The Sad Tale of the Founder of Moderation Management

Moderation Management

by bob k

According to its website, Moderation Management “is a behavioral change program and national support group network for people concerned with their drinking and who desire to make positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own path, whether moderation or abstinence.”


What does MM offer?

A supportive mutual-help environment that encourages people who are concerned about their drinking to take action to cut back or quit drinking before drinking problems become severe.

A nine-step professionally reviewed program, which provides information about alcohol, moderate drinking guidelines and limits, drink monitoring exercises, goal setting techniques, and self-management strategies.

As a major part of the program, members also use the nine steps to find balance and moderation in many other areas of their lives, one small step at a time.

Assumptions of MM:

  • Problem drinkers should be offered a choice of behavioral change goals.

  • Harmful drinking habits should be addressed at a very early stage, before problems become severe.

  • Problem drinkers can make informed choices about moderation or abstinence goals based upon educational information and the experiences shared at self-help groups.

  • Harm reduction is a worthwhile goal, especially when the total elimination of harm or risk is not a realistic option.

  • People should not be forced to change in ways they do not choose willingly.

  • Moderation is a natural part of the process from harmful drinking, whether moderation or abstinence becomes the final goal. Most individuals who are able to maintain total abstinence first attempted to reduce their drinking, unsuccessfully. Moderation programs shorten the process of “discovering” if moderation is a workable solution by providing concrete guidelines about the limits of moderate alcohol consumption.

  • MM is good place to begin to address a drinking problem. If MM proves to be an ineffective solution, the individual is encouraged to progress to a more radical solution.

After completing 30 days of abstinence (step two of the MM program) and then starting the moderation part of the program, you may discover that it is more difficult for you to moderate your drinking than to abstain. In this case, consider a self-management goal of abstinence. Some members of MM who choose abstinence remain in our program; others find an abstinence-only group to attend.

Moderation Management

Websites for organizations such as this normally have a section outlining their history. Moderation Management has no history summary, and for good reason.

Audrey Kishline

Moderate DrinkingUpon her exit from an alcohol treatment program, Audrey Kishline decided that she was “not as bad as” her fellow patients, and that she had been mislabelled as an alcoholic. Kishline had not lost a job or a home; she had never experienced withdrawal; and she did not believe she had a disease. Her experience with abstinence-based programs was “unsatisfactory.” Kishline started Moderation Management in 1994, and the following year published Moderate Drinking: The Moderation Management Guide for People Who Want to Reduce Their Drinking. She claimed that she could moderate her drinking with the help of cognitive-behavior therapy principles.

“Moderation Management was born from her rejection of the label of ‘alcoholic,’ and the goal of MM was to use cognitive-behavioral tools—a psychotherapy method that emphasizes practical problem-solving—to help problem drinkers achieve and sustain moderate, controlled alcohol use.”

The Fix: Remembering Audrey Kishline, by Regina Walker

Kishline, her new program, and her handbook, drew a good deal of attention. Time wrote about the new group, and its principal founder was a guest on Oprah. The spokesperson for moderate drinking was always careful to point out that MM was not intended for alcoholics, but rather, for “problem drinkers.”

What would become clear in the years following the founding of MM, however, was that Kishline’s own drinking – MM’s growing popularity and the success of her message notwithstanding – was “out of control.” By January of 2000, Kishline recognized – publicly – that despite MM’s philosophy and methods, for her, at least, it wasn’t working. She posted a message to an official MM email list, saying that she had concluded that her best drinking goal was abstinence, and that she would begin attending Alcoholics Anonymous, SMART Recovery, and Women for Sobriety meetings, while continuing to support MM for others.”

Remembering Audrey Kishline

Her lengthy email included what follows:

For many, including myself, MM is a gateway to abstinence. Seven years ago, I would not have accepted abstinence. Today, because of MM, I do. Whether abusive drinking is a disease or a learned behavior does not matter. If you drink too much and this is causing problems in your life, you need to do something about it. We’re intelligent people, but sometimes we need to quit debating in our heads, and look at what’s in our hearts.

If you, like myself, find eventually that you cannot stay within our guidelines there is no shame in admitting this. In fact, it is a success. A big success, because you have found through our program what you need to do to really live life to its fullest. As Dr. Ernest Kurtz, one of the foremost experts on AA who wrote the forward to our handbook, once predicted “MM will one day refer more people to AA than any other program.” He may be right! My heartfelt best wishes to each and every one of you as you discover your own recovery goal.

