Moderation Management

1. Introduction

Version followed: MM's Nine Steps, Meeting Ground Rules, moderate-drinker profile and Limits as MM currently publishes them on its Meeting Materials page and its Moderate Drinking Guidelines page (moderation.org, October 2026; the guidelines page was last modified August 2026). In substance these match the 1999–2000 version set out by Rotgers & Kishline (International Journal of Self Help & Self Care), which summarises Kishline's guide Moderate Drinking: The Moderation Management Guide (1994); wording changes are noted in B11 and C1. MM now also offers a separate seven-step Guide to Moderation Management Steps of Change (undated PDF on moderation.org, uploaded 2020) and a 30-Day Kickstart course; the site does not say how the Steps of Change relate to the Nine Steps, so both are described (B1–B9 and B16). Verified on moderation.org: the Nine Steps, ground rules, opening and closing statements, limits, moderate-drinker profile, and the current route to becoming a meeting facilitator. Still unverified [uncertain]: the sharing format and length of current meetings, the content of the facilitator training course, MM's current position on professionals who are not members leading meetings, and the Hester et al. 2009 trial paper.

What it is. Moderation Management (MM) is a secular, peer-run mutual-help organisation, not a therapy a clinician delivers. Its current Opening Statement calls MM groups "not treatment or therapy" and welcomes anyone concerned about their drinking [source: MM Meeting Materials 2026]. Audrey Kishline founded it in 1994 in Ann Arbor, Michigan, and it was incorporated in 1995. Its stated audience in the founding literature is problem drinkers with mild to moderate alcohol-related problems who want to cut down, not necessarily quit [source: Rotgers & Kishline 2000; SAGE 2009; Lembke 2015]. One source dates the founding to 1993 (Faces & Voices of Recovery); most sources give 1994. MM's site now lists virtual meetings on an events calendar, some in-person meetings, online communities, month-long 30-Day Kickstart courses, a toolbox of 30 tools and a directory of "moderation-friendly" providers [source: MM Getting Started page; MM 2025 survey page]. Early online support was an email list and a chat room; the University of Pittsburgh directory also lists a web forum and a Facebook group [source: SAGE 2009; Pitt directory]. In MM's 2025 member survey (nearly 300 respondents), mean age was 56, about two-thirds were women, and about 10% had ended up abstaining [source: MM 2025 survey page]. MM explicitly supports members who choose abstinence and frames itself as a harm-reduction, early-intervention and prevention option [source: Rotgers & Kishline 2000; SAGE 2009].

How change happens, in MM's model. MM treats problem drinking as a learned habit rather than a permanent disease, so it can be unlearned through self-management. The method draws on cognitive-behavioural moderation training: Miller & Muñoz's behavioural self-control training and Sanchez-Craig's DrinkWise [source: SAGE 2009; Rotgers & Kishline 2000]. The sequence is:

• an initial alcohol-free period that lowers tolerance and lets the member observe their triggers;
• self-assessment and writing down life priorities;
• explicit drinking limits;
• self-monitoring;
• small weekly lifestyle changes toward "balance";
• peer support that runs alongside all of the above.

MM expects that some members will find moderation unworkable and move to abstinence. The authors estimated that up to a third do so, and called MM a "stepping stone" [source: Rotgers & Kishline 2000].

What this guide covers. It is written for a clinician who assesses whether MM fits a client, refers and prepares the client, uses MM's steps and tools within individual treatment, or helps start an MM meeting. MM's 1999–2000 literature allowed professionals to start or lead meetings, with control left to the participants [source: Rotgers & Kishline 2000; Wikipedia 2008 copy]. MM's current site describes meetings as facilitated by an experienced member and routes would-be facilitators through a volunteer form and a facilitator training course; the sources say nothing either way about professionals leading meetings [source: MM Getting Started page; MM Volunteer page; MM Facilitator Training page] [uncertain]. The parts that describe what the clinician does, as opposed to MM's own published practice, are marked [synthesis].

Context clinicians should know. In January 2000 Kishline announced on an MM email list that she had concluded abstinence was her own best goal. In March 2000, while intoxicated, she caused a wrong-way crash that killed two people [source: Wikipedia]. The episode does not change MM's published exclusion criteria. It does show why screening for dependence and agreeing in advance on a point at which to switch to abstinence are important (see sections 4 and 5) [synthesis].

2. Framework

MM has no clinical phases or session count. Its core structure is the Nine Steps, which still appear in MM's current meeting materials, used at the member's own pace alongside ongoing meetings [source: MM Meeting Materials 2026; Rotgers & Kishline 2000]. MM also offers a seven-step Steps of Change guide that orders similar tasks differently (B16). Below, the Nine Steps are grouped into the stages they imply, followed by the clinician's parallel tasks.

Stage A: Entry and learning (Step 1).

• Goal: attend meetings or online groups and learn the programme [source: MM Meeting Materials 2026].
• Format: in the 1999–2000 version, face-to-face meetings were typically weekly, about an hour long, anonymous and free, with a voluntary collection, and online groups ran continuously [source: Rotgers & Kishline 2000; Wikipedia 2008 copy]. Today most meetings are virtual, are facilitated by an experienced member and are listed on MM's events calendar; no fee is stated and the closing statement invites donations [source: MM Getting Started page; MM 2025 survey page; MM Meeting Materials 2026; Wikipedia]. Current meeting length and frequency are [uncertain].

