From: carnes@quip.eecs.umich.edu (Richard Carnes)
Subject: Abstinence (was: easier?)
Organization: University of Michigan EECS Dept., Ann Arbor
Date: Thu, 10 Sep 1992 14:26:03 GMT

dab@ism.isc.com (David A. Butterfield) writes:

>Why do you think that it is "easier" to learn how to use alcohol
>in reasonable quantities than it is to learn how to abstain from
>it completely?  It seems to me the former would be much harder.

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
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.  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.
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.  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.

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

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).  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.  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.

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.

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.

Richard Carnes
Newsgroups: alt.recovery