Resources: Abstinence, Moderation, Harm Reduction & "The Great Debate" over Controlled Drinking.

Alexander DeLuca, M.D.
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References and Resources:
Abstinence, Moderation, and Harm Reduction Approaches to Alcohol Problems, Prohibition, and the "The Great Debate" over Controlled Drinking Strategies.

This Collection is organized into the following Series:
Peer-reviewed / academic literature & official reports [NEW! - 2006-09-10- NEW!]
The 'Great Debate' over controlled drinking [NEW! - 2006-09-10 - NEW!]
Abstinence, Moderation (including MM) & Harm Reduction approaches [NEW! - 2006-09-10 - NEW!]

Other Series:
Abstinence / harm reduction /prohibition journalism & advocacy [NEW! - 2006-09-04 - NEW!]
Pharmacotherapy of Substance Use Disorders Collection [NEW! - 2006-04-29 - NEW!]
Abstinence / Moderation / Harm Reduction links

SERIES:
Peer-reviewed / academic literature & official reports

New!
Harm Reduction and Individually Focused Alcohol Prevention
Neighbors et al.; IJDP; 17(4); 2006
--
"[A] brief overview of harm reduction and individually focused alcohol prevention strategies. Universal, selective, and indicated prevention strategies are described...

Zero-tolerance approaches continue to be the norm in... the US, despite research suggesting that harm reduction approaches can be effective. [E]xisting evidence supports that harm reduction shows considerable promise in universal prevention and have become best practices..."

See also:
The MM Programme in 2004: What Type of Drinker Seeks Controlled Drinking?
-Ana Kosok, MM Program Director; IJDP; 2006

Overview of HR Treatments for Alcohol Problems - Witkiewitza, and Marlatt; IJDP; 17(4); 285-294; 2006

Are Alcoholism Treatments Effective? The Project Match Data (PDF) - Cutler and Fishbain; 2005

Symposium on Moderation Management - Kern, Rotgers, and DeLuca; 109^th APA; 2001

New!
Overview of Harm Reduction Treatments for Alcohol Problems
Witkiewitza, and Marlatt; IJDP; 17(4); 285-294; 2006
--
"In this article, we review recent empirical articles and scholarly reviews of harm reduction treatments for alcohol abuse and dependence.

We focus this review on peer-reviewed articles published in the last 3 years, with a particular emphasis on interventions designed to reduce alcohol-related harm, including overall levels of consumption and alcohol-related problems."

See also:
The MM Programme in 2004: What Type of Drinker Seeks Controlled Drinking? - Kosok; IJDP; 2006

Are Alcoholism Treatments Effective? The Project Match Data (PDF) - Cutler and Fishbain; 2005

Harm Reduction Psychotherapy: Extending the Reach of Traditional Substance Use Treatment
Tartarsky; J. Substance Abuse Treatment, 2003

Harm Reduction: Meeting Clients Where They Are - Kate Jackson, Social Work Today, 4(6), 200

Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence: COMBINE: A Randomized Controlled Trial
Anton, et al., JAMA 295(17), 2003-2017; 2006-05-03
--
"Patients receiving medical management with naltrexone, CBI, or both fared better on drinking outcomes, whereas acamprosate showed no evidence of efficacy, with or without CBI.

No combination produced better efficacy than naltrexone or CBI alone in the presence of medical management... "

See also:
Combined Behavioral Intervention for Alcohol Dependence - Miller et. al; CBI Therapist Manual; 2005

A Group Motivational Treatment for Chemical Dependency - Foote, DeLuca, Magura, et al; JSAT; '99

Naltrexone for the Treatment of Alcoholism - Meta Analysis of Randomized, Controlled Trials - Srisurapanont, 2005

Long-Acting Injectable Naltrexone [Vivitrol] for Alcohol Dependence - A Randomized Controlled Trial
James Garbutt et al; JAMA; 293; 2005-04-06

Related resources:
Disulfiram, Acamprosate, and, Naltrexone archives

The Moderation Management Programme in 2004: What Type of Drinker Seeks Controlled Drinking?
Ana Kosok; International Journal of Drug Policy; 2006
--
Comment (DeLuca):
This is a hugely important paper, the first of three planned articles thoroughly describing the demographics, drinking patterns, alcohol related consequences, program component usage, and the effect of the MM program on abusive drinking. MM seekers are characterized by moderate to high alcohol intake but very few life problems compared to seekers of AA or traditional treatment. Fascinating. Thank you Dr. Kosok!!

