Vice Squad
Thursday, March 03, 2005
Controlled Drinking for Recovering Alcoholics?

Someone close to you has a serious drinking problem. Should this person be counseled to cut back on alcohol consumption, or to become completely abstinent? Like certain other zero-tolerance v. harm reduction issues (e.g., abstinence-only sex education for high schoolers), this question is very controversial.

This month the journal Addiction contributes to the debate, first with an article by Dawson, et al., "Recovery from DSM-IV alcohol dependence: United States, 2001-2002," and then with four responses to the article and a rejoinder by Dawson, et al.

The main finding of Dawson et al. is that lots of folks who meet the standard markers for alcohol dependence eventually change their ways. While many of these folks become abstinent, a movement to low-risk drinking is also a common outcome. And these "recoveries" are generally accomplished without treatment for alcohol dependence. The authors themselves are quite measured in their interpretation of these findings, and the responses by and large are further calls for caution.

My own not-well-informed view is that for some (but by no means all) alcoholics, controlled drinking is essentially impossible. [Update: perhaps years after the current crisis or in a radically different environment even these individuals would be able to drink "socially".] A similar view (I think) is provided in Deborah Hasin's response:
A very important result of Dawson et al.'s paper is that full remission from the symptoms of DSM-IV alcohol dependence can occur among individuals who continue to drink. At one time, this finding would have been revolutionary. Fortunately, our field has matured enough so that is no longer the case. However, we remain without guidelines concerning who really must stop drinking in order to recover from DSM-IV alcohol dependence, and who can recover stably from dependence even while drinking moderately. While many guidelines exist on how to cut down or stop in terms of psychological (e.g. motivation, cognitive planning) and environmental changes (new peer groups, avoidance of cues for binging), however, these do not address the question of abstinence versus controlled drinking....

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