About Alcoholism--Abstinence Versus Controlled Drinking

Must "recovering"alcoholics resign themselves, for the rest of their lives, to ordering fruit juice or ginger-ale when their friends are having a beer, cocktail , or high-ball? According to Alcoholics Anonymous and most of the twelve step treatment programs in North America, the answer is yes. For years the goal of all alcoholism treatment in Canada has been abstinence, the total avoidance of alcohol in any form--the assumption being that even one glass of beer or wine may be sufficient to plunge the recovering alcoholic back into uncontrolled drinking. This is a basic tenet of the Alcoholics Anonymous philosophy, and it is still widely accepted by the public. Alcoholics who wish to stop drinking must completely. However, the Alcoholics Anonymous program has serious flaws.--especially if you believe in the Freudian reality principle, the way in which the ego seeks to satisfy the id, with safety as the main concern. Participants in the Alcoholics Anonymous program keep stating, reinforcing, and reminding themselves and others constantly that they ARE "alcoholics" or "recovering alcoholics." The "Reality Principle" states that--just as a carpenter works with wood, or a mechanic works with machinery-- alcoholics drink alcohol--it is abnormal for them not to do so, therefore it is unsafe and creates an anxiety. The alcoholic then rationalizes that he or she must be drinking in order to be "normal" and safe and as long as they are not doing so the anxiety remains. Evidence that controlled drinking is not only possible; but in some cases a preferable alternative to complete abstinence has been accumulating for almost fifty years. In 1962 it was reported that seven out of ninety-three men who had participated in treatment programs stressing abstinence as a goal had been able to maintain "normal" social drinking for seven to eleven years after treatment for alcoholism. It was concluded that alcoholism, like cancer, was not one disorder, with one treatment; clearly, certain "ex- alcoholics" could engage in normal social drinking without relapsing, while other "recovering alcoholics" could not. Many subsequent studies supported this conclusion.
One research program attracted a good deal of attention. In this experiment there were four groups of alcoholic subjects. One had conventional hospital treatment with abstinence as their treatment goal. The second had the same treatment, with controlled drinking as their goal. The third had the regular hospital treatment, plus seventeen behaviour- therapy sessions, with abstinence as their goal.The fourth also had the conventional treatment and the behaviour therapy, but with controlled drinking as their goal.
In a two-year follow-up period, data on drinking behaviours were collected regularly from the subjects themselves and from other sources who might  have knowledge about the subjects drinking and or later acquired drug habits. On the basis of these data, the group that did the best was the fourth--the behaviour therapy/controlled drinking group. They were functioning well--that is, abstaining or engaging in controlled drinking (consuming less than 6 oz. of 86 proof liquor, or its equivalent, a day)--on the average of nine days out of ten. The behaviour therapy /abstinence group group functioned well on an average of six and one-half days out of ten. The other groups did even worse. A third-year follow-up study found that the controlled-drinking group continued to be superior to the abstinence group.in another study using data from a number of alcohol treatment centres across North America, the investigators compared the relapse rate of patients who aimed for controlled drinking. The conclusion was that "relapse rates for normal drinkers are no higher than those for long- term abstainers" This release was given prominent nationwide coverage.
Of course, this report has sparked a bitter debate among alcoholic researchers. The report has been criticized for basing its conclusions on too short a follow-up period--eighteen months. In the opinion of many researchers, more time is needed to determine whether rehabilitated controlled drinkers will resist the temptation to slip back into uncontrolled drinking. Another criticism is that the report defined controlled drinking too liberally--allowing an average of six or seven drinks on a given day.  But, of course, any definition of controlled drinking is arbitrary, since drinkers exhibit a wide variety of drinking patterns. The appropriate treatment goal should be reduction of drinking to a non-problem level. Finally, critics objected to the fact that the findings were released to the press. Alcoholics Anonymous and other clinicians feared the findings would put numerous recovering alcoholics back on the road to oblivion, while encouraging current abusive drinkers and people looking at the symptoms, of their problem, rather than the cause or causes, to delay treatment in the hope that "cutting back" on their drinking will be enough. There were also charges of fraud but these charges were reviewed by a prestigious panel appointed by the Addiction Research Foundation of Toronto  with "no reasonable cause to doubt the scientific or personal integrity of the publishers" found. According to the panel report, evidence supported the conclusion that those given treatment with controlled drinking as a goal fared better than those given treatment with abstinence as the goal  and  exceptionally better than those on a Alcoholics Anonymous or other twelve step program alone (although over the long run,  none of the treatment programs has done well , because none get down to the real cause or root of the problem.).
Controlled drinking as a treatment goal for alcoholics remains very controversial. A number of experts believe that any alcoholic entering a controlled -drinking program runs a substantial risk of failure and some claim that they have run such programs without one success.Their criterion for success, however, was very stringent. A patient was considered to have failed if he or she had even one day of excessive drinking, whether or not that drinking lead  to any other problem.
At the present time, even those who have been actively involved  in developing controlled drinking programs stress that it should not be tried as a home remedy for alcoholism.  Controlled drinking should only be used by individuals who have participated in a carefully developed mental health program in which they are taught methods of coping with their compulsive/impulsive nature and the benefits, dangers, and imitations of this approach. Further, it appears that controlled drinking programs work best for those who are beginning to develop drinking problems, rather than for those who have had a long-term serious dependence on alcohol.