saw my drinking as a choice,” she says. She went online to research alternatives and discovered HAMS (Harm Reduction, Abstinence, and Moderation Support), founded in 2007. The program’s orientation is more pragmatic and encouraging than MM’s. HAMS “recognizes recreational intoxication as a reality and seeks to reduce the harm associated with it,” according to its website, and it “does not force people to change in ways that they do not choose themselves.” Members name an objective—safer drinking, reduced drinking, or quitting—and craft a plan to get there.

Participating via chat rooms, Jane abstained from alcohol for the required 30-day period. It was a challenge, she says. “I had to learn to enjoy being in my own skin again.” She read books, cooked, and played her guitar.

After she reintroduced alcohol into her life, she followed the HAMS suggestions and took notes when she drank. When she reviewed the notes the next day, she saw that she felt good after the first and second drinks but worse after the third and fourth. And although alcohol brought pleasure, Jane realized it kept her from activities that truly made her happy: playing the guitar and reading. “I still have the occasional night when I go over my two-drink limit,” she says, “but it’s rare. I like having access to my brain.”

Fifteen years ago, Ashley Phillips, a 59-year-old women’s health educator and life coach in San Diego, hit a personal low—she was juggling two jobs, she and her husband had decided to divorce, and she was worried about being a single mom (the couple have one daughter). “I used wine as my anxiety reducer,” she says, imbibing more than a bottle a night. Her family held an intervention, and Ashley spent a month in rehab. She attended AA for two years as part of her outpatient treatment. But as someone who had devoted her career to supporting women, she was unsettled by its insistence that she submit her will to God (five of its 12 steps refer to God).

She looked for other options and read about SMART Recovery (Self-Management And Recovery Training), which was created in 1994 by mental-health professionals as a science-based recovery group that “teaches increasing self-reliance.” SMART has four strategies: building and maintaining motivation; coping with urges; managing thoughts, feelings, and behaviors; and living a balanced life. It urges people to use logic to examine their drinking. When an online facilitator gave her a cost-benefit analysis contrasting her drinking with her ideals, Ashley realized that her consumption didn’t make sense: “Seeing it in black-and-white, I could make healthy choices going forward.” (Since 2010, she’s been a SMART facilitator and counsels members.) “Now I can deal with stress and frustration without drinking,” she says.

There are many other AA alternatives. Rational Recovery helps alcohol abusers recognize their “addictive voice”; SOS (Secular Organizations for Sobriety) is a network of autonomous, science-based recovery groups.

Some women are modifying their drinking with pharmaceutical aid. Naltrexone, approved by the FDA in 1994 for addiction, blocks the release of endorphins, which create the “high” of drinking. (Naltrexone isn’t the same as disulfiram, or Antabuse, which makes people vomit when they consume alcohol but is not as effective, because people stop taking it when they want to drink.) Researchers theorize that when alcohol no longer produces feelings of well-being in a person, as with those who take naltrexone, she “unlearns” the habit of drinking. Since using the drug under a physician’s supervision in 2009, Los Angeles actress Claudia Christian, 48, reports she’s never had more than two drinks in a night. “I have a glass of wine, and the taste is enough to satisfy me,” she says.

Still, the vast majority of problem drinkers—male or female—never get assistance. So in some ways, it’s a positive sign that more women are seeking help today. Of course, women who’ve achieved success with AA or other 12-step approaches should continue. But those for whom it doesn’t work shouldn’t blame themselves for failing. When it comes to treating alcohol abuse, our society needs to acknowledge what so many studies have found: One size could not possibly fit all. “We have many tools now to help,” says Scott Stern, a New York City psychotherapist who works with clients who have drinking problems. “It’s tragic more women don’t know [about them].”

Additional reporting by Alyssa Jung

Gabrielle Glaser is a journalist who has written about women and health for the Wall Street Journal and the New York Times.