Controlled Drinking: More Than Just a Controversy

Michael E. Saladin; Elizabeth J. Santa Ana

Disclosures

Curr Opin Psychiatry. 2004;17(3) 

In This Article

Brief History of the Controlled Drinking Controversy

The controversy surrounding controlled drinking has waxed and waned for most of the past 50 years. While it has mostly waned in the past 10-15 years, it is now widely acknowledged that most of the early debate was associated with three important defining events.[9,10,11] The first event was D.L. Davies' publication of a report indicating that seven of 97 serious 'alcoholics' at Maudsley Hospital, London, UK were able to control their alcohol consumption over a 7-11-year follow-up period.[12] This important first event was inconsistent with the prevailing European belief that abstinence was the only viable treatment goal. As several authors have noted,[10,13] most of the numerous published responses to the Davies findings were largely negative or dismissive. While the overall influence of the Davies article was modest, it did set the stage for several subsequent confirmatory reports on controlled drinking.

The second defining event was the publication of the Rand Report on 18-month follow-up outcomes of men receiving abstinence-focused treatment at 45 National Institute on Alcohol Abuse and Alcoholism-funded centers across the US.[14] Aside from documenting a high improvement rate, the authors noted that 22% of the improved men were reporting non-problematic drinking. They also noted that relapse to problematic drinking was no more likely amongst those with a controlled drinking outcome than those with an abstinence outcome, thereby mitigating the argument that moderate drinking outcomes are unstable and prone to relapse. Additional evidence for the stability of the moderate drinking outcomes was marshaled by a 4-year follow-up of the Rand study[15] in which 18% of the patients were found to be drinking moderately (i.e. without problems or symptoms of dependence). Collectively, these reports were difficult to dismiss because of the national scale of the study, the participation of prestigious research organizations, and the extensive coverage by the popular media. Nonetheless, numerous challenges and critical responses to the Rand Reports were forwarded, most of them faulting the research on methodological grounds. Clearly, the debate surrounding the controlled drinking controversy had intensified.

The third and most divisive event concerning controlled drinking pertains to a series of reports by psychologists Mark and Linda Sobell in the early to mid 1970s. These treatment studies attracted a great deal of ideologically motivated criticism that, at times, was more vitriolic than scholarly.[16,17,18,19] Briefly, the Sobells' initial investigational report[20] and two follow-up reports[21,22] indicated that severe alcoholics could be trained to moderate their drinking and that persons so trained (n=40) had better outcomes at 2-year follow-up (functioning well for 85% of days) than those who received standard abstinence-focused treatment (n=30; functioning well for 42% of days). A 3-year follow-up study of the Sobells' subjects[23] indicated that moderate drinking participants maintained superior drinking and adjustment outcomes than abstinence-oriented participants. What sets the Sobells' work apart from the numerous studies that preceded and followed was that the integrity of their scientific and professional conduct was questioned.[16,17,19,24] Importantly, a number of impartial panels/committees convened to review the Sobells' work ultimately exonerated them of any misconduct.[18] While a more subdued version of 'the controversy' has persisted to the present day, there is growing consensus in the research arena that controlled drinking is a viable outcome for people who misuse alcohol.[25]

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