Foreword

Responsible Drinking; Foreword

The opening statement is clear about the challenges, conceptual and methological, of moderation as an alcohol problem recovery tool. Reading a bit further into Sobell and Sobell you can tell how much of an uphill battle the practice of moderation management has been: 93% of US based recovery programs are 12 step based. Even though moderation is science based and backed with data strong resistance remains. A point is made that heavy/problem drinkers are not necessarily alcohol dependent.

Notes

• Moderation as a route to recovery from alcohol problems. A data driven evidence based field.

• Problem drinkers vs drunks - alcoholic label.

• Rarity of moderation approach, two factors: (a) " progressive and irreversible for all" assumption (b) unfounded concern moderation will be misused to rationalize heavy drinking.

• Alcohol abuse predicts a less persistent, milder disorder that does not usually progress to "dependence" 2001 Schuckit et al

• Classic reference cited: Obstacles to the adoption of low risk drinking goals in the treatment of alcohol problems in the United States: A commentary. Sobell and Sobell, Addiction Research and Theory February 2006; 14(1): 19–24

The result of this accommodation was that in the early 1990s a survey of 450 private-sector alcohol and chemical dependency programs in the US found that more than 93% were based on a 12-step model of treatment (Peele 1998). Although recent research suggests that treatment orientation may not be an important factor with regard to treatment outcomes (Allen et al., 1997), what is important is that in the US there developed a large and influential body of treatment providers whose allegiance was not only to a particular view but also at the level of strong personal beliefs associated with their personal recovery. Central to their recovery were the beliefs that they had lost the ability to control their drinking, that they must be forever abstinent, and that they must have faith that a higher power would help them because their ‘own willpower has been defeated by alcoholism’ (Nowinski, Baker, & Carroll, 1992, p. 2).

Given this context, it should not be surprising that moderation has not been embraced by an establishment that defines the disorder as based on powerlessness over alcohol and a key symptom of the disorder as denial that one has lost control over drinking (Pattison et al., 1977). Consequently, a factor that continues to hinder moderation goals has been that counselors invested in a 12-step model will be philosophically unlikely to adopt moderation approaches.

(...)  Although problem drinkers are unlikely to enter traditional treatment programs a large majority will see their physicians at least annually.

•  More info: Mark and Linda Sobell. Nova Southeastern University - The healthy lifestyles guided self-change program

• Assess Risk Form