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.


jclaudeg said...

I disagree to a large extent.

First off, the “not publicised enough nor often discussed” 2006 NESARC study contradicts your assertions rather strongly. Second, clich├ęs and funny sounding sayings are fine and inspiring in cocktail party’s but shouldn’t be overused.

That said, no one can predict with certainty who can or cannot go back to moderate drinking and there surely are many white knuckle but others (a substantial proportion or not is beside the point) surely find it easier to learn how to stop after one or two drinks rather than abstain altogether. Alcoholics (a confusing mixture of abusing and dependant persons) may seem to appear the worst candidates for this type of learning - just look at their past behavior-, but that doesn't absolutely prove they can't.

Looking forward to reading your response or others comments.

Dirk Hanson said...

My response to the controlled drinking assertion is pretty consistent: It's the myth every alcoholic wants to believe.If controlled drinking for a majority of alcoholics was a viable alternative, every alcoholic in AA or rehab would have found out about it a long time ago. Why don't more abusive drinkers engage in controlled drinking rather than abstinence? Because they can't. And if they can, they very likely weren't biological alcoholics to begin with, but social problem drinkers.

Dirk Hanson said...

One other thing: It's very hard for a person who is not an alcoholic to understand the assertion that recovering alcoholics frequently make: It is easier for them not to drink at all than to limit themselves to 2 drinks a day.

Kenneth Anderson said...

Although the general public continues to believe the myth that AA is highly effective in getting people to quit drinking, studies by researchers such as Jeffrey Brandsma and George Vaillant show us that about two thirds of people who go to AA drop out. These studies also show us that controlled drinking is a viable option for some people who abuse alcohol
For the majority who are either unwilling or unable to abstain from alcohol and who fail to drink within moderate limits, harm reduction is the only viable solution. Taking steps to reduce drinking or to drink more safely are better than doing nothing at all, The HAMS Harm Reduction Network offers tips and strategies for safer drinking, reduced drinking, or quitting.

Anonymous said...

I am no doubt an alcoholic, or whatever name you would like to give me. I know without a doubt that I cannot drink again. In fact, I have no desire to drink again. It is much easier to abstain. I would never want to have just one or two drinks. There is no point in it. Maybe controlled drinking work for some, but for me, I would NEVER try it.

Dirk Hanson said...

I've always felt the same way. I never wanted just one or two drinks before, why would I want just one or two now? The idea of controlled drinking remains unappealing to this abstinent alcoholic.

Jay said...

I was alcohol dependent and after several years of failing to control my drinking I found abstinence worked because the limit was clear. I always missed drinking but felt it wouldn't be possible to control.
But after more than 5 years I had started to become happier in life, more secure and less bothered about drinking or not. With this came contemplation that perhaps I could drink again. I sought advice from 'experts' on both 'sides'. The advice that resonated most with me was 'you could probably drink again without problems if you feel you are really not that bothered about whether you drink or not'.
After several years of further contemplation, and asking myself was it worth it, I attempted controlled drinking.
That was one year ago and it has gone fine, no problems or the urge to drink to destruction as in the past.

I take on many of the points in this article. There is a nuerobiological element to addiction, abstinence is safer and easier, but when life circumstances have changed considerably controlled drinking is possible for some.

Dirk Hanson said...

I have no doubt that many heavy drinkers can at some point return to controlled drinking. And it may even be true for some alcoholics. But it is clearly a minority, else all us alcoholics would know about it, and would have happily returned to controlled drinking. It's not that it can't happen; it's the risks involved in making the attempt that bother me. If it DOESN'T work, you can be back in the shit very quickly.

I think most addicts have to ask themselves if the ability to have the odd glass of wine in company, or one cocktail daily, is really worth the downside risk.I mean, was your life really all that pointless and drab because you couldn't have a social drink every other day? Not saying it didn't work out okay for you, but I would be hesitant (I AM hesitant) to suggest that experiment for alcoholics in general.

Jay said...

Dirk thanks for your response. I agree with the general notion that the potential benefits or controlled drinking will in most cases be far outweighed by the risks.

It presents a very difficult issue though - a tension between the fact that controlled drinking is possible for some, with the risk that this being widely known may increase attempts at controlled drinking amongst those who can't achieve it - but will only know once they've tried and failed.