Remembering Audrey Kishline

Two months later, Kishline hit another vehicle while she was driving the wrong way on an interstate highway. A 12 year-old girl and her father were killed. Kishline’s blood alcohol level was an immoderate 0.26, more than three times the legal limit, and she admitted to “driving a hundred miles an hour in a total blackout.”

After serving three and a half years, in August of  2003, the MM founder was released from prison. She was unable to refrain from drinking, and went back to lock-up for forty-three days. Her life was a struggle as an ex-con banned from driving.

In a 2006 Dateline interview, Kishline reversed much of what she’d said publicly about her own drinking in previous years, and during the rise of Moderation Management:

Dateline: As you look back on it, was MM something you devised to give yourself license to drink because you didn’t want to abstain?

Kishline: I do think that deep down as an addict that was the purpose.

Dateline:  All the good research that you did and the presentation of it to a national audience, it was really to justify it for you as a drinker.

Kishline:  It would legitimize my drinking.

Face To Face

Sherly Maloy-Davis, the wife of the man killed in the car crash, and mother of the 12 year-old child was a devout Christian whose faith compelled her to forgive the woman who had brought devastation to her life.

Face to FaceIn 2007, Kishline and Sheryl Maloy – the wife and mother of accident victims Richard Davis and 12-year-old LaShell – co-authored the book Face to Face, which chronicled both the fatal accident and the subsequent forgiveness and friendship that grew between the two women (Maloy had visited Kishlane in prison). In the book, Kishline frankly admitted that she was still drinking regularly.

Remembering Audrey Kishline

In the second edition of Face to Face, Audrey wrote with blunt candor about her own struggles and shortcomings. In the preface to the second edition of the book—dated June 14, 2012—Audrey wrote, “The book is all wrong,” admitting to not having written the text of the first, 2007 edition, but also having failed to live up to her obligations to promote and support it. “I’m trying to rewrite words that I never wrote… I was drunk… most of the time…

“Alcohol is the love of my life.” ~ Audrey Kishline “Face to Face”

 (I) took the easy way out (and) let the agent get someone else to write it.” And then, writing as if defending herself from her own accusations, she admits, “I was drinking too much to write a coherent grocery list.”

The Fix: New Details Emerge About Audrey Kishline’s Death, Regina Walker

Walker’s follow-up article reports that Maloy-Davis claimed that Fishline’s mother had told her she had found her daughter dead, two empty vodka bottles nearby, and all her prescription drug containers emptied. “She overdosed and she hung herself.” Sheryl said that Audrey’s mother had told her that Audrey had been “deeply, deeply depressed for at least two months prior to her death, and that her drinking had continued unabated.” (New Details Emerge, The Fix)

The grieving mother contacted The Fix to contradict Maloy-Davis’s account of the events. She denied that her daughter’s death was suicide, and she denied finding empty vodka bottles and prescription vials. If she is being less than forthcoming, I think that’s understandable.

Hard Drinkers

Alcoholics Anonymous takes the position that total abstinence is the only option for “real” alcoholics.

Then we have a certain type of hard drinker. He may have the habit badly enough to gradually impair him physically and mentally. It may cause him to die a few years before his time. If a sufficiently strong reason – ill health, falling in love, change of environment, or the warning of a doctor – becomes operative, this man can also stop or moderate, although he may find it difficult and troublesome and may even need medical attention.

AA Big Book, pp. 20-21

Some members of Alcoholics Anonymous did not react well to the Kishline tragedy. Attacks were launched against the very existence of Moderation Management. The program was “killing alcoholics” by deluding them that they might somehow manage their drinking. Of course, alcoholics were chasing that dream long before there was a Moderation Management.

MOST OF US have been unwilling to admit we were real alcoholics. No person likes to think he is bodily and mentally different from his fellows. Therefore, it is not surprising that our drinking careers have been characterized by countless vain attempts to prove we could drink like other people. The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death.

AA Big Book, p. 30

Audrey Kishline was a real alcoholic, but for as long as she was able, she went to great lengths to preserve the delusion that she wasn’t. She lied to others and to herself. She pursued the illusion into the gates of vehicular homicide and her own death.