See also:
Evolution of the MM Network - Kosok & Cannon; 2006

Symposium on Moderation Management - Kern, Rotgers, and DeLuca; 109^th APA; 2001

A Research-Based Analysis of the Moderation Management Controversy - Humphreys; 2003

Characteristics and Motives of Problem Drinkers Seeking Help from MM Groups - Klaw et al.; 2003

A Combined Behavioral Intervention for Treating Alcohol Dependence [for the COMBINE Study]
Miller, Moyers, and Arciniega; from: Miller (Ed): Combined Behavioral Intervention Therapist Manual (COMBINE); 2005.
--
Comment (DeLuca):
CBI is a modular, manual-guided, semi-structured therapy integrating evidence based behavioral methods developed as the state of the art psychotherapy to be tested in the COMBINE Study. Structured around Motivational Interviewing, CBI includes assessment, feedback, and highly individualized treatment plan development that is flexible regarding treatment goal.

This Poster Presentation is a sneak preview of the CBI Therapist Manual (in press). CBI is probably the most thoughtfully designed, research based substance abuse therapy ever created. Clinicians, especially, will want to study this.

See also:
A Group Motivational Treatment for Chemical Dependency
Foote, DeLuca, Magura, Warner, Grand, Rosenblum and Stahl; J. Substance Abuse Treatment; 17(3); 1999

Naltrexone for the Treatment of Alcoholism - a Meta Analysis of Randomized, Controlled Trials - Srisurapanont, 2005

Long-Acting Injectable Naltrexone [Vivitrol] for Alcohol Dependence - A Randomized Controlled Trial
James Garbutt et al; JAMA; 293; 2005-04-06

Design and Analysis of Trials of Combination Therapies [in the COMBINE Study]
Hoskings et. al; J Stud. Alcohol; 2005
=======
Choosing Pharmacotherapies for the COMBINE Study - Process and Procedures
Swift and Pettinati; J Stud. Alcohol; 2005
=======
When Worlds Collide: [The COMBINE Study] Blending Pharmacotherapy and Psychotherapy Research
W.R. Miller, et al.; J Stud. Alcohol; 2005

Comment (DeLuca):
The COMBINE trial is designed to study the efficacy (alone and combined) of naltrexone and acamprosate with 'medical management' and a psychotherapy treatment known as the Combined Behavioral Intervention. The Study is in progress. I will post more interim articles soon.

Related resources:
Disulfiram collection ; Acamprosate collection ; Naltrexone collection
Abstinence and Harm Reduction for Alcohol - Academic Literature archives

See also:
Comparing and Combining Naltrexone and Acamprosate - A Double-blind, Placebo-Controlled Study
Falk Kiefer, et. al.; Archives of General Psychiatry; 60(1); 2003

Efficacy and Safety of Naltrexone and Acamprosate in the Treatment Of Alcohol Dependence: A Systematic Review
Bouza Carmen, et al.; Addiction; 99(7):811-828; 2004
A 1-Year Pragmatic Trial of Naltrexone vs. Disulfiram in the Tx of Alcohol Dependence - deSouza and deSouza; Alcohol and Alcoholism; 2004.
Harm Reduction: Meeting Clients Where They Are - Kate Jackson, Social Work Today, 4(6), 2004.

See also:
Symposium on Moderation Management - Kern, Rotgers, and DeLuca; 109^th APA Conf.; 2001

A Research-Based Analysis of the Moderation Management Controversy - Humphreys; 2003

Characteristics and Motives of Problem Drinkers Seeking Help from MM Groups - Klaw et al.; 2003

The Controlled Drinking Debates: Four Decades of Acrimony - Brook Hersey, Psy.D., 2001

The Abstinence vs. Harm Reduction Wars of Summer 2000 - Addiction Medicine Shoots Self in Foot, Again

Revised!
Unhealthy Alcohol Use - Richard Saitz, New England Journal of Medicine, 352(6): 596-607, 2005-02-10. Posted: 2005-02-14; Mofied: 2006-02-20
--
"The balance of <increased risk of> harm and <reduced risk of ischemic disease> determines <what are moderate, or less-than-risky,> amounts... Either naltrexone or acamprosate is first-line therapy; naltrexone is the better choice if the patient has not abstained... Disulfiram is an alternative that works best when supervised."

See also:
Are Alcoholism Treatments Effective? The Project Match Data (PDF) - Cutler and Fishbain, BMC Public Health, 2005

Shelter-Based Managed Alcohol Administration to Chronically Homeless People Addicted to Alcohol
Tiina Podymow et al., Canadian Medical Association Journal, 174(1): 45-49; 2006.

"People who are homeless and chronically alcoholic have increased health problems, use of emergency services and police contact, with a low likelihood of rehabilitation... A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters."

See also:
Alcoholics can Find Drinks and Help in 'Wet Shelter' - Sharon Boase, The Hamilton Spectator, 2006-02-07

Evidence for Controlled Heroin Use? -- Shewan and Dalgarno, British .J. Health Psych. 2005

Comment (DeLuca):
In this study, subjects had occupational and educational status comparable to that of general UK pop. Ongoing problems were rare; heroin was not a significant predictor. Use frequency data suggests importance psych factors. The pharmacological properties of opioids, per se, do not inevitably lead to harmful use patterns.

