From: rdh@Veritas.COM (Robert Hartman)
Newsgroups: alt.recovery
Subject: Re: Abstinence (was: easier?)
Date: 11 Sep 92 04:22:17 GMT
Organization: VERITAS Software

[ cross-postings outside of alt.recovery omitted to prevent
  inadvertent crosstalk from folks who don't understand what a.r
  is about  -r ]

In article <1992Sep10.142603.4016@zip.eecs.umich.edu> carnes@quip.eecs.umich.edu (Richard Carnes) writes:
>dab@ism.isc.com (David A. Butterfield) 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 

Hmmm.  I'm finding that I'm starting to have the same reaction to this
that I had to the person who quoted from the Big Book.  If this is your
opinion, I'd appreciate it if you'd qualify it as such.  Even though
you soften your statement, if there are people who have been harmed by
AA, I think it would be better to let them speak for themselves.  If
_you've_ been harmed by AA I know that I'd be very interested in
hearing about what happened to you.

> -- which is not to deny that abstinence
>is the best solution for many others.  All problem drinkers are not
>alike.  Here is another way in which the one-solution-fits-all
>dogmatism of the AA approach has done harm as well as good.  

As I've tried to point out, there are certainly dogmatic AA members,
but the AA approved literature, which even the most dogmatic of members
rely on, says that AA is not concerned with other programs one way or
another.

If other programs work, my sense is that that would be just fine with
most people in AA.  I know it would be just fine with me.  If
there had been any way I could have avoided withdrawal, I'd have
done it that way.  It's just that for most people in AA, nothing else
worked.  And although a 12-step program was the first thing I tried,
once I became aware of the nature of my problem, I doubt that anything
else would have worked for me.

And I certainly have my quibbles with AA.  It is certainly not
perfect.  But it doesn't claim to be and it doesn't have to be.  It
works if you work it.  And that's good enough.

> ... The
>prevailing dogma of the alcoholism movement (of which AA is the
>central institution) asserts that alcoholism is an incurable disease
>(rather than learned behavior) and that the impaired control and
>craving that are its principal symptoms are irreversible; it follows
>that the victims of the "disease" must avoid alcohol permanently.

Yes.

>This fixation on abstinence as the only solution to a drinking problem
>carries a number of serious disadvantages.
>
>To begin with, it restricts our attention to the most serious cases of
>alcohol dependence, where abstinence is indeed necessary.  Of course,
>these serious cases deserve help and compassion.  

So far, this is the only one you've mentioned.  What are the others?

> ... But the impression
>is given that the less severe cases of problem drinking are not worthy
>of concern.  In reality, many kinds of alcohol-related problems in our
>society are caused by less severe and more easily remediable problem
>drinking.

This is really interesting, because to my knowledge, AA was made an
anonymous fellowship because of the stigma associated with being an
out-of-control, helpless drinker.  I agree that the more dogmatic
members and certain portions of the Big Book do express a dim view of
the problem drinker who just wants to get his drinking under control.
But coming from people whose failure to do so typically brought them
severe losses, this may be understandable.

It would be truly a shame if AA were responsible for that old stigma
being reassigned to problem drinkers who could control their intake,
but for whatever reason just weren't doing so at the moment.  But I
think that it is the uncontrolled behavior of people who are under the
influence that creates the bad impression, not the disease model.  An
intoxicated person is a _sick_ person, even if the sickness ends when
the hangover subsides.  Alcohol impairs people.  If someone can get
better without AA, that doesn't mean they aren't sick while they're
drunk!  Drunken behavior is a symptom of alcohol intoxication, e.g.,
poisoning.

>Thus the disease concept to alcoholism fails to deal effectively with
>the full range of problem drinking: since the possibility of ever
>drinking again is ruled out by this approach, and because lifelong
>abstinence is a daunting prospect for most people in our society, the
>problem drinker usually must experience severe suffering ("hit
>bottom") before he will consider treatment.

