From: met48546@uxa.cso.uiuc.edu (Marc E. Talbot)
Subject: Re: Abstinence (was: easier?)
Organization: University of Illinois at Urbana
Date: Thu, 10 Sep 1992 17:20:19 GMT

carnes@quip.eecs.umich.edu (Richard Carnes) writes:

>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

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

>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

It would be nice to call it a "recovery" movement! :-)

>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.

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.

>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).

How large a population?

>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.

I would like to see any evidence that "skid row" alcoholics can drink
socially again.  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.

>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.

>Richard Carnes

Marc Talbot