See also:
Occasional and Controlled Heroin Use - Not a Problem? - Warburton et al., Rowntree Foundation, 2005
Some Eminent Narcotics Addicts ; The Heroin Overdose Mystery - Edward Brecher; Chapter 5;12, "Licit and Illicit Drugs"; 1972
How Bad is Heroin Withdrawal? - Jara Krivanek; Chapter in "Heroin, Myths and Realities"; Allen & Unwin, Publishers; 1988

British Livers and British Alcohol Policy - [Outline, References, and Link to Full Text PDF] - Robin Room; The Lancet; 367(9504); 10-11; 2006-01-07 -- "Great Britain has recorded the steepest rise in [cirrhosis mortality] rates in western Europe [and] there is no doubt that the cumulative amount of alcohol consumed has a primary role. But the UK Government has turned a determined blind eye to the problem and has failed to make the reduction of the population's alcohol intake a policy goal."

See also:
Liver Cirrhosis Mortality Rates in Britain, 1950-2002 Leon and McCambridge; The Lancet; 367(9504); 2006

2Updated! (2005-12-30)
Does Naltrexone Cause Permanent Liver Disease? (No) - Can Naltrexone be Used in the Presence of Liver Disease (Carefully)
[References with Abstract from Medline Search for 'naltrexone' and 'hepatotoxicity'] - Alex DeLuca, M.D.; 2001-06-16; Updated: 2005-12-30
--
"A review of the literature indicates that even when given at much higher doses than are needed for treating heroin or alcohol abusers, there is no evidence that naltrexone causes clinically significant liver disease or exacerbates, even at high doses, serious pre-existing liver disease." [Brewer et al.; Addiction .Biology; 2004]

Revised! (2005-12-28)
How Bad is Heroin Withdrawal?
Jara A. Krivanek; Chapter in: "Heroin, Myths and Realities"; Allen & Unwin, Publishers; 1988.Posted 2001-10-09. Modified: 2005-12-28.
--
Comment:
An excerpt from the book: "Heroin, Myths and Reality." Discussion of withdrawal, with particulate reference to the harm that stems from the illegal status of the drug. These include shared paraphernalia, the 'heroin lifestyle' and it's accompanying violence, desperation, poverty, malnutrition and poor hygiene, adulterated drug, and overdose.

See also:
Some Eminent Narcotics Addicts - Edward Brecher; Chapter 5, "Licit and Illicit Drugs"; 1972
Occasional and Controlled Heroin Use - Not a problem? - Warburton, Turnbull and Hough; Joseph Rowntree Foundation; 2005
The Heroin Overdose Mystery and Other Occupational Hazards of Addiction - Edward Brecher; Chapter 12, "Licit and Illicit Drugs"; 1972

Occasional and Controlled Heroin Use - Not a problem? - Hamish Warburton, Paul J. Turnbull and Mike Hough; Joseph Rowntree Foundation; 2005 -- "The study describes how this largely hidden population maintained stable and controlled patterns of heroin use. It examines reasons for starting to use heroin, previous and current patterns of use, mechanisms and factors that helped to control use, and why this group saw their use as fairly problem-free."

See also:
Some Eminent Narcotics Addicts - Edward Brecher; Chapter 5, "Licit and Illicit Drugs"; 1972
How Bad is Heroin Withdrawal? - Jara Krivanek; Chapter in "Heroin, Myths and Realities"; Allen & Unwin, Publishers; 1988
The Heroin Overdose Mystery and Other Occupational Hazards of Addiction - Brecher; Chapter 12, "Licit and Illicit Drugs"; 1972

Can Campral Cure Alcohol Abuse? - Anderson, S. Journal of Addictive Disorders; 2004 -- "A serious concern is the challenge of getting the new treatments to the addicts. Our health and social policies coupled with financial priorities seem to work to keep addicts from receiving treatment. Blaming the alcoholic is still a prevalent attitude."

Comment (DeLuca):
More accessible to the non-scientist reader than most of the articles on this site about acamprosate, this article reviews the history of the development of Campral and covers most of the major studies along the way, and discusses some problems with treatment.
A pretty good review.

College Student Binge Drinking and the "Prevention Paradox" - Weitzman and Nelson; J.Drug Ed.; 2004 --"While the heaviest drinkers are at great risk for harm, they are few... [lower level drinkers] are numerous, [and] account for the majority of harms... This paradoxical pattern suggests we moderate consumption among the majority using environmental approaches..."

See also:
Harm Reduction Approaches to Alcohol Use - Marlatt and Witkiewitz; Addictive Behaviors; 2002

A Research-Based Analysis of the Moderation Management Controversy - Keith Humphreys, Ph.D.; Psychiatric Services; Vol. 54; 621-622, 2003 -- "The question of whether MM is beneficial or detrimental to public health therefore becomes one of values more than of empirical data per se, and it echoes the question that society has often asked about alcohol: Should something be denied to those who may benefit from it so that it cannot be obtained by others who may be harmed and do harm?"

