Dr. Wilkens is familiar with that pattern. She was a college binge drinker herself and also struggled with bulimia. Once she left her home state of Kansas for New York City, where she attended Hunter College, she felt culturally stimulated and intellectually challenged, she said, and the drinking and disordered eating disappeared.

“When you focus on building up the world around you, you find stimulation and rewards that are very different from using drugs and alcohol. You find other ways of soothing yourself, and things can get better,” she said.

That is precisely what L.S. learned five years ago. L.S., a Manhattan lawyer in his early 30s who asked to be identified only by his initials to protect his privacy, spent nearly a decade as an episodic binge drinker. He began drinking as a student at his large Midwestern university, where he played rugby and where many of his best friends belonged to fraternities. Alcohol, he said, flowed freely through both subcultures. L.S. said he thought his drinking — weeks of no drinking followed by serious binges of a few dozen drinks over several days — would end after college. Yet the behavior did not fade. The morning after his wedding, he awoke with a hangover that lasted a day and a half.

His father, who drinks socially, told him that people either were alcoholics or were not. But L.S. was unprepared to accept that label and began researching moderation on his own. He found a New York branch of Moderation Management, or M.M., a secular, peer-led support group that takes a cognitive behavioral approach.

In contrast to A.A., which stresses a drinker’s lack of power in the presence of alcohol, M.M. encourages personal responsibility for drinking. The group, founded in 1993, encourages members to start with an alcohol-free month, and then allows for the reintroduction of moderate amounts of alcohol. (Critics note that one of its founders, Audrey Kishline, was involved in a fatal accident while driving drunk. She left the group in January 2000 with the intention of joining A.A., and three months later, crashed head-on into another vehicle, killing the driver and his 12-year-old daughter.)

L.S. now attends hourlong meetings once a week at which he and about a dozen others discuss their goals for moderate drinking, as well as tips, challenges and progress on avoiding triggers. Since he began attending, L.S. limits himself to about five drinks a week, well below the 14 drinks M.M. advises as a safe limit for men.

L.S. is convinced that there is no single approach for all problem drinkers. “M.M. doesn’t profess to work for everybody. It has a scientifically based approach that works for some people,” he said.