Abstract
Although moderation and harm reduction approaches to the treatment of alcohol problems are accepted in many parts of the world, they continue to be rare in the US. A major reason for this state of affairs has to do with the way alcohol treatment services in the US developed, and in particular the creation of a group of paraprofessional counselors many of whom attributed their recovery to the 12-step philosophy. While it is unlikely that these counselors will offer moderation services, the provision of services to problem drinkers in primary care medical settings presents a promising alternative.