See also:
The Controlled Drinking Debates: A Review of Four Decades of Acrimony - Brook Hersey, Psy.D., 2001

The Association Between Stress and Drinking: Modifying Effects of Gender and Vulnerability - Dawson, D.A.; Grant, B.F.; Ruan, W.J.; Alcohol and Alcoholism; 40(5); 453-460; 2005-09-01 -- "Stress does not so much lead individuals to drink more often as to substitute larger quantities of alcohol on the days when they do drink. Treatment and brief interventions aimed at problem drinkers might benefit from addressing the issue of tension alleviation and the development of alternative coping mechanisms."

See also:
Neurobehavioral Performance of Residents After Heavy Night Call vs. After Alcohol Ingestion - Arnedt et al.; JAMA, (294), 1025-1033, 2005

Negotiating the Place of Alcohol in Public Health: The Arguments at the Interface - Robin Room; Addiction, 100(10), Page 1396;, 2005-10 -- "[A] major stumbling-block to an effective programme has emerged in the role of the USA as a principal paladin for alcohol industry interests. This is a reversal of the USA's earlier role in support of WHO's alcohol programmes, including extra-budgetary contributions."

Neurobehavioral Performance of Residents After Heavy [On-Call] vs. After Alcohol - J.T. Arnedt et al.; JAMA; 2005; 294: 1025-1033
---
Comment:
This prospective 2-sessionwithin-subject study of 34 pediatric residents published in the Journal of the American Medical Association concludes that fatigue from hospital schedules can impair the driving ability of physicians about as much as 3 or 4 drinks during a light on-call schedule.

See also:
The Association Between Stress and Drinking - Dawson, et al.; Alcohol and Alcoholism; 2005-09-01

Study Questions Effectiveness of Alcoholism Therapy - Reuters Health; 2005-07-22 -- "[The authors] found that in the months following treatment, patients who attended no therapy sessions did nearly as well as those who went to all [and those] who stuck with treatment made most of their improvement in the first week, before they had received [much] therapy."

See also:
Are Alcoholism Treatments Effective? The Project Match Data (PDF) by Robert Cutler & David Fishbain; BMC Public Health; 2005; 5:75

Centre for Addiction & Mental Health on Harm Reduction: a Review of its Meaning and Application in Canada - CAMH; University of Toronto; Canada; 2003 -- "There is evidence that programs that reduce... harm to substance users benefit the entire community through reduced crime and public disorder, [and through] benefits that accrue from the inclusion... of previously marginalized members of society.

Comment:
I think I'm falling in love with Canada.

Patient Self-Management Tools: An Overview by M.J. Barrett, Calif. Healthcare Foundation; 06/05 -- "[Defines] self-management tools as technologies used by consumers to deal with their health issues outside formal medical institutions and provides a taxonomy for better understanding the types of self-management tools available in today’s market."

Comment:
Not specifically about substance use disorders, but members of MM and other HR practitioners will be interested, I think, in this POV and terminology from the Quality Improvement movement.

Crimes of Indiscretion: Marijuana Arrests in the United States by Jon Gettman, PhD; NORML; 2005

Comment:
The ONDCP would have you believe few are harshly punished for MJ offenses. As usual, this is dissembling gibberish. This report from NORML documents arrests doubling to over 700,000 a year, and the lives and families being wrecked in the process. For what?

Kudzu Reduces Alcohol Drinking by Heavy Drinkers in a Naturalistic Setting by Lukas et al.; Alcoholism: Clin.Exp.Res.; 29(5); 2005 -- "Kudzu treatment resulted in significant reduction in the # of beers... an increase in the number of sips and the time to consume each beer and a decrease in the volume of each sip. [There was an] absence of a significant effect on the urge to drink [and] no reported side effects..."

Beyond Harm Reduction: A New Model of Substance Abuse Treatment Further Integrating Psychological Techniques by Futterman et al; J.Psychotherapy Integration; 2005 --"[The model] emphasizes working on the process of behaviors in session and is based on integrating recent developments in psychological theory and technique (behavioral, cognitive– behavioral, and psychodynamic) into a harm reduction framework, with examples from a clinic that uses this treatment."

* 5/11/2005 - Link to Full Text PDF now working<sorry>*

CORK Bibliography: Treatment Outcome and Alcohol Problems - 2004. Project Cork: 75 citations with abstracts;
January 2004 through September 2004

Comment:
Excellent collection of references and abstracts covering the best articles concerning research on treatment interventions including medications and brief intervention, and treatment outcomes, for alcohol use disorders.