Sadly, this is not a unique story. If some folks want to gather together to support each other in their efforts to drink less, so be it. Will there be alcoholics among the moderation-seeking demographic? I think that’s inevitable. Do we of AA kill people with our Big Book suggestion:

We do not like to pronounce any individual as alcoholic, but you can quickly diagnose yourself. Step over to the nearest barroom and try some controlled drinking. Try to drink and stop abruptly. Try it more than once.

AA Big Book, pp. 31-32

Despite all we can say, many who are real alcoholics are not going to believe they are in that class. By every form of self-deception and experimentation, they will try to prove themselves exceptions to the rule, therefore non-alcoholic.

AA Big Book, p. 31

AA’s province lies in helping those already convinced that they can neither moderate, nor stop on their own.

Of course, folks from the Moderation Management side fired back. “Audrey had left MM and was attending AA. The failure was AA’s.” Leaders of the recovery movement stepped forward urging a cessation of the hostilities.

The idea of moderation societies is not new. Before finding total abstinence through Christian conversion, Col. Henry Harrison Hadley founded the short-lived “Business Men’s Moderation Society.” Years later, greater wisdom produced this remark: “The man in need of a Moderation Society cannot moderate, and the man who can moderate has no need of a moderation pledge.”

Undoubtedly, Moderation Management will help some people to take a step toward that realization. Mr. Kurtz was a wise man.


23 Responses

  1. Maricica S says:

    Audrey Kishline was actually an AA newcomer. when she was involved in the fatal traffic accident. I saw the 12 step recovery movement especially in Washington State really use this to discredit any other approach to Alcohol Use Disorder DSM 303.90.

    Moderation management actually advises those who fail at moderating their alcohol use to move on to an abstinence based treatment. Audrey actually did this. She joined a King County Group of AA as well as making contact with a women’s group.

    It appears Audrey was following her own program when as per MM tenet that she seek out an abstinence based programming which she did and was involved with at the time of her accident on Snoqualmie Pass.

    I got quite the earful about AA being the only way as opposed to “that other way” – which was largely true 23 years ago.

    I heard a parallel statement from an obscure religionist not long ago speaking for some reason of “that new bible” out there that doesn’t have anything about God in it @_@ . He may have been speaking of a self help booklet The Way To Happiness.

  2. Mike O says:

    Moderation Management is a perfectly sensible concept. It just isn’t for addicts. It is more likely to work with people who have a drinking problem but still show some ability to control their drinking. The problem is that the line between problem drinker and alcoholic is often a blurry one and most alcoholics are loathe to admit they have no real control until they’ve really gone way too far.

    • Gen I. says:

      I agree that the line between problem drinker and alcoholic is blurry. It is also sometimes a moving target. You can find lots of “former” members of Moderation Management in a 12 step environment, and they are also success stories. MM sees abstinence as a perfectly valid choice.

      MM simply doesn’t define success for our participants when they start our program; it’s up to our members to decide where their journey will lead as they seek recovery. Our goal is to encourage recovery from a life dominated by alcohol; we simply don’t set arbitrary limits on how this will be achieved. I’m sure you can tell I am a member of MM, and I am glad we can all reach out to each other with offers of support on this difficult journey. Let’s keep the conversation going.

      • Mike O says:

        Interesting point. I’m sympathetic to Moderation Management and I find it to be a natural outgrowth in the recovery movement. Like I said, for those who can HONESTLY control their drinking it sounds like a valid and useful tool. For myself, though, while there’s much I don’t agree with about AA and as I’ve achieved several years of sober time and experience I’ve grown more comfortable in expressing myself about some of those differences, the one area I have held firm FOR MYSELF is to not take a drink today (“no mater what, no matter what” as one of my friends from the rooms tells me ;)). In my case, before I stopped I tried all kinds of various controlled drinking for a good 10+ years and had periods, even extended periods, of “success” (meaning I wasn’t directly getting into immediate trouble).

        I often relate my experience to the “frog in boiling water” metaphor. For anyone unfamiliar with it, it’s the idea that a frog placed in boiling water will immediate jump out but if that same frog is placed in tepid water and the temperature is gradually increased the frog won’t be able to detect the change and slowly will eventually boil. Similarly, since my drinking increased gradually and incrementally it was difficult to detect the progression. Until the end of my drinking when the consequences had become obvious it was hard to tell exactly where the lines between normal and troublesome and alcoholic drinking were and at what point they were being crossed. Even once I stopped, it was a couple years before I could really start piecing together the many different parts of my experience and solidly start to delineate where and when my drinking started to veer off track.

