|
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.
|