Combined Effects of Treatment Intensity, Self-Help Groups and Patient Attributes on Drinking Outcomes by S. Magura, ... & A. DeLuca; Journal of Psychoactive Drugs; 37(1); 85-92; March 2005 -- "[We] tested a set of hypotheses relating to the effects on drinking outcomes of treatment modality, matching, retention, aftercare, self-help participation & patient attributes... Study hypotheses were generally supported."

Comment:
Most recent of a series of studies stemming from the implementation of a research infrastructure within the clinical framework of what was then called Smithers Treatment Center, late 1990s.

It is gratifying to me that good work still flows from all that wonderful real-world data we collected in the latter 1990's at Smithers. <smile>

*Currently Abstract only - will obtain full text soonest*

Harm Induction vs. Harm Reduction: Comparing American & British Approaches to Drug Use by K. Van Wormer; J. Offender Rehab.; 1999. -- "This paper examines [the US disease model and the British harm reduction model] in light of historical/cultural differences related to Puritan zealotry and argues that with regard to illegal drugs, America's War on Drugs actually inflicts harm."

Reduced-risk Drinking as Treatment Goal: What Clinicians Need to Know by Janet Ambrogne, JSAT; Vol 22; 45-53; 2002 --
"[Reviews] potential advantages of reduced-risk drinking [and promotes] strategies designed to assist... clients who wish to [moderate rather than abstain]."

Cognitive Function in Early Abstinence may Influence Treatment Outcome News item from DukeHealt.org; 2/28/2005 -- "[Researchers] found that alcohol abuse patients showed significant deficits in 'executive functioning' during the critical first weeks of abstinence."

Ibogaine: GDNF Mediates Desirable Actions against Alcohol Consumption by He et al.; J. Neuroscience; 25(3); 1/19/05 -- In conclusion, we have identified [that] GDNF... mediates... the effects of ibogaine on ethanol consumption. [Up-regulating] GDNF may be useful in [substance abuse] treatment.

Naltrexone for the treatment of alcoholism: a meta-analysis of Randomized Controlled Trials by Srisurapanont et al.; Int J. Neuropsychopharmacology; 2005.

See also news item about the about publication:
Medication [naltrexone] Helps Alcoholics Control Drinking Medical News Today item; 2/18/2005
--
"Naltrexone is most effective, says Volpicelli, in a program 'designed to support the notion that... what you really want to stop is excessive drinking.”

Unhealthy Alcohol Use by Richard Saitz,; NEJM; 352(6); 596-607; 2/10/05 -- "Brief counseling should be provided... make explicit the relationship betweendrinking and health consequences, assess readinessto change, advise him to cut down... or to abstain and obtain treatment(for dependent use)... "

Alcohol-Related Injuries: Evidence for the Prevention Paradox by Spurling & Vinson; Ann Fam Med.; 3(1); 47-52; 2005. -- "Injury is associated more with an occasion of alcohol consumption than with alcohol dependence. A substantial proportion of the PAF that is due to an occasion of alcohol consumption is from what are usually considered low-risk quantities."

Does Disulfiram Have a Role in Alcoholism Treatment Today? by Fuller & Gordis; Addiction 99(1); 21-24; 2004. --

Comment:
Excellent, recent review of the issues surrounding disulfiram (Antabuse) therapy making the point that supervised administration is both safe and effective.
See also:
Commentaries about the above article regarding safety and psychological aspects of disulfiram therapy, from the same issue of Addiction, and a response by Fuller & Gordis:

Commentaries (PDF); Addiction; 99(1); 2004.

Next Day Effects of a Normal Night's Drinking on Memory and Psychomotor Performance by McKinney & Coyle; Alcohol & Alcoholism; 39(6); pages 509-513; 2004 -- "Themorning after alcohol (mean 14.7 drinks for men; 10.4 drinks for women), free recall was impaired at 09:00 hoursand delayed recognition and psychomotor performance were impaired throughout the morning, despite blood alcohol levels of zeroor very near zero."

A One-Year Pragmatic Trial of Naltrexone vs. Disulfiram in the Treatment of Alcohol Dependence by deSouza & deSouza; Alcohol & Alcoholism; 39(6); pages 528-531; 2004 -- "[T]he number of patients that remained abstinent with Disulfiram were twice that with Naltrexone. The survival time till the first relapse was greater with Disulfiram [and the] number who were abstaining at the end of one year was [much greater]. Naltrexone patients had significantly lower [craving] scores..."

** January 5, 2005: FULL TEXT PDF added **

Cannabis as a Substitute for Alcohol by Tod Mikuriya, MD; O'Shaughnessy's, Summer 2003. -- "Ninety-two [patients] using cannabis as an alternative to alcohol... [with] efficacy defined as reduced harm to the patient. [For] a subset of alcoholics, cannabis use is associated with reduced drinking."

