From: carnes@quip.eecs.umich.edu (Richard Carnes)
Subject: Re: AA beliefs? 
Organization: University of Michigan EECS Dept., Ann Arbor
Date: Sun, 13 Sep 1992 20:46:19 GMT

altshule@skid.ps.uci.edu (Eric Altshuler) writes:

>> Research over the last 30 years has repeatedly
>> confirmed that persons reliably diagnosed as alcoholics can
>> sometimes resume normal drinking
>
>Seriously???  I won't dispute it, but I also won't believe it until I
>see it in writing.  Please site your research.  

First let me stress that no one whose alcohol dependence is/was severe
or of long standing, or who is abstaining and reasonably satisfied
with their recovery, should attempt controlled drinking without first
seeking competent professional advice.

Here are a few references to serve as a starting point, from most
recent to oldest.  Of course, "further research is required" as usual.

W.R. Miller et al., "Long-Term Follow-Up of Behavioral Self-Control
Training," JOURNAL OF STUDIES ON ALCOHOL 53: 249-261, 1992.  (JSA is
probably the leading journal in the field of alcohol studies.)  Some
quotes:

  "Reports of problem-free drinking outcomes among treated alcoholics
  have been numerous.  The reported prevalence of such outcomes has
  varied from approximately 20% to less than 2% among alcoholics treated
  with a goal of abstinence....
  
  "Such reports shed little light, however, on the outcome when treatment
  is *designed* to instill moderation.  Miller and Baca (1983) reported
  67% favorable outcomes at 2-year follow-up of two clinical trials of
  outpatient moderation-oriented treatment....
  
  [From the conclusions:] "A subset of patients do establish and maintain
  stable asymptomatic drinking.  In our located sample, 14% were
  classified by very conservative criteria as asymptomatic drinkers,
  sustaining moderate consumption with no evidence of either negative
  consequences or symptoms of dependence....
  
  "The verified asymptomatic drinkers were not limited to nonalcoholics
  or less severe cases.  Ten of 14 were clearly diagnosable as
  manifesting alcohol dependence (DSM-III).  Classified on stage of
  alcoholism based on symptomatology at intake, one had been at
  pre-alcoholic, four at prodromal, seven at crucial and two at chronic
  stage....
  
  "Asymptomatic drinking is an achievable and sustainable outcome for
  some persons showing evidence of alcohol dependence.  It appears that
  the prognosis for achieving this outcome is poor at higher levels of
  dependence and more favorable when individuals are treated earlier
  rather than later on the continuum of dependence and problem
  severity....
  
  "...for many patients the opportunity to attempt controlled drinking
  under supervision and monitoring without prejudice was clearly useful.
  Some of them found that they could sustain problem-free drinking,
  while others ascertained that for them abstinence would be the better
  choice...."

N. Heather, "Controlled drinking treatment: where do we stand today?"
In ADDICTIVE BEHAVIORS, ed. T. Loberg et al., Amsterdam, 1989.

Nick Heather and Ian Robertson, PROBLEM DRINKING, 2nd ed., 1989, pp.
90-108.  "The contention that persons with previous drinking problems
who have recovered the ability to drink normally were not 'real' or
'true' alcoholics in the first place has been shown to be false.  The
evidence indicates that there is no upper limit to severity of
physical dependence which absolutely precludes the possibility of
recovered control.  There *is* evidence that normal drinking becomes
increasingly rare as severity of dependence increases."

Ron Roizen, "The Great Controlled-Drinking Controversy," RECENT
DEVELOPMENTS IN ALCOHOLISM 5, 245-279, 1987.  An overview of this
long-standing controversy.

W.E. Miller and N. Heather, eds., TREATING ADDICTIVE BEHAVIORS, 1986,
pp. 145-148.  The article in which this discussion of controlled
drinking appears is perhaps the best survey of the effectiveness of
the various treatment methods for alcoholism.

N. Heather and I. Robertson, CONTROLLED DRINKING, revised ed., 1983.
An entire book on the topic.

Richard Carnes
Newsgroups: alt.recovery