Stage B: Alcohol-free period with self-assessment (Steps 2–6).

• Goal: 30 days without alcohol. MM's current Step 2 asks members to "Abstain from alcoholic beverages for 30 days" and to work through Steps 3–6 in that time [source: MM Meeting Materials 2026]:
  • Step 3: look at how drinking has affected their life;
  • Step 4: write down their life priorities;
  • Step 5: review how much, how often and in what circumstances they drank;
  • Step 6: learn MM's guidelines and limits.
• MM strongly recommended the 30 days but did not require them [source: Rotgers & Kishline 2000]. The SAGE entry describes the period as abstinence for "up to 30 days" [source: SAGE 2009]. The current Steps of Change guide recommends 30 days "or more", says shorter breaks are an option if a full month feels like too much, and suggests repeating a "30" yearly [source: MM Steps of Change guide]. MM also runs a guided 30-Day Kickstart course; its content is not drawn on [source: MM Getting Started page] [uncertain].
• Moving on: the member has finished the alcohol-free period and Steps 3–6. MM's groups help members who struggle to complete the 30 days develop new strategies; failing does not lead to exclusion [source: Rotgers & Kishline 2000].

Stage C: Moderation with limits and lifestyle change (Steps 7–8).

• Goal: set personal drinking limits within MM's ceilings, start weekly "small steps" toward balance in other areas of life, monitor drinking, then review progress and update goals [source: MM Meeting Materials 2026; Rotgers & Kishline 2000].
• Format: the member self-monitors, attends meetings and uses online tools. The current Steps of Change guide uses a drinking diary (B13) and points to ModerateDrinking.com, a subscription web program [source: MM Steps of Change guide]. MM earlier offered a self-monitoring program called Abstar [source: SAGE 2009]; it is not mentioned in the current materials. One study combined MM with the moderatedrinking.com web program [source: Hester et al. 2009, as reported by Wikipedia] [uncertain].

Stage D: Maintenance and giving back (Step 9).

• Goal: continue lifestyle changes, attend meetings when support is needed, and help newcomers [source: Rotgers & Kishline 2000].

Moving to abstinence (any stage).

• MM accepts moderation, abstinence and harm reduction as legitimate outcomes [source: Rotgers & Kishline 2000]. Its current Ground Rules welcome people who choose other paths if they are concerned about their drinking [source: MM Meeting Materials 2026].
• A member who cannot stay within the limits is advised to use AA or another abstinence-based programme [source: Faces & Voices of Recovery]. The current Steps of Change guide lists AA, SOS, SMART Recovery and Women for Sobriety for abstinence-oriented support [source: MM Steps of Change guide].
• People with a history of dependence or medical risk are encouraged to seriously consider abstinence, but MM will not turn them away [source: Rotgers & Kishline 2000]. The current Steps of Change guide uses a self-scored dependence questionnaire to point members toward abstinence or toward seeing a therapist (A1) [source: MM Steps of Change guide].

The clinician's parallel framework [synthesis]. MM has no clinician protocol; these steps are my own.

• (1) Assess fit using MM's own exclusions (section 4, "Assessing fit").
• (2) Hold one or two sessions to prepare the client, including medical clearance for stopping drinking.
• (3) During MM Steps 2–6, use weekly or fortnightly sessions to support the step work.
• (4) Agree a moderation trial with a review date, often 8–12 weeks after drinking resumes, and switching criteria written down in advance.
• (5) At review, continue moderating, move to abstinence, or step up care.

3. Guiding principles

MM's published principles and values [source: Rotgers & Kishline 2000; SAGE 2009]:

• Balance. A balanced life lowers the risk of substance problems. In practice, work on stress, the gap between "shoulds" and "wants", and alcohol-free sources of pleasure, not only on drink counts.
• Moderation in all areas. Moderation applies to eating, work and play as well as alcohol. In practice, the weekly "small steps" can target any part of life.
• Self-management, not powerlessness. MM uses an empowerment model. In practice, the member designs their own plan, and the clinician and the group advise rather than prescribe.
• Personal responsibility. The member controls how much, how fast and how long they drink, and must be honest with themselves. In practice, monitoring is self-report, so honesty is the core skill.
• Drinking as learned behaviour. In practice, lapses are information to analyse, not proof of disease.
• The individual chooses the goal. Neither the group nor anyone else chooses for them. In practice, offer moderation or abstinence as real options and respect the choice within safety limits.
• Early intervention. Address harmful drinking before problems become severe. In practice, MM is aimed at people whose problems are mild to moderate.
• Informed choice. Choices rest on education and peers' experience. In practice, give the client the limits, the BAC charts and the reasons behind them.
• Harm reduction. Reducing harm is worthwhile when eliminating risk is unrealistic. In practice, less drinking counts as a gain even if the target is not met.
• No coercion. People should not be forced to change. In practice, MM is a poor fit for clients mandated to attend [synthesis inference].
• Moderation as a step either way. Moderation can lead to stable moderation or to abstinence. In practice, a later move to abstinence is not failure.
• No punishment for missed goals. MM is "not anti-abstinence" or anti-AA, and it meets missed goals with open problem-solving. In practice, review lapses without blame.
• Core values: peer helping and the helper benefit. Helping others also helps the helper. In practice, encourage Step 9 service once the member is stable.
• Core values: self-esteem, respect and dignity. In practice, use non-shaming language and avoid labels such as "alcoholic" unless the client chooses them.

