From: carnes@quip.eecs.umich.edu (Richard Carnes)
Subject: Re: Abstinence (was: easier?)
Organization: University of Michigan EECS Dept., Ann Arbor
Date: Thu, 10 Sep 1992 21:32:19 GMT

met48546@uxa.cso.uiuc.edu (Marc E. Talbot) writes:

>>I don't know about "easier", but controlled drinking is a much more
>>*useful and effective* goal than lifelong abstinence for a large
>>proportion of problem drinkers -- which is not to deny that abstinence
>
>How are we defining controlled drinking?  Drinking so that the drinker
>only gets drunk when he wants to?  The drinker never wanting to drink
>too much?  

I mean harmless drinking, what is generally called normal, social, or
moderate drinking.  Research over the last 30 years has repeatedly
confirmed that persons reliably diagnosed as alcoholics can sometimes
resume normal drinking.  This finding is embarrassing (i.e.,
anomalous) to the conception of alcoholism as a disease, but as you
may realize a paradigm shift is no trivial matter.

>            How large is a large proportion of problem drinkers?  Ten
>percent? Fifty?

I couldn't put a hard number on it.  Let's put it this way: I think
severely dependent problem drinkers should normally be advised to
abstain, because it is extremely difficult for them to achieve
controlled drinking and they are courting failure by attempting it.
Controlled drinking is most applicable to those with moderate and less
severe problems.  One treatment possibility is to give clients an
informed choice as to which goal to pursue.

>>prevailing dogma of the alcoholism movement (of which AA is the
>
>It would be nice to call it a "recovery" movement! :-)

You have a point, but actually the term "Alcoholism Movement" has a
specific meaning: it refers to AA, the Yale Center for Alcohol
Studies, and the National Council on Alcoholism, the organizations
that, with little or no scientific basis, have advocated the disease
conception of alcoholism in order to combat stigma and prejudice and
encourage alcoholics to seek treatment (worthy goals, I agree).

>How do you treat someone who doesn't think that they have a problem?
>I don't quite belive in the "hitting bottom" theory myself, as I
>believe that things could ALWAYS get worse.  I think that the level of
>suffering required for someone to realize that they have a problem
>varies from person to person, but it is very hard to preempt.  If you
>don't think you have a problem, you aren't going to try to fix it.

Right.  I don't think a drinker necessarily has to suffer severely to
realize that he has a problem; his recognition that he has a drinking
problem may be facilitated if he knows that lifelong abstinence will
not necessarily be insisted on, and if he is not forced by a
confrontation to "admit" that he is an "alcoholic", i.e., forced to
accept a permanent, identity-changing label that many people perceive
as stigmatizing.

>>In some cases, particularly with "skid row" alcoholics, abstinence is
>>unrealistic as a treatment objective.  There are people who are so
>>impaired that radical changes in drinking behavior are impracticably
>>difficult to achieve.  Again, the disease approach to alcoholism, with
>>its insistence on abstinence, fails to help these individuals.
>
>I would like to see any evidence that "skid row" alcoholics can drink
>socially again.  

Me too.  However, I meant only that abstinence was unrealistic for
many of them, not that controlled drinking was a reasonable objective.

>I agree that the behavior changes required for total
>abstinence would be overwhelming, but I think that abstinance is the
>only thing that will stop them from dying as practicing alcoholics.

Maybe not.  Reasonable treatment goals might be reduced if not
moderate drinking, better health, and holding some kind of job.

>>Finally, the disease concept of alcoholism tells us nothing about how
>>to treat alcohol abuse other than that alcoholics must never touch
>>alcohol; that is, disease-oriented treatment is a superficial approach
>>which "treats" the "disease" merely by suppressing its principal
>>symptom.  It generally consists of little more than common-sense
>>cajoling and persuasion, rather than teaching the drinker new ways of
>>dealing with the stresses of life.
>
>My disagreements with the earlier parts of your post were fairly
>minor, but I really feel that I ought to comment on this last part.  I
>agree that simply telling someone that they have a disease and that
>they should not drink is not teaching a drinker new ways of dealing
>with life.  However, if you look at the 12 steps and 12 traditions of
>any 12 step program, alcohol is only mentioned once.  The rest of the
>steps explain how to make an adjustment to a healthy lifestyle.  The
>traditions explain how we relate withother people.  Meetings flesh
>these out.  At most meetings, people talk about how to deal with life
>on life's terms, through the application of the steps and traditions.

I agree that AA offers a new way of life and doesn't just tell people
to stop drinking.  However, I was primarily referring to clinic
treatment centers that require abstinence.  It is arguable that
drinking should be allowed in order to facilitate understanding and
changing the drinking behavior.  It is as if a doctor merely
prescribed aspirin to suppress the symptoms of a disease without
treating the pathology.

Richard Carnes
Newsgroups: alt.recovery