Tuesday, August 21, 2007
The Myth of Controlled Drinking
Forward into the Past: White-Knuckle Alcoholics
For the past two decades, social psychologist Stanton Peele has questioned the necessity of abstinence for alcoholics, claiming, in The Meaning of Addiction and in Diseasing Of America: Addiction Treatment Out Of Control, that the “myth” of instant relapse is not well supported by statistical research.
Bulling his way past hundreds of published scientific studies about the neurobiology of addiction, Peele continues to insist that the disease concept of alcoholism has no basis in current science. Believing that people’s personal values determine whether or not they become addicts, Peele has also written that “no data of any sort support the idea that addiction is a characteristic of some mood-altering substances and not of others.”
“Those with better things to do,” Peele writes, “are protected from addiction.”
Andrew Weil, a well-known drug authority and author of The Natural Mind, has also objected to the “grossly materialistic conceptions of addiction” offered up by proponents of the biochemical view.
A biological view of addiction can be a way of giving intractable addicts hope, researchers say. Peele, however, draws exactly the opposite conclusion, arguing that the disease model is telling addicts that there is no hope, that they cannot do anything about their incurable “disease.”
Considering all the basic qualifiers about biochemical theories that the researchers themselves felt obliged to use in the first place, it was galling in the extreme to have critics like Peele deriding the effort in its entirety--and most amazingly of all, bringing back the old bugaboo about controlled drinking. Adherents of the controlled drinking theory hold that alcoholics can frequently return to social, responsible drinking, without having to maintain total abstinence.
If an alcoholic limits himself to two or three drinks a day, and does it successfully for a period of time, this behavior looks from the outside like controlled drinking. Many alcoholics and other drug addicts are able to accomplish this feat for varying lengths of time. Indeed, AA members are familiar with this counterfeit form of controlled drinking, and even have a name for it: White-knuckle sobriety. Controlled drinking-- also known as sobriety without abstinence--is certainly not unheard of among alcoholics
But is it a practical response to alcoholism?
Dr. Arnold Ludwig, professor of psychiatry at Kentucky University’s College of Medicine, disagrees. In his book, Understanding the Alcoholic’s Mind, Ludwig writes: “Those authors who argue that many can return to normal drinking fail to grasp an essential point: it is less frustrating for the preponderance of alcoholics to avoid drinking altogether than to settle for one normal-sized drink, such as a single martini, a glass of wine, or a beer.”
For most serious alcoholics, it is easier to abstain altogether, rather than to engage in controlled, responsible, non-intoxicated drinking.
The idea of controlled drinking (or controlled drug use) is the one hope almost every addict brings to his or her initial encounter with treatment. As one AA veteran put it: “If it were possible for a majority of alcoholics to revert to controlled drinking, every alcoholic in AA would have found out about it a long time ago.”
It sometimes seems as if critics like Stanton Peele are attempting to resurrect the moral view of the past, offering no new approaches while legitimizing the criminal penalties and social stigma that has been America’s response to addiction all along.
Peele, Stanton. Diseasing of America. Jossey-Bass, 1999
Peele, Stanton. "A Moral Vision of Addiction: How People’s Values Determine Whether They Become and Remain Addicts,” Journal of Drug Issues, Vol. 17, Spring, 1987.
Ludwig, Arnold M., Understanding the Alcoholic's Mind. Oxford University Press, New York, 1988.