Principles for the clinician working alongside MM [synthesis]:

• Safety before goal choice. Screen for dependence, withdrawal risk, pregnancy, medical and psychiatric contraindications and drug use before endorsing moderation, because MM itself excludes these groups.
• MM is the client's, not yours. Don't run the group from therapy or demand reports on what others said in meetings, which are anonymous.
• Decide the exit criteria in advance. Agree specific signs that moderation isn't working while the client is sober and calm, not after a heavy-drinking episode.
• Use data, not impressions. Base reviews on drinking diaries or tracker data and BAC estimates.

4. Intervention inventory

This section has three parts. Part A covers the clinician's procedures for working with MM [synthesis unless tagged]. Part B covers MM's own steps and tools as the organisation publishes them; the clinician's role there is to support work the client does in MM. The Nine Steps (B1–B9), the moderate-drinker profile (B10) and the Limits (B11) were checked against MM's current Meeting Materials and Moderate Drinking Guidelines pages and match Rotgers & Kishline 2000 in substance [source: MM Meeting Materials 2026; Rotgers & Kishline 2000 unless tagged]. B16 adds MM's newer Steps of Change guide. Part C covers MM's group and online formats. MM's own materials, including assessment instruments, are paraphrased here and not reproduced.

A. Clinician procedures

A1. Assessing fit for MM

• Purpose: to decide whether a moderation goal and MM are appropriate, using MM's published exclusions as the minimum standard.
• When: before suggesting MM, and again whenever drinking escalates.
• MM's published exclusions [source: Rotgers & Kishline 2000]:
  • significant withdrawal symptoms on stopping;
  • physical or mental conditions that alcohol worsens even in moderation, including pregnancy;
  • serious dependence;
  • former dependent drinkers who are now abstinent;
  • minors;
  • illegal drug problems, which are outside MM's scope.
• Steps [synthesis]:
  1. Take a quantity-frequency history, recording standard drinks per drinking day, drinking days per week and the heaviest day in the last month.
  2. Use a validated screen, for example the AUDIT, and assess severity of alcohol use disorder against current diagnostic criteria.
  3. Ask about past or present withdrawal: shakes, sweats, morning drinking, seizures or delirium.
  4. Screen for pregnancy, liver disease and other medical conditions, medications that interact with alcohol, current psychiatric conditions (especially depression and suicidality), other drug use, drink-driving history and previous failed attempts at moderation.
  5. Classify the client:
     • (a) Fits MM: problems mild to moderate, no significant withdrawal, no contraindications.
     • (b) Moderation is high-risk: present this honestly, recommend abstinence, and if the client still chooses moderation, agree strict safety conditions and closer review.
     • (c) Outside MM's scope: refer to medical detoxification or treatment, or to an abstinence-based group.
• Example language (illustrative): "Before we look at cutting down, I need to check a few things that would make cutting down unsafe, rather than just harder."
• Watch for: under-reporting. Some clients prefer MM to avoid the word "alcoholic". MM itself says it is not for everyone [source: Faces & Voices of Recovery]. Version note: the exclusions above come from the 1999–2000 version; MM's current Opening Statement welcomes anyone concerned about their drinking and lists no exclusions. Its current Steps of Change guide instead has members score the Alcohol Dependence Questionnaire: a score of 20 or more points toward abstinence, and 16–19 toward seeing a therapist [source: MM Meeting Materials 2026; MM Steps of Change guide]. Treat that self-test as one input to your own assessment, not a substitute [synthesis].

A2. Preparing the client to attend

• Purpose: to make the first meeting or online contact likely to happen and useful.
• Steps [synthesis, with MM facts tagged]:
  • Explain that MM is peer-led and calls its groups "not treatment or therapy"; no fee is stated and donations are invited [source: MM Meeting Materials 2026].
  • Explain the current Ground Rules: meetings are confidential; members should not arrive intoxicated and are asked to consider not drinking on meeting days; members are discouraged from socialising together in drinking settings; alcohol is not allowed at meetings or official MM events; members share experience without judging and try to avoid giving personal advice; people on other paths are welcome [source: MM Meeting Materials 2026; Rotgers & Kishline 2000].
  • Tell the client that newcomers may introduce themselves but are also welcome just to listen until comfortable [source: MM Meeting Materials 2026].
  • Help the client choose a format: a virtual meeting from MM's events calendar, an in-person meeting where one exists, MM's online communities, or a 30-Day Kickstart course [source: MM Getting Started page]. Older directories also list a forum, chat room and Facebook group [source: Pitt directory]; whether each is still active is [uncertain].
  • Tell the client they may hear people with heavier or lighter drinking than theirs, and that each member chooses their own goal.
  • Agree when the client will attend, and debrief at the next session.
• Example language (illustrative): "In MM, nobody decides your goal for you. You'll hear how other people set their limits, and you can borrow what fits."
• Watch for: a client who chooses online-only support as a way to stay hidden. One survey found online-only members drank more often than face-to-face members [source: Humphreys & Klaw 2001, as reported by Wikipedia].

