Alexander DeLuca, M.D.
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Confusing the ‘means’ with the ‘ends’


Fred Rotgers, Psy.D.
7/14/2000


 

Alex,


Here are a few of my favorites that present a broad case for offering moderation options for some problem drinkers, as well as the disadvantages of programs imposing any specific drinking goal.


Before I give you the references, I want to share an idea about how we can get out of this largely semantic mess --abstinence, moderation, controlled drinking, naltrexone, AA, MM--are all means to an end that have become confused with the end itself. The end is remission of the disease. In treatment of every other disease, remission is the goal. There are different degrees of remission--partial, full, sustained full, maybe others. All are considered "good" outcomes, but
some are better.

No physician would consider a partial remission of AIDS to be bad--even though the physician would want to push viral loads down to zero, if possible. If that isn't possible we neither consider it a failure, nor abandon the patient.

There are also, clearly, many paths to remission--even with most other diseases. There are cases of spontaneous remission of cancer, of successful remission of hypertension using one of several different classes of meds, etc. Good (and ethical) medical practice is based on having *ALL* of the possible tools available to bring to bear on each individual patient's disease--until we find the one that works best.

In addictions, abstinence is one path to remission (defined as cessation of symptoms), but moderation is also--if a person successfully moderates, and shows no symptoms of alcohol abuse or dependence, isn't he/she in just as good a remission in a medical sense as someone who is abstinent and not showing any symptoms of dependence or abuse? The remission may be more fragile in the case of the moderator vs. the abstainer, but isn't it still remission?

Anyway, enough rambling. Here are your references. (BTW:Did you see the scathing attack on some folks who have been making hay over this from LeClair and Anne on ADD-MED?)
 


Fred Rotgers



References:

Hodgins, D.C., Leigh, G., Milne, R. & Gerrish, R.
(1997) Drinking goal selection in behavioral self-management treatment of chronic alcoholics.
"Addictive Behaviors", Vol. 22, 247-255.

Rosenberg, H. (1993) Prediction of controlled drinking in alcoholics and problem drinkers. "Psychological Bulletin", Vol 113, 129-139.

Ryan, R. & Deci, E.L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development and well-being. "American Psychologist", Vol. 55, 68-78.

Sanchez-Craig, M. & Lei, H. (1986). Disadvantages of imposing the goal of abstinence on problem drinkers: An empirical study. "British Journal of Addiction", Vol. 81, 505-512.

 

 

 

Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., FASAM.

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Originally posted:  7/14/2000

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