"Can alcoholics be conditioned to drink socially? Under such titles as
"harm reduction" and "moderation management" that old question has
been*resurrected. Moderate drinking is certainly a more appealing goal
to many problem drinkers than total abstinence. But medical
professionals and addictions counselors are unanimous in their
opposition.

Self-deception is so typical of alcoholics that the American Society of
Addiction Medicine included the term "denial" in its latest definition.
Talk of harm reduction just feeds the denial.

Most research fails to adequately separate true alcoholics from problem
drinkers, which makes reports of success misleading.

We psychologists know that conditioning is limited in its ability to
produce behavioral changes. To attempt to condition alcoholics to drink
socially is asking of behavior modification more than it can do.

Some have thought one value of controlled-drinking experiments could be
that the patient learns for himself what he has not been able to accept
from others, that he cannot drink in moderation giving all that extra
scientific help might destroy the rationalizations of the alcoholic who
still thinks he can drink socially "if I really tried." Actually, most
uses of conditioning in the field have been to create an aversion
against drinking, to condition alcoholics to live comfortably in a
drinking society and to learn how to resist pressure to drink. In that
we have been reasonably successful, since this is in accord with the
physiology and psychology of addiction.

The research of Peter Nathan indicates that whereas others may be able
to use internal cues (subjective feelings of intoxication) to estimate
blood-alcohol level while drinking, alcoholics cannot; so that method of
control is not available to them. To ask a recovered addict to engage in
"responsible heroin shooting" or a compulsive gambler to play just for
small amounts is to ignore the whole psychology and physiology of
addiction.

Alcoholism is not a simple learned behavior that can be unlearned, but a
habitual disposition that has profoundly modified the whole person, mind
and body. That explains the admitted failure of psychoanalysis to
achieve any notable success in treating alcoholics, and renders vapid
the notion of Claude Steiner in "Games Alcoholics Play" that the
alcoholic is a naughty child rather than a sick adult. Even the Sobells'
claimed successful cases are now reported to have given up controlled
drinking. For them abstinence is easier - for them trying to take one
drink and stop is sheer misery. The reason is that one cannot "unlearn"
the instant euphoric reinforcement that alcohol gives."

James E. Royce, S.J., Ph.D. is professor emeritus of psychology and
addiction studies at Seattle University and author of a leading textbook
on alcoholism.
http://www.bipolarhome.org/alcohol.html

NeuroEquipoise@webtv.net (neuro equipoise) wrote in message news:<20881-410FBB7D-113@storefull-3277.bay.webtv.net>...
> "Can alcoholics be conditioned to drink socially? Under such titles as
> "harm reduction" and "moderation management" that old question has
> been resurrected. Moderate drinking is certainly a more appealing goal
> to many problem drinkers than total abstinence. But medical
> professionals and addictions counselors are unanimous in their
> opposition.

Hi Neuro, just a heads-up that the above passage may well apply here
in the states, but it doesn't hold in the UK. Moderation management is
what (arguably) most (and if not, at least a third) of health
authorities push for those who can still function socially and in
employment at some level.

Not a challenge, just an observation based on personal experience.
Unfortunately, a family member of mine there -- a case as hopeless as
me except ten years further down the line (i.e. older than me) -- is
not being substabtially helped but seems to be more like 'minimally
facilitated' by this approach.

I have no professional experience. It sounds like an ideal approach
for those for whom it will work. I suspect that group wouldn't include
me. At least not in the long term.

Best,

C.

On - Tue, Aug 3, 2004, 10:51pm (EDT-3) cheggers2004@hotmail.com
(Cheggers) wrote:

> Unfortunately, a family member of mine there -- a
> case as hopeless as me except ten years further
> down the line (i.e. older than me) -- is not being
> substabtially helped but seems to be more like
> 'minimally facilitated' by this approach.

I have friends in the UK, who depend on the NHS for health care. I'm
sorry to hear about your kin.


"In addition to rigorous examination of NHS cost-effectiveness, there
must also be a sensible reappraisal of the precise conditions which the
NHS should be expected to treat at public expense. These should
certainly exclude things like alcoholism, drug-addiction,
smoking-related illnesses, obesity, HIV/ AIDS (treatment costing over
£30,000 per case per year), venereal diseases, infertility in women
over 35, self-inflicted injuries and elective abortions. After all, what
insurance company would provide comprehensive cover for a person with an
obviously reckless lifestyle - except at a premium no-one but the very
rich could afford?

Those feckless individuals who wittingly expose themselves to avoidable
disease and injury simply should not expect more sensible people to pick
up the bills for treating them; they should therefore look to private
health insurance or charitable bodies."