The common experience among people in 12-step programs is that as long
as it worked for them to drink, they'd keep drinking (or whatever).
That was my experience as well.  What you call a dogmatic belief I see
as the wisdom of experience.  Of course the possibility of drinking
again is there.  That's why abstinence is taken one day at a time.
However, so is the very high risk of another spiral toward bottom, and
that needs to be considered whenever someone who's lost it behind
alcohol contemplates the prospect of taking a drink on any given day.

When someone says, "I've got it under control, I'll be OK," it
could be true.  But I know better than to bet the rent when I'm
the one who's saying it.

>The insistence on
>abstinence and the dogmatic belief in hitting bottom have therefore
>impeded *early* intervention into the development of problem drinking.

How so?  How can a person tell, early in his drinking career, that it's
going to get so far out of control he'll need treatment?  I've never
seen a warning label on a bottle!  While I agree that early
intervention would be less painful, it seems to me that it is the
purveyors of alcohol and the macho image of drinking in our culture
that inhibits prompt recognition and treatment of a drinking problem.

>Because of the taboo on controlled drinking as a treatment objective,
>few treatment programs or self-help procedures have been developed for
>the very large population of less severe problem drinkers (or severely
>dependent drinkers in an early stage of development).

I don't know about this.  It seems to me that there have been
innumerable attempts by concerned friends and relatives to counsel
problem drinkers and get them to slow down--ever since alcohol was
first consumed.  If there isn't a formal program for high-bottom
controlled drinkers, and it seems important to you, I have no objection
to your starting one!

BTW, there are a couple of programs that you might be interested
in.  One is called Rational Recovery.  Another is called SOS.
I'm not sure if they're exactly what you have in mind, but you
might feel them to be more to your liking than AA.

>There is evidence that abstinence as a treatment goal is sometimes
>counterproductive; that is, some studies have shown higher failure
>rates for certain populations (particularly younger and less serious
>problem drinkers) when abstinence was the goal than when moderate
>drinking was the goal (references available on request).

Well ... I guess I'd want to see longitudinal studies.  Where
were these younger, less serious, problem drinkers 20 years
later?  I'll bet at least a few of them found their way into AA.
AA tends to take a very long view of the problem.

>The reasons
>are not far to seek: abstinence tends to be regarded as deviant
>behavior in our consumption- and leisure-oriented society of the late
>20th century.

Fortunately, this seems to be changing.  At least in the SF Bay Area.

>Much more than in the 19th century with its socially
>mainstream temperance movement (from which the 20th-century alcoholism
>movement is directly descended), today the abstaining individual tends
>to take on the role of a social outcast (deviant), and for many people
>in recovery this in itself creates additional difficulties.

Well, not so for me.  None that concern me all that much, at any rate.
Alcohol is not my addiction.  I just don't like it much.  So I don't
drink very often.  Some people don't like that about me, but then, I
don't like the way some people act when they drink.  So it's no much of
a loss either way.  Who was it you were thinking of?

>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.

Hmmm.  I know of some people who have pulled themselves up out of the
gutter with the help of AA.  I don't know of anyone who has done so by
any other method.  Do you?  Do you know of anything else that has a
_better_ track record with low-bottom drunks?

>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.

Well ... there's a lot more to AA than abstinence.  In fact, abstinence
is only the beginning.  The 12 steps go directly after the internalized
sources of chronic emotional pain that drive people to drink.
Unfortunately, in my experience, those issues didn't come to the
surface as long as there was an effective anasthetic in my system.  I
had to give up the anasthetic before I could locate and root out the
sources of my pain.

>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.

Well, Richard, this is the exact opposite of my experience.  It is so
far removed from the approach taken by the 12-step programs I've been
involved with that I have a hard time understanding how you could
believe it or why you'd say it.

Why _did_ you say it?

What is it exactly that you're looking for here?

-r
Newsgroups: alt.recovery,talk.politics.drugs