        For myself, I feel like alcohol (and other mood-altering substances and potentially addictive behaviors) is kind of like a bad friend when you’re a teenager. You get hooked in and keep lowering your standards of behavior and keep doing things you wouldn’t otherwise do because you feel a (one-sided) loyalty to this “friend”. It may be a friend you’ve had many good times with, especially early on, a friend who introduced you to new experiences and made you come out of your shell or feel more powerful and less scared than before. However, if you’re honestly addicted it’s still a toxic friend who’s ultimately only lying and taking from you and destroying you and turning you against everybody who cares about you. I don’t WANT to give that “friend” yet another chance, I don’t want to keep trying to “manage” the unmanageable and drinking isn’t probably going to get any easier or better. Besides, alcohol isn’t WORTH it. It kills brain cells and ultimately makes you less stable and intelligent before slowly destroying the rest of your body.

        Anyway, thanks for reading my take on it. Agnostic AA (as well as SMART, Rational Recovery and a host of other secular and scientifically based tools) has allowed me to stretch sobriety in many different directions and find my own voice. For me, I DIDN’T need to “take the cotton out of your ears and stick it into your mouth” (an actual oft-repeated line in AA meetings). I needed to regain confidence and self-esteem through establishing my own path. If Moderation Management is part of some people’s path and it works for them, I’m honestly glad for them. It’s not something I would be interested in though. Total abstinence is what empowers me.

  3. Linda Kurtz says:

    “Thanks for the article on Audrey Kishline. My husband, Ernie Kurtz, worked with her on her book when she lived here in Ann Arbor. She came to one of my classes and impressively talked about Moderation Management and the students loved her. She was an impressive person with many good qualities. Ernie stayed in close touch with her to the end of her life and worried about her constantly as she struggled to overcome the time in prison and her own lack of sobriety. Her story was very tragic, as many have already mentioned. Especially as she lost her husband and child over her drinking. Maybe if she had not lost them she would have survived somehow. One never knows.

  4. Wisewebwoman says:

    Oh the tragedy of Audrey. Well written article and also wonderful and enlightening comments. I have a close friend who is experimenting with moderation in a group of mixed addicts (not 12 step affiliated). I do not judge her. Her last experiment resulted in concussion, broken limbs and her grandson accidentally showing up, horrified, as her paramedic. Suspension of driver’s license. Followed by an elbow gnawing period of abstinence resulting, once again, in vodka experiments and the prideful announcement that she was drinking less before she passed out. I gently suggested she have liver testing. This denial is an ongoing lesson to me in the cunning, baffling and powerful nature of addiction.

    I meet with her regularly to get her “hilarious” updates on her moderation programme. Her group supports her in these endeavours and I derive hope that at least she attends these every Wednesday morning. I just worry that the next bad “accident” will see her as Audrey ended.

    The delusion is gobsmacking.

  5. Donna M says:

    ‪“Alcohol is cunning, baffling and insidious…” ‬I pray Audrey found her peace.

  6. John B. says:

    Bob – Your post motivated me to pull the Kishline book, Moderation Management, off the shelf where it was peacefully resting with some other 12 step critics. The list of acknowledgements reads like the AA doubters hall of fame.

    One quick point here at the beginning: to call itself a” national support group” is like calling the Prohibition Party a national political party. When the book came out in 1995 I was working as a addictions counselor for the V.A. I knew I was going to hear about moderation from some savvy old vet. I drank alcoholically from age 18 to age 48 and in the process had risked/damaged everything associated with normal human living, and had developed an impressive arsenal of denial weapons. But, being the hardcore drunk that I had been, even I was impressed by what Kishline was able to deny.

    I’ll use some minor paraphrasing here, but anyone can check this out on p.3 and p.4 of her book. She first drank in her late teens, drank socially in her early 20’s, over the next six years drank more and more often, drinking became a central life activity, most associates were heavy drinkers, evenings meant drinking, fun meant alcohol, alcohol was needed to cope with life, felt bad physically, did not eat right or sleep right, drove drunk with others in the car, lost a long term relationship, felt depressed, scared, and lonely. After saying this about herself, Kishline had this to say about her AA experience: “I did not relate to the severity of their drinking stories.” (p.6, Moderation Management). I can understand her level of denial, she was the alcoholic. What I do not comprehend is how so many people with M.D. or Ph.D. connected to their name got conned by this drunk.