A3. Integrating MM step work into therapy sessions

• Purpose: to use the client's MM work as session material without taking it over.
• Steps [synthesis]:
  1. Open each session by reviewing the drinking diary or tracker, with BAC estimates for drinking days.
  2. Ask which step the client is on and what they wrote, such as the effects list or the priorities list.
  3. Work through one over-limit or near-miss episode in detail: trigger, thoughts, feelings, the decision point, and the alternative they could have used.
  4. Agree one weekly "small step", matching MM's Step 7 language.
  5. Note what the client wants to take to their next meeting.
• Watch for: the client reporting only good weeks. Reinforce honest reporting of over-limit days.

A4. Agreeing the moderation trial and switching criteria

• Purpose: to make the choice between moderation and abstinence a decision based on evidence, in line with MM's guidance that people who cannot stay within limits should move to an abstinence approach [source: Faces & Voices of Recovery; Rotgers & Kishline 2000].
• Steps [synthesis]:
  1. Before drinking resumes after the alcohol-free period, write down a review date and two or three concrete criteria for switching. Examples: exceeding the daily limit more than an agreed number of times in a month; any drinking before driving; any blackout; any drinking in a setting the client listed as dangerous.
  2. Give the client a copy.
  3. On the review date, compare the diary data with the criteria.
  4. If a criterion is met, offer a move to abstinence, which MM itself supports, plus medical or more intensive care where needed.
• Example language (illustrative): "Let's decide now, while you're clear-headed, what would tell us moderation isn't working, so it isn't a debate on a bad morning."
• Watch for: criteria being renegotiated after the fact.

A5. Starting or facilitating an MM meeting as a professional

• Purpose: to provide MM where no meeting exists, for example in a counselling service, or to support a client who wants to facilitate.
• What MM publishes:
  • 1999–2000 version: meetings could be led by professionals or lay people, with no formal qualification beyond following MM's meeting guidelines, and participants kept control [source: Rotgers & Kishline 2000; Wikipedia 2008 copy].
  • Current route: MM describes meetings as "Facilitated by an experienced member". People who have attended MM meetings for a while and want to facilitate or start a meeting fill in a volunteer form describing their meeting experience and how MM has helped them [source: MM Getting Started page; MM Volunteer page].
  • MM runs a Meeting Facilitator Training Course. Registration is open to people aged 18 or over; a small donation (US$10) is requested for resources, with a waiver available on request; after completion an MM Meeting Coordinator makes contact to get the new facilitator started [source: MM Facilitator Training page]. Course content and length were not shown [uncertain].
  • Meetings work from documents now posted on MM's Meeting Materials page: an Opening Statement read by the discussion leader, the Ground Rules, the Nine Steps, What Is a Moderate Drinker and the MM Limits, BAC tables, a Closing Statement and a flyer [source: MM Meeting Materials 2026].
  • The current pages do not say whether a professional who is not an MM member may start or lead a meeting [uncertain].
• Steps [synthesis]:
  • Contact MM (volunteer form or contact page) before starting anything under MM's name; ask whether a professional without personal MM attendance may facilitate, and expect to complete the facilitator training.
  • Keep the meeting separate from therapy: no clinical notes on attendees, no fees and no promotion of your practice. MM separately runs a directory of "moderation-friendly" providers that professionals can apply to join [source: MM Getting Started page].
  • Hand leadership to members as soon as possible.
• Watch for: dual relationships, such as your own therapy clients in the group. Make it clear the meeting is not treatment.

B. MM's own steps and tools

B1. Step 1: Attend meetings and learn the programme

• Purpose: to orient the member and connect them with peers.
• Steps: attend face-to-face or online groups and read the MM guide.
• Example language (illustrative): "What did you notice about how members talked about their limits?"
• Watch for: whether the client identifies with the group. Members have been mostly employed and college-educated [source: Wikipedia, citing a 2001 survey], so some clients may feel out of place.

B2. Step 2: The 30-day alcohol-free period

• Purpose [source: Rotgers & Kishline 2000]:
  • lower tolerance, so fewer drinks produce the effect later;
  • give a respite in which many members feel better, with improved sleep and energy;
  • allow self-observation of the situations and emotions linked to overdrinking, so coping plans can be built;
  • build self-efficacy. Steps 3–6 are completed during this period.
• Steps [synthesis on clinical details]:
  1. Screen for withdrawal risk first, and get medical clearance and supervised withdrawal where indicated.
  2. Pick a start date.
  3. Remove alcohol from the home if the client wants to.
  4. List the high-risk situations expected in the next 30 days, and plan alternatives and refusal phrases.
  5. Keep a daily record of urges and situations.
  6. If 30 days isn't achieved, review what happened, with no blame, and plan again. MM groups help members who struggle develop new strategies [source: Rotgers & Kishline 2000].
• Example language (illustrative): "Use this month as an experiment. Watch when you miss the drink, because that list becomes your plan."
• Watch for:
  • Signs of withdrawal are a medical issue and a sign that MM may not fit.
  • Being unable to manage even a few alcohol-free days is important information for the assessment of fit.
  • Some members choose to keep abstaining; MM supports this [source: Rotgers & Kishline 2000].

