Controlled Drinking: More Than Just a Controversy

Michael E. Saladin; Elizabeth J. Santa Ana

Disclosures

Curr Opin Psychiatry. 2004;17(3) 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: We intend to provide clinicians and clinical scientists with an overview of developments in the controlled-drinking literature, primarily since 2000. A brief description of the controversy surrounding controlled drinking provides a context for a discussion of various approaches to controlled drinking intervention as well as relevant clinical research.
Recent Findings: Consistent with previous research, behavioral self-control training continues to be the most empirically validated controlled-drinking intervention. Recent research has focused on increasing both the accessibility/availability and efficacy of behavioral self-control training. Moderation-oriented cue exposure is a recent development in behaviorally oriented controlled drinking that yields treatment outcomes comparable to behavioral self-control training. The relative efficacy of moderation-oriented cue exposure versus behavioral self-control training may vary depending on the format of treatment delivery (group versus individual) and level of drinking severity. In general, the efficacy of both techniques does not appear to vary as a function of drinking severity but may vary as a function of drinking-related self-efficacy. Guided-self change is a relatively new and brief cognitive-behavioral intervention that has demonstrated efficacy with problem drinkers. Interventions based on harm reduction principles have decreased alcohol use in various student populations. Finally, Moderation Management is the only self-help program that supports non-abstinence goals, a feature that makes it popular with problem drinkers who are avoidant of traditional treatment services.
Summary: The controversial past of controlled drinking is slowly giving way to a hopeful future in which individuals are less likely to be forced into an abstinence-only treatment scenario. The enhanced accessibility of effective controlled-drinking interventions should significantly expand the treatment options of individuals within the full spectrum of alcohol-related problems.

Introduction

The disease model of alcoholism[1,2,3,4] and the folk wisdom promulgated by the Alcoholics Anonymous, or AA, fellowship[5,6] continue to greatly influence the treatment of alcohol problems in the US. Proponents of the disease model and Alcoholics Anonymous assert that excessive alcohol use is a progressive disease (also known as alcoholism) in which the ingestion of even small amounts of alcohol can lead to a loss of control. Over time, the alcoholic's excessive use of alcohol leads to an uneven and painful path of morbidity that can terminate in death. Consequently, the primary goal of most US treatment providers/agencies has focused on abstinence[7] or complete cessation of alcohol use as a means of interrupting the inexorable path of self-destructive behavior.

Despite the dominance of abstinence-focused treatment, there is an increasing tide of treatment alternatives that emphasize goals other than abstinence. This class of treatments or interventions goes by a host of names including, but not limited to, controlled drinking, reduced-risk drinking, moderated drinking, and asymptomatic drinking.[8] In the present review, we will use the term controlled drinking when making a general reference to non-abstinence interventions but will use designated nomenclature when discussing specific intervention approaches, such as behavioral self-control training (BSCT). Controlled drinking interventions emphasize the notion that a hazardous pattern of excessive alcohol consumption can be changed to a sustained pattern of relatively modest consumption that does not yield appreciable negative consequences. As a general class, these treatments do not assume that everyone who misuses alcohol can achieve a sustained pattern of safe drinking but rather acknowledges this potential outcome as an acceptable and realistic goal that is in parity with abstinence.

The literature on controlled drinking dates back to the early 1960s and is now quite vast. The present review will make no attempt to chronicle developments spanning this entire period but rather, will be restricted primarily to the period between 2000 and 2003. Out of necessity, certain papers and research reports prior to this time will be discussed. Most notable in this regard is the following brief account of the historical literature pertaining to the 'controversy' surrounding controlled drinking. It is our hope that placing the present review of controlled drinking in a historical context will both inform and convey a sense of how much progress has been made despite the intervention technique's troubled early years.

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