As a successful 'controlled drinker' this is something I have stuggled with and I would NEVER attempt to pursuade or influence someone to try it themselves. In fact I am sometimes even reluctant to tell my story in case I do influence someone to try who might not otherwise. Including writing here.

Equally though I am not comfortable with "hiding" that controlled drinking may be possible for some formerly dependent drinkers. You asked "was your life really all that pointless and drab because you couldn't have a social drink every other day?". No, it wasn't at all, but after several years of contemplation, reserach and discussion, I felt that confident enough I would not desire to drink problematically that the modest benefits of moderate and occassional social drinking might on balance be worth it.

Honestly I have to say I had in mnay ways over-romanticised those benefits and although I enjoy a 'social drink', particualry with a meal, I enjoy it less than I thought I would. Certinaly part of that is the fear that what I'm doing could in time lead back to problem drinking, but overall moderate alcohol use is at best mildly plesurable.

So, even as a 'successful' controlled drinker, I wouldn't say abstainers are missing out on much. In fact I miss many things about abstinance, not least the solidarity and support of others who know and have expereinced alcohol as potentially dangerous and addictive drug and accept that for them its best not to use it..

Dirk Hanson said...

Thanks for the thoughtful response, Jay.

Kenneth Anderson said...

I believe that giving people maximally accurate information is the best way to empower them to make correct decisions. The NESARC study has shown us that about half of people with alcohol dependence recovery via abstinence and about half recovery by cutting back. Moreover, far more people recover on their own than recover via AA or a treatment program.

However, this still does not answer the question of how many who have successfully achieved abstinence from alcohol will then turn around and choose to attempt controlled drinking. My personal experience suggests that this number is very small--I believe that most people who have successfully achieved abstinence are no longer interested in experimenting with controlled drinking.

Dirk Hanson said...

"I believe that most people who have successfully achieved abstinence are no longer interested in experimenting with controlled drinking."
That's been my experience as well.

My beef with the NIAAA research that everybody jumped on, as I have state before, is that it kind of throws alcoholics and heavy social drinkers into the same categorial bin, whereas in fact we know that treatment for the two categories is different, or tends to be. Abusive drinkers respond to social sanctions and positive rewards, even straight cash awards. Active alcoholics, not so much, or at least not so consistently.

Simon Pryor said...

"And if they can, they very likely weren't biological alcoholics to begin with, but social problem drinkers." - Dirk Hanson.

As a former heavy drinker myself, I get tired of this argument. Talking from my own experience, if you had observed me in the days I was drinking heavily, and many people did, you would not have called me a "social problem drinker". I was not social, and yes, I related to what was said at AA meetings. The feeling of telling yourself you're not going to drink for the whole day, then drinking 3 bottles of wine, and doing the same the next day. Waking up in ambulances with no idea of the past 5 hours, then waking up in a police station the next day. People in AA seem to want to claim that those of us who now drink a glass of wine with dinner were just cool guys who went to lots of parties, when the truth is many of us woke up shaking in the morning and hallucinating later just like they did. The evidence shows that a lot of us exist, and for many people addiction is a dire but temporary experience. We may even be the silent majority outside AA. I do not say that everyone should drink alcohol if they choose not to or that anyone should be FORCED to go for moderation, but I find it sad when people in the exact position I was in are told (just as I was) that they have a lifelong disease, that they must abstain or else die drunk (there is nothing in between and there is no point trying to be safe), and that all their feelings of powerlessness are entirely correct, that they're in denial for thinking they're able to control they're own life. I can only speak for myself, but the best thing I ever did for myself was to reject AA's doctrines in their entirety, and embrace just how powerful I really was. Abstinence or Moderation, the most important thing is being able to recognise that we are powerful, and alcohol is powerless.

Dirk Hanson said...

Can some alcoholics revert to social drinking? Sure. But we have no way of knowing which ones those are. I'm not against moderation, who would be, but I don't personally know many longtime abstinent alcoholics who retain any interest in that experiment.

Anonymous said...

Hi Dirk,
My opinion on Stanton Peele and co., and the "life process program:"
Scientology front (formerly the "process church"), selling cleverly packaged propaganda - it's snake oil, folks. Please don't fall for it.

I did some digging ;)

It's another cult worm from the Medusa head of the CIA, in disguise.

And be sure to note the paid shill websites promoting this bs and steer clear of them too.


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