  7. Thank you for including my articles in your piece.

    I just want to make one correction – when a family member contacted The Fix after my second article about Audrey was published, they did not deny that Audrey had committed suicide (she had hanged herself). They denied that empty pill and liquor bottles were found.

  8. Mike says:

    Thanks for a fascinating article. Your articles and comments on here gave me great strength, inspiration and confidence during the summer when I had realised that I could no longer tolerate the god stuff but was apprehensive about stepping away from meetings through fear of picking up.

    I’m no longer active in AA, but stay in touch with friends, and have had no desire or even thoughts of drinking, mainly because of the paragraph you quote about stepping into a bar for a spot of controlled drinking. My entire history with alcohol, if it has taught me anything, is that I cannot control my drinking. Those I saw coming into the rooms from a referral from the local health professionals who recommended controlled drinking alongside the program all disappeared quickly, occasionally returning looking very much worse, I see a couple of them out and about occasionally and they don’t seem to be treading the path of happy destiny. Four people I saw at meetings who were following the controlled drinking path have to my knowledge died.

    I cannot drink like a normal person, I know that I never shall, and I am extraordinarily grateful to have learned that lesson through AA.

    Living in the UK I had never heard of Audrey Kishline, thank you again for bringing her story to my attention.

  9. John M. says:

    Really heartbreaking story. Trying to feel my way into her hopelessness; trying to imagine the guilt of having killed a man and his daughter, then being “forgiven” by mother and wife, Sheryl Maloy-Davis, and then still knowing that she could not quit, what a feeling of stark, desperate loneliness she must have suffered with.

    A story like this makes me value all the more those who have helped me stay sober throughout the years. Thanks, Bob, for presenting this well written account of a very sad story. It does remind me of the importance of me staying vigilant however.

  10. life-j says:

    Thank you Bob, and thanks for the comments that follow. It is a humbling read all of it. Important to recognize that “addictive personality” is at the root of everything for us, not “just” alcoholism, as evidenced by all the smoking and coffee drinking at meetings, and personally I have also indulged in substitute addictions. Drinking is just the addiction (among the more common ones) which has the most unpredictable consequences. I’m grateful I never hurt anyone with all the times I drove drunk.

    As for moderation vs abstinence, we do have to recognize that it is a continuum. Many young people have a problem drinking for a few years, recognize it, and quit the excessive behavior all on their own, and go on to become normal drinkers.

    It wasn’t me, to be sure, but I want to recognize that the spectrum of problems is broad.

    And there are apparently many who can be helped by Naltrexone to where the addiction is extinguished pharmaceutically, and while many choose to become abstinent, some will have an alcoholic drink occasionally without ill consequences, so long as they follow their program.

    It’s all about harm reduction, and the measures taken vary with individual needs, and I want to recognize that, even though abstinence is the only way to go for me.

  11. Joe C says:

    Thanks Bob. I look forward to your talk at the upcoming ORC Friday afternoon (Canada’s largest annual gathering of AA, Alateen and Al-Anon).

    I go to AA but I am a member of the larger recovery community. Long term recovery and improving life is the goal of abstinence peer2peer, treatment and harm reduction options. More people die from addiction than find lasting recovery. The larger the organization, the more failure because the fix is in for all of us.