The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America by Harry G. Levine; Journal of Studies on Alcohol. 1979. -- "[The post-Prohibition] paradigm defined addiction as a central problem... and diagnosed it as a disease, or disease-like. The idea that alcoholism is a progressive disease - the chief symptom of which is loss of control... and whose only remedy is abstinence from all alcoholic beverages--is now about 175 or 200 years old, but no older."

Drug use as a ‘practice of the self’: is there any place for an 'ethics of moderation’ in contemporary drug policy? by Cameron Duff; Intl.J.Drug Policy; Vol. 15; 2004. -- "What exists for the vast majority of existing drug users once prevention has failed, and before treatment is considered?"

12-month, Randomized Controlled Trial of Family-Supervised Disulfiram vs Family-Supervised Naltrexone (Abstract) by deSouza & deSouza; Alcohol & Alcoholism (in press) -- "[T]he number of patients that remained abstinent with Disulfiram were twice that with Naltrexone. The survival time till the first relapse was greater with Disulfiram... The number who were abstaining at the end of one year was 86% with Disulfiram compared to 56% with Naltrexone. However, the Naltrexone patients had significantly lower [craving] scores..."

Disulfiram for alcohol abuse: Why is such an effective drug so under-prescribed? by Colin Brewer, Primary Care in the New NHS ; 2001 --
"[Looking at] only those studies in which disulfiram was [supervised] as part of the treatment programme, we find that out of 13 controlled and 5 uncontrolled studies, all but one are positive, and often very strongly positive."

Development of a Controlled Drinking Self-Efficacy Scale and appraising its relation to alcohol dependence
by Sitharthan et al.; J. Clinical Psychology; 59(3); 2003. -- "Compared to women, men had low self-efficacy to control their drinking in situations relating to positive mood/social context, and subjects with high alcohol dependence had low self-efficacy for situations relating to negative affect, social situations, and drinking less frequently."

Prediction of Alcohol-related Harm from Controlled Drinking Strategies & Alcohol Consumption Trajectories
by Toumbourou et al.; Addiction 99(4); 498-508; 2004. -- "[T]he overall level of utilization of alcohol control strategies... were highest for 'low weekly drinkers' [who drank at recommended levels less than weekly]."

Comment:
Interesting prospective study of adolescents in Australia (with its national policy of harm reduction) which raises the question whether encouraging less than weekly drinking at recommended levels may be a way to reduce alcohol-related harm.

Naltrexone improves outcome of a controlled drinking program by Gabriel Rubio, et al.; J. Subs. Abuse Treatment; 2002 -- "[The naltrexone] group showed significantly less craving [during the 3 mon. treatment period]. In the 12-month follow-up period, the [naltrexone] group showed significantly fewer drinking days and heavy drinking days and less craving than the CD group. The results of this study suggest a role for naltrexone in controlled drinking programs."

Comment:
Interesting and potentially useful study by a good team who ask the right question. However, good luck finding those "controlled drinking programs" - they hardly exist. That is the problem. 90% of treatment centers are abstinence oriented, and for them this article is irrelevant or anathema. ..alex...

Learning the Language of Abstinence in Addiction Treatment: Some Similarities Between Relapse-Prevention With Disulﬁram [and] Naltrexone and... “Immersion” Methods of Foreign Language Teaching Colin Brewer & Emmanuel Streel; Substance Abuse; 2003. -- "Most therapeutic effort should be directed at those who, though willing in principle to learn new habits of thinking and behaving, ﬁnd—sometimes to their genuine surprise and annoyance— that the old habits continue to assert themselves."

Comment:
Colin Brewer is one of *very* few addiction authors / researchers / clinicians who really understands, from extensive & thoughtful experience and study, Antabuse and naltrexone and how to use them. This article is a good example of Brewer's refreshing POV.

Four Beliefs that Impede Progress in the Treatment of Smoking by John Hughes, Tobacco Control; Vol. 8; pg. 323-326; 1999. -- "The FDA label on all smoking cessation products states they are “recommended for use as part of acomprehensive behavioral smoking cessation program... [However] several true experiments and several meta-analytical reviews have clearly shown that medicationsdouble quit rates, independent of adjunctive psychosocial therapy..."

Comment:
This article speaks to the importance that research and reality drive public health interventions rather than addiction treatment industry dogma, or a federal abstinence-uber-alles policy. ..alex...

Integrating Harm Reduction & Abstinence-Based Substance Abuse Treatment in the Public Sector by R. Futterman, et. al.; Substance Abuse, 25 (1); 2004. -- "Harm reduction and abstinence-based treatment can not only be integrated, but their integration is more powerful than either separately... [and] has more positive effects than either model separately on the large problem of patient retention in substance abuse treatment."

Harm Reduction Approaches to Alcohol Use -Health Promotion, Prevention and Treatment - by G. Alan Marlatt & K. Witkiewitz; Addictive Behavior; Vol. 27; 2002. -- "Overall, empirical studies have demonstrated that harm reduction approaches... are at least as effective as abstinence-oriented approaches... [The] importance of individualizing alcohol prevention and intervention to accommodate the preferences and needs of the targeted person or population [is discussed]."