B3. Step 3: Examine how drinking has affected your life

• Purpose: to build personal reasons for change.
• Steps: the member writes down the effects of drinking on health, relationships, work, money, mood and legal matters. The clinician can add a written list of the expected benefits of change [synthesis].
• Example language (illustrative): "Which of these effects matters most to you, rather than to other people?"
• Watch for: minimising. Gently compare the list with the quantity-frequency data.

B4. Step 4: Write down your life priorities

• Purpose: to link drinking goals to values and balance. MM ties overdrinking to stress and to the gap between "shoulds" and "wants".
• Steps: list the most important areas of life, mark where drinking competes with them, and identify neglected wants [synthesis on the last two].
• Example language (illustrative): "If drinking took up less room, what would you put in that space?"
• Watch for: lists made up entirely of obligations. Help the client add enjoyable, alcohol-free activities.

B5. Step 5: Review how much, how often and in what circumstances you drank

• Purpose: to map the client's past drinking pattern and risk situations.
• Steps:
  1. Reconstruct a typical week and the heaviest recent occasions in standard drinks.
  2. Note the setting, company, time of day, emotional state and speed of drinking.
  3. Identify the circumstances that most often led to overdrinking [source: Rotgers & Kishline 2000 on analysing circumstances; reconstruction method is synthesis].
• Example language (illustrative): "Walk me through the last evening that went further than you meant it to."
• Watch for: under-counting home pours. Convert to standard drinks together.

B6. Step 6: Learn MM's guidelines and limits

• Purpose: informed choice. The content is in B10 and B11 below.
• Steps:
  1. Teach the standard-drink equivalents.
  2. Teach the use of BAC charts.
  3. Explain that the numbers are ceilings, not targets [source: Rotgers & Kishline 2000].
• Watch for: the client treating the ceilings as a daily allowance.

B7. Step 7: Set moderate drinking limits and start weekly "small steps"

• Purpose: to set a personal plan within MM's limits and begin lifestyle change.
• Steps:
  1. Write personal limits: maximum drinks per occasion and per week, the planned alcohol-free days (at least three or four per week under MM's limits), and the settings where the client will not drink.
  2. Choose one small lifestyle step for the coming week in any area of life [source: Rotgers & Kishline 2000; written format is synthesis].
• Example language (illustrative): "What's a limit you could stick to on your hardest night of the week, not your easiest?"
• Watch for: personal limits set at MM's maximum. Suggest starting lower.

B8. Step 8: Review progress and update goals

• Purpose: to keep the plan matched to the data.
• Steps:
  1. Review the self-monitoring records at set intervals.
  2. Tighten or keep the limits.
  3. Consider abstinence if the limits are repeatedly exceeded [source: Rotgers & Kishline 2000; Faces & Voices of Recovery]. The A4 criteria apply here.
• Watch for: a review that doesn't use records.

B9. Step 9: Keep making lifestyle changes and use meetings as needed

• Purpose: maintenance and peer helping.
• Steps: keep attending when support is needed, and help newcomers once stable [source: Rotgers & Kishline 2000].
• Watch for: a client taking on a helping role before their own drinking is stable [synthesis].

B10. Guidelines: the profile of a moderate drinker

• Purpose: to give a behavioural model of moderate drinking beyond drink counts.
• Content (paraphrased) [source: MM Meeting Materials 2026; MM Moderate Drinking Guidelines page; Rotgers & Kishline 2000. The current list matches the 1999–2000 one; the guidelines page adds that a moderate drinker has no health, personal, family, social, job, financial or legal problems from alcohol]. A moderate drinker typically:
  • treats a drink as a small part of life;
  • has hobbies and ways to relax that don't involve alcohol;
  • mostly has friends who drink moderately or not at all;
  • eats before, during or soon after drinking;
  • drinks for no more than an hour or two per occasion;
  • drinks no faster than about one drink per half-hour;
  • usually stays under MM's upper BAC limit of .055%, or lower for very light people;
  • is comfortable with their drinking, doesn't drink secretly and doesn't spend much time thinking about or planning drinking.
• Steps [synthesis]:
  1. Go through each feature and have the client rate how far it describes them now.
  2. Pick the two lowest-rated features as behavioural targets, for example pacing or eating with drinks.
• Example language (illustrative): "Which of these is furthest from how you drink now?"
• Watch for: secret drinking or preoccupation with drinking. These are warning signs to weigh in the fit assessment.

