Is controlled drinking a realistic goal for those who are dependent on alcohol? What are the arguments for and against it?
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Alcoholism, whether a product of genetic predisposition or a result of environmental and emotional factors, is a serious addiction. Whether it can be cured or controlled through moderate, regulated drinking, however, is entirely dependent upon the individual and the underlying causes. The main opponents of controlled drinking as a response to alcohol abuse are the National Institute on Alcohol Abuse and Alcoholism and Alcoholics Anonymous (AA), an old and highly respected organization that remains convinced that abstinence is the only appropriate response to alcohol abuse. AA counselors argue vociferously that, given the tendency of most alcoholics to deny their addiction, and given the overpowering sensation addicts experience to resume use of the substance in question, controlled drinking is the wrong path for alcoholics. Advocates for controlled drinking argue that AA’s approach is extreme and not suited to all alcoholics. By permitting occasional drinking in moderate amounts, alcoholics can better control their consumption without enduring the symptoms that accompany withdrawal from an addictive substance. As with heroin users who can control their addictions through methadone treatment – a highly questionable assertion given problems with methadone addictions – supporters of controlled drinking believe that complete abstinence is unrealistic in the vast majority of cases – an assertion possibly borne out by the relatively low percentage of alcoholics “cured” through AA’s “12 step” program. Given the scientific fact that excessive alcoholic consumption damages the brain, particularly the part of the brain that enables individuals to moderate their behavior, use of a “controlled” drinking regimen for alcoholics is a dubious proposition, but one that should not be dismissed out of hand. Clinical trials in Europe and Australia have largely mirrored the expectations of experts on alcohol addiction in the United States. In France, where a study was performed involving controlled drinking for some and abstinence for others, the results showed that around one-half of the subjects responded favorably to controlled drinking while the other half fared better with the more traditional approach of abstinence. Similar studies in Britain and Scandinavia, according to a November 22, 1983 article in the "New York Times", indicated that controlled drinking held promise as a treatment for alcoholism, and that approach has been incorporated into normal treatment plans in clinics in those countries. As one British psychiatrist was quoted in the "Times" article as saying, “total abstinence may sometimes be ill-advised and result in the patient alternating sobriety with explosive relapses, rather than his learning how to control his drinking or attenuate his relapses.” [“Controlled Drinking Gains as a Treatment in Europe,” New York Times, November 22, 1983] There is rarely a good “one size fits all” solution to addictions, and that is certainly the case with alcoholism. As the causes vary according to each individual, so must the solutions vary according to the needs of each individual. Sufficient evidence exists that some alcoholics can be helped through a program of controlled drinking. Inasmuch as even AA concedes that alcoholism cannot be cured, the controlled drinking model will likely remain a part of the broader response to alcoholism for the foreseeable future.
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