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| Abstinence and Non-abstinence Goals in Treatment: A Case Study in the Sociology of Knowledge |
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It is unfortunate that the issues involved in treatment goals for alcoholics often seem to have been argued in terms of simplistic assertions. The dogmatic assertion that no alcoholic can control his or her drinking precludes the possibility that spontaneous remissions may occur in alcoholism as they do in other diseases. Moreover, the assertion ignores the many formal and informal observations of periods of moderate alcohol consumption that occur routinely in the lives of persons considered to be alcoholic. An equally simplistic assertion is the statement that some (number of) alcoholics can control their drinking.
Since it requires documentation of only a single successful case to provide such an assertion to be true, the assertion is trivial. Instead of attempting to debate the merits of either dogmatic or trivial statements, it would probably prove more profitable to consider several critical questions. These are as follows:
1. How many persons diagnosed as alcoholics are likely to be able to drink in a controlled, moderate, attenuated, norrnal, or nonproblem manner?;
2. Over what temporal intervals can such drinking behavior be sustained?;
3. Do reliable treatment technologies exist for achieving non-abstinence goals for diagnosed alcoholics?;
4. What risks are inherent in various definitions of "controlled", "moderate", or "nonproblem" drinking and for whom are such risks apparent?
5. Is it possible to differentiate those persons who are likely to succeed at nonabstinent treatment goals from those persons not likely to succeed at such goals?
6. Is the scientific data base on nonabstinent drinking goals reliable?
7. Do documented spontaneous remissions of alcoholism justify changing treatment goals and procedures from abstinence to nonabstinence goals and methods?
Numerous early studies provided observations concerning non-abstinent but apparently nonproblem drinking behavior among alcoholics. Pattison, Sobell, and Sobell (1977) and Sobell and Sobell (1978) compiled a bibliography of approximately 80 articles that, in part, and in some manner, addressed the issue of controlled or moderate drinking among alcoholics. The majority of these articles did mention or report some degree of controlled, moderate, nonproblem, or "improved" drinking of varying durations among problem drinkers or alcoholics. Wallace (1983) examined this collection of articles and concluded that, "while there are studies in this collection which require serious attention, it would be misleading for anyone to advertise the entire collection as constituting 'strong scientific evidence' in favor of controlled drinking as a viable treatment goal" (p. 481). Nathan (1985) apparently reached a similar conclusion: "when you look carefully at the series of studies on which the presumed efficacy of controlled drinking treatment was based, you quickly come to realize chat only one study, the very well-known study of Mark and Linda Sobell (1973, 1976) yielded positive data. While there were other studies which, when viewed through the microscope of the statistician, yielded data encouraging to advocates of controlled drinking treatment, basically only the Sobell study yielded data that strongly encouraged the view that controlled drinking treatment could work" (p. 172).
Perhaps the most important of the early studies concerning the feasibility of nonabstinent goals for alcoholics was The classic paper by D.L. Davies (1962). In this paper, Davies described his followup of seven men discharged from London's Maudsley Hosptial before 1955. The seven men had been picked out of a large group of ninety-three men with diagnoses of "alcohol addiction" who were involved in a routine follow up system. What attracted D.L. Davies to these seven men was their apparent ability to drink normally over periods of time ranging from seven to eleven years.
One investigator, Griffith Edwards, did not ignore the important empirical questions raised by Davies' research and conducted a further follow up of tile seven patients Davies had originally followed (Edwards, 1985). Edwards' results directly contradicted the observations of Davies. Following re-investigation, Edwards reported that five of the seven putative normal drinkers "experienced significant drinking problems" both during Davies' original follow-up period and
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About The Author:
Extracted from Wallace, John, Abstinence and Non-abstinence Goals in Treatment: A Case Study in the Sociology of Knowledge in: Engs, Ruth C. [editor]. Controversies in the Addiction Field. Dubuque, Iowa:Kendall-Hunt, 1990. Used by permission of the editor and publisher. Available on: http://www.indiana.edu/~engs/cbook
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