B11. Limits

• Purpose: to set fixed safety ceilings.
• Content (paraphrased) [source: MM Meeting Materials 2026; MM Moderate Drinking Guidelines page; Rotgers & Kishline 2000; SAGE 2009]:
  • drink-driving: the current Limits say to strictly obey local drink-driving laws, and the current Opening Statement says MM endorses no drinking and driving [source: MM Meeting Materials 2026]; the 1999–2000 version was summarised in this guide as never driving after drinking [source: Rotgers & Kishline 2000];
  • don't drink in situations that could endanger yourself or others;
  • don't drink every day: abstain on at least three or four days a week;
  • women: more than 3 drinks on any day or more than 9 per week may indicate harmful drinking; the guidelines page notes that NIAAA sets a lower weekly figure of 7 for women and suggests women might consider it;
  • men: more than 4 drinks on any day or more than 14 per week may indicate harmful drinking.
  • A standard drink is 12 oz of 5% beer, 5 oz of 12% wine, or 1.5 oz of 40% spirits. These are US measures; convert for local units [synthesis]. The numbers are "LIMITS and not TARGETS" [source: MM Moderate Drinking Guidelines page]. Some researchers advise one drink a day for people aged 55 and over.
• Version note: the current figures are unchanged from the 1999–2000 version. MM words them as levels above which drinking "may be" harmful, bases them on Sanchez-Craig's 1995 research (American Journal of Public Health) and other published limits, and compares them with NIAAA's [source: MM Moderate Drinking Guidelines page]. The SAGE entry (2009) describes the goal as keeping BAC generally below .05% [source: SAGE 2009]; MM's own upper limit is .055% (B12). The current Steps of Change guide adds that a moderator typically has 1–2 drinks per occasion [source: MM Steps of Change guide].
• Watch for: drink-driving. Whatever local law permits, advise no driving after any drinking, and treat drinking before driving as an immediate safety issue, not just a missed goal [synthesis].

B12. BAC charts

• Purpose: to estimate intoxication more accurately than drink counts, because the charts take account of weight, sex and drinking rate [source: Rotgers & Kishline 2000]. Charts were handed out at meetings [source: SAGE 2009; Rotgers & Kishline 2000]. MM now posts downloadable BAC tables for men and women based on Checkup and Choices, advises very light people to use the .055% ceiling cautiously, and cites .080% as the US legal driving limit [source: MM Moderate Drinking Guidelines page; MM Steps of Change guide].
• Steps [synthesis]:
  1. Using a published BAC chart or calculator, find the client's estimated BAC at their planned number of drinks over their usual time span.
  2. Set the per-occasion limit so the estimate stays below .055%.
  3. Rehearse pacing and alternating with non-alcoholic drinks.
• Watch for: reliance on the estimate in risky situations. BAC estimates are approximate and never make it safe to drive.

B13. Self-monitoring and online tracking

• Purpose: to provide the data behind Steps 5, 7 and 8.
• Content:
  • MM's current Steps of Change guide opens with a drinking diary whose columns cover the date, number of drinks, time spent drinking, the occasion, feelings, positive non-drinking activities and progress [source: MM Steps of Change guide].
  • The same guide points members to ModerateDrinking.com, a subscription web program with step-by-step guidance, interactive feedback and a mood tracker [source: MM Steps of Change guide].
  • MM earlier offered Abstar, an online self-monitoring program [source: SAGE 2009]; it is not mentioned in the current materials.
  • Hester and colleagues (2009) combined MM with the moderatedrinking.com web program and reported more alcohol-free days than MM alone [source: Wikipedia summary] [uncertain].
• Steps [synthesis]: use MM's diary columns or a tracker that records the same items. Record each drink when it happens, not later, and note whether the limit was kept. Bring a weekly summary to sessions.
• Watch for: gaps in the records, which often hide over-limit days.

B14. Choosing abstinence within MM

• Purpose: to let members change goals without leaving their support group.
• Content:
  • MM recognises abstinence as a valid path and supports members who choose it [source: Rotgers & Kishline 2000].
  • People who cannot stay within limits are advised to use AA or another abstinence-based programme [source: Faces & Voices of Recovery].
  • In a three-way referral the clinician can offer SMART Recovery, AA or Women for Sobriety. Kishline herself attended these when she changed goals [source: Wikipedia] [synthesis on clinical use].
• Example language (illustrative): "Switching to not drinking would use everything you've learned here. It's the same programme with a different goal."

B15. Recommended self-help reading

• Content: MM recommended Miller & Muñoz (1982), Sanchez-Craig (1993) and Sobell & Sobell (1993) alongside its own guide [source: Rotgers & Kishline 2000].
• Use [synthesis]: assign a chapter that matches the client's current step.

B16. The Steps of Change guide (MM's seven-step version)

• Purpose: a structured, free self-help workbook MM offers alongside the Nine Steps; useful as between-session homework because it is laid out as a sequence of written exercises [source: MM Steps of Change guide; MM Getting Started page]. The guide is undated (file uploaded 2020) and does not say how it relates to the Nine Steps [uncertain].
• The seven steps (paraphrased), which the guide says can be taken in roughly any order as long as each gets some attention [source: MM Steps of Change guide]:
  • keep a drinking diary to see how problems arise;
  • study the moderate-drinking limits and attitudes, so the goal is clear;
  • choose between moderation and abstinence, using a dependence self-test and other factors;
  • list the problems drinking causes and the benefits expected from moderating, to build commitment;
  • take an alcohol-free period of 30 days or more (the member's "30"), and use it to learn skills for not drinking, control skills, trigger management, personal drinking rules and new activities;
  • after the 30, drink cautiously within the limits and personal rules, keeping the diary;
  • after any slip, do a post-mortem and adjust the plan if needed.
• Tools inside the guide [source: MM Steps of Change guide]: the drinking diary (B13); the Alcohol Dependence Questionnaire with score bands pointing to abstinence or to seeing a therapist (A1; describe it, do not reproduce items); a problems-and-benefits list; refusal phrases and three ways of handling urges (avoiding the situation, confronting the urge, distraction); a list of overdrinking triggers with a strategy for each; a short personal list of drinking rules that changes over time; non-drinking activities; rewards for progress; and a long-term stock-take that includes a yearly "30".
• Steps [synthesis]:
  • Give the client the guide after the fit assessment and agree which section to work on each week.
  • Use the dependence self-test result as one input to A1, alongside your own assessment.
  • In session, review the trigger list and draft the personal drinking rules together; keep the rules short and testable, for example a pace or a setting.
  • After a slip, run the post-mortem with the client: what happened, which rule failed, and what to change.
• Example language (illustrative): "Let's treat last Saturday the way the guide suggests: a post-mortem, not a verdict."
• Watch for: a client skipping the alcohol-free period or the dependence self-test because the steps can be taken in any order. Agree that both are done before moderating [synthesis].

