Moderate-drinking training

Domain II · Behavioural & cognitive · Miller, Muñoz

What it is

Behavioural self-control training (BSCT), also called moderation training or controlled drinking, teaches problem drinkers to reduce alcohol use to a low-risk level rather than abstain. Miller adapted it from behavioural self-control methods used for weight and eating problems, as an early…

Format

• BSCT is a structured, manual-based skills programme rather than a phased psychotherapy. The phases below follow the book's parts; session counts are a fitted to the documented formats.

Who practises it, and how they are trained or regulated

• Behavioural self-control training (BSCT), also called moderation training or controlled drinking, teaches problem drinkers to reduce alcohol use to a low-risk level rather than abstain. Miller adapted it from behavioural self-control methods used for weight and eating problems, as an early intervention for heavy drinkers who would not seek treatment until problems worsened. Its theory of change is operant and…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• an anxiety disorder needing its own treatment.
• rewards never delivered; rewards that involve drinking settings.
• practice only when calm; transfer to the actual trigger time is what matters.
• apologetic or over-explained refusals; social anxiety under the surface (4.21, 4.22).
• the therapist arguing for change (invites push-back); keep the client voicing reasons.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.