Alcoholics cannot learn to be 'social' drinkers
This article appeared in the July 29, 1995 Seattle Post-Intelligencer. It
followed shortly after an article featuring an advocate of teaching
alcoholics "responsible drinking" habits
James E. Royce, S.J., Ph.D. is professor emeritus of psychology and
addiction studies at Seattle University and author of a leading textbook
on alcoholism.
by James E. Royce
Can alcoholics be conditioned to drink socially? Under such titles as
"harm reduction" and "moderation management" that old question has been
resurrected. Moderate drinking is certainly a more appealing goal to many
problem drinkers than total abstinence. But medical professionals and
additions counselors are unanimous in their opposition. Are they just
rigid prohibitionists?
As a lifetime member of the board of directors of the National Council on
Alcoholism and Drug Dependence, I must point out that the big problem is
that alcoholism is a progressive disease, often labeled as "problem
drinking" in its early stages. Monday's cold is the flu on Wednesday and
pneumonia on Friday. Most alcoholics are sure they can control their
drinking on the next occasion. The result is killing alcoholics, who can
expect a normal life span if they remain abstinent. For decades I have
defined an alcoholics as one who says, "I can quit any time I want to."
Self-deception is so typical of alcoholics that the American Society of
Addiction Medicine included the term "denial" in its latest definition.
Talk of harm reduction just feeds that denial.
Most research fails to adequately separate true alcoholics from alcohol
abusers or problem drinkers, which makes reports of success misleading.
We can't know how many of the latter may progress into true alcoholism.
The most thorough research (Helzer and Associates, 1985) studied five-
and seven-year outcomes on 1,289 diagnosed and treated alcoholics, and
found only 1.6 percent were successful moderate drinkers. Of that
fraction, most were female and none showed clear symptoms of true
alcoholism. In any case, it would be unethical to suggest to any patient
a goal with a failure rate of 98.4 percent.
We psychologists know that conditioning is limited in its ability to
produce behavioral changes. To attempt to condition alcoholics to drink
socially is asking of behavior modification more than it can do. Some
have thought one value of controlled-drinking experiments could be that
the patients learns for himself what he has not been able to accept from
others, that he cannot drink in moderation - giving all that extra
scientific help might destroy the rationalizations of the alcoholic who
still thinks he can drink socially " if I really tried ." Actually, most
uses of conditioning in the field have been to create an aversion against
drinking, to condition alcoholics to live comfortably in a drinking
society and to learn how to resist pressure to drink. In that we have
been reasonably successful, since this is in accord with the physiology
and psychology of addiction.
The discussion about turning recovered alcoholics into social drinkers
started in 1962, but no scientific research had been attempted until
1970, when Mark and Linda Sobell, two psychologist at Patton State
Hospital in California with no clinical; experience in treating
alcoholics, attempted to modify the drinking of chronic alcoholics, not
as a treatment goal but just to see whether it could be done. The
research literature is largely a record of failure, indicating that the
only realistic goal in treatment is total abstinence.
The prestigious British alcoholism authority Griffith Edwards (1994)
concluded that research disproved rather than confirmed the Sobell
position. Drs. Ruth fox, Harry Tiebout, Marvin Block and M.M. Glatt were
among the authorities who responded in a special reprint from the 1963
Quarterly Journal of Studies on Alcohol to the effect that never in the
thousands of cases they had treated was there ever a clear instance of a
true alcoholic who returned to drinking in moderation. Ewing (1975) was
determined to prove it could be done by using every technique known to
behavior modification, but he also did careful and lengthy follow up -
and at the end of four years every one of Ewing's subjects had gotten
drunk and he called off the experiment. Finally, Pendery and Maltzman
(AAAS Science, July 9, 1982) exposed the failure of the Sobell work,
using hospital and police records and direct contact to show that 19 of
the 20 subjects did not maintain sobriety in social drinking, and the
other probably was not a true alcoholics to begin with.
THE RESEARCH of Peter Nathan indicates that whereas others may be able to
use internal cues (subjective feelings of intoxication) to estimate
blood-alcohol level while drinking, alcoholics cannot; so that method of
control is not available to them. To ask a recovered addict to engage in
"responsible heroin shooting" or a compulsive gambler to play just for
small amounts is to ignore the whole psychology and physiology of
addiction. Alcoholism is not a simple learned behavior that can be
unlearned, but a habitual disposition that has profoundly modified the
whole person, mind and body. That explains the admitted failure of
psychoanalysis to achieve any notable success in treating alcoholics, and
renders vapid the notion of Claude Steiner in "Games Alcoholics Play"
that the alcoholic is a naughty child rather than a sick adult. Even the
Sobells' claimed successful cases are now reported to have given up
controlled drinking. For them abstinence is easier - for them trying to
take one drink and stop is sheer misery. The reason is that one cannot
"unlearn" the instant euphoric reinforcement that alcohol gives.
Contact:
The Legacy Group of Alcoholics Anonymous © 2005