C. Group and online formats

C1. The face-to-face MM meeting

• What MM publishes now [source: MM Meeting Materials 2026; MM Getting Started page]:
  • A discussion leader, described as an experienced member, opens with MM's Opening Statement. It welcomes anyone concerned about their drinking, says MM groups are "not treatment or therapy", says MM endorses research-based moderate-drinking guidelines including no drinking and driving, and says members' goals differ.
  • Optional introductions follow; newcomers may introduce themselves or just listen until comfortable.
  • The Ground Rules are reviewed (see A2): confidentiality, mutual respect, no attending intoxicated, no alcohol at meetings, no judging, and trying to avoid personal advice.
  • The Closing Statement thanks attendees, asks that who is seen and what is heard stay in the meeting, invites donations and invites volunteers.
  • Meeting documents: Opening Statement, Ground Rules, Nine Steps, What Is a Moderate Drinker and the MM Limits, BAC tables, Closing Statement.
• The 1999–2000 version added: meetings typically weekly, about an hour, anonymous and free with a hat passed; members shared successes and failures; cross-talk, meaning direct feedback between members, was allowed [source: Rotgers & Kishline 2000; Wikipedia 2008 copy and current Wikipedia]. Version note: the current Ground Rules ask members to try to avoid giving personal advice, which is narrower than the older description of open cross-talk [source: MM Meeting Materials 2026].
• Not stated in the sources: how the sharing part of a current meeting runs (rounds, topics, timing) and the current meeting length [uncertain]. Beyond the opening, introductions, ground rules and closing, do not present a specific running order to clients as MM's.
• Clinician role [synthesis]: prepare the client (A2) and debrief afterwards. Ask what they took from the meeting and whether any comments felt unhelpful.

C2. Online MM support

• What MM publishes:
  • Historically MM ran an email list and a chat room that was open around the clock, although members were not always present [source: Rotgers & Kishline 2000].
  • Today MM's site lists virtual meetings on an events calendar, "online communities" described as a space to ask questions and share wins, and month-long 30-Day Kickstart courses [source: MM Getting Started page]. MM calls virtual meetings a cornerstone of the member experience; its 2025 survey drew members from 36 US states and six other countries [source: MM 2025 survey page].
  • Older directories list an MM web forum, a Facebook group and a chat room [source: Pitt directory]; which platforms the online communities now use is not stated in the sources [uncertain].
  • Most meetings are now online; face-to-face meetings returned after the pandemic [source: Wikipedia].
  • A content analysis of online meetings found that self-disclosure, information and advice, and emotional support were the commonest kinds of communication [source: Wikipedia summary].
• Clinician role [synthesis]: agree how often the client will attend or check in. Ask them to bring back advice they want to test, so it can be checked against their own plan.
• Watch for: advice from other members that conflicts with medical guidance, for example about medications or withdrawal.

5. Handling problems

MM's sources say only that members who miss goals get open problem-solving rather than punishment, that groups help with trouble completing the 30 days or keeping to limits, and that members who achieve neither moderation nor abstinence are still welcome. They also advise abstinence-based help for people who cannot moderate [source: Rotgers & Kishline 2000; Faces & Voices of Recovery]. MM's current Steps of Change guide adds a post-mortem after any slip, with the plan adjusted if needed, and allows shorter alcohol-free breaks [source: MM Steps of Change guide]. Everything else in this section is [synthesis].

