Obviously this question is too big for me to address comprehensively in one blog, or a series of blogs, and in fact it represents an ongoing conundrum dating back long before my time and that may well persist long after.
Every so often, new “evidence” crops up that alcoholics (and, by extension, other kinds of addicts) can transform themselves into moderate, non-problem drinkers. To the extent that this occurs, it seems to happen most often among those who have never sought treatment – and perhaps that is one reason why it is relatively alien to my experience and that of my colleagues.
Sometimes these reports come from treatment studies, such as the famous (well, to me, anyhow) Sobell & Sobell studies of the early 1970’s that purported to successful teach alcoholics to drink in moderation. (A follow-up study a few years later indicated that those relatively few individuals who had initially pulled off moderate drinking were now abstinent or drinking alcoholically or deceased.) More recently, some epidemiologic studies (in which large numbers of people in the community are interviewed retrospectively) have indicated that a significant minority of people who at some point met diagnostic criteria for alcohol dependence were currently drinking in a low-risk (i.e., non-problem) manner.
I should say that, in my student days, having read an early study by Davies, I was all for finding a behavioral strategy that could teach alcoholics to be normal drinkers. Over time, however, real life experience dampened those hopes, much as it has done for countless alcoholics.
Moderation Management is a self-help program that says it targets problem drinkers, as opposed to alcoholics. That may make some sense, since I suspect that some of those who reportedly manage to sustain moderate drinking may not be alcoholic in the same way as those I see most of the time -- for them, planning to regularly stop after 2 drinks is like planning to jump off a cliff and fall no more than 2 yards. MM reports that 30% of those who attend end up switching to a goal of abstinence. That includes the founder of that organization, who decided moderation might not make sense for her after she committed vehicular homicide.
More to come.