[END: Series - Peer-reviewed / academic literature & official reports ]

[Top of Page]

SERIES:
The Great Debate

New!
Road to Recovery - Interview with Audrey Kishline, founder of Moderation Management
Dennis Murphy; Dateline, NBC; Air date: 2006-09-01
--
"'I finally had a moment of clarity that said, 'You can’t live this lie anymore.' [Kishline] posted a message to MM members that said: 'I have made the decision recently to change my recovery goal to one of abstinence rather than moderation.' The creator of MM was admitting defeat. She checked herself into a detox facility followed up by AA meetings, but she couldn’t play by those rules either."

See also:
What Audrey Kishline Told MM in January 2000 - Kishline; Moderation Management listServ; 2000-01-20

Why Controlled Drinking Never Dies - Peele; Stanton Peele Addiction website; 2000-08-08

The Controlled Drinking Debates: Four Decades of Acrimony - Brook Hersey, Psy.D., 2001

The Abstinence vs Harm Reduction Follies of Summer 2000 - Addiction Medicine Shoots Self in Foot, Again

A Cure for What Ails - [Vivitrol Revives a Controlled Drinking Controversy] - Chris Wright; Boston Magazine; July, 2006
--
"[Vivitrol] may allow alcoholics to drink moderately. To some, it represents the triumph of science over superstition. To others, it’s a heresy...

According to moderation advocates, controlled drinking is actually more likely to help a patient achieve sobriety than the conventional all-or-nothing approach..."

See also:
Vivitrol for Alcohol Dependence - Randomized, Controlled Trial - Garbutt et al; JAMA; 293; 2005-04-06

The Controlled Drinking Debates: A Review of Four Decades of Acrimony - Brook Hersey, Psy.D., 2001.

The Naltrexone Collection archives

The Abstinence vs. Harm Reduction Follies of Summer 2000 - Addiction Medicine Shoots Self in Foot, Again

Evolution of the Moderation Management Network - Kosok and Cannon; Draft-Excerpt; 2006-09-04
--
"The Network (MM) now has 10 years of real experience. Subjective review suggests the practices of MM [remain] relatively true to the original design. [Experience and practice have brought about] several improvements in program policy that have been incorporated into the culture and literature of [modern] MM."

See also:
Symposium on Moderation Management - Kern, Rotgers, and DeLuca; 109^th APA Conf.; 2001

A Research-Based Analysis of the Moderation Management Controversy - Humphreys; 2003

Characteristics and Motives of Problem Drinkers Seeking Help from MM Groups - Klaw et al.; 2003

The Controlled Drinking Debates: Four Decades of Acrimony - Brook Hersey, Psy.D., 2001

The Abstinence vs. Harm Reduction Wars of Summer 2000 - Addiction Medicine Shoots Self in Foot, Again

Revised!
Tooting Smithers Horn! - Summary of JCAHO Audit of Smithers Addiction Treatment and Research Center, December 2000
Frederick Rotgers; Posted to ADD_MED@MAELSTROM.STJOHNS.EDU, Addiction Medicine listServ; 2000-12-29
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"Here is how [JCAHO auditor Dr. Jack Burke] summarized his audit: 'Any one of your programs are head and shoulders above any other program in the country. When you put all your programs together, well; it's phenomenal. And what makes your program more memorable is that your patients are much more debilitated than the patients in other programs throughout the country.' The total score awarded by Dr. Burke to our programs was 98 out of a possible 100. The national average is 85."

Comment:
I discovered this original document, which was on the website but in an unreadable format, and have reformatted it appropriately. This document is, in one sense, the Epilogue to:
The Abstinence vs. Harm Reduction Follies of Summer 2000 - Addiction Medicine Shoots Itself in the Foot, Again - compiled by DeLuca; 2000-2001

The Controlled Drinking Debates: A Review of Four Decades of Acrimony - by Brook Hersey, Psy.D., 2001.

Comment:
A very thorough, thoughtful, scholarly-yet-readable consideration of the "Great Debate," from 1962 - 2001. If you are only going to read one paper about this topic and want a comprehensive, academic, well argued and well referenced review, read this excellent review by my wife, Brook Hersey, Psy.D.

The Great Controlled-Drinking Controversy - by Ron Roizen. Chapter 9 from Galanter: "Recent Developments in Alcoholism, 1987. -- "Abstract: This chapter reviews the controlled-drinking controversy. It presents cameo descriptions of the controversy's three major episodes--those occasioned by D. L. Davies' 1962 report, the 1976 publication of the first Rand Report, and the 1982 publication in Science of a paper by Pendery, Maltzman, and West--as well as a cameo for the long "interepisode" period between Davies' paper and the Rand Report. I argue that the controversy has emerged out of the failure of the "new scientific approach" to alcoholism, initiated a half century ago, to advance alcoholism treatment significantly beyond the point from which it began."