• Can't complete the 30 alcohol-free days.
  • Review the days that broke the run (B5 method).
  • Offer a shorter first target, such as 7 or 14 days, as a stepping stone. MM's current Steps of Change guide also allows shorter breaks when a full month feels like too much [source: MM Steps of Change guide]; the specific durations are [synthesis].
  • Check for withdrawal or dependence. Repeated failure to manage even short periods suggests MM may not fit (A1). Consider a medical assessment and medication-assisted treatment.
• Repeatedly over the limit. Apply the switching criteria agreed in A4. Offer abstinence within MM (B14), more frequent sessions, or a higher level of care.
  • Illustrative: "The plan we agreed says it's time to look again. That's the plan working, not you failing."
• Resistance to the abstinence period or to monitoring.
  • Explore the client's ambivalence and their reasons.
  • Explain MM's rationale for the alcohol-free period: tolerance, respite, self-observation and confidence.
  • If they refuse, offer reduced drinking with close monitoring as a harm-reduction compromise. Keep the safety limits (no drink-driving, no dangerous settings) non-negotiable.
• Using MM to avoid an abstinence recommendation.
  • Name this openly.
  • Remind the client that MM itself excludes significant dependence and medical risk, and that abstinence is a respected path within MM.
  • Record your advice in the clinical notes.
• Non-attendance or online lurking.
  • Ask what got in the way.
  • Try a different format, for example a live chat in place of the forum, or face-to-face in place of online.
  • Set a small attendance goal as one of the weekly "small steps".
• Inaccurate self-report.
  • Respond to disclosures of over-limit days without judgement, so honesty pays off.
  • With consent, cross-check with a partner's account or with clinical tests where clinically appropriate.
  • Shift the focus from "good weeks" to accurate weeks.
• Overwhelm, low mood or suicidality.
  • Alcohol worsens depression, and MM excludes conditions that alcohol worsens.
  • Screen for suicide risk using standard practice. Make a safety plan, and counsel on restricting access to means as part of it: alcohol and medications kept out of the home or locked away.
  • Advise abstinence while the client is acutely unwell.
• Drink-driving or other dangerous drinking. This is outside MM's limits. Treat it as an immediate safety issue: advise the client, plan transport, and meet any legal or reporting duties in your jurisdiction. Reconsider whether moderation is an appropriate goal.
• Rupture over goal choice.
  • The client may feel judged for wanting to moderate, or you may feel uneasy endorsing it.
  • Acknowledge that the goal is the client's choice under MM's model, and be explicit about the safety conditions you need.
  • Agree a review date so the disagreement is settled by data.
• Clash with other services or 12-step attendance.
  • The client may hear in AA that moderation is impossible. MM describes itself as not anti-AA [source: Rotgers & Kishline 2000].
  • Help the client choose the group that fits their current goal. Avoid setting the groups against each other.
• Poor fit with the group.
  • Past surveys found members were mostly white, employed and college-educated [source: Wikipedia citing a 2001 survey].
  • Clients from other backgrounds may feel out of place. Offer online options and other mutual-aid groups, and adapt MM's tools in individual sessions instead.
• Pregnancy, minors and drug problems. All are outside MM's scope [source: Rotgers & Kishline 2000]. Refer to the appropriate service and do not adapt MM for these groups.

Sources

Sources:

• Rotgers F, Kishline A. Moderation Management®: A support group for persons who want to reduce their drinking, but not necessarily abstain. Int J Self Help & Self Care 1(2):145–158 (1999–2000). This is the primary source for the 1999–2000 version; the current wording was checked against the moderation.org pages listed below.
• Moderation Management. In Fisher GL, Roget NA (eds), Encyclopedia of Substance Abuse Prevention, Treatment, & Recovery, SAGE 2009, pp. 556–557
• Moderation Management, Wikipedia (current article)
• Moderation Management, Wikipedia copy from 2008 (classicistranieri mirror)
• Moderation Management (MM), Faces & Voices of Recovery mutual-aid resource
• Moderation Management, University of Pittsburgh Online Recovery directory
• What is Moderation Management? Steve Rose PhD (2023). A secondary overview by a counsellor; not relied on.
• Alcohol Moderation Management: Programs and Steps, American Addiction Centers (2024/2025). Not used: its eight-step list does not match MM's published Nine Steps.

Further sources:

• Moderation Management Meeting Materials & Guidelines (moderation.org): Opening and Closing Statements, Ground Rules, Nine Steps, moderate-drinker profile and Limits. Cited as "MM Meeting Materials 2026".
• Moderate Drinking Guidelines (moderation.org, last modified August 2026)
• Guide to Moderation Management Steps of Change (moderation.org PDF, uploaded 2020)
• Getting Started with Moderation (moderation.org)
• Volunteer (moderation.org)
• MM Meeting Facilitator Training Course registration (moderation.org)
• What the 2025 Moderation Management Member Survey Reveals About Change That Lasts (moderation.org)
• Lembke A. Moderation Management. SAGE Encyclopedia of Alcohol, 2015, pp. 872–873: only the opening paragraph was visible.
• Mythbusting: Moderation Management, Alcohol Minimalist podcast (March 2022): episode page only, with MM's Executive Director as guest; no programme details used.

Further reading (not drawn on) [uncertain]: Hester et al. 2009 on PMC (PMC2739257); MM's Professional's Guide page; Kosok, Evolution of the MM Program (chestnut.org PDF); a Google Docs PDF that may be an MM meeting document; Humphreys & Klaw 2001, J Stud Alcohol 62:528.

Books cited:

• Kishline A (1994). Moderate Drinking: The Moderation Management Guide for People Who Want to Reduce Their Drinking. Known only through Rotgers & Kishline.
• Miller WR, Muñoz RF (1982). How to Control Your Drinking.
• Sanchez-Craig M (1993). Saying When: How to Quit Drinking or Cut Down. The title is my own addition, as Rotgers & Kishline give only the author and year [uncertain].
• Sobell MB, Sobell LC (1993). Problem Drinkers: Guided Self-Change Treatment. The title is my own addition, as Rotgers & Kishline give only the author and year [uncertain].