MM's primary text, Moderate Drinking (1), and AA's Big Book (4) actually agree on several important points. Both books make explicit distinctions between problem drinkers who are able to return to controlled drinking and alcoholics. Both texts also concur that failure at the goal of moderate drinking indicates that a drinking problem is serious and is best addressed by abstinence. These shared assumptions have been supported in prospective studies showing that, broadly speaking, when problem drinkers recover, abstinence is more common among those who are highly dependent on alcohol, are male, are older, and are socially and economically unstable, whereas moderate drinking is more common among problem drinkers who do not belong to these sociodemographic groups—for example, young women with low levels of dependence (5,6,7).
MM's proponents differ from advocates of abstinence-only approaches in their views on who can be trusted to judge the difference between a moderation-bound problem drinker and an alcoholic rather than in their views on whether such a distinction exists. A large proportion of the 12-step treatment community in the United States has incorporated the psychodynamic concept of denial into its theory of alcoholism; AA's texts describe alcoholics as having a grandiose penchant for overestimating their ability to control drinking (4). Thus many 12-step advocates fear that despite MM's intention to serve only nondependent problem drinkers, the organization's members are in fact alcoholics who are deceiving themselves into thinking that they can drink moderately.