Controversies in the Addiction's Field - by Ruth Engs, 1990. --

An entire book, now out of print, made available in electronic form, free. Very interesting topics and authors. I highly recommend spending some time with this nicely produced work; it's well written; interesting, and you'll enjoy it. Thank you, thank you, Dr. Engs!

Old Battles - the Controlled Drinking Debate - Interview with Linda and Mark Sobel -- A look back at 25 years of controlled drinking research. "There's nothing quite like a controlled drinking debate to arouse the passions of even the mildest-mannered addiction professional. "

Amen, Mark, amen.

Controlled Drinking: More than Just a Controversy by Saladin et. al.; Current Opinion in Psychiatry, 2004. --

Good article reviewing developments in the controlled-drinking literature since 2000, including BSCT, MOCE, Harm Reduction, DCU, & Moderation Management. Makes an excellent companion piece to "The Controlled Drinking Debates: A Review of Four Decades of Acrimony" by Brook Hersey, which examines 'The Great Debate' 1962 - 2000. ..alex...

Slaying the Dragon, by William L. White -

An excellent and informative review of this 1988 history of alcoholism treatment and the recovery movement, by Marty N.

Abstinence as the Only Treatment Goal: New U.S. Battles - by Robin Room, 2000.-- "Why does the idea that some alcoholics may be able to learn controlled drinking generate so much heat in the U.S., and uniquely in the U.S.?"

Controlled Drinking as a Moral Achievement and a Social Program by Robin Room, 1998. -- "Behind the arguments for moderate... drinking can be discerned the outlines of a coherent worldview... In this modern and secularized version of the pilgrim's progress, it is drinking behaviour which becomes a daily test of character. By drinking moderately or in a controlled fashion, the modern pilgrim exercises and demonstrates his or her self-control and rationality in a new trial every day."

Comment:
Dr. Room is a sociologist whose work I always enjoy. He asks fascinating questions and is then rigorous and disciplined in his analysis. A pleasure! ..alex...

Back Door to Prohibition: The New War on Social Drinking by Radley Balko, Cato Policy Analysis #501, 12/5/; 2003. -- "One would think that, given the failure of Prohibition, Americans wouldn't need to worry about its return. That may not be the case. A well-funded movement of neoprohibitionists is afoot, with advocates in media, academia, and government."

No Friends of Bill Wilson by Radley Balko, New Republic, 5/17/2004. -- "The same mindset that finds a symbolic victory over alcoholism more important than a deathbed drink for a sick man can see fit to justify a 25-year prison term for an oxycodone-using MS sufferer and handcuffing an elderly post-polio marijuana user to her bed at the point of a gun."

Comment:
Well written article finds toxic similarities in the mindsets behind both the 'abstinence-uber-alles' mentality and drug war thinking. Recommended.
See also: "Back Door to Prohibition: The New War on Social Drinking" by Radley Balko. ..alex...

The Surprising Truth About Addictions - by Stanton Peele, Psychology Today, May/June 2004 -- "More people quit addictions than maintain them, and they do so on their own... People succeed when they recognize that the addiction interferes with something they value - and when they develop the confidence that they can change."

Comment:
I highly recommend the Stanton Peele Addiction Website.

[END: Series - The Great Debate]

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SERIES:
Moderation Management / Harm Reduction

New!
A Cure for What Ails - [Vivitrol Revives a Controlled Drinking Controversy] - Chris Wright; Boston Magazine; July, 2006
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"[Vivitrol] may allow alcoholics to drink moderately. To some, it represents the triumph of science over superstition. To others, it’s a heresy...

According to moderation advocates, controlled drinking is actually more likely to help a patient achieve sobriety than the conventional all-or-nothing approach..."

See also:
Vivitrol for Alcohol Dependence - Randomized, Controlled Trial - Garbutt et al; JAMA; 293; 2005-04-06

The Controlled Drinking Debates: A Review of Four Decades of Acrimony - Brook Hersey, Psy.D., 2001.

The Naltrexone Collection archives

The Abstinence vs. Harm Reduction Follies of Summer 2000 - Addiction Medicine Shoots Self in Foot, Again

The Moderation Management Programme in 2004: What Type of Drinker Seeks Controlled Drinking?
Ana Kosok; International Journal of Drug Policy; Pre-published: 2006-03-18.
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Comment (DeLuca):
This is a hugely important paper, the first of three planned articles thoroughly describing the demographics, drinking patterns, alcohol related consequences, program component usage, and the effect of the MM program on abusive drinking. MM seekers are characterized by moderate to high alcohol intake but very few life problems compared to seekers of AA or traditional treatment. Fascinating. Thank you Dr. Kosok!!