    My continued recovery is an exception to the odds behind door #1,2 or 3. More die than succeed at 12-Step and we dismiss the contributions of our fallen who’s contributions ought to be celebrated. Ebby T sponsored Bill but didn’t die sober. Hank P, not Bill was the catalyst to the $30-something million Big Book. These men, except for the efforts of historical truth seekers like Bobby Beach here, would be whitewashed out of our narrative or narrowly labelled as bad examples. Every recovery is worth celebrating-regardless of how well it lasts or how it ends.
    I borrowed this way of looking at recovery from researchers who, when looking at addiction, applied the same qualifiers to recovery from addiction as they would any other disease. Anything that improved life quality or duration is successful. If a cancer patient dies of cancer that doesn’t mean oncology killed them. They apply that to chronic relapse patients who the rest of us consecutive-day-counters dismiss as in denial. If chronic relapse is better for the patient and their family than drinking themselves to death in one spiral, count that as a success. Until any of our groups or other non-12 Step fellowships or medically assisted treatment find a formula for %100 success, I want to encourage trying new things. I don’t see harm reduction and/or moderation management as “them” and abstainence as “us”. Most of our abstainence regimes are a form of harm reduction, substituting one substance for other behaviour or substance patterns that we later identify as addiction ( food for comfort, working or exercise or diet that is obsessive, porn, internet or other escapist online activity, debt and spending, smoking, caffeine or other stimulants, unhealthy relationships). I speak for myself when I say that my recovery has had ups and downs that have included therapeutic intervention and other 12-Step rooms. So am I an abstainence guy or harm-reductionist?

    Moderation Management isn’t wrong to offer people choices. I don’t know how many people succeed with it; I only hear from those who transition to abstainence (in as far as each 12-Step organization treats bottom-line behaviour. Because I here the moderation management let-downs becasuse, in 12-Step rooms, I hear their story. I don’t have much access to moderation management success stories. I feel for how the subject of this essay’s life ended. I also applaud her pioneering, imperfect ways. I also see Ebby and Hank as AA founders. And Bob died of cancer (a smoker) and Bill died of emphysema-both treatable/preventable self/inflicted coping mechanisms. I am not calling AA founders closet harm reduction practitioners. We each define for ourselves what success is.

    Yes denial and delusion is ever-present; isn’t that an inescapable condition of Addiction – maybe more broadly, the human condition?

    • Gen I says:

      Thank you, Joe, for your balanced views. There are lots of Moderation Management members who have been and continue to be successful at learning how to moderate their drinking. I’m sure if you reach out to them they can put you in contact w/some successful members. There is no magic bullet, and I agree with you that we can all benefit from more choices on our road to recovery.

    • Norm L. says:

      Pardon me Joe but I believe you’ll find Ebby did die sober in what had been a recovery home – seems without looking it up he was sober about 9 months.

      • bob k says:

        Ebby was about two years sober when he died. He was ill, essentially too sick to drink, and in an environment where he’d have had a hard time getting liquor. He was not attending AA.

  12. Denise E. says:

    Very interesting read – thanks.

  13. Pat N. says:

    I recently had minor surgery and my surgeon handed me a scrip for oxycodone. His guidelines suggested popping a couple every 4 hours for a couple of days. I tried one dose, and could barely eat for the next two days, vomiting on the 3rd. My digestive/elimination system didn’t straighten out for 3 weeks. I’ve had bad experiences with other prescribed opiates long ago.

    Apparently, I cannot safely use opiates.

    Now, I could start experimenting with future pain by taking 1/4 doses of opiates, cutting to 1/8 if that didn’t work. Who knows, I might even be able to work up to full doses.

    WHY? Using opiates isn’t some sort of unquestionable Good Thing, is it?

    I could just do what I finally did after this recent run-in with opiates. I found psychological and over-the-counter aids, and accepted some pain. I learned that pain itself can’t kill me.

    Same thing I learned almost 38 years ago with booze, which I found I could not use safely, although those pains were mostly emotional and mental.

  14. Courtney S. says:

    “Despite all we can say, many who are real alcoholics are not going to believe they are in that class. By every form of self-deception and experimentation, they will try to prove themselves exceptions to the rule, therefore non-alcoholic.”

    …I remember Audrey and saw her on TV a couple of times… in my Homegroup, we discussed MM, I was personally horrified at the suggestion that I could moderate and be successful. I cannot impose that conclusion on anyone else, but my experience mandates that I abstain… Tragic story that I remember well… just as I remember each relapse story shared in meetings.

  15. Norm L. says:

    Good Read Bob – I can identify with so much of Audrey’s story and I feel so much compassion for her – it is cunning and baffling – Thanks.

  16. Murray says:

    I tracked the concept of MM when I was an addictions therapist. It was a possible approach in harm reduction. But when I heard what she had done in the accident I revised my approach. My client base was court ordered young offenders. Harm reduction was the most logical place to start. One of the easiest ways to determine if you have a substance abuse problem is to go thirty days clean and sober. If you can’t, your answer is self evident.

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