Conventional wisdom says that if you have a drinking problem you should stop altogether. Current research however shows that this may not be the case – many problem drinkers can end up controlling their drinking.
Science is about measuring. Ultimately if different scientists measure something similar then that measurement becomes accepted knowledge.
If it wasn’t for science we would think the world is flat and the universe rotates around us. Measurement and exploration has discovered the world is a roughly round rock and we are almost insignificant in a corner of one of millions of galaxies.
The world is heating up by mankind’s fossil fuel emissions. This has been a debate for many years with different scientists measuring different things and achieving bodies of research between them.
Ultimately the greatest body of research – over 95% – has shown that manmade global warming is happening. In the 1970s the bodies of work were more evenly matched and a debate could happen but today it is almost unarguable.
Where it comes to abstinence and controlled drinking, the debate is more open. ‘Conventional wisdom’ over abstinence refers to the large body of established research done for more than a century that has shown different techniques for helping people to stop drinking altogether.
Like the fossil fuel lobby denying climate change, this has been supported by groups such as churches and political organisations that take a strong view on the ‘evils of drink’.
A large number of scientists have taken rigorous scientific measurements to assess controlled drinking and found that the ‘conventional wisdom’ of abstinence was flawed.
This has increasingly been done since the 1960s and a body of evidence has emerged that even severe problem drinkers can with support revert to safe, controlled drinking.
Where there was once a huge stack of papers on one side (abstinence) and a very small stack on the other, the balance of debate has started to be less strongly for abstinence and often, in favour of controlled drinking.
A meta-analysis is a careful review of the evidence from different pieces of primary research. It seeks to look at where the balance of knowledge lies and to encourage more work in one direction or another.
In 2004 a meta-analysis of five types of controlled drinking therapies showed that controlled drinking has in some cases at least as much benefit as abstinence in terms of how long the people on the therapies lasted after the intervention without relapse. Let’s look at three of these.
Two of the therapies – Behavioural Self Control Therapy (BSCT) and Moderation Oriented Cue Exposure (MOCE) – could be done cheaply and had enough success that they should be considered as a tool for helping people manage their drinking problems.
MOCE and BSCT take different approaches. BSCT is similar to cognitive behavioural therapy (CBT) in that it looks at how the person drinks and teaches them over seven steps how to assess it and thereby how to dial their drinking back.
MOCE is more of an aversion therapy where the person is exposed to cues and triggers for their drinking and not allowed to have one.
The research showed that BSCT could be done on a computer (again like CBT) while MOCE can be done in a group setting.
Where it comes to drug and alcohol treatment, budgets are never great and a highly expensive approach will always lose out. Therapy using a computer and group therapies are going to have their costs pared down as against one-to-one therapy.
Both of these were tested on people with severe as well as moderate drinking problems and found they had similar relapse rates to that of established abstinence therapies.
Another therapy was tried at a community level for people who drank too much but didn’t identify themselves as alcoholics as their problems weren’t too severe.
Guided Self Change (GSC) was trialled by two therapists who had their careers nearly ended thanks to the fury of the abstinence lobby for publishing research that showed controlled drinking could be achieved in the 1980s.
The GSC research showed that with mild to moderate drinkers, their alcohol consumption dropped by nearly 50%, their binge drinking days by a third and their days consuming alcohol dropped by 30%. Essentially the problem drinkers ceased to have a problem.
One way of assessing a sound piece of research is when it was done. Yes, science ages too! The meta-analysis above was published in 2004. Earlier this year (2021) another meta-analysis of research was conducted. It looked at 22 studies with 4,204 subjects in abstinence and controlled drinking research.
The paper concluded that controlled drinking therapy is a useful tool, particularly if there is one-to-one support. This didn’t go as far as calling the abstinence lobby ‘scientific fascists’ as the last paper did!
It just showed that on sober reflection, the evidence is that abstinence is not the only tool out there to help someone with a drinking problem.
The abstinence lobby is out there and there are pieces of good quality (that is to say, not politically funded) that show in some cases, abstinence is probably the safest option.
One looked at 205 patients in Sweden and found that patients that had set themselves the goal of abstinence were more successful than those who wished to control their drinking.
If we take a step back and look at Sweden’s long history of tough anti-drinking laws, then we might see a political dimension to the research – ‘we wish to prove what we believe’.
Coming to the conclusion that you need help as your consumption is out of control is a big step to take. In some cases this might be because you have made a few mistakes in life and find yourself drinking a bottle of wine every evening.
Others have developed a full blown alcohol addiction with things like delirium tremens (DTs) when they stop and have liver damage.
Where you’re a little bit out of control and can stop without medical intervention to stop you becoming seriously ill when you stop?
That could be a time to look at a controlled drinking approach. Compared to the person who is physically addicted the psychological effort is a lot less to moderate.
If you have got to the point where you have serious mental and physical health problems then abstinence could well be the better option.
You will need time for your body and nervous system to recover from alcohol being onboard. Coming off may require medical intervention such as a Librium detox to prevent DTs from setting in.
In these cases, while your body and mind recover from the effects of alcohol in your system then you should dry out completely.
The thought of doing something for the rest of your life can be quite daunting but in some cases, that lifespan could be very short unless you stop drinking altogether.
Where your body and or mind are damaged by drinking, perhaps now is the time to leave it alone